bluuebunny/crossref_metadata_2025 huggingface dataset:
A review of risk factors associated with insulin omission for weight loss in type 1 diabetes
Authors: Hall Rebecca , Keeble Leanna , Sünram-Lea Sandra-Ilona , To Michelle
Published: June 2021

Research suggests that as many as 60% of people with type 1 diabetes (T1D) admit to misusing insulin. Insulin omission (IO) for the purpose of weight loss, often referred to as diabulimia, is a behaviour becoming increasingly recognised, not least since prolonged engagement can lead to serious vascular complications and mortality. Several risk factors appear to be relevant to the development of IO, most notably gender, anxiety and depression and increased weight concerns and body dissatisfaction. Evidence suggests that women, especially young girls, are more likely to omit insulin as a method of weight loss compared to men. Mental health conditions such as anxiety and depression are increasingly prevalent in people with T1D compared to their peers, and appear to contribute to the risk of IO. Increased weight concerns and body dissatisfaction are further prominent risk factors, especially given increases in weight which often occur following diagnosis and the monitoring of weight by diabetes teams. This review presents evidence examining these risk factors which increase the likelihood of a person with T1D engaging in IO and highlights the complications associated with prolongment of the behaviour. Further research looking at the comorbidities of these risk factors, alongside other factors, would provide greater insight into understanding IO in people with T1D.
Objective health literacy skills among ninth graders in Finland: outcomes from a national learning assessment
Authors: Summanen Anna-Mari , Rautopuro Juhani , Kannas Lasse K. , Paakkari Leena T.
Published: June 2021

Background:

Health literacy (HL) is an important determinant for maintaining and improving health throughout the lifespan. This underlines the need to monitor HL, including among adolescents, and to understand the factors explaining HL, with a view to decreasing differences in HL. The aim of this study was to objectively measure HL, and the relationship between HL and socio-demographic factors (gender, language of instruction, pupils’ educational aspirations, parents’ educational background and pupils’ school achievement) among pupils ( n = 3652) at the end of basic education in Finland.

Methods:

A nationally representative assessment, which included 55 items on HL, was conducted as a traditional paper-and-pencil test in schools. The data were analysed via descriptive statistics and a two-level hierarchical linear model to determine how the socio-demographic factors affected HL.

Results:

The pupils’ average score on the HL test items was 58.9%, indicating a satisfactory HL level. A two-level hierarchical linear model showed that the variables (gender, language of instruction, pupils’ educational aspirations, parents’ educational background and pupils’ school achievement) predicting the HL level had statistically significant effects.

Conclusions:

Among ninth graders (15–16 years old), almost one third of the boys and 8% of the girls exhibited an unsatisfactory HL level. The study also confirmed the importance of school-related factors in explaining HL differences. Since low HL has been linked to several unfavourable health indicators and has been viewed as an underestimated problem in times of pandemic and other health crises, the findings suggest that the HL level of Finnish ninth graders is a clear public-health issue.
Cyber-safety and COVID-19 in the early years: A research agenda
Authors: Edwards Susan
Published: June 2021

Young children aged birth to 5 years are known users of the internet, both unsupervised and in collaboration with adults. Adults also use the internet to share details of children’s lives with others, via sharenting and educational apps. During COVID-19 internet use by children and families rose significantly during periods of enforced stay-home. Internet use by children, and by adults on behalf exposes children to conduct, contact and content risks online. These risks mean that cyber-safety in the early years is increasingly necessary, especially concerning increased internet usage during COVID-19. While cyber-safety is well developed for primary and secondary-school aged children this is not the case for young children, their families and educators. This paper proposes a research agenda for cyber-safety in the early years, using critical constructivism and internet studies to define the internet as a non-unitary technology. Three main objects of study concerning cyber-safety in the early years, including the reference to COVID-19 are identified for targeted research, including: technologies, context and policy.
Celecoxib Alleviates Radiation-Induced Brain Injury in Rats by Maintaining the Integrity of Blood-Brain Barrier
Authors: Xu Xiaoting , Huang Hao , Tu Yu , Sun Jiaxing , Xiong Yaozu , Ma Chenying , Qin Songbing , Hu Wentao , Zhou Juying
Published: June 2021

The underlying mechanisms of radiation-induced brain injury are poorly understood, although COX-2 inhibitors have been shown to reduce brain injury after irradiation. In the present study, the effect of celecoxib (a selective COX-2 inhibitor) pretreatment on radiation-induced injury to rat brain was studied by means of histopathological staining, evaluation of integrity of blood-brain barrier and detection of the expressions of inflammation-associated genes. The protective effect of celecoxib on human brain microvascular endothelial cells (HBMECs) against irradiation was examined and the potential mechanisms were explored. Colony formation assay and apoptosis assay were undertaken to evaluate the effect of celecoxib on the radiosensitivity of the HBMECs. ELISA was used to measure 6-keto-prostaglandin F1α (6-keto-PGF1α) and thromboxane B2 (TXB2) secretion. Western blot was employed to examine apoptosis-related proteins expressions. It was found that celecoxib protected rat from radiation-induced brain injury by maintaining the integrity of the blood-brain barrier and reducing inflammation in rat brain tissues. In addition, celecoxib showed a significant protective effect on HBMECs against irradiation, which involves inhibited apoptosis and decreased TXB2/6-keto-PGF1α ratio in brain vascular endothelial cells. In conclusion, celecoxib could alleviate radiation-induced brain injury in rats, which may be partially due to the protective effect on brain vascular endothelial cells from radiation-induced apoptosis.
Thromboelastography (TEG) results are predictive of ischemic and hemorrhagic complications in patients with unruptured intracranial aneurysms treated with flow diversion
Authors: Javed Kainaat , Unda Santiago R , Holland Ryan , Fortunel Adisson , Fluss Rose , Inocencio Julio , Haranhalli Neil , Altschul David
Published: June 2021

