bluuebunny/crossref_metadata_2025 huggingface dataset:
Phenotypic characterization of acute headache attributed to SARS-CoV-2: An ICHD-3 validation study on 106 hospitalized patients
Authors: Trigo López Javier , García-Azorín David , Planchuelo-Gómez Álvaro , García-Iglesias Cristina , Dueñas-Gutiérrez Carlos , Guerrero Ángel L
Published: November 2020

Introduction

Headache is a common symptom of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this study, we aimed to characterize the phenotype of headache attributed to SARS-CoV-2 infection and to test the International Classification of Headache Disorders (ICHD-3) phenotypic criteria for migraine and tension-type headache.

Methods

The study design was a cross-sectional study nested in a cohort. We screened all consecutive patients that were hospitalized and had a positive SARS-CoV-2 test. We included patients that described headache if the headache was not better explained by another ICHD-3 diagnosis. Patients were interviewed by two neurologists.

Results

We screened 580 patients and included 130 (mean age 56 years, 64% female). Headache was the first symptom of the infection in 26% of patients and appeared within 24 hours in 62% of patients. The headache was bilateral in 85%, frontal in 83%, and with pressing quality in 75% of patients. Mean intensity was 7.1, being severe in 64%. Hypersensitivity to stimuli occurred in 57% of patients. ICHD-3 criteria for headache attributed to systemic viral infection were fulfilled by 94% of patients; phenotypic criteria for migraine were fulfilled by 25% of patients, and tension-type headache criteria by 54% of patients.

Conclusion

Headache attributed to SARS-CoV-2 infection in hospitalized patients has severe intensity, frontal predominance and oppressive quality. It occurs early in the course of the disease. Most patients fulfilled ICHD-3 criteria for headache attributed to systemic viral infection; however, the phenotype might resemble migraine in a quarter of cases and tension-type headache in half of the patients.
Headache: A striking prodromal and persistent symptom, predictive of COVID-19 clinical evolution
Authors: Caronna Edoardo , Ballvé Alejandro , Llauradó Arnau , Gallardo Victor José , Ariton Diana María , Lallana Sofia , López Maza Samuel , Olivé Gadea Marta , Quibus Laura , Restrepo Juan Luis , Rodrigo-Gisbert Marc , Vilaseca Andreu , Hernandez Gonzalez Manuel , Martinez Gallo Monica , Alpuente Alicia , Torres-Ferrus Marta , Pujol Borrell Ricard , Alvarez-Sabin José , Pozo-Rosich Patricia
Published: November 2020

Objective

To define headache characteristics and evolution in relation to COVID-19 and its inflammatory response.

Methods

This is a prospective study, comparing clinical data and inflammatory biomarkers of COVID-19 patients with and without headache, recruited at the Emergency Room. We compared baseline with 6-week follow-up to evaluate disease evolution.

Results

Of 130 patients, 74.6% (97/130) had headache. In all, 24.7% (24/97) of patients had severe pain with migraine-like features. Patients with headache had more anosmia/ageusia (54.6% vs. 18.2%; p < 0.0001). Clinical duration of COVID-19 was shorter in the headache group (23.9 ± 11.6 vs. 31.2 ± 12.0 days; p = 0.028). In the headache group, IL-6 levels were lower at the ER (22.9 (57.5) vs. 57.0 (78.6) pg/mL; p = 0.036) and more stable during hospitalisation. After 6 weeks, of 74 followed-up patients with headache, 37.8% (28/74) had ongoing headache. Of these, 50% (14/28) had no previous headache history. Headache was the prodromal symptom of COVID-19 in 21.4% (6/28) of patients with persistent headache ( p = 0.010).

Conclusions

Headache associated with COVID-19 is a frequent symptom, predictive of a shorter COVID-19 clinical course. Disabling headache can persist after COVID-19 resolution. Pathophysiologically, its migraine-like features may reflect an activation of the trigeminovascular system by inflammation or direct involvement of SARS-CoV-2, a hypothesis supported by concomitant anosmia.
Modeling of dynamic milling forces considering the interlaminar effect during milling multidirectional CFRP laminate
Authors: Wang Fuji , Bi Guangjian , Ning Fuda
Published: November 2020

The milling process is always required to achieve dimensional tolerance for the near-net-shape carbon fiber reinforced polymer (CFRP) parts. However, delamination and cracking are inevitably induced in milling CFRP due to the excessive milling forces. The milling forces should be thereby well controlled to reduce damages of CFRP parts. Developing a theoretical milling force model is an effective approach to understand the mechanism of milling force generation. Recent studies have established the predictive models; however, the interlaminar effect impacting the material removal process is not considered during milling multidirectional CFRP laminate, limiting the predictive model accuracy. In this work, a model of dynamic milling force for multidirectional CFRP laminate was developed by considering the interlaminar effect for the first time. The specific cutting energy predicted by the artificial neural network methodology was employed to calculate the milling forces during milling a single CFRP layer. Meantime, the support of the layer was enhanced due to the interlaminar effect, and the correction coefficients for each type of support were proposed to reflect the role of this effect. Then, the overall milling forces for multidirectional CFRP laminate can be obtained via the superposition principle, which agreed well with the experimentally measured results.
Effects of COVID-19 on Informal Caregivers and the Development and Validation of a Scale in English and Spanish to Measure the Impact of COVID-19 on Caregivers
Authors: Sheth Khushboo , Lorig Kate , Stewart Anita , Parodi José F. , Ritter Philip L.
Published: November 2020

