bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient preferences for use of virtual consultations in an orthopaedic rehabilitation setting: Results from a discrete choice experiment
Authors: Gilbert Anthony W , Mentzakis Emmanouil , May Carl R , Stokes Maria , Jones Jeremy
Published: August 2021

Objective

Virtual Consultations may reduce the need for face-to-face outpatient appointments, thereby potentially reducing the cost and time involved in delivering health care. This study reports a discrete choice experiment (DCE) that identifies factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting.

Methods

Previous research from the CONNECT (Care in Orthopaedics, burdeN of treatmeNt and the Effect of Communication Technology) Project and best practice guidance informed the development of our DCE. An efficient fractional factorial design with 16 choice scenarios was created that identified all main effects and partial two-way interactions. The design was divided into two blocks of eight scenarios each, to reduce the impact of cognitive fatigue. Data analysis were conducted using binary logit regression models.

Results

Sixty-one paired response sets (122 subjects) were available for analysis. DCE factors (whether the therapist is known to the patient, duration of appointment, time of day) and demographic factors (patient qualifications, access to equipment, difficulty with activities, multiple health issues, travel costs) were significant predictors of preference. We estimate that a patient is less than 1% likely to prefer a virtual consultation if the patient has a degree, is without access to the equipment and software to undertake a virtual consultation, does not have difficulties with day-to-day activities, is undergoing rehabilitation for one problem area, has to pay less than £5 to travel, is having a consultation with a therapist not known to them, in 1 weeks’ time, lasting 60 minutes, at 2 pm. We have developed a simple conceptual model to explain how these factors interact to inform preference, including patients’ access to resources, context for the consultation and the requirements of the consultation.

Conclusions

This conceptual model provides the framework to focus attention towards factors that might influence patient preference for virtual consultations. Our model can inform the development of future technologies, trials, and qualitative work to further explore the mechanisms that influence preference.
Health system influences on potentially avoidable hospital admissions by secondary mental health service use: A national ecological study
Authors: Woodhead Charlotte , Martin Peter , Osborn David , Barratt Helen , Raine Rosalind
Published: August 2021

Objectives

Potentially avoidable hospital admissions (PAAs) are costly to health services and potentially harmful for patients. This study aimed to compare area-level PAA rates among people using and not using secondary mental health services in England and to identify health system features that may influence between-area PAA variation.

Methods

National ecological study using linked English hospital admissions and secondary mental health services data (2016–2018). We calculated two-year average age-sex standardised area-level PAA rates according to primary admission diagnoses for 12 physical conditions, among, first, secondary mental health service users with any non-organic diagnosis, and, second, people not in contact with secondary mental health services. We used penalised regression analyses to identify predictors of area-level variation in PAA rates.

Results

Area-level PAA rates were over four times greater in the mental health group, at 7,594 per 100,000 population compared to 1,819 per 100,000 in the comparator group. Common predictors of variation were greater density of older age groups (lower PAA rates), higher underlying population morbidity of chronic obstructive pulmonary disease and, to a lesser extent, urbanity (higher PAA rates). For both groups, health system factors such as the number of general practitioners per capita or ambulance despatch rates were significant but weak predictors of variation. Mental health diagnosis data were available for half of secondary mental health care records only and sensitivity analyses found that urbanity remained the sole significant predictor for PAAs in this group.

Conclusions

Findings support the need for improved management of physical conditions for secondary mental health service users. Understanding and predicting variation in PAAs among mental health service users is constrained by availability of data on mental health diagnosis, physical health care and needs.
The spontaneous theoreticians: How evaluators build and revise their knowledge of programs through experience
Authors: Tourmen Claire , Berriet-Solliec Marielle , Lépicier Denis
Published: August 2021

What exactly do evaluators learn about programs through experience and how? We chose a constructivist framework to investigate the structure of evaluators’ program-related knowledge, namely the form, content, and origins of their expressed theories. In this context, we complemented a Piagetian theory of learning with new developments offered by “probabilistic” (or “Bayesian”) models of learning. We conducted “explicitation” interviews with nine experienced practitioners, some specializing in the education or agri-environment sectors and some generalists. After examining the form and content of their program-related knowledge, we examine its development through experience but also through contact with researchers and readings. In conclusion, we discuss our study’s strengths and limitations, as well as the implications of our results for evaluation training and teaching.
Regulation of reactive oxygen species in the pathogenesis of matrix vesicles induced calcification of recipient vascular smooth muscle cells
Authors: Chen Neal X , O’Neill Kalisha D , Dominguez James M , Moe Sharon M
Published: August 2021

Introduction:

Increased oxidative stress is associated with vascular calcification in patients with chronic kidney disease (CKD). We have previously demonstrated that cellular-derived matrix vesicles (MV), but not media-derived MV, are endocytosed in the presence of phosphorus by recipient normal rat vascular smooth muscle cells (VSMC) and induce calcification through ERK1/2 and [Ca2+]i signaling. We hypothesized that these changes were mediated by increased reactive oxygen species (ROS) production.