Introduction

Flow diversion is an effective treatment modality for intracranial aneurysms but is associated with ischemic and hemorrhagic complications. Patients treated with flow diversion require dual antiplatelet therapy and subsequent platelet function tests. At our institution, Thromboelastography with Platelet Mapping (TEG-PM) is the test of choice. The primary objective of this study was to identify TEG parameters that are predictive of postoperative complications in patients treated with elective flow diversion.

Methods

This was a retrospective study of 118 patients with unruptured intracranial aneurysms treated with flow diversion. Data was collected via chart review. Bivariate analyses were performed to identify significant variables in patients who suffered an ischemic stroke or a groin hematoma. ROC curves were constructed for the TEG parameters with statistical significance. Bivariate analyses were repeated using dichotomized TEG results.

Results

Patients who experienced a symptomatic ischemic stroke had a history of stroke (p value = 0.007), larger aneurysm neck width (p value = 0.017), and a higher alpha angle (p value = 0.013). Cut off point for ischemic complication is 63° on ROC curve with a sensitivity of 100% and specificity of 65%. Patients who experienced a groin hematoma were no different from their healthy peers but had a lower alpha angle (p value = 0.033). Cut off point for hemorrhagic complication is 53.3° with a sensitivity of 82% and specificity of 67%.

Conclusion

The Alpha Angle parameter of TEG-PM has a sizeable predictive ability for both ischemic complications of the central nervous system and hemorrhagic complications of the access site after elective flow diversion.
Challenging humanist leadership: Toward an embodied, ethical, and effective neo-humanist, enlightenment approach
Authors: Knights David
Published: June 2021

It can be argued that a humanistic enlightenment approach to leadership emerged as a counter to the historical prevalence of totalitarian elitism where leaders were often autocratic and authoritarian, demanding obedience through command and control. Although beginning with the ancient Greeks, this kind of leadership has continued through classical periods from early medieval times up until the industrial revolution, and also into our modern era. Since the 18th century, philosophies of enlightened humanism have been the face of leadership thinking if not always what might be seen as its embodied practice. Beneath the surface, there lurks a controlling and demanding imposition of self-discipline that can be seen as equally if not more, repressive than the elitism it replaces. This article is concerned to challenge such repression by developing a neo-humanist enlightenment approach to leadership and its development. It departs from those studies that reflect and thereby reproduce individualized preoccupations with, and attachments to, identity on the part of leaders and the so-called followers. The focus, instead, is on an embodied leadership that encourages an ethical engagement with the community, institutions, organizations, and society.
Effects of ball properties on throwing in young team-handball beginners
Authors: Fasold Frowin , Noël Benjamin , Nicklas André , Lukac Fabian , Klatt Stefanie
Published: June 2021

Throwing a ball is a primary skill in team-handball and can be directly influenced by the properties of different types of balls. Therefore, the use of different balls (i.e., methodic ball) recommended by the handball federations (e.g., IHF) and the education guidelines, are important in teaching throwing. Previous studies have shown that movement patterns and throwing velocity can be influenced by different ball types and sizes. However, the influence of these factors on throwing accuracy has not been investigated in detail yet. This study aims to replicate the findings of previous studies on increasing throwing velocity in children by comparing the use of a soft methodic ball with a size 0 handball. Furthermore, this study investigates the influence of these balls on throwing accuracy. In an experimental study, participants (10-years of age) threw a soft methodic ball and a size 0 ball at target areas in a handball goal. For all the throws, throwing velocity and accuracy were measured. Commensurate with previous research, throwing velocity was higher for the soft methodic ball compared to a size 0 ball. No difference was found in accuracy, although, it is worth mentioning that the participants were only experienced in throwing using the size 0 ball. Moreover, only one-third of the children favored throwing with a size 0 ball, which is what they are used to in training and competition. The results of our study, therefore, confirm that using soft methodic balls additionally, positively influences the throwing velocity and has no negative effect on the accuracy in throwing among young handball beginners.
No Gender Bias in Audience Perceptions of Male and Female Experts in the News: Equally Competent and Persuasive
Authors: Greve-Poulsen Katrine , Larsen Frederik K. , Pedersen Rasmus T. , Albæk Erik
Published: June 2021