To understand how the COVID-19 pandemic has affected caregivers, we assessed its perceived impact on caregiving through a new measure: the Caregiver COVID-19 Limitations Scale (CCLS-9), in Spanish and English. We also compared levels of caregiver self-efficacy and burden pre-COVID-19 and early in the pandemic. We administered surveys via internet to a convenience sample of caregivers in January 2020 (pre-pandemic, n = 221) and in April–June 2020 (English, n = 177 and Spanish samples, n = 144) to assess caregiver self-efficacy, depression, pain, and stress. We used the early pandemic surveys to explore the validity of the CCLS-9. The pre-COVID-19 survey and the April English surveys were compared to determine how the COVID-19 pandemic affected caregivers. The CCLS-9 had strong construct and divergent validity in both languages. Compared to pre-COVID-19, caregiver stress ( p = .002) and pain ( p = .009) were significantly greater early in COVID-19, providing evidence of its validity. COVID-19 added to caregiver stress and pain.
Institutionalizing Diversity-and-Inclusion-Engaged Marketing for Multicultural Marketplace Well-Being
Authors: Kipnis Eva , Demangeot Catherine , Pullig Chris , Cross Samantha N.N. , Cui Charles Chi , Galalae Cristina , Kearney Shauna , Licsandru Tana Cristina , Mari Carlo , Ruiz Verónica Martín , Swanepoel Samantha , Vorster Lizette , Williams Jerome D.
Published: November 2020

Within an institutional theory framework, this article identifies three interconnected fields of the marketing institution—research, education, and practice—that contribute to advancing the diversity and inclusion discourse in promoting multicultural marketplace well-being. Conducting three studies, one in each field and across contexts in three continents, the authors identify barriers that inhibit effective implementation of diversity and inclusion initiatives in today’s multicultural marketplaces. These barriers exist within and across fields and pertain to cultural-cognitive (shared meanings), normative (normative factors), and regulatory (rules and systems) pillars supporting the existence or transformation of institutions. From the research findings, the authors provide specific guidance for institutional work within marketing’s fields and policy developments needed to advance diversity-and-inclusion-engaged marketing for enhancing multicultural marketplace well-being.
Myasthenia Gravis Associated With Programmed Death-1 (PD-1) Receptor Inhibitor Pembrolizumab: A 40-day Case Report
Authors: Ziobro Aidan S. , LaPlante Reid L. , DeMari Shayna R. , Clark Larissa M. , Kingsley David J. , Smith Alyssa J.
Published: November 2020

Purpose:

This case report describes myasthenia gravis-like symptoms after treatment with a programmed cell death 1 inhibitor, pembrolizumab, the treatment modalities utilized, and associated patient outcomes.

A 76-year old male treated with pembrolizumab for palliative therapy for metastatic melanoma presented with increasing weakness, neck pain, diplopia in the left eye, abducens palsy, periorbital edema, and decreased appetite. The patient was diagnosed with acetylcholine receptor antibody (AChR) negative myasthenia gravis. The patient was started on prednisone 1 mg/kg/day, followed by pyridostigmine 60 mg by mouth 3 times a day, and IVIg for 5 days. Due to minor improvements in myasthenia gravis symptoms, 5 cycles of plasmapheresis were ordered. The patient was successfully treated for aspiration pneumonia after cardiopulmonary arrest. On day 28, the patient was diagnosed with ventilator associated pneumonia and received appropriate therapy. Due to ICU agitation and delirium, VAP, and long duration of treatment, the patient requested withdrawal of care and passed.

Conclusion:

Programmed cell death inhibitors, such as pembrolizumab, can provide great benefit to patients but can also be associated with rare but serious adverse events. With new reports of MG after use, providers should continually weigh the benefits versus harm in using these products and monitor patients closely for such adverse events.
Random changepoint segmented regression with smooth transition
Authors: Singer Julio M , Rocha Francisco MM , Pedroso-de-Lima Antonio Carlos , Silva Giovani L , Coatti Giuliana C , Zatz Mayana
Published: November 2020

We consider random changepoint segmented regression models to analyse data from a study conducted to verify whether treatment with stem cells may delay the onset of a symptom of amyotrophic lateral sclerosis in genetically modified mice. The proposed models capture the biological aspects of the data, accommodating a smooth transition between the periods with and without symptoms. An additional changepoint is considered to avoid negative predicted responses. Given the nonlinear nature of the model, we propose an algorithm to estimate the fixed parameters and to predict the random effects by fitting linear mixed models iteratively via standard software. We compare the variances obtained in the final step with bootstrapped and robust ones.
Growth, Poverty, Inequality and Well-Being: Regional Contrast in India
Authors: Radhakrishna R. , Mishra Brajaraja
Published: November 2020

