bluuebunny/crossref_metadata_2025 huggingface dataset:
Continuous Glucose Monitoring in Women with Normal OGTT in Pregnancy
Authors: Tartaglione Linda , di Stasio Enrico , Sirico Angelo , Di Leo Mauro , Caputo Salvatore , Rizzi Alessandro , Caneschi Agnese , De Carolis Sara , Pitocco Dario , Lanzone Antonio
Published: August 2021

Continuous glucose monitoring (CGM) might be an effective tool to improve glycemic control in gestational diabetes mellitus (GDM). Few data are available about its utilization as a diagnostic tool to find potential alterations of glycemia in subjects with normal oral glucose tolerance test (OGTT). In this preliminary prospective real-life observational study, we aimed to analyze the glycemic pattern in normal and gestational diabetes mellitus (GDM) women by continuous glucose monitoring (CGM) in order to detect potential differences between the two groups and glycemic alterations despite a normal OGTT. After the screening for GDM, subjects were connected to a CGM system for seven consecutive days. The areas under the curve of the first 60 minutes after each meal and 60 minutes before breakfast were analyzed. Women with normal OGTT that during CGM showed impaired glycemic values (more than 95 fasting or more than 140 one hour after meals or more than 120 two hours after meals) performed one week of self-monitoring of blood glucose (SMBG). After OGTT, 53 women considered normal and 46 affected by GDM were included. CGM parameters did not show any differences between the two groups with impaired glycemic excursions found in both groups. After CGM period, 33 women with normal OGTT showed abnormal glycemic patterns. These 33 women then performed one week of SMBG. After evaluation of one week of SMBG, 21 required diet therapy and 12 required insulin treatment and were followed until the delivery. An increase in gestational weight gain was observed in normal women with normal OGTT but this was not significant. No significant data were found regarding neonatal outcomes in the two groups of women. In conclusion, CGM use in pregnancy might help to detect glycemic fluctuations in women with normal OGTT, improving their treatment and outcomes.
Metastasis-Entrained Eosinophils Enhance Lymphocyte-Mediated Antitumor Immunity
Authors: Grisaru-Tal Sharon , Dulberg Shai , Beck Lir , Zhang Chunyan , Itan Michal , Hediyeh-zadeh Soroor , Caldwell Julie , Rozenberg Perri , Dolitzky Avishay , Avlas Shmuel , Hazut Inbal , Gordon Yaara , Shani Ophir , Tsuriel Shlomo , Gerlic Motti , Erez Neta , Jacquelot Nicolas , Belz Gabrielle T. , Rothenberg Marc E. , Davis Melissa J. , Yu Hua , Geiger Tamar , Madi Asaf , Munitz Ariel
Published: August 2021

The recognition of the immune system as a key component of the tumor microenvironment (TME) led to promising therapeutics. Because such therapies benefit only subsets of patients, understanding the activities of immune cells in the TME is required. Eosinophils are an integral part of the TME especially in mucosal tumors. Nonetheless, their role in the TME and the environmental cues that direct their activities are largely unknown. We report that breast cancer lung metastases are characterized by resident and recruited eosinophils. Eosinophil recruitment to the metastatic sites in the lung was regulated by G protein–coupled receptor signaling but independent of CCR3. Functionally, eosinophils promoted lymphocyte-mediated antitumor immunity. Transcriptome and proteomic analyses identified the TME rather than intrinsic differences between eosinophil subsets as a key instructing factor directing antitumorigenic eosinophil activities. Specifically, TNFα/IFNγ–activated eosinophils facilitated CD4+ and CD8+ T-cell infiltration and promoted antitumor immunity. Collectively, we identify a mechanism by which the TME trains eosinophils to adopt antitumorigenic properties, which may lead to the development of eosinophil-targeted therapeutics.