Methods:

MV were co-cultured with recipient VSMC in the presence of high phosphorus and ROS production and cell signaling assessed.

Results:

The results demonstrated MV endocytosis led to increased ROS production in recipient VSMC with no increase in mitochondrial oxygen consumption or oxidative phosphorylation (OXPHOS), indicating the ROS was not from the mitochondria. The use of inhibitors demonstrated that endocytosis of these MV by VSMC led to a signaling cascade in the cytoplasm beginning with ERK1/2 signaling, then increased [Ca2+]i and stimulation of ROS production, mediated by nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX)1/4. Media-derived MV did not induce this cascade, indicating endocytosis itself was not a factor. Furthermore, inhibition of either ERK1/2 activation or [Ca2+]i reduced vascular calcification.

Conclusion:

We conclude that endocytosis of pro-mineralizing MV can induce a series of signaling events in normal VSMC that culminate in generation of ROS via activation of NOX1/4. Understanding these pathways will allow the development of future targeted therapeutics.
Digital welfare fraud detection and the Dutch SyRI judgment
Authors: van Bekkum Marvin , Borgesius Frederik Zuiderveen
Published: August 2021

In 2020, a Dutch court passed judgment in a case about a digital welfare fraud detection system called Systeem Risico Indicatie (SyRI). The court ruled that the SyRI legislation is unlawful because it does not comply with the right to privacy under the European Convention of Human Rights. In this article we analyse the judgment and its implications. This ruling is one of first in which a court has invalidated a welfare fraud detection system for breaching the right to privacy. We show that the immediate effects of the judgment are limited. The judgment does not say much about automated fraud detection systems in general, because it is limited to the circumstances of the case. Still, the judgment is important. The judgment reminds policymakers that fraud detection must happen in a way that respects data protection principles and the right to privacy. The judgment also confirms the importance of transparency if personal data are used.
Work and nonwork engagements between life domains: Effects on subjective health and life satisfaction of employees across 53 nations varying in economic competitiveness
Authors: Mitra Atul , Bond Michael Harris , Lu Qing , Guay Russell P , Shaw Jason D
Published: August 2021

Using the framework of role balance theory, the authors take a cross-national view of an employee’s engagement in the work and nonwork domains of life. Employing the World Values Survey (WVS) with a sample of 21,270 married employees from 53 nations, we find cross-national variations in the relationship of employees’ degree of work and nonwork domain engagements with their subjective health and satisfaction with life. To explore the impact of the national focus on motivation for economic productivity and innovation, we used a country’s global competitiveness index (GCI), predicting that a nation’s GCI would moderate the relationship of an employee’s work and nonwork domain engagements with both subjective health and life satisfaction. Overall, the results suggest that work–nonwork balance leads to better subjective health and higher life satisfaction only for married employees living in nations high in GCI; for married employees living in countries low in GCI, higher subjective health and life satisfaction resulted for those more highly engaged in nonwork life domains. Theoretical and methodological contributions are discussed, along with implications for future research on national culture concerning work and its impact on employed persons.
Sanguine: Visual analysis for patient blood management
Authors: Lin Haihan , Metcalf Ryan A , Wilburn Jack , Lex Alexander
Published: August 2021

Blood transfusion is a frequently performed medical procedure in surgical and nonsurgical contexts. Although it is often necessary or even life-saving, it has been identified as one of the most overused procedures in hospitals. Unnecessary transfusions not only waste resources but can also be detrimental to patient outcomes. Patient blood management (PBM) is the clinical practice of optimizing transfusions and associated outcomes. In this paper, we introduce Sanguine, a visual analysis tool for transfusion data and related patient medical records. Sanguine was designed with two user groups in mind: PBM experts who oversee blood management practices across an institution and clinicians performing transfusions. PBM experts use Sanguine to explore and analyze transfusion practices and their associated medical outcomes. They can compare individual surgeons, or compare outcomes or time periods, such as before and after an intervention regarding transfusion practices. PBM experts then curate and annotate views for communication with clinicians, with the goal of improving their transfusion practices. We validate the utility and effectiveness of Sanguine through case studies.
Community sanctions in youth justice compared to other youth crime responses: A meta-analysis
Authors: Koops-Geuze Gwendolyn J. , Weerman Frank M.
Published: August 2021

This meta-analysis examines the official recidivism effects of two types of community sanctions in youth justice, namely community service and behavioural intervention programmes. Two analyses were conducted: a comparison between the effects of community sanctions and custodial sanctions, versus a comparison between the effects of community sanctions and dismissals. Following a systematic literature search, data extraction and analysis, mean effect sizes were calculated utilizing (log) odds ratio as the main effect measure. To explore heterogeneity, a meta-regression was conducted with four moderator variables: methodological rigour, referral stage, main focus of sanction and sample risk level. The hypotheses were that recidivism would be significantly lower for delinquent youth subject to community sanctions compared with those subject to custodial sanctions, but that differences in recidivism between delinquent youth subject to community sanctions versus dismissals would be insignificant. In total, 23 studies were deemed eligible for inclusion ( Ncust = 7, Ndism = 16). Final results were in favour of the hypotheses, namely, significantly lower recidivism rates for community sanctions compared with custodial sanctions, and no significant differences for community sanctions compared with dismissals. For both comparisons, the 95% confidence interval indicated the effects varied from just below zero to substantially in favour of community sanctions. Finally, moderator analysis revealed that studies of lower methodological quality and mixed referral stages were more likely to report larger effect sizes.
The role of deprivation and alcohol availability in shaping trends in violent crime
Authors: Lightowlers Carly , Pina-Sánchez Jose , McLaughlin Fiona
Published: August 2021

