bluuebunny/crossref_metadata_2025 huggingface dataset:
Production and Characterization of a Conditionally Immortalized Dog Beta-Cell Line from Fetal Canine Pancreas
Authors: Czernichow P , Reynaud K , Ravassard P
Published: November 2020

Since the 1970s, rodent and human insulin-secreting pancreatic beta-cell lines have been developed and found useful for studying beta-cell biology. Surprisingly, although the dog has been widely used as a translational model for diabetes, no canine insulin-secreting beta cells have ever been produced. Here, a targeted oncogenesis protocol previously described by some of us for generating human beta cells was adapted to produce canine beta cells. Canine fetal pancreata were obtained by cesarean section between 42 and 55 days of gestation, and fragments of fetal glands were transduced with a lentiviral vector expressing SV40LT under the control of the insulin promoter. Two Lox P sites flanking the sequence allowed subsequent transgene excision by Cre recombinase expression. When grafted into SCID mice, these transduced pancreata formed insulinomas. ACT-164 is the cell line described in this report. Insulin mRNA expression and protein content were lower than reported with adult cells, but the ACT-164 cells were functional, and their insulin production in vitro increased under glucose stimulation. Transgene excision upon Cre expression arrested proliferation and enhanced insulin expression and production. When grafted in SCID mice, intact and excised cells reversed chemically induced diabetes. We have thus produced an excisable canine beta-cell line. These cells may play an important role in the study of several aspects of the cell transplantation procedure including the encapsulation process, which is difficult to investigate in rodents. Although much more work is needed to improve the excision procedure and achieve 100% removal of large T antigen expression, we have shown that functional cells can be obtained and might in the future be used for replacement therapy in diabetic dogs.
Moving to Opportunity, or Aging in Place? The Changing Profile of Low Income and Subsidized Households and Where They Live
Authors: Reina Vincent J. , Aiken Claudia
Published: November 2020

The profile of households receiving rental assistance has changed over time, yet much of the policy and political dialogue surrounding rental assistance has not. Understanding the changing profile of subsidized households is important to evaluating the role of rental subsidies, particularly in the context of neighborhood access. This paper analyzes how the composition of subsidized households has changed over time, and how this relates to existing measures of neighborhood opportunity. We find that since 2000, the share of subsidized households headed by seniors grew, while the share with children dropped. In particular, households using vouchers used to be young relative to the general population and to households in other housing subsidy programs but have aged rapidly. We also find that current neighborhood amenity measures do not reflect these changes, and we use a national analysis and a case study of southeastern Pennsylvania to test alternative metrics.
Unmet supportive care needs and determinants among cancer patients treated at University of Gondar Specialized Hospital, Northwest Ethiopia: A prospective cross-sectional study
Authors: Gebresillassie Begashaw Melaku , Ayele Asnakew Achaw , Abegaz Tadesse Melaku
Published: November 2020

Background

Assessment of supportive care needs is an important requirement to plan supportive care intervention. This study aimed to assess the unmet supportive care needs of cancer patients treated at the University of Gondar Specialized Hospital, Ethiopia.

Methods

A prospective cross-sectional study was conducted from January 1, 2017 to August 30, 2017. Adult (18 years and greater) cancer patients and those who were receiving therapy were included. The 34-Item short-form Supportive Care Needs Survey(SCNS-SF34) tool was used to assess unmet needs. The data collected were analyzed using SPSS version-21.

Results

A total of 150 interview guides were included in the analysis (97.4% of response rate). In the majority of 65(43.3%) the participants, the disease was metastasized even though they have undergone surgery 78 (52%). The overall mean score level of unmet need for cancer care was 3.49. The highest unmet need mean score was reported from the health system and information need domain. A significant unmet need difference concerning different need domain was found in sex, age, residence, occupation status, and monthly income. Sex and residence were found to be independent predicting factors for unmet supportive care needs.

Conclusion

The overall level of unmet need was high. A significant unmet need difference was found in sex, age, residence, occupation status, and monthly income. Sex and residence were found to be independent predicting factors. Hence, professionals working in the oncology unit should be aware of unmet needs and expect changes over time. Certain programs and services to address the identified unmet needs should be urgently provided.
Commentary on Housing, Health, and Well-Being in Aotearoa/New Zealand
Authors: Howden-Chapman Philippa , Pierse Nevil
Published: November 2020

Housing is poorly constructed for the New Zealand climate and is a major cause of poor health and premature mortality. Private rental housing is older and in poorer condition than public housing and owner-occupied housing. This special issue describes four different approaches to improving housing, which have implications for international housing, health, and well-being policies. The first approach looks at generating the evidence base for improving the quality of the rental sector; the second, the aftereffects of the Christchurch earthquake and the unprecedented role taken by the central government to override local government and community involvement in rebuilding housing and regenerating the city; the third, measuring the effectiveness of the remediation of public housing; and finally, community-based partnerships between community workers and academics to improve the housing of children who have been hospitalized for housing-sensitive hospitalizations.
Behavioral, Histopathologic, and Molecular Biological Responses of Nanoparticle- and Solution-Based Formulations of Vincristine in Mice
Authors: Bluette Crystal T. , Shoieb Ahmed M. , Peng Qinghai , Manickam Balasubramanian , Huang Wenhu , Shin Eyoung , Zhang Wei , Song Young-Ho , Liu Chang-Ning
Published: November 2020