Significance:

These findings demonstrate antitumor activities of eosinophils in the metastatic tumor microenvironment, suggesting that harnessing eosinophil activity may be a viable clinical strategy in patients with cancer.
Variants in the PNPLA1 Gene in Families with Autosomal Recessive Congenital Ichthyosis Reveal Clinical Significance
Authors: Ahmad Farooq , Ahmed Ishtiaq , Alam Qamre , Ahmad Tanveer , Khan Ammara , Ahmad Ijaz , Bilal Muhammad , Hayat Amir , Khan Amjad , Waqas Ahmed , Rafeeq Misbahuddin M. , Sain Ziaullah M. , Umair Muhammad
Published: August 2021

The term autosomal recessive congenital ichthyosis (ARCI) is the subgroup of ichthyosis, which describes a highly heterogeneous group of genetic disorders of the skin characterized by cornification and defective keratinocytes differentiation associated with mutations in at least 14 genes including PNPLA1. To study the molecular basis of the Pakistani kindreds (A and B) affected by ARCI, whole-exome sequencing (WES) in the DNA samples of affected members was performed followed by Sanger sequencing of the candidate gene to hunt down the disease-causing sequence variant/s. WES data analysis led to the identification of a novel nonsense sequence variant (c.892C>T; p.Arg298*, family A) and a recurrent missense variant (c.102C>A; p.Asp34Glu, family B) in PNPLA1 mapped to the ARCI locus in chromosome 6p21.31. Validation and cosegregation analysis of the variants in the remaining family members of the respective families were confirmed by Sanger sequencing. The current investigation expands the spectrum of PNPLA1 mutations and helps establish the proper clinico-genetic diagnosis and correct genotype-phenotype correlation.
Biomarkers in Chronic Obstructive Pulmonary Disease: Emerging Roles of Eosinophils and Procalcitonin
Authors: Sivapalan Pradeesh , Jensen Jens-Ulrik
Published: August 2021

Antibiotics can improve the prognosis in patients with exacerbation of chronic obstructive pulmonary disease. However, the overuse of antibiotics can carry serious adverse effects for patients (gastrointestinal infections) and for society (bacterial resistance). Likewise, systemic corticosteroids may also help these patients, but also carries severe adverse effects like osteoporosis, muscle loss, and diabetes, in many patients. Whenever safe methods exist to reduce these two treatment modalities, they should be implemented. The blood biomarkers procalcitonin and the fraction of leukocytes known as eosinophil granulocytes have been proven in randomized controlled trials (RCTs), to effectively, significantly, and substantially assist in reducing the use of these two potent, yet toxic medication types. In this review, the background and main clinical results are discussed, explaining the rationale for biomarker-guided clinical decisions. Also, the main expected effects, their sizes, and importantly the limitations to such a strategy are described. Clinical evidence is prioritized with main weight on RCTs and meta-analyses of these and regarding outcomes, and focus is set on the safety of such a biomarker-guided strategy, as well as the effects on medicine reduction. In an epoch of increasing demands to physicians from patients and politicians to cure and reduce symptoms, the Hippocratic phrase of “primum non nocere” or “first, do no harm” seems more than ever of contemporary importance.
Double-Sheath Vacuum Suction Minimally Invasive Percutaneous Nephrolithotomy for Management of Large Renal Stones
Authors: Wu Zhong-Hua , Wang Yong-Zhi , Liu Tong-Zu , Wang Xing-Huan , Zheng Hang , Zhang Yin-Gao
Published: August 2021