It is well known that both deprivation and alcohol availability are associated with violent crime. However, less is known about whether the former moderates the latter. Pioneering the linkage of novel alcohol availability measures derived from consumer data with police data and an index of deprivation, we examine inequalities in violent crime across small-level geography (LSOAs) for the whole of England. Our findings confirmed a recent upward trend in recorded violent crime in England between 2011 and 2018 and substantial between-area variability in recorded violent crime, as well as an increase in violent crime inequality across LSOAs during the period of analysis. Violent crime was higher in areas with increased deprivation and alcohol availability, especially in the form of on-licensed premises. On-licence availability, in the form of pubs, bars and nightclubs, explained variability in recorded violent crime more so when compared with off-licence availability. A positive interaction effect between alcohol availability (in the form of on-licensed premises) and deprivation showed how deprivation amplified the impact of alcohol availability, with more deprived areas having a stronger impact of on-licence availability on violent crime. Deprivation is thus an important contextual factor when considering rates and the social ecology of violence. Our findings suggest a need to respond to the disproportionate impact of violence on areas with higher levels of deprivation and availability of on-licensed premises.
Hydrogen Peroxide: Its Use in an Extensive Acute Wound to Promote Wound Granulation and Infection Control – Is it Better Than Normal Saline?
Authors: Rai Sanjay , Gupta Tej Pratap , Shaki Omna , Kale Amit
Published: August 2021

Background: Hydrogen peroxide (H2O2) is used as a topical antiseptic in contaminated wounds caused by road traffic accidents. It kills bacteria by producing oxidation through local, nascent, free oxygen radicals. It also removes dirt from the wound due to its frothing action. H2O2 is synthesized by various cells as an active biochemical agent that affects cell biological behavior through complex chemical reactions. H2O2 has also been used as a wound cleaning agent, removing debris, preventing infection, and causing hemostasis due to its exothermic reaction with blood. Despite its widespread use, there is scanty literature on its use to promote granulation tissue formation. Objective: In the orthopaedics literature, studies on H2O2 use are very limited and its potential is underestimated. In the present study, we would like to report our protocol of use of H2O2 for its tremendous potential for stimulating granulation and early wound healing. Material and Methods: A total of 53 patients with large acute extensive lower limb contaminated wounds reported to the emergency department have been included with and without lower limb fracture. In group A (43 patients) wound management was done using 7% H2O2 and group B (10 patients) was treated by only saline dressing as a control group. Results: In the present study, daily dressing by 7% H2O2 solution and provide solution gives excellent results compared to the Saline group. Granulation tissue appeared much earlier with a mean SD 6.3 ± 6.8 days in the hydrogen peroxide group as compared to the Saline group where granulation tissue appeared in 9.3 ± 8.4 days. Conclusion: Spontaneous wound healing is a controlled balance between destructive and healing processes. It is mandatory to remove damaged tissue to promote healing by secondary intention and minimize infection. The dynamic effect of H2O2 promotes faster healing, stimulates granulation, and minimizes infection by oxidative stress.
Neurofeedback Training Protocol Based on Selecting Distinctive Features to Treat or Reduce ADHD Symptoms
Authors: Jalali Parham , Sho’ouri Nasrin
Published: August 2021

Recent research has shown that electroencephalography (EEG) theta/beta ratio (TBR) in cases with attention deficit hyperactivity disorder (ADHD) has thus far been reported lower than that in healthy individuals. Accordingly, utilizing EEG-TBR as a biomarker to diagnose ADHD has been called into question. Besides, employing known protocol to reduce EEG-TBR in the vertex (Cz) channel to treat ADHD via neurofeedback (NFB) has been doubted. The present study was to propose a new NFB treatment protocol to manage ADHD using EEG signals from 30 healthy controls and 30 children with ADHD through an attention-based task and to calculate relative power in their different frequency bands. Then, the most significant distinguishing features of EEG signals from both groups were determined via a genetic algorithm (GA). The results revealed that EEG-TBR values in children with ADHD were lower compared with those in healthy peers; however, such a difference was not statistically significant. Likewise, inhibiting alpha band activity and enhancing delta one in F7 or T5 channels was proposed as a new NFB treatment protocol for ADHD. No significant increase in EEG-TBR in the Cz channel among children with ADHD casts doubt on the effectiveness of using EEG-TBR inhibitory protocols in the Cz channel. Consequently, it was proposed to apply the new protocol along with reinforced beta-band activity to treat or reduce ADHD symptoms.
Patients with Atrial Fibrillation Undergoing Cardiac Surgery: No Left Atrial Appendage Shall Remain Untouched
Authors: Whitlock Richard P. , Belley-Cote Emilie P.
Published: August 2021