This paper analyses the regional dimensions of growth and well-being in the post-reform period. It also analyses the inter-state variations in Gross State Domestic Product (GSDP) per capita. It examines whether disparities in GSDP per capita have narrowed down during the post-reform period. It addresses how economic growth is a determinant of inter-state inequality, performance in poverty reduction and attainment of multidimensional well-being. It identifies factors responsible for widespread inter-state inequality with regard to consumption and multidimensional well-being in general and nutritional attainment in particular. It examines the level and performance of states in reduction of poverty. It also ranks the states on an index of multiple deprivation.
Verbal Abuse Among Nurses Working in a Nepalese Government Hospital
Authors: Lamichhane Anjana , Bae Sung-Heui
Published: November 2020

Verbal abuse among nurses is the most prevailing type of violence encountered by nurses. A cross-sectional research design was used to identify the characteristics of verbal abuse among nurses. A self-administered questionnaire was completed by 201 nurses working in a government hospital of Nepal. Nurses were exposed to verbal abuse and yelling or raising voice in an angry fashion was the most common forms experienced by 96.5% of the respondents. Patient’s relatives were reported as the main source of verbal abuse. Frequent exposure to verbal abuse was found in Nepalese nurses, which makes nurses feel unsupported, increased stress levels, and decreased sense of relaxation/well-being in the job. There is an immediate need of monitoring and training among nursing staff in recognition and management of aggressive behavior.
Early Career Nurses’ Experiences of Providing Family Nursing Care: Perceived Benefits and Challenges
Authors: Swan Marilyn A. , Eggenberger Sandra K.
Published: November 2020

Faculty at Minnesota State University, Mankato (USA) developed a family-focused baccalaureate curriculum to address gaps between evidence and practice with families that have been linked to undergraduate nursing education. The purpose of this study was to understand the perceptions of new graduate nurses in providing family-focused nursing care in practice settings. A descriptive design focused on narrative data was used to identify the nurses’ perceived benefits and challenges of caring for families in their current nursing practice. Data were collected from three cohorts of new graduate nurses who were currently employed in health care settings ( N = 109) through a five-contact procedure and examined using a content analysis method. Nine perceived benefit categories, subcategories, and summary statements were identified. Seven challenge categories were identified. The early career graduate nurses’ ability to translate family-focused knowledge to their practice was a significant finding. The benefits and value of developing interactions with families were evident in a number of categories. Education and practice systems can implement educational innovations and partner to support new career graduates’ ability to offer skilled family nursing practice.
Interpretations of mindfulness practices in organizations: A multi-level analysis of interpretations on an organizational, group, and individual level
Authors: Ihl Andreas , Strunk Kim , Fiedler Marina
Published: November 2020

Organizations increasingly experiment with spiritual and wellness practices in contemporary work contexts. Particularly, mindfulness practices play a dominant role in this movement. Rooted in spirituality and applied in clinical psychology, mindfulness is explained as a tool for dealing with workplace demands. Despite the increasing interest in mindfulness practices and the critical debate on their appropriation in the business context, knowledge on how organizational members interpret these practices, is underdeveloped. This inhibits a comprehensive understanding of what these practices are meant to achieve, and what they imply for organizational members. Viewing organizations as interpretive systems, we investigate how organizational members interpret mindfulness practices on the organizational, group, and individual level. Our qualitative study reveals the multiple interpretations of mindfulness practices existing in organizations. On an organizational level, mindfulness practices are interpreted as generalizable human resource development tools, aimed at boosting performance. Yet, mindfulness produces uncertainties in the organizational level interpretation. On a group level, mindfulness practices are interpreted as a means to enhance group efficiency via improved personal relationships; however, they are also associated with creating dysfunctional group dynamics. On an individual level, practicing mindfulness is interpreted as a tool for self-actualization. Even so, individuals associate the risk of negative social ramifications with the practice. We show the multiple meanings of mindfulness in organizations. This informs the critical debate among organizational scholars and explains the multitude of applications. Further, the paper offers a balanced view on benefits as well as unintended consequences, in relation to former applications and interpretations of the concept.
How does familiarity shape destination image and loyalty for visitors and residents?
Authors: Casali Gian Luca , Liu Yulin , Presenza Angelo , Moyle Char-Lee
Published: November 2020

Destination familiarity is thought to critically influence tourists’ decision-making processes. Yet the role of familiarity in shaping tourists’ and residents’ image of, and loyalty to, a destination remains uncertain. This research tests a complex and holistic model of familiarity, affective, cognitive and overall images, and the conative behavioural intentions of visiting and recommending the destination for both residents and visitors in the context of the emerging tourism destination of Molise, Italy. The results reveal that residents and visitors differ in terms of their familiarity and intention to visit a place, with familiarity being less likely to influence residents’ intentions. There is heterogeneity between residents and visitors’ affective image and intention to visit, as well as between their overall image and intention to recommend Molise. Hence, unlike visitors, residents are more likely to respond to factual cognitive imaging, rather than emotional messaging, suggesting that shifting residents’ perceptions of place image requires a different approach to that of visitors. Future research should seek to confirm the relationships in a multi-destination study.
A critical reflection on the Health and Care Professions Council Standards of Proficiency for music therapists: A critical disability studies perspective
Authors: Pickard Beth
Published: November 2020