Objectives: This study aimed to describe a novel double-sheath vacuum suction minimally invasive percutaneous nephrolithotomy (mini-PCNL) to overcome the deficiencies of the conventional procedure. Patients and Methods: Between March 2019 and December 2019, 65 patients (37 males and 28 females) with a mean age of 41 years (range 23–69) underwent mini-PCNL with double-sheath vacuum suction. It consisted of an F20 Y-shaped sheath as an outer sheath and an F16 Y-shaped sheath as an inner sheath, in which the inner sheath was longer than the outer sheath. The oblique arm of the outer sheath and the inner sheath was connected to the perfusion inflow and the vacuum suction, respectively. A 550-μm holmium-YAG laser was introduced for stone fragmentation through the working channel of the mini-nephroscope, which was no longer connected to the perfusion fluid. Results: All procedures were successful. Mean operation time was 50.2 min (range 39–83). Mean hemoglobin decrease was 5.2 g/L (range 1.0–15.5), and no patient needed a blood transfusion. One patient (1.5%) with low fever (<38°C) at day 1 had returned to normal at day 2 without administration of antibiotics. There were no Clavien grade 2–4 complications. Mean postoperative hospital stay was 2.4 days (range 2–6). The initial stone-free rate of PCNL was 81.53% (53 of 65 patients). One month after surgery, the final stone-free rate increased to 90.77% (59/65 patients). Conclusions: The double-sheath vacuum suction mini-PCNL is a safe and effective modality for large renal stones, which might increase the efficiency of stone extraction with low intrapelvic pressure.
HPV Screening Test for the Detection of Precancerous Cervical Lesions and Cervical Cancer in Israeli Women
Authors: Feinberg Tali , Yehuda-Shnaidman Einav , Wolf Tamar , Sandbank Judith , Segal Jacob , Vaknin Zvi , Schejter Eduardo
Published: August 2021

Objectives: This work is aimed to summarize the first year of the high-risk human papillomavirus (hrHPV) screening test and compare it to the cytology screening test, regarding positivity rates and premalignant lesions diagnosed in the Israeli population. A specific consideration is for the age group 25–30 that is not considered mandatory for the HPV primary screening testing. Methods: A retrospective study was performed in women who were screened for prevention of cervical cancer in Maccabi HealthCare HMO from March 2017 to March 2019. Screening methods included hrHPV typing for types 16, 18, and the other 12 hrHPV types and the PAP LBC test. Results: A total of 115,807 cervical samples were tested for HPV presence and 91% (105,225) were found negative for hrHPV. The other 9% (10,582) were positive for one or more of the 14 hrHPV types tested, and 37% (3,916) of them showed abnormal PAP LBC results. In the age group of 25–30, 3,104 (17.5%) women were found positive for hr­HPV (825 had hrHPV types 16 and/or 18), of which 42% (1,293) of them showed abnormal PAP LBC results. During the hrHPV versus PAP LBC screening era, 258 more women were diagnosed with precancerous cervical lesions (CIN2/3), 70% increased detection versus cytology screening. Conclusions: The hrHPV screening test is currently the best method for the detection of precancerous cervical lesions and cervical cancer, and it is better started at age 25.
The Role of Innate Immune Cells in Nonalcoholic Fatty Liver Disease
Authors: Nati Marina , Chung Kyoung-Jin , Chavakis Triantafyllos
Published: August 2021

Nonalcoholic fatty liver disease (NAFLD) is a very common hepatic pathology featuring steatosis and is linked to obesity and related conditions, such as the metabolic syndrome. When hepatic steatosis is accompanied by inflammation, the disorder is defined as nonalcoholic steatohepatitis (NASH), which in turn can progress toward fibrosis development that can ultimately result in cirrhosis. Cells of innate immunity, such as neutrophils or macrophages, are central regulators of NASH-related inflammation. Recent studies utilizing new experimental technologies, such as single-cell RNA sequencing, have revealed substantial heterogeneity within the macrophage populations of the liver, suggesting distinct functions of liver-resident Kupffer cells and recruited monocyte-derived macrophages with regards to regulation of liver inflammation and progression of NASH pathogenesis. Herein, we discuss recent developments concerning the function of innate immune cell subsets in NAFLD and NASH.
A Thematic Analysis of the UN Convention on the Rights of the Child (crc) State Party Reporting Mechanisms Related To Physical Education, Physical Activity and Sport
Authors: Yelamos Gerard Masdeu , Carney Sarah , Carty Catherine , MacLachlan Malcom
Published: August 2021