The Left Atrial Appendage Occlusion Study III randomized 4,811 patients with atrial fibrillation and a CHA2DS2VASc score ≥2 undergoing cardiac surgery to surgical left atrial appendage occlusion or no occlusion. At a mean follow-up of 3.8 years, stroke or systemic embolism was reduced by 33% in the occlusion group with no evidence of early or late adverse effects. This review discusses the implication of these findings.
Lung Cryobiopsy Outside of the Operating Room: A Safe Alternative to Surgical Biopsy
Authors: Menezes Vanessa , Molina Juan Carlos , Pollock Clare , Romeo Philippe , Morisset Julie , Ferraro Pasquale , Lafontaine Edwin , Martin Jocelyne , Nasir Basil , Leduc Charles , Liberman Moishe
Published: August 2021

Objective

Transbronchial lung cryobiopsy (TBLC) is a promising technique that can provide a histologic diagnosis in interstitial lung diseases (ILD) and is an alternative to surgical lung biopsy. The main concerns with the procedure are safety and diagnostic accuracy. The technique is applicable in patients unable to undergo surgical biopsy due to severe comorbidities or when patient transport to the operating room is dangerous. This study reports the initial experience with TBLC on a thoracic surgical service as a first attempt at diagnosis in patients with diffuse parenchymal lung diseases (DPLD).

Methods

Between May 2018 and July 2020, 32 patients underwent TBLC using bedside flexible bronchoscopy for suspected ILD on a thoracic surgical endoscopy service. Retrospective evaluation of the procedure details, complications, and diagnostic yield were analyzed and reported.

Results

A total of 89 pathological samples were obtained (mean 2.8 per patient). Pneumothorax and minor bleeding occurred in 25% and 16.7% of patients, respectively. Sixty-seven percent of complications occurred with use of the 2.4 mm cryoprobe ( P = 0.036). Concordance between the histologic diagnosis and final clinical diagnosis was observed in 62.5% of patients and the pathology guided the final treatment in 71% ( P = 0.027) with Kappa-concordance of 0.60 ( P < 0.001).

Conclusions

Cryobiopsy is becoming part of the diagnostic evaluation in patients with indeterminate DPLD or hypoxemic respiratory failure. TBLC is easy to perform and has a favorable safety profile. Thoracic specialists should consider adding TBLC to their procedural armamentarium as a first option for patients with indeterminate PLD.
A descriptive and exploratory study of factors contributing to augmented feedback duration in professional Australian football practice
Authors: Tribolet Rhys , Sheehan William Bradshaw , Novak Andrew Roman , Watsford Mark Langley , Fransen Job
Published: August 2021

Augmented feedback supplements or replaces task-intrinsic feedback and is common in team sports, however, no studies have reported on augmented feedback provision in professional Australian Football (AF) practice. This study investigated the effects of practice characteristics (feedback intervention frequency, practice time, practice type, season phase, practice activity form and competitive match result) on the duration of feedback provided by professional AF coaches. Two linear mixed-effects models were constructed. The first examined the collective associations between these practice characteristics and feedback durations while the second model investigated the associations between the same practice characteristics and previous match result. Results showed the feedback intervention frequency, practice time and a practice time*feedback intervention frequency interaction explained 65% of feedback duration whenever feedback was provided. Additionally, practice time, feedback intervention frequency, a practice time*match result interaction and a match result*feedback intervention frequency interaction explained 99% of feedback duration in-season. Important factors that were hypothesised to affect feedback durations in AF such as practice type, practice activity form or season phase did not contribute any explanatory power. This study provides information on how professional AF coaches provide augmented feedback in-situ and provides opportunities for skill acquisition specialists to aid coaches when delivering augmented feedback.
Does context matter? Examining robbery reporting in a high crime country
Authors: Hernández Wilson , Heimark Katrina R
Published: August 2021

Most empirical studies that examine why individuals report property crimes to the police have focused on Global North countries where crime rates are low. This study is situated in the most violent area of the world, Latin America, and examines Peru, which has the highest robbery victimization rate in the Americas. This article examines the applicability of theories of crime reporting in this Global South context using a large sample and multilevel modeling. We find that trust in the police has no impact on the reporting of the robbery of one’s cellphone, purse or wallet. The theories of rational choice and Black’s stratification of law provide strong explanations for the reporting of robbery of these personal items. Individuals of higher social status and those who reside in districts with low levels of social disadvantage are more likely to report, as well as those who have experienced violent victimization.
The impact of lateral bow angle variation on an archer’s score
Authors: Park James L
Published: August 2021