This article takes the theoretical and philosophical lens of critical disability studies to critically reflect on the Health and Care Professions Council Standards of Proficiency for Arts Therapists. The discipline of critical disability studies, evolving from disability studies and the disability rights movement, is initially defined before multiple paradigms of disability are introduced as central tenets of these disciplines. The relationship between critical disability studies and music therapy is explored, with reference to seminal publications and the perceptions of music therapy within them. The Health and Care Professions Council Standards of Proficiency are then taken as a source of reflection to attempt to understand the perpetuation of medicalised perspectives in the profession and the potential friction between critical disability studies and music therapy. A selection of the Standards of Proficiency are analysed according to distinct paradigms of disability. Questions are posed to interrogate and contextualise the standards in relation to critical disability studies philosophy. From this critical reflection, a discussion emerges which reflects on the reach of these professional standards and how they might contribute to a continuing, outdated expert-model of music therapy in the United Kingdom. The article concludes by drawing these threads together in a series of recommendations to educators, practitioners and the wider profession.
Securing decent incomes at a crossroads: On the legal feasibility of a Framework Directive on Minimum Income
Authors: Aranguiz Ane
Published: November 2020

In spite of having been an alleged priority for the EU and the Member States over the last ten years, the number of people in situations of poverty and social exclusion remains unacceptably high. As the Covid-19 crisis unfolds, the EU is left at a crossroads that will likely be determinant for its future. This contribution explores the possibility of taking the solidarity route at this crossroads by activating the social competences in the form of a Framework Directive on Minimum Income. To this end, this contribution first discusses the context of this proposal and the importance of minimum income schemes in improving the living standards of the population. From there, it explores the possibilities for legal action under the current Treaty framework. It then emphasizes the importance of choosing adequate methodologies in such an instrument when aiming to secure adequate incomes to live a life in dignity in any given Member State. It is argued that this is equally important to comply with the principles of subsidiarity and proportionality. Ultimately, the EU will have to bet on its social dimension to remain true to its raison-d’être of becoming a social market economy.
Research Trends of Acupuncture Therapy on Cancer Over the Past Two Decades: A Bibliometric Analysis
Authors: Guo Jing , Pei Lixia , Chen Lu , Chen Hao , Gu Dongmei , Xin Chen , Peng Yongjun , Sun Jianhua
Published: November 2020

Purpose:

Acupuncture has been used for managing cancer-related symptoms. However, there are still few studies concerning the overall trends in acupuncture therapy on cancer based on bibliometric analysis. This study aims to demonstrate the current status and trends in this field over the past 2 decades.

Methods:

Articles were retrieved from the Web of Science from 2000 to 2019. CiteSpace was used for co-authorship network of countries/institutions, dual-map analysis, and detecting the keywords with citation bursts. VOSviewer was used to construct networks based on co-authorship and co-citation analysis of authors, and co-occurrence of keywords.

Results:

A total of 927 articles and reviews were included in the final analysis. The number of publications has steadily increased with some fluctuations among years. The country and institution contributing most to this field are the USA and Memorial Sloan Kettering Cancer Center. Mao JJ was the most productive author and Molassiotis A ranked first in the cited authors. The co-occurrence analysis revealed 5 clusters (including “clinical trials,” “clinical studies on chemotherapy/radiation-induced symptoms,” “CAM therapy for cancer,” “clinical studies on vasomotor symptoms,” and “systematic reviews”). Most recent keyword bursts were “neuropathic pain,” “arthralgia,” “prevention,” “supportive care,” and “integrative medicine”.

Conclusions:

The annual publication output would increase rapidly in the next decade, which shows a promising future in this research field. Future research hotspots would focus on the role of acupuncture in neuropathic pain, arthralgia, prevention, supportive care, and integrative medicine.
High rate of cardiac thrombus diagnosed by adding cardiac imaging in acute stroke computed tomography protocol
Authors: Bernard Angélique , Leclercq Thibault , Comby Pierre-Olivier , Duloquin Gauthier , Ricolfi Frédéric , Béjot Yannick , Guenancia Charles
Published: November 2020

Background

Detection of left atrial appendage thrombus (LAAt) in acute stroke patients can be improved by cardiac computed tomography using prospective electrocardiogram-gated volume acquisition, which was added to the acute stroke computed tomography protocol in our institution in 2018.

Aims

To evaluate the factors and clinical management associated with LAAt in patients with acute ischemic stroke.

Methods

We retrospectively included 324 consecutive patients with ischemic stroke from November 2018 to October 2019. Clinical data and post-stroke management were compared in LAAt and no-LAAt patients.

Results

Thirty-five patients (10.8%; 95%CI 7.4–14.2) had LAAt and 289 had no-LAAt. LAAt patients were significantly older (82 ± 12 vs. 74 ± 14 yo for no-LAAt, p = 0.002), predominantly female (71% vs. 45%, p = 0.004), and were more likely to have previous atrial fibrillation (63% vs. 15%, p < 0.001) and previous stroke (32% vs. 14%, p = 0.005). There was no significant difference between groups in stroke localization or severity scales at admission or at hospital discharge. After multivariable analysis, female sex (odds ratio 2.51; 95%CI 1.09–5.77, p = 0.031), previous atrial fibrillation (odds ratio 4.87; 95%CI 2.11–11.22, p < 0.001), and left atrial volume >86 ml (odds ratio 5.33; 95%CI 1.70–16.69, p = 0.004) were independently associated with LAAt. More than a third of LAAt patients (37%) received acute heparin therapy compared to 13% of no-LAAt patients (p < 0.001). Moreover, despite comparable stroke severity at admission, the mortality rate was markedly higher in the LAAt group than in the no-LAAt group (37% vs. 13%, p < 0.001).