The UN Convention on the Rights of the Child (crc) is the most ratified human rights treaty. In this article, three intimately connected concepts will be explored in relation to the framework of the State Party reporting mechanism related to the UN Convention on the Rights of the Child: physical education, physical activity and sport (pepas). A documentary analysis of three key document types from the Treaty Body reporting mechanisms was undertaken, including State Parties Reports (n = 104), List of Issues (n = 126) and Concerns/Observations and Recommendations (n = 797). There was a very low prevalence of the concepts of physical education, physical activity and, to a greater extent, sport, in these three reports. Seven themes emerged after the qualitative analysis: sport programmes, school-based sport, legislation and policies, key agents, interdisciplinary approach, enablers of sport and miscellaneous. Increased questioning of States with regards to their implementation of the right to sport, the issuance of pepas-based recommendations and guidance on how to achieve these rights from the Treaty Bodies would assist in solidifying understanding of sport as a human right and increase the impetus on States to act for pepas provision.
Limonium divaricatum (Plumbaginaceae), the Arabian Phoenix of sea-lavenders
Authors: ERBEN MATTHIAS , DEL GUACCHIO EMANUELE
Published: August 2021

Limonium divaricatum has been regarded for a long time the name of a taxon occurring in the main islands of western Mediterranean, or as a mere synonym of L. virgatum. In this paper, a critical review of literature and herbarium data allows us to reduce L. divaricatum to a synonym of L. dubium; the lectotypification of this latter name is also amended.
Border Crossing between the Russian Far East and Manchuria
Authors: Gamsa Mark
Published: August 2021

This article addresses population movements across the Amur and the Ussuri River borders between Russia and China. It analyses the history of border crossing in this region from Russia’s acquisition of the Amur and Maritime provinces from the Qing Empire in 1860 to the present time, with a focus on the 1920s and 1930s. The article’s first part demonstrates that the movement of people (settlers, work migrants, refugees) across the two river borders went in both directions. The second part asks when the formerly porous river borders became sealed through strengthened military control. By analysing the mechanics of border crossing, such as the clandestine passages of Mennonites, a Russian–German Protestant sect, from Soviet territory into Chinese Manchuria over the Amur in 1929 and 1930, as well as the escape stories of other refugees from the Soviet Union, the article shows in its third part that the ‘sealed’ borders could nonetheless be transgressed.
Intravascular Guidewire Residue After Endovascular Embolization for Intractable Epistaxis: A Case Report
Authors: Wang Fei , Cui Shijun , Yang Shengjia , Guo Lianrui
Published: August 2021

Endovascular embolization (EE) has become an effective method for the treatment of intractable epistaxis (IE). However, complications such as facial pain, headaches, aphasia, hemiplegia, and transient blindness can also occur during or after surgery. In this article, we report a rare case of IE with residual intravascular guidewire after EE. Open surgery was used to remove the guidewire. However, to avoid serious complications such as massive hemorrhage, only part of the guidewire was removed.
Multidisciplinary Simulation Training for Surgical Tracheostomy in Patients Mechanically Ventilated Secondary to Severe Acute Respiratory Syndrome Coronavirus 2
Authors: Towning Rebecca , Rennie Catherine , Ferguson Mark
Published: August 2021

Objective:

A proportion of patients with coronavirus disease (COVID) and severe respiratory manifestations of disease will require admission to intensive care for intubation and ventilation. When anticipating prolonged ventilation, the patient may proceed to surgical tracheostomy to afford safe respiratory wean. As surgical tracheostomy is an aerosol-generating procedure, it poses a high risk of viral transmission and ultimately may prompt anxiety and caution in participating staff members. We aimed to mitigate these risks by providing staff with appropriate training and experience, to improve their confidence as well as practical ability.

Methods:

We developed a multidisciplinary simulation training experience and checklist in order to optimize team performance during the high-stakes procedure. We evaluated staff confidence before and after the training with questionnaires.

Results:

Post-simulation, surgeons were more confident with donning the high level personal protective equipment, and nurses were more confident in performing their role.