Experts are prevalent and persuasive in modern media coverage of politics. The perceived competence of experts makes them popular sources in the media, and their statements can in some cases move citizens’ policy opinions substantially. However, men are generally used far more as experts than women are. Because of this predominance of male experts and general biases against women, we theorize that media audiences may find women to be less competent and consequently less persuasive as experts on policy issues. We investigate this through two experiments embedded in a survey with more than 2000 respondents in Denmark. Despite advances in gender equality, women are still in the minority among experts used in the Danish news media. However, despite this current gender imbalance, we find no gender biases against women as policy experts among the Danish news media audience. There are no significant differences in the perceptions of the competence of male and female experts, and the persuasiveness of the experts are also unrelated to the gender of the expert. These results hold across different policy issues, and across practically all demographics within the media audiences. These results are relevant both to the study of gender representation in the mass media, and to the study of gender biases more generally. Furthermore, the results are important for discussions on news media selection of experts.
Multifactorial origin of pulmonary hypertension in a child with congenital heart disease, Down syndrome, and BMPR‐2 mutation
Authors: Bajolle Fanny , Malekzadeh‐Milani S. , Lévy M. , Bonnet D.
Published: June 2021

A late preterm infant had pulmonary hypertension caused by a variety of mechanisms leading to complex management. This child had complete atrioventricular septal defect associated with mild left ventricular hypoplasia and Down syndrome diagnosed prenatally. The mother had been treated by antiretroviral HIV treatment during pregnancy. Aortic coarctation was diagnosed and rapidly repaired. After surgery, he required noninvasive ventilation for persisting elevated PCO2. Pulmonary CT scan showed normal bronchial tree, lung parenchymal abnormalities with mosaic aspect and hyperlucent zones, and indirect signs of lung hypoplasia with peripheral microbubbles. During follow‐up, severe pulmonary hypertension was diagnosed on echocardiography without recoarctation, significant intracardiac shunting or diastolic dysfunction. The patient died after four months unable to be weaned from noninvasive ventilation. Post mortem lung biopsy showed abnormally muscularized arterioles with intimal fibrosis and pulmonary immaturity. Gentetic screening identified a BMPR‐2 mutation. This patient illustrates the multifactorial origin of pulmonary hypertension in the neonatal period. The respective contribution of left‐to‐right shunt, post‐capillary obstruction, and abnormally elevated pulmonary vascular resistances led to perform right heart catheterization to exclude excessive shunting and restrictive physiology of the left heart. Subjects with Down syndrome are also highly susceptible to decreased lung vascular and alveolar growth, which may increase the risk for pulmonary hypertension and lung hypoplasia. This case highlights two issues. The first one is that right heart catheterization should be discussed in neonates with unexplained pulmonary hypertension and the second is to extend indications of genetic testing for pulmonary hypertension genes in neonates who have unusual course of neonatal pulmonary hypertension, particularly in the setting of associated congenital heart disease (CHD).
How partners mediate platform power: Mapping business and data partnerships in the social media ecosystem
Authors: van der Vlist Fernando N , Helmond Anne
Published: June 2021

Social media platforms’ digital advertising revenues depend considerably on partnerships. Business partnerships are endemic and essential to the business of platforms, yet their role remains relatively underexplored in the literature on platformisation and platform power. This article considers the significance of partnerships in the social media ecosystem to better understand how industry platforms, and the infrastructure they build, mediate and shape platform power and governance. We argue that partners contribute to ‘platformisation’ through their collective development of business-to-business platform infrastructures. Specifically, we examine how partners have integrated social media platforms with what we call the audience economy – an exceptionally complex global and interconnected marketplace of intermediaries involved in the creation, commodification, analysis, and circulation of data audiences for purposes including but not limited to digital advertising and marketing. We determined which relationships are involved, which are exclusive or shared, and identified key ecosystem partners. Further, we found that partners build and integrate extensive infrastructures for data-sourcing and media distribution, surfacing infrastructural and strategic sources and locations, or ‘nodes’, of power in this ecosystem. The empirical findings thus highlight the significance of partnerships and partner integrations and draw attention to the powerful industry players and intermediaries that remain largely invisible.
Predictors of Health Deterioration Among Older New Zealanders Undergoing Dialysis: A Three-Year Accelerated Longitudinal Cohort Study
Authors: Shettigar Reshma , Samaranayaka Ari , Schollum John B. W. , Wyeth Emma H. , Derrett Sarah , Walker Robert J.
Published: June 2021

Background:

Patient involvement in dialysis decision-making is crucial, yet little is known about patient-reported outcomes over time on dialysis.

Objective:

To examine health-related outcomes over 24 and 36 months in an older cohort of dialysis patients.

Design:

The “Dialysis outcomes in those aged ≥65 years study” is a prospective longitudinal cohort study of New Zealanders with kidney failure.

Setting:

Three New Zealand nephrology units.

Patients:

Kidney failure (dialysis and predialysis) patients aged 65 or above. We have previously described outcomes after 12 months of dialysis therapy relative to baseline.

Measurements:

Patient-reported social and health factors using the SF-36, EQ-5D, and Kidney Symptom Score questionnaires.

Methods:

This article describes and compares characteristics of 120 older kidney failure patients according to whether they report “Same/better” or “Worse” health 24 and 36 months later, and identifies predictors of “worse health.” Modified Poisson regression modeling estimated relative risks (RR) of worse health.