Conclusions

Cardiac computed tomography for left atrial appendage thrombus evaluation in routine acute stroke imaging protocol could be beneficial for decision-making with regard to the initiation of early anticoagulation.
Prevalence of autoimmune conditions in pregnant women in a tertiary maternity hospital: A cross-sectional survey and maternity database review
Authors: Lim Jacqueline R , Nielsen Timothy C , Dale Russell C , Jones Hannah F , Beech Amanda , Nassar Natasha , Lain Samantha J , Shand Antonia
Published: November 2020

Background

Autoimmune conditions are associated with adverse pregnancy and offspring outcomes; however, the prevalence in pregnant women is not well understood. Estimates based on administrative data alone may underestimate prevalence.

Methods

A cross-sectional survey of women attending a tertiary referral hospital for antenatal care in December 2018–February 2019 and review of the hospital’s maternity database of women giving birth from October 2017–June 2018 to estimate autoimmune disease prevalence.

Results

A total of 400 women completed surveys (78% response rate) and 41 (10.3%) reported an autoimmune disease, most commonly Hashimoto’s thyroiditis (2.8%) and psoriasis (2.5%). From the maternity database, 112 of 2756 women giving birth (4.1%) had a recorded autoimmune disease, most commonly Hashimoto’s thyroiditis (1.3%) followed by coeliac disease, Graves’ disease, and immune thrombocytopenic purpura (all 0.4%).

Conclusion

Autoimmune disease prevalence in pregnant women is higher when self-reported and may be more common than previously reported using administrative data.
Construct validity, floor and ceiling effects, data completeness and magnitude of change for the eight-item HAKIR questionnaire: a patient-reported outcome in the Swedish National Healthcare Quality Registry for hand surgery
Authors: Carlsson Ingela K , Ekstrand Elisabeth , Åström Mikael , Stihl Kerstin , Arner Marianne
Published: November 2020

Introduction

The aim of this study was to evaluate the construct validity, floor and ceiling effects, data completeness and magnitude of change over time for the eight-item patient questionnaire (HQ-8) in the Swedish Healthcare Quality Registry for hand surgery (HAKIR).

Methods

Construct validity was investigated through predefined hypotheses and correlation statistics between the single items in HQ-8 (pain on load, pain on motion without load, pain at rest, stiffness, weakness, numbness, cold sensitivity and ability to perform daily activities) and QuickDASH. Floor and ceiling effects and data completeness were analysed at preoperative ( n = 13,197), three months ( n =10,702) and one year ( n = 9,986) responses from hand surgery patients. Effect sizes were calculated for pre- and postoperative change scores in elective conditions and postoperative scores for acute conditions.

Results

Correlation coefficients at pre, 3 and 12 months ranged from 0.44 to 0.79 in the total group. No ceiling effect occurred, but a floor effect for the total group was noted for all items at all follow-ups. Missing responses were < 2.6% except for cold sensitivity. The effect sizes varied from small to large for individual items in elective diagnoses. For acute injuries, small effect sizes were found.

Discussion

This study provides evidence of construct validity of HQ-8, lack of ceiling effect, expected floor effect, good data completeness and an ability to detect changes over time. The results indicate that HQ-8 measures unique aspects of disability. The HQ-8 could complement the Quick-DASH in describing patient-reported outcomes after hand surgery.
Measuring efficiency levels in Qatari organizations and causes of inefficiencies
Authors: Al-Shaiba Abdulla , Al-Ghamdi Sami G , Koç Muammer
Published: November 2020

Organizational efficiency is considered as one of the important factors affecting the sustainability and viability of an organization and of the larger society that such organizations are part of. Scholars in the interdisciplinary studies of engineering, business, and economics have concluded that the socioeconomic parameters of society are deeply linked with organizational efficiency. Organizational efficiency is generally defined as a measure of the relation between the input resources and output generated within a system. Organizational efficiency in public and private sector enterprises plays a crucial role in ensuring value creation and sustaining the economic and social development of countries. The importance of a sustainable economy and social well-being requires many countries around the world to design and implement tailored pathways to achieve their target of sustainable development, which requires assessing and continuously improving the efficiency of their organizations. Measuring efficiency and implementing periodic course corrections are imperative for maintaining high levels of organizational efficiency. The literature on organizational efficiency measurement is limited and qualitatively inferior, especially when it comes to sustainability considerations and for organizations operating in the Arabian Gulf. The research approach developed in this study to measure efficiency in Qatari organizations is crucial in understanding and improving the transformation journey of Qatari, and similar organizations. This paper focuses on the research approach adopted to measure organizational efficiency based on international best practices and conducts a comparative analysis on the local organizations from a sustainability perspective considering all dimensions of economics, environment and social impacts. The methodology involved in measuring and benchmarking organizational sustainability identifies the “as is” state of organizational sustainability and efficiency in the organization. Identifying the causes of the efficiency gap and improving organizational efficiency from the local perspective are the objectives. The survey result ranked the main areas for improvement within local organizations as 23% Overall organization culture and behavior, 21% Human Resources, 19% Leadership and Governance, 18% Operation, 11% Finances and 8% Quality Assurance.
Exercise for Sport-Related Concussion and Persistent Postconcussive Symptoms
Authors: Haider Mohammad Nadir , Bezherano Itai , Wertheimer Alex , Siddiqui Akas H. , Horn Emily C. , Willer Barry S. , Leddy John J.
Published: November 2020

Context:

Emerging research supports the use of mild to moderate aerobic exercise for treating sport-related concussion (SRC) and persistent postconcussive symptoms (PPCS), yet the current standard of care remains to be strict rest. The purpose of this review is to summarize the existing literature on physical activity and prescribed exercise for SRC and PPCS.