Conclusions:

Simulation allows the multidisciplinary team an opportunity to practice high-risk procedures and prompts the team to assess staff knowledge base, troubleshoot queries, and teach roles and responsibilities in a safe environment. In the context of COVID-19, simulation encourages staff sense of preparedness and protection for true participation during a high-risk procedure.
Collective Identity Development Amid Institutional Chaos: Boundary Evolution in a Women’s Rights Movement in Post Gaddafi Libya
Authors: Basir Nada , Ruebottom Trish , Auster Ellen
Published: August 2021

Collective identity is important for the cohesion of social movements, yet there is an inherent tension between group unity and heterogeneity when multiple groups are motivated to come together to work for change. Through a three-year investigation of the early stages of a women’s rights movement following the Libyan revolution, we explore the dynamics of collective identity development. Our findings capture how two heterogeneous groups, Libyan locals and Libyan diaspora, interact to negotiate and re-negotiate the boundaries of collective identity. We find that this process unfolds through an ongoing struggle where the point of difference between the groups—their uncommon past—is the mechanism first used to ensure inclusion of insiders, and then to exclude outsiders from the collective identity. Our paper contributes to our understanding of the relational process through which collective identity co-evolves, and the challenges faced by heterogeneous groups engaging in collective action.
Digital platforms as entangled infrastructures: Addressing public values and trust in messaging apps
Authors: Pierson Jo
Published: August 2021

Digital platforms have increasingly become accepted and trusted by European citizens as indispensable utilities for social interaction and communication in everyday life. This article aims to analyze how trust in and dependence of these ubiquitous platforms for mediated communication is configured and the kind of consequences this has for user (dis)empowerment and public values. Our analysis builds on insights from the domestication perspective and infrastructure studies. In order to illustrate our conceptual approach, we use the case of messaging apps. We demonstrate how these apps as an essential social infrastructure are entangled with a corporate-computational infrastructure. The entangling of both types of infrastructures leads to a paradox where users feel compelled to appropriate these socially indispensable apps in everyday life, while also making them dependent on their corporate control mechanisms. In order to get out of the paradox and empower users these infrastructures and their data sharing need to be disentangled. For this, we apply the notion of ‘infrastructural inversion’ as a way to surface opaque and hidden properties of the digital platforms. We conclude with a discussion of potential other routes for infrastructural inversion in order to establish data disentanglement that serves public interest values.
Hepatic lesions associated with iron accumulation in captive kori bustards (Ardeotis kori)
Authors: Cudd Sarah K. , Garner Michael M. , Cartoceti Andrew N. , LaDouceur Elise E. B.
Published: August 2021

There are anecdotal reports of iron storage disease in captive kori bustards ( Ardeotis kori), but detailed descriptions of this disease have not been reported. The goals of this retrospective, multi-institutional study were to (1) describe microscopic findings associated with iron accumulation in postmortem tissues of kori bustards and (2) use an adapted grading scale to score iron accumulation and associated hepatic lesions. Tissue sections from 19 adult captive kori bustards (age range 3–28 years; 12 males and 7 females) were evaluated histologically with hematoxylin and eosin, Masson’s trichrome, and Prussian blue stains, and scored for iron accumulation. Hemochromatosis was diagnosed in cases with iron storage (in hepatocytes and/or Kupffer cells) and concurrent parenchymal damage (defined as having both necrosis and fibrosis). Hemosiderosis was diagnosed in animals with evidence of iron storage without necrosis or fibrosis. Ten of the 19 cases (age range 8–27 years; 7 males and 3 females) were diagnosed with hemochromatosis, including 6 with mild disease, 3 with moderate disease, and 1 with severe disease. Histologic evidence of iron accumulation was also identified in kidney, intestinal tract, adrenal gland, and spleen, but there were no associations between severity of iron accumulation in the liver and accumulation in other organs.
Simulating Large-Scale Events as a Network of Heterogeneous Queues: Framework and Application
Authors: Cummings Christopher , Abkarian Hoseb , Zhou Yuhan , Tahlyan Divyakant , Smilowitz Karen , Mahmassani Hani S.
Published: August 2021