Clinical use of the chemotherapeutic agent vincristine (VCR) is limited by chemotherapy-induced peripheral neuropathy (CiPN). A new formulation of VCR encapsulated by nanoparticles has been proposed and developed to alleviate CiPN. We hypothesized in nonclinical animals that the nanoparticle drug would be less neurotoxic due to different absorption and distribution properties to the peripheral nerve from the unencapsulated free drug. Here, we assessed whether VCR encapsulation in nanoparticles alleviates CiPN using behavioral gait analysis (CatWalk), histopathologic and molecular biological (RT-qPCR) approaches. Adult male C57BL/6 mice were assigned to 3 groups (empty nanoparticle, nano-VCR, solution-based VCR, each n = 8). After 15 days of dosing, animals were euthanized for tissue collection. It was shown that intraperitoneal administration of nano-VCR (0.15 mg/kg, every other day) and the empty nanoparticle resulted in no changes in gait parameters; whereas, injection of solution-based VCR resulted in decreased run speed and increased step cycle and stance ( P < 0.05). There were no differences in incidence and severity of degeneration in the sciatic nerves between the nano-VCR-dosed and solution-based VCR-dosed animals. Likewise, decreased levels of a nervous tissue-enriched microRNA-183 in circulating blood did not show a significant difference between the nano- and solution-based VCR groups ( P > 0.05). Empty nanoparticle administration did not cause any behavioral, microRNA, or structural changes. In conclusion, this study suggests that the nano-VCR formulation may alleviate behavioral changes in CiPN, but it does not improve the structural changes of CiPN in peripheral nerve. Nanoparticle properties may need to be optimized to improve biological observations.
Legal empowerment as a tool for engendering access to justice in South Africa
Authors: Durojaye Ebenezer , Mirugi-Mukundi Gladys , Adeniyi Oluwafunmilola
Published: November 2020

This article examines the concept of access to justice and the challenges vulnerable and marginalised groups encounter in accessing justice. The article further discusses the recognition of access to justice as human rights imperative under international and regional human rights instrument. It then discusses barriers to access to justice for women. It argues that while access to justice remains a challenge for many vulnerable and marginalised groups, women particularly encounter serious barriers to access to justice in society. Furthermore, it discusses the notion of legal empowerment and the significance of this for the realisation of access to justice for vulnerable groups, especially women in disadvantaged communities. This is followed by the discussion on the experience of the Dullah Omar Institute in providing legal empowerment training for women in informal settlements in Cape Town and some of the, important lessons from this process. It concludes by making useful recommendations in ensuring access to justice for vulnerable women in informal settlements.
Evaluation of the primary medical treatments based on the advanced trauma life support principles in trauma patients
Authors: Asadi Payman , Kasmaei Vahid Monsef , Zia Ziabari Seyyed Mahdi , Rimaz Siamak , Modirian Ehsan , Sarbazi-Golezari Ali
Published: November 2020

Objective

In Iran, road traffic accidents were responsible for 14716 deaths in 2015. This study aimed to compare the initial resuscitation of traumatically injured patients to the internationally recognized ATLS standards.

Materials and methods

As a cross-sectional study, 506 traumatically injured patients who were referred to the tertiary referral major trauma center in Poursina Hospital during the study period, were evaluated. All therapeutic interventions were compared to the ATLS standards. Data on mortality by demographic was compared to those in whom the ATLS standards were met and in those whom it was not met

Results

Mean age of the patients was 37.37 ± 19.72 and motorcycle was the most common cause of accidents (40.9%). ATLS guideline interventions were completely performed in 18.2% of the patients in their primary hospital, and in rest of 414 cases (81.8%), ATLS algorithms were not fully carried out. The mortality rate was significantly higher in the second group: 10.86% vs 32.36%, respectively.

Conclusion

Application of ATLS principles in multiple trauma patients can reduce the mortality rate.
The stratification of media usage in Finland, 2007–2018: Signs of socio-political polarization?
Authors: Heikkilä Riie , Leguina Adrian , Purhonen Semi
Published: November 2020

Over the last 10–15 years, Western societies have faced two interrelated social changes: the digitalization of media and the increase in socio-political polarization. While their relationship is causally reciprocal, population-level empirical studies focusing on over-time change remain scarce. We adopt the temporal perspective on the socio-political stratification of media usage in the context of Finland, one of the so-called Nordic media welfare states. We ask whether the ways in which media usage is socially stratified has changed from 2007 to 2018 and whether there is political polarization of media consumption. We draw on two nationally representative comparative surveys, collected in 2007 ( N = 1388) and 2018 ( N = 1425), and show that the main media usage patterns—the wide, the narrow, and the Internet-focused media repertoires—differ both in terms of their sociodemographic and political profiles and that the opposition between the wide and the narrow repertoires becomes increasingly polarized.
A study of the reporting of patient and public involvement and engagement (PPIE) in orthodontic research
Authors: Patel Veena A , Shelswell Jonathan , Hillyard Neil , Pavitt Sue , Barber Sophy K
Published: November 2020

Introduction:

Patient and public involvement and engagement (PPIE) in research is an essential component of high-quality research. Patients and the public can identify which research topics are most relevant to them, contribute to study design, and interpretation and dissemination of findings. While inclusion of PPIE is widely adopted in medical research, awareness within the dental research community is more limited.