Evidence Acquisition:

PubMed and Embase were searched in April of 2019 for studies assessing rest or prescribed exercise for SRC and PPCS. No specific search syntax was used.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results:

A majority of studies show that spontaneous physical activity is safe after SRC and that subsymptom threshold aerobic exercise safely speeds up recovery after SRC and reduces symptoms in those with PPCS. Exercise tolerance can safely be assessed using graded exertion test protocols within days of injury, and the degree of early exercise tolerance has diagnostic and prognostic value.

Conclusion:

Subsymptom threshold aerobic exercise is safe and effective for the treatment of SRC as well as in athletes with PPCS. Further research is warranted to establish the most effective method and dose of aerobic exercise for the active treatment of SRC and whether early exercise treatment can prevent PPCS in athletes.

Strength of Recommendation Taxonomy:

2.
Factors Associated with Lack of HIV Testing among Latino Immigrant and Black Patients at 4 Geographically and Demographically Diverse Emergency Departments
Authors: Bennett Christopher L. , Marks Sarah J. , Liu Tao , Clark Melissa A. , Carey Michael P. , Merchant Roland C.
Published: November 2020

The need for HIV testing in US emergency departments (EDs) has not been assessed, particularly among Latino immigrants and Blacks. We surveyed Latino immigrant and Black 18 to 64-year-old patients at 4 EDs about demographic characteristics, HIV testing history, and health literacy. A subset of patients was further surveyed on HIV risk-taking behaviors. Of the 2,265 participants, 24% had never been tested for HIV. Latino immigrants were more likely than Blacks never to have been tested for HIV (28% vs. 16%). In multivariable logistic regression, for Latino immigrants, male gender and lower health literacy were associated with no previous HIV testing. Among the 1,141-participant subset providing HIV risk-taking behavior data, 23% reported at least one risk factor and of those with at least one risk factor, 23% had never been tested for HIV. There remains a need for HIV testing among adult Latino immigrant and Black patients in US EDs.
Characterizing Frailty in Myeloproliferative Neoplasms: Baseline Results from the Orchid Study
Authors: Jackson Chornenki Nicholas L , Karampatos Sarah , Leong Darryl , Siegal Deborah M , Hillis Christopher M.
Published: November 2020

Background: Contemporary treatment of Myeloproliferative Neoplasms (MPNs) has altered their natural history. Frailty, a state of reduced physiologic reserve is prevalent among older individuals, and increases risk for cardiovascular disease (CVD) and other adverse health outcomes. However, little is known about frailty in MPNs. An improved characterization of frailty may inform MPN treatment goals including the impact of treatment on frailty and CVD.

Methods : We utilized the ORCHID database, a multi-centre prospective observational registry of MPN patients. Frailty-related factors collected included: unintentional weight loss (>4kg lost in prior year); grip strength (below 20th percentile for age and sex); Timed Up and Go test (TGUG) greater than 13.5 seconds (indicative of high fall risk); self-reported exhaustion; and cognitive frailty measured by the Digit Symbol Substitution test (DSST). Baseline information on cardiovascular event history was also collected.

Results: In total, 150 patients were included (56 CML, 28 ET, 14 PMF, 52 PV). Baseline information and past medical history are detailed in Table 1. Cardiovascular events prior to diagnosis were most common in patients with PV (7.7% MI and 5.8% stroke). Past medical history of Venous Thromboembolism (VTE) was more common in Ph-negative MPNs (15.3% PV, 21.4% PMF, 21.4% ET) compared to CML where VTE history was absent. Hypertension and dyslipidaemia were overall the most common cardiovascular comorbidities. The burden of depression was highest in PMF with 30.7% of patients reporting a PHQ-9 score ≥ 10. Frailty related outcomes are detailed in Table 2. All four MPNs had high rates of frailty in every domain at baseline. Among Ph- MPNs (ET, PV, and PMF), ET and PV patients generally had a lower burden of frailty compared to PMF patients in most measurements. A high risk of falls as determined by a prolonged get-up-and-go test was present in approximately 20% of PV, CML, and ET patients and 42% of PMF patients. ET patients had the lowest self-reported exhaustion, with less than 40% reporting they ever felt "everything was an effort" or that they "just couldn't get going". PMF patients had the highest self-reported exhaustion. The proportion of patients with low DSST scores was greater in PMF (38.5%) and PV patients (24.3%) than ET (20%) and CML (15%) patients. Unintentional weight loss was common across MPN patients (33.9% to 50%).

Conclusion: There is a high rate of baseline frailty among patients with MPNs with domains differing between diseases. In this cohort, cardiovascular event history at diagnosis was highest among PV patients and lowest in CML patients.