Results:

Of 120 patients at 12 months, 47.5% had worse health or had died by 24 months. Of those surviving at 24 months (n = 80), 40% had “Worse health” or had died at 36 months. Variables independently associated with reduced risk of “Worse health” (24 months) were as follows: Māori ethnicity (RR = 0.44; 95% CI = 0.26-0.75), Pacific ethnicity (RR = 0.39; 95% CI = 0.33-0.46); greater social satisfaction (RR = 0.57; 95% CI = 0.46-0.7). Variables associated with an increased risk of “Worse health” were as follows: problems with usual activities (RR = 1.32; 95% CI = 1.04-1.37); pain or discomfort (RR = 1.48; 95% CI = 1.34, 1.63). At 36 months, lack of sense of community (RR = 1.41; 95% CI = 1.18-1.69), 2 or more comorbidities (RR = 1.21; 95% CI = 1.13-1.29), and problems with poor health (RR = 1.47; 95% CI = 1.41-1.54) were associated with “Worse health.”

Limitations:

Participant numbers restricted the number of variables able to be included in the multivariable model, and hence there may have been insufficient power to detect certain associations.

Conclusions:

In this study, the majority of older dialyzing patients report “Same/better health” at 24 and 36 months. Māori and Pacific people report better outcomes on dialysis. Social and/or clinical interventions aimed at improving social satisfaction, sense of community, and help with usual activities may impact favorably on the experiences for older dialysis patients.

Trial registration:

Australian and New Zealand clinical trials registry: ACTRN12611000024943.
COVID-19 Pandemic and Small-Scale Industries in a Local Geographic Space of Nigeria: An Assessment of the Impact of Strategic Interfirm Alliance
Authors: Nwokocha Victor Chukwunweike , Anyanwu Ogochukwu Christiana , Madu Ignatius Ani , Nwankwo Christopher Emmanuel
Published: June 2021

The outbreak of Coronavirus pandemic has brought with it stagnation in all sectors of the economy, unemployment and loss of jobs, threats of recession, and annihilation of industries across the world. This paper examined the impact of strategic interfirm alliance on small-scale industries (SSI) amid the threat of COVID-19 pandemic in Nsukka, a local geographic space in Nigeria. A survey research design and a questionnaire survey of 82 SSIs were used in the paper. The data for the paper were analyzed using descriptive statistics while tables and percentages were used to illustrate the results. Results in the study revealed that 15.47%, 22.45%, and 44.20% of the respondents have experienced relative increase, increased, and significant increase, respectively, in COVID-19-induced challenges on their operations. The paper also showed that 24.81%, 25.01%, and 34.64% of the industries have experienced relative increase, increase, and significant increase, respectively, in their operations following their use of alliance, while 5.06% and 10.48% have experienced relative and significant decreases. The paper suggests that SSIs in Nigeria should adopt/institutionalize the use of strategic interfirm alliance in their operations in order to survive the COVID-19-induced challenges which have distrupted their production flow.
Examining Boyhood Masculinity Within an Irish Context: An Assessment of the Reliability and Structural Validity of the Meanings of Adolescent Masculinity Scale and the Adolescent Masculinity Ideology in Relationships Scale
Authors: Katz Joshua W. , Morrison Todd G. , Ó Beaglaoich Cormac
Published: June 2021

The Meanings of Adolescent Masculinity Scale (MAMS) and the Adolescent Masculinity Ideology in Relationships Scale (AMIRS) were designed by American researchers to assess masculinity in adolescent boys. Given that masculinities differ cross-culturally, though, these scales may not be viable for use with non-American populations. In the current study, 221 Irish adolescents completed the MAMS and the AMIRS. Using confirmatory factor analyses (CFAs), the MAMS’s and the AMIRS’s factor structures were tested. Results indicated poor goodness-of-fit in both cases. Attempts to improve the models were unsuccessful. Accordingly, neither the MAMS nor the AMIRS appear to be structurally valid within an Irish context. We recommend that researchers consider cultural variations when designing, validating, and utilizing indicators of masculinity.
Childhood Peer Victimization, Identity Diffusion and Disordered Eating Behaviors in Emerging Adults
Authors: Markou Maria , Charalampous Kyriakos , Tantaros Spyridon , Stavrinides Panayiotis
Published: June 2021

Childhood peer victimization (CPV) has been associated with clinical and subclinical forms of disordered eating behaviors (DEBs). However, less is known about the mechanisms involved in this association, especially in emerging adulthood. The present study examined the relationship between harmfulness of the CPV experiences, identity diffusion and DEBs using Structural Equation Modeling. Emphasis was given in the investigation of the indirect effect of CPV harmfulness on DEBs through identity diffusion. Data from 414 emerging adults was collected via an online questionnaire. The analysis indicated significant direct effects of CPV harmfulness on both restrictive and binge-eating. More importantly, findings supported the indirect relationship between CPV harmfulness and binge-eating through identity diffusion. Results provide preliminary support for the role of CPV harmfulness and identity diffusion as contributing factors in the development of DEBs in emerging adults. Implications for future research are discussed.
Racial Disparities in Perioperative Morbidity Following Oncological Spine Surgery
Authors: De la Garza Ramos Rafael , Choi Jong Hyun , Naidu Ishan , Benton Joshua A. , Echt Murray , Yanamadala Vijay , Passias Peter G. , Shin John H. , Altschul David J. , Goodwin C. Rory , Sciubba Daniel M. , Yassari Reza
Published: June 2021

Study Design:

Retrospective cohort study.

Objective:

To assess the impact of race on complications following spinal tumor surgery.