Variation of the bow’s lateral angle (‘bow cant’ angle) affects the lateral position of arrows on the target, thus impacting an archer’s score. The displacement of arrows on the target depends approximately on the target distance squared and is hence of greatest impact at longer distances. A total of eight archers participated in this study, ranging in skill level from three who have performed at the highest levels internationally through to competent club-level archers, plus the author. The bow cant variation was measured and the impact on archers’ scores was calculated, assuming no other score loss mechanisms. The results show that the score loss associated with bow cant angle can be a substantial portion of an archer’s total score loss, particularly for elite archers using recurve bows.
BMPR2 mutations and response to inhaled or parenteral prostanoids: a case series
Authors: Scelsi Laura , Greco Alessandra , Acquaro Mauro , Olivieri Carla , Sobrero Matteo , Turco Annalisa , Cappelletti Donata , Visconti Luigi Oltrona , Ghio Stefano
Published: August 2021

Whether mutations in the BMPR2 gene may influence the response to PAH‐specific therapies has not yet been investigated. In this study, in 13 idiopathic, heritable or anorexigen‐associated PAH patients, in whom treatment escalation was performed by adding a prostanoid, a greater haemodynamic improvement was observed in BMPR2‐negative than in BMPR2‐positive patients.
Understanding an unusual urothelial disorder: cystitis cystica et glandularis
Authors: Garg Harshit , Singh Prabhjot , Nayak Brusabhanu , Nayyar Rishi , Kaushal Seema , Kumar Rajeev , Seth Amlesh
Published: August 2021

Objectives:

To study the presentation and natural course of cystitis cystica et glandularis.

Methods:

A retrospective analysis of patients with histopathologically confirmed cystitis cystica et glandularis from March 2016 to March 2018 who at least completed their 2 years’ follow-up was performed. Perioperative details along with the last available follow-up were included in the analysis.

Results:

A total of 10 patients were included. The mean age (± standard deviation) was 33.4 (±14.0) years and nine (90%) were men. The most common presentation was storage and voiding lower urinary tract symptoms (80%) along with haematuria (40%) and dysuria (20%). Four patients had the presence of hydronephrosis in preoperative imaging, of which three patients had bilateral mild hydroureteronephrosis. All the patients underwent transurethral resection of the bladder tumour as all were diagnosed with urinary bladder mass on preoperative imaging. All the patients had a trigonal lesion with a bullous appearance partially obstructing the bladder neck. Six patients underwent double J stenting in the perioperative period. The mean (± standard deviation) follow-up duration was 32.8 (±7.5) months. Patients were kept on regular surveillance with imaging and cystoscopy as indicated. Eight patients (80%) developed recurrence in the follow-up period. The mean number of recurrences was 1.5 (±1.1). One of the patients had to undergo augmentation ileocystoplasty with bilateral ureteric reimplantation because of the recurrent lesion with small contracted bladder, while another patient underwent cystectomy with urinary diversion owing to recurrence and refractory lower urinary tract symptoms. Besides, there was no evidence of malignancy after this entity in any of the patients.

Conclusion:

Cystitis cystica et glandularis is a rare clinic pathological entity which often mimics bladder tumour. Cystitis cystica et glandularis is common in men and often presents with lower urinary tract symptoms. Transurethral resection forms the mainstay of treatment. However, it is often associated with upper tract hydronephrosis. Its controversial premalignant nature compounded with recurrence and risk of upper tract deterioration warrants close surveillance.

Level of evidence:

4
Occupational Health Nurses’ Self-Efficacy in Implementing Smoking Cessation Interventions for Workers: A Manufacturing Company Quality Improvement Project
Authors: Thornberry Amy , Garcia Theresa J. , Peck Jessica , Sefcik Elizabeth
Published: August 2021

Background:

Effective smoking cessation interventions (SCIs) are urgently needed for the working population where smoking continues at high rates. Occupational health nurses (OHNs) could be effective in providing SCI, but self-efficacy was found to be a major barrier. The purpose of this study was to improve the delivery of SCI to those who smoke in the workplace and to explore nurse self-efficacy.

Methods:

Pretest and posttest were conducted on two groups, OHNs ( n = 5) and smokers ( n = 11) working at U.S. manufacturing facilities. OHNs were trained on motivational interviewing (MI) techniques who then recruited smokers to help them practice their newly acquired skills. The two groups were measured by Likert-type scale for OHN self-efficacy and smoker level of change toward quitting.

Findings:

Paired t-tests detected statistically significant differences in OHN’s preintervention and postintervention self-efficacy scores, t(4) = −4.46, p < .001,; d = 2.92) and smokers’ preintervention and postintervention stage of change toward quitting scores, t(10) = −9.07, p < .001,; d = 2.09), suggesting that the training and MI intervention were effective in increasing OHN self-efficacy and smokers’ motivation to change.