Aim:

To examine patient and public involvement and engagement in orthodontic research activity.

Design:

Identification and appraisal of use of PPIE in orthodontic research reporting and funding applications using a systematic approach.

Methods:

Three sources of information were examined: (1) research articles published between September 2018 and September 2019 in four major orthodontic journals. Articles were examined for reported PPIE; (2) common funding bodies for orthodontic research were assessed to establish whether PPIE was mandated (National Institute for Health Research, Medical Research Council, Wellcome Trust, Chief Scientist Office (Scotland), Health and Care Research Wales, British Orthodontic Society Foundation, Royal College of Surgeons and CLEFT); and (3) publication guidance for authors in these journals was examined to identify whether reporting of PPIE was included.

Results:

Of the 363 research articles, 2 (0.6%) mention patient/public involvement. None of the 363 research articles mention patient/public engagement. Of nine funding bodies, 2 (22%) request evidence of patient/public involvement as a condition of receiving funding with one (11%) expecting evidence of public engagement to be provided as a condition of receiving funding. None of the four major orthodontic journals include patient/public involvement and/or engagement in their guidance for authors.

Conclusion:

There is currently: (1) a notable lack of reporting of PPIE in orthodontic research; (2) variability in the requirements of funding bodies for researchers to include PPIE in funding applications and throughout the research process; and (3) no stipulation in journals’ instructions for authors.
Cowboys and Pirates in Mental Health Care: A Musical Autoethnography
Authors: Carless David
Published: November 2020

A cowboy can be defined as “an unscrupulous tradesman” and a pirate can be “a person or organization broadcasting without official authorisation.” Looking through a subversive lens, I see both cowboys and pirates operating within the mental health care professions. Cowboys can be validated, authorized, rewarded, and empowered through the machinery of evidence-based medicine. Pirates may be criticized, restricted, marginalized, or dismissed by the same machinery. Through a layered performance of song and spoken word, I explore some of the personal consequences of all this for those living—and suffering—within differing paradigms of health care.
Modal characteristics and phase response of vibrator under excitation of sweep frequency
Authors: Li Gang , Qi Wen , Huang Zhiqiang , Tao Zhifei
Published: November 2020

To analyze the dynamic responses of vibrator, a vibrator-ground coupling vibration model considering sweep frequency is proposed based on half-space theory, and modal characteristics and phase response of the structure are investigated. Results show that the sweep frequency has a significant effect on the dynamic responses of the vibrator. The natural frequency of the vibrator changes with sweep frequency, and the resonance may occur at 2.071 Hz and 53.12 Hz. The vibrator has two mode shapes. The first-order mode shape is that the reaction mass and the baseplate move in the same direction and the structure is dominated by the reaction mass. At the second-order resonance, the reaction mass and the baseplate move in opposite directions and the baseplate dominates the system. The phase of the vibrator also changes with the frequency and varies greatly. The phases of reaction mass acceleration, baseplate acceleration and ground force suffer abrupt changes at about 2 Hz and 50 Hz. Especially, the phase of the baseplate acceleration experiences a 180° jumping at about 50 Hz. The abrupt change/jumping frequencies of the phase are basically the same as the natural frequencies, indicating that the resonance has significant effect on the vibrator output.
Robust place recognition based on salient landmarks screening and convolutional neural network features
Authors: Niu Jie , Qian Kun
Published: November 2020

In this work, we propose a robust place recognition measurement in natural environments based on salient landmark screening and convolutional neural network (CNN) features. First, the salient objects in the image are segmented as candidate landmarks. Then, a category screening network is designed to remove specific object types that are not suitable for environmental modeling. Finally, a three-layer CNN is used to get highly representative features of the salient landmarks. In the similarity measurement, a Siamese network is chosen to calculate the similarity between images. Experiments were conducted on three challenging benchmark place recognition datasets and superior performance was achieved compared to other state-of-the-art methods, including FABMAP, SeqSLAM, SeqCNNSLAM, and PlaceCNN. Our method obtains the best results on the precision–recall curves, and the average precision reaches 78.43%, which is the best of the comparison methods. This demonstrates that the CNN features on the screened salient landmarks can be against a strong viewpoint and condition variations.
A clinical nomogram and heat map for assessing survival in patients with stage I non-small cell lung cancer after complete resection
Authors: Cao Xun , Zheng Yu-zhen , Liao Hong-ying , Guo Xiang , Li Yong , Wang Zhen , Zhang Li , Wang Xu-dong , Wang Xin
Published: November 2020

Background:

Assessing the prognosis of patients with early-stage non-small cell lung cancer (NSCLC) has become a major clinical issue. This study aimed to devise an effective clinical nomogram and heat map for assessing the survival of patients with stage I NSCLC receiving complete resection.