Methods:

Adults with cancer who underwent spine tumor surgery were identified in the American College of Surgeons National Surgical Quality Improvement Program datasets from 2012 to 2016. Clavien-Dindo Grade I-II (minor complications) and Clavien-Dindo Grade III-V (major complications including 30-day mortality) complications were compared between non-Hispanic Whites (NHW) and Black patients. A multivariable analysis was also conducted.

Results:

Of 1,226 identified patients, 85.9% were NHW (n = 1,053) and 14.1% were Black (n = 173). The overall rate of Grade I-II complications was 16.2%; 15.1% for NHW patients and 23.1% for Black patients ( P = .008). On multivariable analysis, Black patients had significantly higher odds of having a minor complication (OR 1.87; 95% CI, 1.16-3.01; P = .010). On the other hand, the overall rate of Grade III-V complications was 13.3%; 12.5% for NHW patients and 16.2% for Black patients ( P = .187). On multivariable analysis, Black race was not independently associated with major complications (OR 1.26; 95% CI, 0.71-2.23; P = .430). Median length of stay was 8 days (IQR 5-13) for NHW patients and 10 days (IQR 6-15) for Black patients ( P = .011).

Conclusion:

Black patients who underwent metastatic spinal tumor surgery were at a significantly increased risk of perioperative morbidity compared to NHW patients independent of baseline and operative characteristics. Major complications did not differ between groups. Race should be further studied in the context of metastatic spine disease to improve our understanding of these disparities.
Upper End Vertebra of Proximal Thoracic Curve At T1 is a Novel Risk Factor of Postoperative Shoulder Imbalance in Lenke Type 2 Adolescent Idiopathic Scoliosis
Authors: Isogai Norihiro , Yagi Mitsuru , Otomo Nao , Maeda Yoshihiro , Suzuki Satoshi , Nori Satoshi , Tsuji Osahiko , Nagoshi Narihito , Okada Eijiro , Fujita Nobuyuki , Nakamura Masaya , Matsumoto Morio , Watanabe Kota
Published: June 2021

Study Design:

Retrospective single-center study.

Objective:

We investigated the risk factors of postoperative shoulder imbalance (PSI) in patients with Lenke type 2 adolescent idiopathic scoliosis (AIS) including the position of preoperative upper end vertebra (UEV).

Methods:

Seventy-five patients with Lenke type 2 AIS who underwent posterior correction and fusion surgeries from 2008 to 2018 were included. We included only patients whose upper instrumented vertebrae were at T2. The patients were divided into 2 groups based on radiographic shoulder height (RSH) at final follow-up, namely PSI group and non-PSI group, and PSI was defined as RSH > 10 mm. UEV, RSH, Cobb angle, curve flexibility, T1 and T2 tilt, correction rate, Risser grade, Scoliosis Research Society-22 scores, and demographic data were compared between the groups using independent t-tests or chi-square tests. Variables with P value < 0.20 in univariate analysis were assessed in logistic regression analysis.

Results:

Thirty-four patients in the PSI group and 37 patients in the non-PSI group were analyzed. Univariate analysis revealed that there were more patients with UEV at T1 (PSI: 85%, non-PSI: 54%, P < 0.01) and Risser grade ≥ 3 (PSI: 88%, non-PSI: 62%; P < 0.05) in the PSI group than in the non-PSI group. Logistic regression analysis revealed that UEV at T1 (odds ratio [OR] = 4.1 [1.2–14.4], P < 0.05) and Risser grade ≥ 3 (OR = 3.9 [1.1–14.5], P < 0.05) are significantly associated with PSI.

Conclusions:

UEV at T1 and Risser grade ≥ 3 at the time of surgery are significant risk factors of PSI.
Fatal Pediatric COVID-19 Case With Seizures and Fulminant Cerebral Edema
Authors: Ninan Siddharth , Thompson Peyton , Gershon Timothy , Ford Natalie , Mills William , Jewells Valerie , Thorne Leigh , Saunders Katherine , Bouldin Thomas , Smedberg Jason R. , Miller Melissa B. , Wu Eveline , Tilly Alyssa , Sites Jeremy , Lercher Daniel , Clement Katherine , Walker Tracie , Shea Paul , Joyner Benny , Smith Rebecca
Published: June 2021

The novel coronavirus, SARS-CoV-2, can present with a wide range of neurological manifestations, in both adult and pediatric populations. We describe here the case of a previously healthy 8-year-old girl who presented with seizures, encephalopathy, and rapidly progressive, diffuse, and ultimately fatal cerebral edema in the setting of acute COVID-19 infection. CSF analysis, microbiological testing, and neuropathology yielded no evidence of infection or acute inflammation within the central nervous system. Acute fulminant cerebral edema (AFCE) is an often fatal pediatric clinical entity consisting of fever, encephalopathy, and new-onset seizures followed by rapid, diffuse, and medically-refractory cerebral edema. AFCE occurs as a rare complication of a variety of common pediatric infections and a CNS pathogen is identified in only a minority of cases, suggesting a para-infectious mechanism of edema. This report suggests that COVID-19 infection can precipitate AFCE, and highlights the need for high suspicion and early recognition thereof.
A 12 Years Neonatal Mortality Rate and Its Predictors in Eastern Ethiopia
Authors: Dheresa Merga , Daraje Gamachis
Published: June 2021