Large-scale planned special events (PSEs) can pose unique transportation and logistics challenges. Data collection and simulation are important tools to address these challenges, although they are often difficult because of event size and complexity. This paper discusses methods to address the challenge of multimodal simulation at large PSEs through the context of AirVenture, a large week-long airshow organized by the Experimental Aircraft Association in Oshkosh, Wisconsin. Sampling and data collection techniques are discussed for a variety of modal processes like private vehicles, pedestrians, and shuttles, and for different situations like vehicle arrivals and departures, pedestrian queues, and shuttle systems. A flexible simulation framework for integrating these three modes and numerous activities is developed as a network of heterogeneous queues and queue-dependent choices. The simulation tested a variety of proposed policy changes around the site, including rerouting shuttle lines, and adjusting the system of vehicle arrivals to the site. Results of this study demonstrate the effectiveness and flexibility of the data collection and simulation methodologies. The techniques developed in this work can be used to improve planning and transportation systems at many other forms of PSE.
Systems leadership in the early years
Authors: James Deborah M , Wicker Kate , Street Martina , Bibby Rebecca J , Robinson Jan
Published: August 2021

This paper describes a new leadership coaching model that was delivered as part of Manchester city region's delivery of the Department for Education's Early Outcomes Fund. The coaching model explicitly paralleled the relational practices that are increasingly shaping early intervention policy and practice. Goodwin's theory of professional vision ( 1994 ) and Shotter's theorisation of with-ness ( 2011 ) provided the conceptual lens for this paper. The coaching facilitation aimed to afford the emergence of a new way of seeing leadership by scrutinising events of relational practice between participants in the coaching sessions (using video recording and review) and creating discursive practices using strengths-based analysis. We exemplify the coaching model using notes from a collaborative ethnographic evaluation of the six half-day group coaching sessions, surfacing how a new way of seeing silence may have seeded a new ‘object of knowledge’ in the group's emerging professional vision of leadership in the early years.
How Low Can You Go? Safety and Efficacy of Sodium-Glucose Cotransporter Inhibitors in Decreased Renal Function
Authors: Barvian Chelsea K. , Cipriano Gabriela
Published: August 2021

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a class of medications primarily used as either monotherapy or add-on therapy in those with type 2 diabetes. Given the mechanism of SGLT2 inhibitors, a renal dose adjustment or glomerular filtration rate cutoff in which it should be avoided due to decreased efficacy is recommended. However, studies have shown that these agents may possess renal benefits through decreasing serum glucose levels as well as decreasing intraglomerular pressure and albuminuria. The safety and benefits of SGLT2 inhibitors in patients with decreased renal function is an area of uncertainty.
Computational analysis of the effects of interprosthetic distance on normal and reduced cortical thickness femur models
Authors: Güngörürler Musa , Gürsan Onur , Havıtçıoğlu Hasan
Published: August 2021

Distal femoral fractures associated with the femoral stem in a well-fixed hip arthroplasty pose a risk of an interprosthetic fracture, the treatment of which is known as difficult. To effectively prevent and treat IP fractures, biomechanical effects must be demonstrated. We defined eight variations of the interprosthetic distance ranging from 48 mm overlap to 128 mm gap. Femoral geometries with normal and reduced cortical thickness were modeled to evaluate the effects of cortical thickness. In addition to the intact model, a total of 16 finite element models were analyzed under physiological boundary conditions. Maximum and minimum principal strains on the lateral and medial cortex surfaces were always found to be greater in models with reduced cortical thickness than in normal femurs. The model with 48 mm overlapping interprosthetic distance produced the least peak strain and the model with 16 mm interprosthetic gap produced the greatest strain with both normal and reduced cortical thickness. The screw holes produced local strain concentrations and increased the peak strains on the cortex surfaces, especially close to the stem tip. Statistically, a significant correlation ( R2 = 0.9483) was found between strain shielding and interprosthetic distance. Axial stiffness, interfragmentary shear motion, and maximum von-Mises stress on the distal plate showed a high correlation with the interprosthetic distance. It was concluded that the overlapping structures are superior to other fixations we analyzed in that they offer better mechanical stability and eliminates the local strain concentrations.
Palliative Care Unit at Home: Impact on Quality of Life in Cancer Patients at the End of Life in a Rural Environment
Authors: Moncho Maria Elena Iriarte , Palomar-Abril Vicente , Soria-Comes Teresa
Published: August 2021

Introduction:

Advanced cancer is accompanied by a substantial burden of symptoms, and palliative care (PC) plays an essential role, especially at the end of life (EOL). In fact, a comprehensive PC through Home Palliative Care Units (HPCU) has been associated with reducing potentially aggressive care at the EOL. We aim to study the impact of HPCU on the quality of assistance of cancer patients at Alcoy Health Department.