Methods:

Nomograms were established based on a retrospective study of 654 patients with stage I NSCLC who underwent radical resection at Sun Yat-Sen University Cancer Center between January 2009 and December 2014. The concordance index (C-index) and calibration curve were used to measure the accuracy and discriminative ability of the final nomogram. Heat maps were constructed with prognostic factors and survival probabilities. Survival curves were depicted using the Kaplan–Meier method, and the log-rank test was used to determine significance. Patients were classified into low- and high-risk subgroups using recursive partitioning analysis based on nomogram scores.

Results:

In univariate and multivariate analyses, the independent factors for overall survival (OS) and disease-free survival (DFS) were age, sex, tumor size, and visceral pleural invasion, which were all selected in the nomogram. The C-indices of the nomogram for predicting OS and DFS were 0.694 [95% confidence interval (CI) 0.651–0.737] and 0.653 (95% CI 0.61–0.696), respectively. The calibration curves for OS and DFS probabilities showed a good agreement between the nomogram prediction and actual observation. A heat map was generated using the above independent factors for OS and DFS. High-risk patients had shorter OS [hazard ratio (HR) = 3.535, 95% CI 2.444–5.113, p < 0.001] and DFS (HR = 2.607, 95% CI 1.922–3.537, p < 0.001) than low-risk patients.

Conclusion:

We established a prognostic nomogram and heat map that can be useful for evaluating survival in patients with stage I NSCLC after complete resection. The tools resulted in more accurate prediction and may guide clinicians in making treatment decisions.
Management of patients with intermediate stage hepatocellular carcinoma
Authors: Prince David , Liu Ken , Xu Weiqi , Chen Minjiang , Sun Jin-Yu , Lu Xiao-Jie , Ji Jiansong
Published: November 2020

Hepatocellular carcinoma (HCC) causes a significant health burden globally and its impact is expected to increase in the coming years. Intermediate stage HCC, as defined by the Barcelona Clinic Liver Cancer (BCLC) system stage B, represents up to 30% of patients at diagnosis and encompasses a broad spectrum of tumor burden. Several attempts have been made to further subclassify this heterogenous group. The current standard of care recommended by BCLC for intermediate stage HCC patients is transarterial chemoembolization (TACE), with modest outcomes reported. While refinements have been made to TACE technique and patient selection, it remains non-curative. In the real-world setting, only 60% of patients with intermediate stage HCC receive TACE, with the remainder deviating to a range of other therapies that have shown promise in select patient subgroups. These include curative treatments (resection, ablation, and liver transplantation), radiotherapy (stereotactic and radioembolization), systemic therapies, and their combination. In this review, we summarize the classifications and current management for patients with intermediate stage HCC as well as highlight recent key developments in this space.
Negotiating Organizational Identity: The Communicative Resilience of Small-Town Gay Bars
Authors: Branton Scott E.
Published: November 2020

Gay bars historically functioned as the only space where LGBTQ+ (lesbian, gay, bisexual, trans*, queer) people could escape intolerance and persecution. From drag shows to dancing to counterculture, gay bars are symbols of expression and hope for those misunderstood. In many ways, they are LGBTQ+ institutions that have withstood time. However, the rapid closing of gay bars coupled with Big D discourses of “post-gay,” “mainstream,” and “death of the gay bar” have threatened their existence. Much of these gay culture discourses stem from research on metropolitan cities (New York and San Francisco) with larger gay populations. Yet very few have examined how this experience affects gay bars in smaller cities with fewer LGBTQ+ spaces. Drawing on the communicative theory of resilience, I examined two gay bars in a small Midwestern city to understand how they (a) construct and negotiate their identity, and (b) manage organizational resilience in discursive and material ways. Findings and implications are discussed.
Components of a safe cystectomy service during coronavirus disease 2019 in a high-volume centre
Authors: Nelson Adam W , Arianayagam Ranjan , Umari Paolo , Campbell Emily , Tetlow Nicholas , Duncan Jacqueline , Baker Hilary , Parker Jo , Lucetta Cristina , Perkins Rachel , Tan Melanie , Kasivisvanathan Veeru , Kelly John D , Sridhar Ashwin
Published: November 2020

Objective:

Delivery of a safe cystectomy service is a multidisciplinary exercise. In this article, we detail the measures implemented at our institution to deliver a cystectomy service for bladder cancer patients during coronavirus disease 2019 (COVID-19).

Methods:

A ‘one-stop’ enhanced recovery clinic had been established at our hospital, consisting of an anaesthetist, an exercise testing service, urinary diversion nurses, clinical nurse specialists and surgeons. During COVID-19, we modified these processes in order to continue to provide urgent cystectomy safely for bladder cancer. We collected patients’ outcomes prospectively measuring demographic characteristics, oncological and perioperative outcomes, the presence of COVID-19 symptoms and confirmed COVID-19 test results.

Results:

From March to May 2020, 25 patients underwent radical cystectomy for bladder cancer. Twenty-four procedures were performed with robotic assistance and one open as part of a research trial. We instituted modifications at various multidisciplinary steps, including patient selection, preoperative optimisation, enhanced recovery protocols, patient counselling and perioperative protocols. Thirty-day mortality was 0%. The 30-day rate of Clavien ⩾3 complications was 8%. Postoperatively, none of the patients developed COVID-19 based on World Health Organization criteria and testing.