Introduction. Surviving and thriving of newborn is essential to ending extreme poverty. However, the surviving and thriving of new born is depends on where neonates are born. The true feature of neonatal mortality rate and trends is not well known in the study area. Thus, we aimed to estimate a neonatal mortality incidence in each year, and determine factors associated though pregnancy observation cohort study in Eastern Ethiopia. Methods. The study was conducted in Kersa Health Demographic Surveillance System (KHDSS) among 36 kebeles. We extracted all events (38 541 live birth and 776 neonatal death) occurred between January 1, 2008 and December 30, 2019. Neonatal mortality rate was presented by neonatal death per 1000 live birth with 95% confidence interval in each years, and trends of neonatal morality was described with line regression. Cox proportional regression model was used to assess predictors and presented with an adjusted hazard ratio (AHR) and 95% CI. Results. The estimated cumulative average of neonatal mortality rate in this study was 20.3 (95% CI: 18.9-21.8) per 1000 live births. The rate was decline with regression coefficient β = −1.60. Risk of neonatal death was found to be significantly associated with neonate born to mother living in rural Kersa (AHR = 5.31; 95% CI: 3.07-9.18), born to mother not receiving antenatal care (AHR = 1.43; 95% CI: 1.15-1.78), low birthweight (AHR = 2.59; 95% CI: 2.05-3.27), and preterm newborn (AHR = 12.10; 95% CI: 9.23-15.86). Conclusion. Neonatal mortality in the study site is far from reaching the national and global target goals.
Challenges Faculty Faced Transitioning to e-Learning Platforms during the Current Pandemic in the United Arab Emirates
Authors: O’Sullivan Siobhán M , Khraibi Ali A , Chen Wei , Corridon Peter R
Published: June 2021

The authors recount the challenges they overcame to deliver lecture content and assessments while engaging students at their newly established medical school. Faculty must multitask in new and added ways to achieve the same goal in e-learning platforms. Online course delivery introduces additional barriers to engaging students, atypical of face-to-face sessions. We received valuable feedback, adjusted our delivery, and allowed our students to access lecture recordings at their convenience. Our sessions with students were more than just a lecture but a way to help people through a unprecedented time. Remote learning platforms also provided faculty with opportunities to develop new pedagogical skills and alternative assessments.
Reverse Total Shoulder Arthroplasty Baseplate Stability in Superior Bone Loss With Augmented Implant
Authors: Martin Elise J , Duquin Thomas R , Ehrensberger Mark T
Published: June 2021

Background

Glenoid bone loss is commonly encountered in cases of rotator cuff tear arthropathy and can create challenges during reverse shoulder arthroplasty. In this study, we sought to investigate the biomechanical properties of a new treatment option for superior glenoid defect, an augmented reverse total shoulder baseplate.

Methods

Three conditions were examined: non-augmented baseplate without defect, non-augmented baseplate with defect, and augmented baseplate with defect. The augmented baseplates included a 30-degree half wedge which also matched the created superior defect. The samples were cyclically loaded at a 60° simulated abduction angle to mimic baseplate loosening. The migration and micromotion of the baseplate were measured on the superior edge using a 3D Digital Image Correlation System.

Results

The migration measured in the augmented baseplate showed no significant difference when compared to the no defect or defect cases. In terms of micromotion, the augmented baseplate showed values that were between the micromotions reported for the no defect and defect conditions, but not by a statistically significant amount.

Conclusion

This study provides biomechanical evidence that augmented baseplates can reduce the amount of micromotion experienced by the RSA construct in the presence of significant superior glenoid bone deficiency, but do not fully restore stability to that of a full contact non-augmented baseplate.
Reconstruction of a Combined Frontal Bone and Orbital Roof Defect With Associated Meningoencephalocele Using 3D Modeling and 3D Navigation
Authors: O’Connor Rory C. , Abazi Sead , Soleman Jehuda , Thieringer Florian M.
Published: June 2021

Introduction:

Orbital roof fractures are uncommon and normally associated with high energy trauma in which multiple other injuries are present. Most can be managed non-operatively with close observation. However, in a small proportion the defect is such that it permits the development of a meningoencephalocele, which can cause exophthalmos, a reduction in visual acuity and pain, all of which are unlikely to improve without surgical treatment. In light of their scarcity and the potential of serious risks with surgery that includes meningitis and visual disturbance (or even loss), thorough planning is required so that the meningoencephalocele can be reduced safely and the orbital roof adequately reconstructed.

Methods:

We report a case of a patient with a frontal bone defect, orbital roof fracture and associated meningoencephalocele that presented years after being involved in a road traffic accident in another country, who complained of a significant headache and orbital pain. The use of 3D modeling to help plan the surgery, and intraoperative 3D navigation to help negotiate the anterior skull base are described along with the reconstruction of the frontal bone and orbital roof using titanium mesh contoured on the 3D model.

Conclusions:

Although conservative management of orbital roof fractures predominates; those that are symptomatic, have associated neurologic symptoms or pose a risk to the eyesight warrant a surgical approach. The methods of repair, which center around separating the intracranial and intraorbital contents, are described in the context of this patient and previous cases, and a treatment algorithm is proposed.
Sexuality Among Adolescents and Young Adults With Intellectual Disability: Knowledge, Attitude, and Practices
Authors: Chavan Bir Singh , Ahmad Wasim , Arun Priti , Mehta Shivangi , Nazli  , Ratnam Vani , Raina Deepti
Published: June 2021

Context:

It is generally believed that persons with intellectual disability (PWID) do not have sufficient knowledge about sex and sexuality. As there is not much published work from India, such an attitude of clinicians and caregivers appears more to be an assumption. The scant information from other countries on sex and sexuality of the PWID cannot be generalized to India because of cultural differences.