Conclusion/Application to Practice:

This quality improvement (QI) project indicated smokers can be successfully recruited and counseled using MI techniques, while simultaneously improving OHN self-efficacy toward helping patients. Theory-based applications brought OHNs and smokers together in a new paradigm resulting in positive changes for both. Secondary findings in the reverse nurse–patient role revealed success in an innovative recruitment method for smoking cessation.
Scapular Dyskinesis, Shoulder Joint Position Sense, and Functional Level After Arthroscopic Bankart Repair
Authors: Sayaca Cetin , Unal Miray , Calik Mahmut , Eyuboglu Filiz Erdem , Kaya Defne , Ozenci A. Merter
Published: August 2021

Background:

Scapular kinesia is an important component of glenohumeral rhythm and shoulder stability. No studies have evaluated scapular dyskinesis and its relationship to shoulder proprioception in patients who have undergone arthroscopic Bankart repair (ABR).

Purpose:

To investigate scapular dyskinesis, proprioception, and functional level after ABR.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This study included 13 male patients who underwent ABR (ABR group; mean age, 30 years; range, 24-36 years) and 13 sex- and age-matched healthy individuals (control group). The age, height, weight, and dominant side of all participants were collected. Scapular dyskinesis was evaluated using the lateral scapular slide test and the scapular dyskinesis test; proprioception was measured by the active angle reproduction test using a smartphone goniometer application, and functional level was assessed using the upper-quarter Y-balance test for dynamic stability as well as the Rowe score and Walch-Duplay score for quality of life and return to activities of daily living.

Results:

The presence of static scapular dyskinesis in the neutral position, at 45° of abduction, and at 90° of abduction as well as the presence of dynamic scapular dyskinesis was higher in the ABR group compared with the control group ( P ≤ .04 for all). Shoulder joint position sense (absolute error) at 40° and 100° of shoulder elevation and shoulder functional level according to the Rowe score were worse in the ABR patients compared with the healthy controls ( P ≤ .02 for all). Dynamic scapular dyskinesis was negatively related to shoulder joint position sense at 40° of shoulder elevation ( r = –0.64; P = .01). Static scapular movement as measured on the lateral scapular slide test was moderately related to the Rowe score ( r = 0.58; P = .03).

Conclusion:

Scapular kinematics and proprioception should be evaluated after ABR. Treatment approaches to improve scapular control and proprioceptive sense should be included in the rehabilitation program for patients after ABR.
Circulating Gremlin-1 is elevated in systemic sclerosis patients
Authors: O’Reilly Steven
Published: August 2021

Introduction:

Systemic sclerosis is an autoimmune connective tissue disease in which there is activation of the immune system, vascular disease and fibrosis. Activation of quiescent fibroblasts to myofibroblasts is key to disease pathogenesis. Gremlin-1 is a bone morphogenetic protein antagonist which is important in development and we recently reported in skin fibrosis. The aim of this study was to determine the serum circulating levels of Gremlin-1 in early diffuse systemic sclerosis.

Methods:

Twenty-one early diffuse systemic sclerosis patients (less than 2 years from first non-Raynaud’s symptom) were included and age and sex-matched healthy controls. Serum was isolated from blood and measured with a specific enzyme-linked immunoassay for Gremlin-1. Clinical variables were also measured.

Results:

Significantly elevated Gremlin-1 was found in sera of early diffuse systemic sclerosis patients ( p < 0.001). In patients with interstitial lung disease, this compared to systemic sclerosis without evidence of interstitial lung disease, Gremlin-1 was significantly elevated ( p < 0.0007). A correlation was found between circulating Gremlin-1 and modified Rodnan Skin Score, albeit weak.

Discussion:

In early diffuse systemic sclerosis patients, elevated Gremlin-1 is found in serum. This is particularly prominent in systemic sclerosis–associated interstitial lung disease. This suggests that Gremlin-1 may be a biomarker for systemic sclerosis interstitial lung disease.
Elevated plasma concentration of complement factor C5 is associated with risk of future venous thromboembolism
Authors: Skjeflo Espen Waage , Brækkan Sigrid Kufaas , Ludviksen Judith Krey , Snir Omri , Hindberg Kristian , Mollnes Tom Eirik , Hansen John-Bjarne
Published: August 2021

The role of complement in the pathogenesis of venous thromboembolism (VTE) is unclear. We wanted to investigate (1) whether plasma complement component C5 (C5) levels are influenced by genetic variants or chronic inflammation and (2) the association between plasma C5 and risk of future VTE in a nested case-control study of 415 patients with VTE and 848 age- and sex-matched controls derived from the Tromsø Study. Plasma C5 levels were measured at inclusion. Odds ratios (ORs) with 95% confidence intervals (95% CIs) for provoked and unprovoked VTE across tertiles of C5 concentrations were estimated by logistic regression. Adjustment for C-reactive protein (CRP) served as a proxy for general inflammation. Whole-exome sequencing and protein quantitative trait loci analyses were performed to assess genetic influence on C5 concentrations. There was no association between genome-wide or C5-related gene variants and C5 levels. The association between plasma C5 levels and VTE risk displayed a threshold effect, where subjects with C5 levels above the lowest tertile had increased risk of VTE. Subjects in tertile 3 (highest C5 levels) had an age- and sex-adjusted OR of 1.45 (95% CI, 1.07-1.96) compared with tertile 1 (lowest). These statistics were more pronounced for unprovoked VTE (OR, 1.70; 95% CI, 1.11-2.60). Adjustments for body mass index and CRP had minor impact on risk estimates. The OR increased substantially with shorter time between blood sampling and VTE event. In conclusion, plasma C5 was associated with risk of future VTE. C5 levels were not genetically regulated and were only slightly influenced by chronic inflammation.
Baseline pro-inflammatory gene expression in whole blood is related to adverse long-term outcomes after transcatheter aortic valve replacement: a case control study
Authors: Goldwater Deena S. , Leng Mei , Karlamangla Arun , Seeman Teresa , Elashoff David , Wanagat Jonathan M. , Reuben David B. , Lindman Brian R. , Cole Steve
Published: August 2021