Methods:

A retrospective study was conducted including patients diagnosed with terminal cancer at the Medical Department of Hospital Virgen de los Lirios who died between January 2017 and December 2018. The Multivariate Cox regression model was used to assess the impact of HPCU assistance on the quality of life indicators.

Results:

388 patients were included. The median age was 71 years; 65% patients were male, and 68% presented with a 0-2 score on the ECOG scale. On the multivariate analysis, a lack of assistance by HPCU was associated with a higher risk of consulting in the emergency department (OR = 1.29, 95% CI: 1.02-1.67), of hospital admissions (OR = 4.72, 95% CI: 2.45-9.09), a higher probability of continuing active treatment (OR = 2.59, 95% CI: 1.44-4.67), and a greater probability of dying in hospital (OR = 6.52, 95% CI: 3.78-11.27).

Conclusions:

Patients receiving HPCU assistance have a lower number of emergency room visits and hospital admissions, and are more likely to die at home. Taken together, these results support the relevance of HPCU providing a high quality attention of cancer patients.
Economic Abuse of Palestinian Mothers in Israel: The Case of Participants in a Welfare-to-Work Program
Authors: Meler Tal , Herbst-Debby Anat , Sabbah Karkabi Maha
Published: August 2021

Focusing on Palestinian mothers in Israel participating in a nonmandatory welfare-to-work program, the study addresses whether these women experience economic abuse from their intimate partner/ex-partner, as well as whether they perceive the program as an opportunity to escape economic abuse and move toward economic independence. Based on interviews of 26 mothers and three trainers, the findings revealed dual economic abuse: in the domestic sphere and at the structural level (the labor market and welfare laws). The findings also suggest that the assistance the women receive from the welfare-to-work program has been insufficient to extricate them from their abusive situation.
Social enterprises and community wellbeing in regional Australia
Authors: McKinnon Katharine , Kennedy Melissa , De Cotta Tracy
Published: August 2021

This article reflects on a research project that has mapped the ways in which social enterprises in regional Australian cities produce wellbeing for their employees. The majority of enterprises in this study offer supported work opportunities to people with a disability while also running commercially viable enterprises delivering goods and services to regional communities. These enterprises demonstrate the challenges and the potential for organisations in regional settings to contribute in meaningful ways, not only to the wellbeing of the workers they support, but to the wellbeing of the broader community. This article considers how social enterprises are understood to be contributing to regional communities and situates them as key actors in a community economy that contributes to wider community wellbeing as distinct from individual wellbeing.
Cerebrovascular disease at young age is related to mother’s health during the pregnancy—The Northern Finland Birth Cohort 1966 study
Authors: Rissanen Ina , Geerlings Mirjam I , Juvela Seppo , Miettunen Jouko , Paananen Markus , Tetri Sami
Published: August 2021

Background and purpose

For prevention of cerebrovascular diseases at younger age, it is important to understand the risk factors occurring early in life. We investigated the relationship between mothers’ general health during pregnancy and the offspring’s risk of cerebrovascular disease in age of 15 to 52 years.

Methods

Within the population-based prospective Northern Finland Birth Cohort 1966, 11,926 persons were followed from antenatal period to 52 years of age. Information on their mother’s ill health conditions, i.e., hospitalizations, chronic diseases, medications, vitamin or iron supplement, fever, anemia, mood, and smoking was collected from 24th gestational week onwards. Ischemic and hemorrhagic cerebrovascular diseases of the offspring were identified from national registers in Finland. Cox proportional hazard models were used to estimate the association of mother’s health conditions with incidence of cerebrovascular disease in the offspring, with adjustments for potential confounders.