Conclusion:

We safely delivered a complex cystectomy service during the peak of the COVID-19 pandemic without any COVID-19-related morbidity or mortality.

Level of evidence:

Level 2b.
Mobilizing opposition voters under electoral authoritarianism: A field experiment in Russia
Authors: Peisakhin Leonid , Rozenas Arturas , Sanovich Sergey
Published: November 2020

Under electoral authoritarianism opposition supporters often abstain from voting because they think that their votes will not make a difference. Opposition parties try to counteract this apathy by informational campaigns that stress how voting can impact the outcome of the election and policy. Evidence from established democracies suggests that such campaigns are generally ineffective, but it remains an open question whether the same holds in elections under authoritarianism where information is scarce. We follow a large-scale campaign experiment by an opposition candidate in Russia’s 2016 parliamentary election, which distributed 240,000 fliers to 75% of the district’s households. Relative to a control flier, priming voters about the closeness of the election or the link between voting and policy outcomes had no practically meaningful impact on turnout or votes. Contrary to some existing theories and the stated expectations of politicians, information about the value of voting appears as ineffective in uncompetitive electoral autocracies as it is in democracies.
Radioisotopic and Luminescence Counting in 384-Well Microplates
Authors: Kolb Al , Neumann Ken
Published: November 2020

Reprinted with permission of author and publisher from The Screening Forum, Vol. 4, No. 2.

Over the last few years there has been a growing demand for assay miniaturization in high throughput screening. The successful adaptation of the 96-well microplate serves as a practical example of the power of miniaturization. Assays that once required 2 to 3 mL volumes are now done in 1/10 this volume. However, before the 96-well plate became a standard in HTS there were many questions about the suitability of this small format to screening assays and the availability of all the necessary peripheral equipment to support it. These problems were quickly solved. Today we are faced with the same questions about the 384-well format.
Osteochondral reconstruction for post-traumatic coronoid deficiency
Authors: Kholinne Erica , Kwak Jae-Man , Kim Hyojune , Sun Yucheng , Koh Kyoung-Hwan , Jeon In-Ho
Published: November 2020

Purpose:

This study aimed to evaluate the clinical outcome and graft survival following coronoid reconstruction with osteochondral bone grafts for post-traumatic coronoid deficiency treatment. We hypothesized that coronoid reconstruction using an osteochondral bone graft will provide favorable results in treating post-traumatic coronoid deficiency.

Methods:

A retrospective review was performed on eight patients (mean age = 45.8 years) who underwent osteochondral bone graft reconstruction indicated for post-traumatic coronoid deficiency. The osteochondral bone grafts were obtained from the radial head remnant (four patients), olecranon tip (two patients), and iliac crest (two patients). All the injuries were terrible triad. The mean duration from injury to surgery was 79.3 weeks. The visual analog scale (VAS) for pain, motion arc, and Mayo elbow performance score (MEPS) were used to evaluate the clinical outcome. Radiologic evaluation of graft healing and integrity was performed using computed tomography at 19 months and plain elbow radiography at 24.1 months after reconstruction. The immediate graft height was measured.

Results:

VAS and MEPS values improved from 4.1 ± 1.2 to 1.1 ± 0.3 and 34.2 ± 16.9 to 85.0 ± 7.1, respectively ( p = 0.018, p = 0.018) after reconstruction. The motion arc significantly improved from 84.2° ± 16.1° to 102.1° ± 18.2° at the final follow-up of 39.1 ± 18.8 months ( p = 0.048). All the osteochondral grafts survived, with nonunion in two patients (25%). The mean immediate graft height was 15.4 ± 2.6 mm. Among the eight patients, three (37.5%) developed secondary osteoarthritis of the ulnohumeral joint.

Conclusions:

Coronoid reconstruction with osteochondral bone graft may serve as an option to salvage post-traumatic coronoid deficiency. Sufficient graft height was required for graft survival. Secondary osteoarthritis of the ulnohumeral joint should not be underestimated during follow-up.
Frailty and Perceived Financial Exploitation: Findings from the Finance, Cognition, and Health in Elders Study
Authors: Axelrod Jenna , Mosqueda Laura , Weissberger Gali H. , Nguyen Annie L. , Boyle Patricia A. , Parunakian Emanuil , Han S. Duke
Published: November 2020

Objective: Many older adults who are cognitively intact experience financial exploitation (FE), and the reasons for this are poorly understood. Methods: Data were gathered from 37 older adults ( M age = 69.51, M education = 15.89, 62% female) from the Finance, Cognition, and Health in Elders Study (FINCHES). Twenty-four older adults who self-reported FE were demographically-matched according to age, education, race, and MoCA performance to thirteen older adults who denied experiencing FE. Participants completed the Tilburg Frailty Inventory. Results: FE participants reported greater total frailty ( t = 2.06, p = .04) when compared to non-FE participants. Post-hoc analyses revealed that FE participants endorsed greater physical frailty ( U = 89, p = .03), specifically poorer sensory functioning (hearing and vision). Discussion: Findings suggest frailty is associated with FE in old age and may represent a target for intervention programs for the financial wellbeing of older adults.
Nudging Discharge Readiness With a Poster: A Sequential, Exploratory Mixed Methods Pilot Study of Patient Caregivers
Authors: Leets Laura L , Cahill Jennifer , Sprenger Amber M , Thomas Juli Simon , Hartman Rob , Reed Mary E Poyner , Manning Haylee , Britt Marge , Vu Chrissy T , Kohn Nicholas W , Aguirre Sandi , Wijesinghe Sanith , Klaus Sybil
Published: November 2020