Background

Age-associated inflammation and immune system dysfunction have been implicated as mechanisms that increase risk for adverse long-term procedural outcomes in older adults. The purpose of this study was to investigate relationships between baseline inflammatory and innate antiviral gene expression and outcomes after transcatheter aortic valve replacement (TAVR) in older adults with severe aortic stenosis.

Methods

We performed a retrospective case–control study comparing pre-procedural pro-inflammatory and Type 1 interferon (IFN) gene expression in 48 controls with favorable outcomes (alive 1 year after TAVR with improved quality of life [QoL]) versus 48 individuals with unfavorable outcomes (dead by 1 year or alive at 1 year but with reduced QoL). Gene expression was evaluated in whole blood via (1) pre-defined composite scores of 19 inflammation-associated genes and 34 Type I IFN response genes, and (2) pro-inflammatory and antiviral transcription factor activity inferred from promotor based bioinformatics analyses of genes showing > 25% difference in average expression levels across groups. All analyses were adjusted for age, gender, body mass index, diabetes, immunosuppression, cardiovascular disease (CVD), and frailty.

Results

Relative to controls, those with unfavorable outcomes demonstrated higher expression of the pro-inflammatory gene composite prior to TAVR (p < 0.01) and bioinformatic indicators of elevated Nuclear Factor kB (p < 0.001) and Activator Protein 1 (p < 0.001) transcription factor activity, but no significant differences in Type I IFN-related gene expression.

Conclusions

These results demonstrate that a pro-inflammatory state prior to TAVR, independent of CVD severity and frailty status, is associated with worse long-term procedural outcomes.
HIV virological non-suppression and its associated factors in children on antiretroviral therapy at a major treatment centre in Southern Ghana: a cross-sectional study
Authors: Afrane Adwoa K. A. , Goka Bamenla Q. , Renner Lorna , Yawson Alfred E. , Alhassan Yakubu , Owiafe Seth N. , Agyeman Seth , Sagoe Kwamena W. C. , Kwara Awewura
Published: August 2021

Background

Children living with human immunodeficiency virus (HIV) infection require lifelong effective antiretroviral therapy (ART). The goal of ART in HIV-infected persons is sustained viral suppression. There is limited information on virological non-suppression or failure and its associated factors in children in resource limited countries, particularly Ghana.

Methods

A cross-sectional study of 250 children aged 8 months to 15 years who had been on ART for at least 6 months attending the Paediatric HIV clinic at Korle Bu Teaching hospital in Ghana was performed. Socio-demographic, clinical, laboratory and ART Adherence related data were collected using questionnaires as well as medical records review. Blood samples were obtained for viral load and CD4+ count determination. Viral load levels > 1000 copies/ml on ART was considered virological non-suppression. Logistic regression was used to identify factors associated with virological non-suppression.

Results

The mean (±SD) age of the study participants was 11.4 ± 2.4 years and the proportion of males was 53.2%. Of the 250 study participants, 96 (38.4%) had virological non-suppression. After adjustment for significant variables, the factors associated with non-suppressed viral load were female gender (AOR 2.51 [95% CI 1.04–6.07], p = 0.041), having a previous history of treatment of tuberculosis (AOR 4.95 [95% CI 1.58–15.5], p = 0.006), severe CD4 immune suppression status at study recruitment (AOR 24.93 [95% CI 4.92–126.31], p < 0.001) and being on a nevirapine (NVP) based regimen (AOR 7.93 [95% CI 1.58–1.15], p = 0.005).

Conclusion

The prevelance of virological non-suppression was high. Virological non-suppression was associated with a previous history of TB treatment, female gender, severe CD4 immune suppression status at study recruitment and being on a NVP based regimen. Early initiation of ART and phasing out NVP-based regimen might improve viral load suppression in children. In addition, children with a history of TB may need focused measures to maximize virological suppression.
Upregulated NLGN1 predicts poor survival in colorectal cancer
Authors: Yu Qian , Wang Xiaojie , Yang Yinghong , Chi Pan , Huang Jianping , Qiu Shengliang , Zheng Xin , Chen Xiaowen
Published: August 2021

Background

Neuroligin1 (NLGN1) is a main component of excitatory glutamatergic synapses complex and is important for synapse assembly and function. The clinical value of NLGN1 in colorectal cancer (CRC) is not clear.