Disclosures

Siegal: Leo Pharma: Honoraria; Novartis: Honoraria; Portola: Honoraria; Bayer: Honoraria; BMS Pfizer: Honoraria. Hillis:Roche: Honoraria.
Predictors of All Cause Post Operative Bleeding in Patients with Left Ventricular Assist Device
Authors: Elkayam Natalie , Gegechkori Nana , Bernstein Aryeh , Lipshitz Jay
Published: November 2020

Background:Patients with implanted left ventricular assist device (LVAD) have been shown in multiple studies to have significantly increased bleeding rates, and yet independent risk factors for such complications remain poorly characterized.

Objective:This study sought to assess factors associated with increased bleeding risks after LVAD implantation.

Methods: The case-control study was represented by a retrospective electronic medical chart review for all adult patients above age 18, who had the LVAD implanted at Maimonides Medical Center from 2013-2018. The study comprised of a follow up period of 24 months after the LVAD implantation.

84 adult patients with implanted LVADs at Maimonides Medical Center were included in the study. The predictors among patients with any late postoperative bleeding (>7 days post-surgery) within the study period were compared to those without any events of interest. The outcome measure was a composite variable reflecting any bleeding event, such as upper and lower gastrointestinal (GI) bleed, intracranial hemorrhage or hemorrhage in any other organ. Patients were considered to have GI bleed if they had one or more of the following symptoms: guaiac-positive stool with hemoglobin drop >2g/dL, hematemesis, melena, active bleeding or blood within the GI tract at the time of endoscopy or colonoscopy. Intracranial or other organ bleeding was defined as appropriate clinical presentation and findings on imaging with hemoglobin levels reduced by more than or equal to 2 g/dl with no alternative explanation for anemia.

Logistic regression was used to create a multivariable model to identify predictors associated with an increased risk of all cause bleeding within 24 months after LVAD implantation.

Results: The study population consisted of 43 cases and 41 controls. Baseline characteristics were similar in both groups. A total of 43 (51%) patients had at least 1 episode of any type of bleed within study period.

Multivariable analyses showed that blood urea nitrogen (BUN) >20 before LVAD implantation and Creatinine >1.2 at the time of bleeding were significantly associated with all cause bleeding risk within 24 months after surgery with odds ratio (OR): 4.46, 95% confidence interval (CI): 1.78 to 11.15 and OR 3.55, 95% CI 1.13 to 11.15 respectively.

Conclusions: Perioperative BUN >20 (p=0.001) and postoperative Creatinine >1.2 (p=0.03) are associated with higher incidence of all cause bleeding within 24 months after surgery among patients with LVAD. Future studies should evaluate whether there are other factors accurately predicting bleeding events in order to improve outcomes.

Disclosures

No relevant conflicts of interest to declare.
Comparative Efficacy of First-Line Chemotherapy-Free Combinations in Chronic Lymphocytic Leukemia (CLL): A Network Meta-Analysis
Authors: Haddad Philip A , Ganey Nowell , Gallagher Kevin M.
Published: November 2020

Introduction:

Chronic Lymphocytic Leukemia (CLL) is an incurable B-cell malignancy which disproportionately affects the elderly. Although first-line chemoimmunotherapy (CIT) improved CLL clinical outcomes, recent randomized trials revealed superior outcomes with novel chemotherapy-free combinations (CFC) incorporating anti-CD20 monoclonal antibodies and inhibitors of BTK or Bcl-2. So far, these CFC have not been compared head-to-head. We conducted this network meta-analysis to evaluate their relative efficacy to each other.

Methods:

A review of the medical literature was conducted using online databases. Inclusion criteria consisted of English language; diagnosis of CLL; trials that explored the efficacy of first-line CFC with Obinutuzumab (O), Rituximab (R), Ibrutinib (IB), Acalabrutinib (ACAL), Venetoclax (VEN) compared to standard CIT that included Chlorambucil (CHLOR) with either R or O, Bendamustine+Rituximab, or Fludarabine+ Cyclophosphamide+R; and phase 3 randomized studies reporting responses, progression, death, and adverse (AE) events. A frequentists network meta-analysis was conducted using netmeta package and random-effects model.

Results:

Five studies comprising a total of 2,272 participants were included. When O-based CFC data was analyzed, only ACAL-O had a significant lower relative risk (RR) of progression and death (P&D). There were no significant differences with respect to overall response rates (ORR), complete remission (CR), minimal residual disease (MRD), or grade >3 adverse events (Grd3+) among O-based CFC. When R-based CFC data was analyzed, IB and IB-R were not different with respect to RR of P&D, ORR, CR, MRD, or Grd3+. When the data was analyzed as CFC versus combined CIT, only ACAL-O was found to be significantly superior to other O- and R-based CFC with respect to RR of P&D. ORR and Grad3+ rates of O- and R-based CFC were not significantly different. While ACAL-O, IB-O, and VEN-O had superior CR and MRD rates compared to other CFC, there were no significant differences among each other.

Conclusions:

This network meta-analysis is the first to compare and rank first-line CFC therapies in CLL. It indicates that ACAL-O has a superior profile having the lowest RR of P&D without significant difference in Grd3+ among CFC.