Many hospitals face a common challenge: limited space for a high number of patients. This has led to quick patient throughput, which can impact patient perception of discharge readiness. This study examined whether a poster highlighting tasks to complete as part of the discharge process improved caregiver perception of readiness to transition home. Using a sequential, exploratory mixed methods design, focus groups were convened to explore clinical staff perspective on the discharge process on 3 pediatric inpatient units at a large, urban, pediatric academic medical center in the United States. Analysis of this content informed the design of a poster intervention to “nudge” caregivers (eg, parents, legal guardians) toward readiness and self-efficacy that was then tested in a randomized, controlled experiment. The poster focused on practical knowledge for specific areas of transition adjustment, such as medication and care recipient recovery behaviors, barriers, and enablers. Caregivers (n = 135) completed surveys at discharge indicating their perceived readiness to transition home with their child. Analysis of covariance was used to test the effect of the poster condition (poster vs no poster) on caregiver readiness, preparedness, and confidence for discharge while controlling for previous admission history. Significant effects for poster presence were found on caregivers’ perceived readiness for discharge, F 1,125 = 7.75, P = .006, Cohen’s d = 0.44; and caregivers’ perceived preparedness for the transition home, F 1,121 =7.24, P = .008, Cohen’s d = 0.44. Only a marginal effect was found for poster condition on caregivers’ confidence ratings, F 1,125 = 2.93, P = .090, Cohen’s d = 0.29. The results suggest that simple nudges in the patient care environment may yield measurable improvements in caregiver outcomes.
Experiences From a Coaching Program for Parents of Children and Adolescents With Type 1 Diabetes Developed Through Experienced-Based Co-Design (EBCD)
Authors: Ramfelt Kerstin , Petersson Christina , Åkesson Karin
Published: November 2020

Many children and adolescents with type 1 diabetes (T1D) have difficulties reaching the national treatment goal for HbA1c (long-term blood sugar) which is associated with increased risk for complications. This makes it important to explore what patients and their caregivers describe important in coping with everyday life. The study has been conducted within a pediatric diabetes team in the south of Sweden. The aim was to explore how Experienced-Based Co-Design (EBCD) can be used to identify, test, and evaluate improvement efforts in order to support the family with a child with T1D. A modified variant of EBCD based on focus groups, workshops, and interviews with stakeholders was used. The improvement proposal parental coaching was tested and was appreciated by the participants. The qualitative content analysis of the interviews showed that the coaching program contributed to better confidence and self-efficacy. Both coaches and coachees described that the coaching contributed to better competence and a feeling of hope after attending the coach program. Experienced-Based Co-Design gave an opportunity to explore what´s important to improve, based on experiences and needs of several stakeholders.
Die Außenseiterrolle der Graphologie in der Personalauswahl. Eine Bestandsaufnahme
Authors: Domsch Michel E. , Ladwig Ariane
Published: November 2020

Ist die Graphologie als Auswahlinstrument zu empfehlen? Ist diese Hilfswissenschaft heute überhaupt noch aktuell, wird sie noch nachgefragt? Dies sind zwei zentrale Fragen, mit denen sich dieser Artikel (u.a.) beschäftigt. Dabei werden sowohl die generellen Einsatzbereiche bzw. die Möglichkeiten und Grenzen der Graphologie beschrieben - insbesondere vor dem Hintergrund kontroverser Diskussionen in der Vergangenheit - als auch auf ihre Gütekriterien eingegangen. Anhand einer Literaturrecherche und de Ergebnisse einer empirischen Stellenanzeigenanalyse wird dann abschließend der Versuch unternommen, die aktuelle Nachfrage nach graphologischen Gutachten zu manifestieren. Darüber hinaus bietet der Artikel dem interessierten Leser einen Einblick in die Historie der Graphologie, ihre verschiedenen Schulen, typische Vorgehensweisen bei der Gutachtenerstellung sowie einige Facetten der Deutungspraxis.
Long-term neurodevelopmental outcomes of hematopoietic stem cell transplantation for late-infantile Krabbe disease
Authors: Yoon Isabel C. , Bascou Nicholas A. , Poe Michele D. , Szabolcs Paul , Escolar Maria L.
Published: November 2020