Methods

We obtained the expression data of 1143 CRC patients from 3 independent Gene Expression Omnibus (GEO) datasets (GSE32323, GSE24551, GSE39582) and The Cancer Genome Atlas (TCGA) to make the comparison of the NLGN1 expression level between CRC tissues and matched noncancerous tissues, and to evaluate its value in predicting survival of CRC patients. At the protein level, these results were further confirmed by immunohistochemical staining of 52 CRC samples in our own centre. Finally, the function of NLGN1 was explored by gene set enrichment analysis (GSEA).

Results

Increased mRNA and protein levels of NLGN1 expression were associated with worse overall survival or recurrence-free survival in CRC patients from 2 GEO datasets, the TCGA database, and our cohort. In addition, multivariate regression analysis showed that NLGN1 was an independent poor prognostic factor of survival in patients with CRC in TCGA database (OR = 2.524, P = 0.010). Functional analysis revealed that NLGN1 was correlated with function involving the Hedgehog signaling pathway, mismatch repair process, and some material metabolism processes.

Conclusions

This study is the first to implicate and verify NLGN1 as a new poor prognostic marker for CRC.
The COVID-19 pandemic in francophone West Africa: from the first cases to responses in seven countries
Authors: Bonnet E. , Bodson O. , Le Marcis F. , Faye A. , Sambieni N. E. , Fournet F. , Boyer F. , Coulibaly A. , Kadio K. , Diongue F. B. , Ridde V.
Published: August 2021

Background

In early March 2020, the COVID-19 pandemic hit West Africa. In response, countries in the region quickly set up crisis management committees and implemented drastic measures to stem the spread of the SARS-CoV-2 virus. The objective of this article is to analyse the epidemiological evolution of COVID-19 in seven Francophone West African countries (Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Niger, Senegal) as well as the public health measures decided upon during the first 7 months of the pandemic.

Methods

Our method is based on quantitative and qualitative data from the pooling of information from a COVID-19 data platform and collected by a network of interdisciplinary collaborators present in the seven countries. Descriptive and spatial analyses of quantitative epidemiological data, as well as content analyses of qualitative data on public measures and management committees were performed.

Results

Attack rates (October 2020) for COVID-19 have ranged from 20 per 100,000 inhabitants (Benin) to more than 94 per 100,000 inhabitants (Senegal). All these countries reacted quickly to the crisis, in some cases before the first reported infection, and implemented public measures in a relatively homogeneous manner. None of the countries implemented country-wide lockdowns, but some implemented partial or local containment measures. At the end of June 2020, countries began to lift certain restrictive measures, sometimes under pressure from the general population or from certain economic sectors.

Conclusion

Much research on COVID-19 remains to be conducted in West Africa to better understand the dynamics of the pandemic, and to further examine the state responses to ensure their appropriateness and adaptation to the national contexts.
Design and analysis of three-dimensional printing of a porous titanium scaffold
Authors: Yang Jiajie , Li Yaqiang , Shi Xiaojian , Shen Meihua , Shi Kaibing , Shen Lingjie , Yang Chunxi
Published: August 2021

Objective

Mechanic strength, pore morphology and size are key factors for the three-dimensional (3D) printing of porous titanium scaffolds, therefore, developing optimal structure for the 3D printed titanium scaffold to fill bone defects in knee joints is instructive and important.

Methods

Structural models of titanium scaffolds with fifteen different pore unit were designed with 3D printing computer software; five different scaffold shapes were designed: imitation diamond-60°, imitation diamond-90°, imitation diamond-120°, regular tetrahedron and regular hexahedron. Each structural shape was evaluated with three pore sizes (400, 600 and 800 μm), and fifteen types of cylindrical models (size: 20 mm; height: 20 mm). Autodesk Inventor software was used to determine the strength and safety of the models by simulating simple strength acting on the knee joints. We analyzed the data and found suitable models for the design of 3D printing of porous titanium scaffolds.

Results

Fifteen different types of pore unit structural models were evaluated under positive pressure and lateral pressure; the compressive strength reduced when the pore size increased. Under torsional pressure, the strengths of the imitation diamond structure were similar when the pore size increased, and the strengths of the regular tetrahedron and regular hexahedron structures reduced when the pore size increased. In each case, the compressive strength of the regular hexahedron structure was highest, that of the regular tetrahedron was second highest, and that of the imitation diamond structure was relatively low. Fifteen types of cylindrical models under a set force were evaluated, and the sequence of comprehensive compressive strength, from strong to weak was: regular hexahedron > regular tetrahedron > imitation diamond-120° > imitation diamond-90° > imitation diamond-60°. The compressive strength of cylinder models was higher when the pore size was smaller.

Conclusion

The pore size and pore morphology were important factors influencing the compressive strength. The strength of each structure reduced when the pore size (400, 600 and 800 μm) increased. The models of regular hexahedron, regular tetrahedron and imitation diamond-120°appeared to meet the conditions of large pore sizes and high compressive strength.