Aims and Objectives:

The study was conducted to find out knowledge, attitude, and sexual practices among persons with mild intellectual disability (ID).

Settings and Design:

Thirteen participants with DSM-5 diagnosis of mild ID (intellect quotient [IQ] between 50 and 69) in the age ranging from 16 to 27 years (mean IQ and age was 56.69 and 21.0, respectively) were selected from the Government Rehabilitation Institute for Intellectual Disabilities, Chandigarh. For this study, exploratory method using focus group discussion (FGD) was used. Data was collected using qualitative method of FGD.

Results:

The results showed that persons with mild ID have knowledge about sex and sexual practices and they are sexually active and are indulging in sexual acts.

Conclusion:

Based on the findings derived from this research, it is concluded that PWID have knowledge and skills to experience sexual activities. However, findings of this study are limited to only persons with mild ID (IQ: 50-69). Need to sensitize and provide appropriate sexual health care for persons with ID are discussed.
Synthesis of SPIO Nanoparticles and the Subsequent Applications in Stem Cell Labeling for Parkinson’s Disease
Authors: An Li , Tao Qing , Wu Yue , Wang Nana , Liu Yan , Wang Feifei , Zhang Lixing , Shi Aihua , Zhou Xiumin , Yu Shuang , Zhang Jingzhong
Published: June 2021

Parkinson's disease (PD) is characterized by the progressive loss of dopaminergic neurons in the midbrain, and the stem cell transplantation method provides a promising strategy for the treatment. In these studies, tracking the biological behaviors of the transplanted cells in vivo is essential for a basic understanding of stem cell function and evaluation of clinical effectiveness. In the present study, we developed a novel ultrasmall superparamagnetic iron oxide nanoparticles coating with the polyacrylic acid (PAA) and methoxypolyethylene glycol amine (PEG) by thermal decomposition method and a two-step modification. The USPIO-PAA/PEG NPs have a uniform diameter of 10.07 ± 0.55 nm and proper absorption peak of the corresponding ligands, as showed by TEM and FTIR. MTT showed that the survival of cells incubated with USPIO-PAA/PEG NPs remained above 96%. The synthesized USPIO-PAA/PEG had a good relaxation rate of 84.65 s−1 Mm−1, indicating that they could be efficiently uptake and traced by MRI. Furthermore, the primary human adipose-derived stem cells (HADSCs) were characterized, labeled with USPIO-PAA/PEG and transplanted into the striatum of 6-hydroxydopamine (6-OHDA)-induced PD rat models. The labeled cells could be traced by MRI for up to 3 weeks after the transplantation surgery; moreover, transplantation with the labeled HADSCs significantly attenuated apomorphine-induced rotations in PD models and increased the number of the dopaminergic neurons in the substania nigra. Overall, the development of USPIO-PAA/PEG NPs provides a promising tool for in vivo tracing technique of cell therapy and identifies a novel strategy to track stem cells with therapeutic potential in PD.
Prostatic basal cell carcinoma treated by chemoradiation with weekly cisplatine: case report and literature review
Authors: Ridai S. , Moustakbal C. , Lachgar A. , Jouhadi H. , Benider A. , Regragui M. , Marnissi F.
Published: June 2021

Background

Basal cell carcinoma of the prostate is a relatively rare entity. Their evolution is characterized by the frequency of local and/or distant relapses. Due to their rarity, the treatment is not consensual in the literature. We report here a case of Basal cell carcinoma of the prostate in a 40-year-old patient.

Case presentation

Our patient initially presented an obstructive lower urinary tract symptoms with a normal initial level of prostate specific antigen (PSA) test (3.5 ng/m). The transurethral resection of the prostate (TURP) was in favor of a prostatic basal cell carcinoma with its specific anatomopathological and immunohistochemical characteristics. The prostatic MRI and thoraco-abdominal CT realized after the TURP revealed a tumoral lesion of the prostatic peripheral zone with extra-capsular extension combined with right seminal vesicle invasion and a suggestion of posterior bladder wall adherence. No evidence of visceral or nodal metastases at this point. Considering the tumor being locally advanced, a concurrent chemoradiotherapy with intensity modulated technique was indicated after a multidisciplinary meeting with a 70 Gy total target dose delivered in 35 fractions and weekly Cisplatin. A year and a half after, he developed a cerebellous metastases revealed by intracranial hypertension with no other visceral lesion and complete local remission with the disappearance of the lower urinary tract symptoms and the pain and the appearance of a prostatic atrophy. The PSA level was still on the upper limit of normal. He underwent metastasectomy, and the anatomopathological study was in favor of a cerebellous metastasis of the known BCC. The patient presented postoperatively paraparesis of lower limbs with balance problems for which he was placed in palliative care with indication of postoperative radiation therapy in case of improvement of his general condition. He did not recover and deceased three months later.