Krabbe disease is a rare neurodegenerative disorder caused by a deficiency in galactocerebrosidase. The only effective treatment is hematopoietic stem cell transplantation (HSCT). Approximately 85% of Krabbe disease cases are the infantile subtypes, among which ∼20% are late infantile. Prior studies have demonstrated that HSCT is effective for early-infantile patients (0-6 months of age) who undergo transplantation while asymptomatic, compared with those receiving transplants while symptomatic. However, no studies evaluated the efficacy of HSCT for late-infantile patients (6-36 months). In this prospective, longitudinal study, patients were evaluated at a single site according to a standardized protocol. Survival analysis was performed using the Kaplan-Meier method. Differences between groups were estimated using mixed regression models to account for within-person repeated measures. Nineteen late-infantile patients underwent HSCT (March 1997 to January 2020). Compared with untreated patients, transplant recipients had a longer survival probability and improved cognitive and language function. Gross and fine motor development were most affected, with variable results. Asymptomatic patients benefitted the most from transplantation, with normal to near-normal development in all domains and some gross motor delays. Among symptomatic patients, those with disease onset at >12 months of age had better cognitive outcomes than untreated patients. Those with disease onset at ≤12 months were comparable to untreated patients. We found that HSCT prolonged the lifespan and improved the functional abilities of late-infantile patients with Krabbe disease, particularly those who underwent transplantation before onset of symptoms. In addition, our findings support prior literature that reclassifies late-infantile Krabbe disease to be symptom onset at 12 to 36 months of age.
Hemolysis inhibits humoral B-cell responses and modulates alloimmunization risk in patients with sickle cell disease
Authors: Pal Mouli , Bao Weili , Wang Rikang , Liu Yunfeng , An Xiuli , Mitchell William B. , Lobo Cheryl A. , Minniti Caterina , Shi Patricia A. , Manwani Deepa , Yazdanbakhsh Karina , Zhong Hui
Published: November 2020

Red blood cell alloimmunization remains a barrier for safe and effective transfusions in sickle cell disease (SCD), but the associated risk factors remain largely unknown. Intravascular hemolysis, a hallmark of SCD, results in the release of heme with potent immunomodulatory activity, although its effect on SCD humoral response, specifically alloimmunization, remains unclear. Here, we found that cell-free heme suppresses human B-cell plasmablast and plasma cell differentiation by inhibiting the DOCK8/STAT3 signaling pathway, which is critical for B-cell activation, as well as by upregulating heme oxygenase 1 (HO-1) through its enzymatic byproducts, carbon monoxide and biliverdin. Whereas nonalloimmunized SCD B cells were inhibited by exogenous heme, B cells from the alloimmunized group were nonresponsive to heme inhibition and readily differentiated into plasma cells. Consistent with a differential B-cell response to hemolysis, we found elevated B-cell basal levels of DOCK8 and higher HO-1–mediated inhibition of activated B cells in nonalloimmunized compared with alloimmunized SCD patients. To overcome the alloimmunized B-cell heme insensitivity, we screened several heme-binding molecules and identified quinine as a potent inhibitor of B-cell activity, reversing the resistance to heme suppression in alloimmunized patients. B-cell inhibition by quinine occurred only in the presence of heme and through HO-1 induction. Altogether, these data suggest that hemolysis can dampen the humoral B-cell response and that B-cell heme responsiveness maybe a determinant of alloimmunization risk in SCD. By restoring B-cell heme sensitivity, quinine may have therapeutic potential to prevent and inhibit alloimmunization in SCD patients.
Bronchoscopic treatment of inoperable nonsmall cell lung cancer
Authors: Kniese Christopher M. , Musani Ali I.
Published: November 2020

Patients with unresectable lung cancer range from those with early-stage or pre-invasive disease with comorbidities that preclude surgery to those with advanced stage disease in whom surgery is contraindicated. In such cases, a multidisciplinary approach to treatment is warranted, and may involve medical specialties including medical oncology, radiation oncology and interventional pulmonology. In this article we review bronchoscopic approaches to surgically unresectable lung cancer, including photodynamic therapy, brachytherapy, endoscopic ablation techniques and airway stenting. Current and past literature is reviewed to provide an overview of the topic, including a highlight of potential emerging approaches.
ISSEC: inferring contacts among protein secondary structure elements using deep object detection
Authors: Zhang Qi , Zhu Jianwei , Ju Fusong , Kong Lupeng , Sun Shiwei , Zheng Wei-Mou , Bu Dongbo
Published: November 2020

Background

The formation of contacts among protein secondary structure elements (SSEs) is an important step in protein folding as it determines topology of protein tertiary structure; hence, inferring inter-SSE contacts is crucial to protein structure prediction. One of the existing strategies infers inter-SSE contacts directly from the predicted possibilities of inter-residue contacts without any preprocessing, and thus suffers from the excessive noises existing in the predicted inter-residue contacts. Another strategy defines SSEs based on protein secondary structure prediction first, and then judges whether each candidate SSE pair could form contact or not. However, it is difficult to accurately determine boundary of SSEs due to the errors in secondary structure prediction. The incorrectly-deduced SSEs definitely hinder subsequent prediction of the contacts among them.

Results

We here report an accurate approach to infer the inter-SSE contacts (thus called as ISSEC) using the deep object detection technique. The design of ISSEC is based on the observation that, in the inter-residue contact map, the contacting SSEs usually form rectangle regions with characteristic patterns. Therefore, ISSEC infers inter-SSE contacts through detecting such rectangle regions. Unlike the existing approach directly using the predicted probabilities of inter-residue contact, ISSEC applies the deep convolution technique to extract high-level features from the inter-residue contacts. More importantly, ISSEC does not rely on the pre-defined SSEs. Instead, ISSEC enumerates multiple candidate rectangle regions in the predicted inter-residue contact map, and for each region, ISSEC calculates a confidence score to measure whether it has characteristic patterns or not. ISSEC employs greedy strategy to select non-overlapping regions with high confidence score, and finally infers inter-SSE contacts according to these regions.