Disclosures

No relevant conflicts of interest to declare.
The Asia-Pacific Myeloma and Related Diseases Registry: Preliminary Results of Real-World Treatment Patterns and Clinical Outcomes
Authors: Huynh Kim , Aoki Naomi , Kim Kihyun , Chng Wee Joo , Gan Gin Gin , Min Chang-Ki , Lee Je-Jung , Goh Yeow Tee , Wellard Cameron , McQuilten Zoe , Moore Elizabeth M. , Wood Erica M. , Spencer Andrew
Published: November 2020

Background and Aims: The Asia-Pacific (APAC) Myeloma and Related Diseases Registry (MRDR) collects data on epidemiology, treatment and outcome trends for patients with multiple myeloma (MM) in participating regional countries. Prevalence of MM is expected to continue to increase with ageing populations and improvements in survival. Although some MM data are available for Asia, very few exist at regional level. Generation of 'real world evidence' on practice and outcomes is important to complement data from clinical trials. In the APAC MRDR, regional clinical experts provide local clinical context and registry oversight, and participating hospitals obtain local ethics approval and manage patient recruitment and data collection.

Methods: The APAC MRDR prospectively collects observational data on patient characteristics, diagnosis, medical history, treatment (including supportive therapies), and outcomes (overall and progression-free survival, and quality of life using the EQ-5D-5L) on newly diagnosed MM (NDMM), plasma cell leukaemia, plasmacytoma, and MGUS patients via a secure, country-specific, web-based database. Participants are reviewed 4-monthly for a minimum of 2 years. Preliminary data from October 2018 to June 2020 were analysed.

Results: 20 hospitals have ethics approval to participate and patient recruitment has commenced at 14 hospitals in Korea, Singapore, and Malaysia. Sites in Taiwan will also start recruitment in 2020, and sites in China have been identified. To date, a total of 469 patients (419 NDMM) have been enrolled, of which, data from 348 (83%) NDMM participants from Korea, Singapore, and Malaysia were available for analysis. Results are presented in Table 1.

Summary and Conclusions: The APAC MRDR is now successfully established and expanding. As data mature, these will provide important new information on the epidemiology and treatment of MM across the APAC region, and provide opportunities for regional benchmarking and collaborative research.

Disclosures

Spencer: Janssen: Consultancy, Honoraria, Research Funding, Speakers Bureau; Sanofi: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria, Research Funding; Pfizer: Consultancy, Honoraria; BMS: Consultancy, Honoraria, Research Funding, Speakers Bureau; Takeda: Honoraria, Research Funding, Speakers Bureau; Amgen: Consultancy, Honoraria, Research Funding; Secura Bio: Consultancy, Honoraria; Pharmamar: Research Funding; Roche: Honoraria; Servier: Consultancy, Honoraria, Research Funding; HaemaLogiX: Consultancy, Honoraria, Research Funding.
Clinicopathological Features of Hematological Malignancies Presenting As Breast Lesions on Mammography: The Mount Sinai Medical Center Experience
Authors: Galarza Fortuna Gliceida , Dvir Kathrin , Febres-Aldana Christopher , Delgado Ruben , Gonzalez Ferrua Maria , Poppiti Robert , Sriganeshan Vathany
Published: November 2020

Background:Breast involvement by hematological malignancies is extremely rare and encompasses approximately 1% of all breast tumors. In this retrospective data review, we aimed to evaluate the clinical, pathological and radiographic characteristics of hematological malignancies involving the breast.Methods:Our database was searched for "leukemia", "lymphoma" and "myeloma" in reports of breast biopsies, obtained between August 2009 and August 2019. A total of 13 cases met inclusion criteria.Results:A total of 13 breast biopsies with the diagnosis of leukemia or lymphoma were identified. All samples were obtained through ultrasound guided core needle biopsy. All 13 patients were females, 61.54% Caucasian, 15.38% Black, 15.38% Hispanic and 7.7% Asian, with median age of 71 years. In 8/13 patients (61.54%), a palpable breast lesion prompted the imaging study, while the remaining 5/13 patients (38.46%) were detected on routine screening mammography. Average lesion size was 2.7cm (±2.47cm, SD). On mammogram, 61.5% of cases were described as BIRADS 4, 30.8% as BIRADS 0 and 7.7% as BIRADS 5. Pathological evaluation revealed all cases (100%) were lymphomas. The commonest lymphoma subtype was marginal zone B-cell Lymphoma (MZL) (38.48%), followed by diffuse large B cell lymphoma (DLBCL) (15.38%) and small lymphocytic lymphoma (SLL) (15.38%). Burkitt's lymphoma (7.69%), follicular lymphoma (7.69%), hairy cell leukemia (7.69%) and lymphoplasmacytic lymphoma (7.69) were also identified. Primary breast lymphoma (PBL) was identified in 4/13 patients (30.77%), while in 9/13 (69.23%) the breast lesion were secondary breast lymphomas (SBL). Treatment options for patients with PBL consisted of local radiation in two patients, R-CHOP chemotherapy in one patient and immunotherapy with rituximab plus radiation in one patient. Patients with SBL received systemic chemotherapy. None of the patients were treated surgically.Conclusion:Hematological malignancies involving the breast can present as a palpable or subclinical lesions with a high BIRADS on mammography. MZL was the predominant subtype, followed by DLBCL and SLL. PBL can be a localized disease suitable for conservative management.

Disclosures

No relevant conflicts of interest to declare.