Conclusions

The prostatic basal cell carcinoma is a rare aggressive entity often non-evoked at the clinical or radiological stages because of its unspecific appearance. The diagnostic of these tumors is based on histological examination and a large immunohistochemistry panel. Given its scarity, very few data is available for locally advanced non-metastatic stages treated by radiation therapy. We assess here a good local response with concurrent chemoradiation therapy.
Development of a clinical tool for rating the body function categories of the ICF generic-30/rehabilitation set in Japanese rehabilitation practice and examination of its interrater reliability
Authors: Senju Yuki , Mukaino Masahiko , Prodinger Birgit , Selb Melissa , Okouchi Yuki , Mizutani Kouji , Suzuki Megumi , Yamada Shin , Izumi Shin-Ichi , Sonoda Shigeru , Otaka Yohei , Saitoh Eiichi , Stucki Gerold
Published: June 2021

Background

The International Classification of Functioning, Disability, and Health (ICF) Generic-30 (Rehabilitation) Set is a tool used to assess the functioning of a clinical population in rehabilitation. The ICF Generic-30 consists of nine ICF categories from the component “body functions” and 21 from the component “activities and participation”. This study aimed to develop a rating reference guide for the nine body function categories of the ICF Generic-30 Set using a predefined, structured process and to examine the interrater reliability of the ratings using the rating reference guide.

Methods

The development of the first version of the rating reference guide involved the following steps: (1) a trial of rating patients by several raters; (2) cognitive interviews with each rater to analyze the thought process involved in each rating; (3) the drafting of the rating reference guide by a multidisciplinary panel; and (4) a review by ICF specialists to confirm consistency with the ICF. Subsequently, we conducted a first field test to gain insight into the use of the guide in practice. The reference guide was modified based on the raters’ feedback in the field test, and an inter-rater reliability test was conducted thereafter. Interrater agreement was evaluated using weighted kappa statistics with linear weights.

Results

The first version of the rating reference guide was successfully developed and tested. The weighted kappa coefficient in the field testing ranged from 0.25 to 0.92. The interrater reliability testing of the rating reference guide modified based on the field test results yielded an improved weighted kappa coefficient ranging from 0.53 to 0.78. Relative improvements in the weighted kappa coefficients were observed in seven out of the nine categories. Consequently, seven out of nine categories were found to have a weighted kappa coefficient of 0.61 or higher.

Conclusions

In this study, we developed and modified a rating reference guide for the body function categories of the ICF Generic-30 Set. The interrater reliability test using the final version of the rating reference guide showed moderate to substantial interrater agreement, which encouraged the use of the ICF in rehabilitation practice.
Burden of illness in US hospitals due to carbapenem-resistant Gram-negative urinary tract infections in patients with or without bacteraemia
Authors: Shields Ryan K. , Zhou Yun , Kanakamedala Hemanth , Cai Bin
Published: June 2021

Background

Urinary tract infections (UTIs) are the most common infections caused by Gram-negative bacteria and represent a major healthcare burden. Carbapenem-resistant (CR) strains of Enterobacterales and non-lactose fermenting pathogens further complicate treatment approaches.

Methods

We conducted a retrospective analysis of the US Premier Healthcare Database (2014–2019) in hospitalised adults with a UTI to estimate the healthcare burden of Gram-negative CR UTIs among patients with or without concurrent bacteraemia.

Results

Among the 47,496 patients with UTI analysed, CR infections were present in 2076 (4.4%). Bacteraemia was present in 24.5% of all UTI patients, and 1.7% of these were caused by a CR pathogen. The most frequent CR pathogens were Pseudomonas aeruginosa (49.4%) and Klebsiella pneumoniae (14.2%). Patients with CR infections had a significantly longer hospital length of stay (LOS) (median [range] 8 [5–12] days vs 6 [4–10] days, P < 0.001), were less likely to be discharged home (38.4% vs 51.0%, P < 0.001), had a higher readmission rate (22.6% vs 13.5%, P < 0.001), and had greater LOS-associated charges (mean US$ 91,752 vs US$ 66,011, P < 0.001) than patients with carbapenem-susceptible (CS) infections, respectively. The impact of CR pathogens was greater in patients with bacteraemia (or urosepsis) and these CR urosepsis patients had a significantly higher rate of mortality than those with CS urosepsis (10.5% vs 6.0%, P < 0.001).

Conclusions

Among hospitalised patients with UTIs, the presence of a CR organism and bacteraemia increased the burden of disease, with worse outcomes and higher hospitalisation charges than disease associated with CS pathogens and those without bacteraemia.
The role of a virtual avatar in attention and memory tasks in Rett syndrome
Authors: Fabio Rosa Angela , Pergolizzi Giorgia , Nucita Andrea , Iannizzotto Giancarlo , Caprì Tindara
Published: June 2021

Background

Since subjects with Rett syndrome (RTT) focus their attention mainly on the faces of people with whom they interact, in this study the role of a human-like smart interactive agent (an avatar) in enhancing cognitive processes is examined. More in depth, this study aimed to understand if, and to what extent, the use of an avatar can improve attention and memory abilities in subjects with RTT.

Method

Thirty-six subjects with RTT participated in the study. All participants performed over-selectivity and memory tasks, for a total of six trials. These trials were randomly presented in two different conditions: with and without virtual avatar.

Results

The results indicated that the participants improved their attention and memory abilities when they performed the tasks with the avatar. There were no improvements when they performed the tasks without the avatar.

Discussion

The results were discussed considering the relationship between motivation, attention and memory in RTT.