Conclusions

Comprehensive experimental results suggested that ISSEC outperformed the state-of-the-art approaches in predicting inter-SSE contacts. We further demonstrated the successful applications of ISSEC to improve prediction of both inter-residue contacts and tertiary structure as well.
An elderly diabetic patient with McArdle disease and recurrent rhabdomyolysis: a potential association with late hypoinsulinemia?
Authors: Chocair Pedro Renato , Mohrbacher Sara , de Menezes Neves Precil Diego Miranda , Pereira Leonardo Victor Barbosa , Oliveira Erico Souza , Nardotto Luciana Loureiro , Bales Alessandra Martins , Sato Victor Augusto Hamamoto , Silva Sabrina Neves , Ferreira Bernadete Maria Coelho , Cuvello-Neto Américo Lourenço
Published: November 2020

Background

McArdle disease is a myopathy caused by mutations in PYGM gene that is characterized by reduced or absent activity of myophosphorylase. Reports of patients with concomitant McArdle disease and diabetes are scarce. We report a case of a patient with a late diagnosis of McArdle disease and we postulate that symptoms may be related to hypoinsulinemia.

Case presentation

This report describes the evolution of an elderly diabetic patient with confirmed diagnosis of McArdle’s disease based on the absence of myophosphorylase activity in the analysis of muscle biopsy, and a homozygous mutation in the PYGM gene. The variant – Chr11: 64.525 (p. Asn168*fs) has not been previously described. The diagnosis of McArdle disease was confirmed after two episodes of rhabdomyolysis, at 77 and 81 years of age, as the symptoms were, until then, discrete. The “second-wind phenomenon” was not spontaneously reported, but it was confirmed when directly questioned. We postulate that the later episodes of rhabdomyolysis occurred because of a progressive decrease in insulin production with a consequent reduction in the uptake of blood glucose by muscle cells, thus compromising the cellular energy balance. To our knowledge, this is the first report of recurrent rhabdomyolysis in an elderly diabetic patient with genetically proven McArdle disease. Our initial attempt to reduce insulin resistance with metformin and pioglitazone was not effective, possibly because of inadequate insulinemia. However, an improvement was evident after the administration of low doses of intermediate-acting insulin.

Conclusions

In view of the patient’s clinical evolution, we suggest the use of medication that reduces insulin resistance for patients with McArdle disease and type 2 diabetes, pre-diabetes or even normoglycemic metabolic syndrome.
Emergency department and hospital admissions among people with dementia living at home or in nursing homes: results of the European RightTimePlaceCare project on their frequency, associated factors and costs
Authors:   on behalf of the RightTimePlaceCare Consortium, Afonso-Argilés F. Javier , Meyer Gabriele , Stephan Astrid , Comas Mercè , Wübker Ansgar , Leino-Kilpi Helena , Lethin Connie , Saks Kai , Soto-Martin Maria , Sutcliffe Caroline , Verbeek Hilde , Zabalegui Adelaida , Renom-Guiteras Anna
Published: November 2020

Background

Evidence is lacking on the differences between hospitalisation of people with dementia living in nursing homes and those living in the community. The objectives of this study were: 1) to describe the frequency of hospital admission among people with dementia in eight European countries living in nursing homes or in the community, 2) to examine the factors associated with hospitalisation in each setting, and 3) to evaluate the costs associated with it.

Methods

The present study is a secondary data analysis of the RightTimePlaceCare European project. A cross-sectional survey was conducted with data collected from people with dementia living at home or who had been admitted to a nursing home in the last 3 months, as well as from their caregivers. Data on hospital admissions at 3 months, cognitive and functional status, neuropsychiatric symptoms, comorbidity, polypharmacy, caregiver burden, nutritional status, and falls were assessed using validated instruments. Multivariate regression models were used to investigate the factors associated with hospital admission for each setting. Costs were estimated by multiplying quantities of resources used with the unit cost of each resource and inflated to the year 2019.

Results

The study sample comprised 1700 people with dementia living in the community and nursing homes. Within 3 months, 13.8 and 18.5% of people living in nursing homes and home care, respectively, experienced ≥1 hospital admission. In the nursing home setting, only polypharmacy was associated with a higher chance of hospital admission, while in the home care setting, unintentional weight loss, polypharmacy, falls, and more severe caregiver burden were associated with hospital admission. Overall, the estimated average costs per person with dementia/year among participants living in a nursing home were lower than those receiving home care.

Conclusion

Admission to hospital is frequent among people with dementia, especially among those living in the community, and seems to impose a remarkable economic burden. The identification and establishment of an individualised care plan for those people with dementia with polypharmacy in nursing homes, and those with involuntary weight loss, accidental falls, polypharmacy and higher caregiver burden in the home care setting, might help preventing unnecessary hospital admissions.