Results

During 565,585 person-years of follow-up, 449 (2.8%) of the offspring had a cerebrovascular disease. Hospitalization during pregnancy was associated with an increased risk of cerebrovascular disease in the offspring (hazard ratio (HR) = 1.49; 95% confidence interval (CI) 1.06–2.08) after adjustment for confounders, as was having more than three ill health conditions (HR = 1.89; CI 1.14–3.11). Not using vitamin or iron supplement was associated with increased risk for cerebrovascular disease in the offspring (HR = 1.39; CI 1.01–1.89).

Conclusions

The results suggest that the risk of cerebrovascular disease may start as early as during the antenatal period, and the health characteristics of mothers during pregnancy may play a role in cerebrovascular disease risk of the offspring.
Outcome in Patients Treated with Intra-arterial thrombectomy: The optiMAL Blood Pressure control (OPTIMAL-BP) Trial
Authors: Nam Hyo Suk , Kim Young Dae , Choi Jin Kyo , Baik Minyoul , Kim Byung Moon , Kim Dong Joon , Heo JoonNyung , Shin Dong Hoon , Lee Kyung-Yul , Jung Yo Han , Baek Jang-Hyun , Hwang Yang-Ha , Sohn Sung-Il , Hong Jeong-Ho , Park Hyungjong , Kim Chi Kyung , Kim Gyu Sik , Seo Kwon-Duk , Lee Kijeong , Seo Jung Hwa , Bang Oh Young , Seo Woo-Keun , Chung Jong-Won , Chang Jun Young , Kwon Sun U , Lee Jun , Kim Jinkwon , Yoo Joonsang , Song Tae-Jin , Ahn Seong Hwan , Cho Bang-Hoon , Cho Han-Jin , Kim Jae Guk , Chang Yoonkyung , Lee Chan Joo , Park Sungha , Park Goeun , Lee Hye S
Published: August 2021

Rationale

Very early stage blood pressure (BP) levels may affect outcome in stroke patients who have successfully undergone recanalization following intra-arterial treatment, but the optimal target of BP management remains uncertain.

Aim

We hypothesized that the clinical outcome after intensive BP-lowering is superior to conventional BP control after successful recanalization by intra-arterial treatment.

Sample-size estimates

We aim to randomize 668 patients (334 per arm), 1:1.

Methods and design

We initiated a multicenter, prospective, randomized, open-label trial with a blinded end-point assessment (PROBE) design. After successful recanalization (thrombolysis in cerebral infarction score ≥ 2 b), patients with elevated systolic BP level, deﬁned as the mean of two readings ≥ 140 mmHg, will be randomly assigned to the intensive BP-lowering (systolic BP < 140 mm Hg) group or the conventional BP-lowering (systolic BP, 140−180 mm Hg) group.

Study outcomes

The primary efficacy outcomes are from dichotomized analysis of modified Rankin Scale (mRS) scores at three months (mRS scores: 0–2 vs. 3–6). The primary safety outcomes are symptomatic intracerebral hemorrhage and death within three months.

Discussion

The OPTIMAL-BP trial will provide evidence for the effectiveness of active BP control to achieve systolic BP < 140 mmHg during 24 h in patients with successful recanalization after intra-arterial treatment.

Clinical trial registration

ClinicalTrials.gov Identifier: NCT04205305.
Why hospital design matters: A narrative review of built environments research relevant to stroke care
Authors: Bernhardt Julie , Lipson-Smith Ruby , Davis Aaron , White Marcus , Zeeman Heidi , Pitt Natalie , Shannon Michelle , Crotty Maria , Churilov Leonid , Elf Marie
Published: August 2021

Healthcare facilities are among the most expensive buildings to construct, maintain, and operate. How building design can best support healthcare services, staff, and patients is important to consider. In this narrative review, we outline why the healthcare environment matters and describe areas of research focus and current built environment evidence that supports healthcare in general and stroke care in particular. Ward configuration, corridor design, and staff station placements can all impact care provision, staff and patient behavior. Contrary to many new ward design approaches, single-bed rooms are neither uniformly favored, nor strongly evidence-based, for people with stroke. Green spaces are important both for staff (helping to reduce stress and errors), patients and relatives, although access to, and awareness of, these and other communal spaces is often poor. Built environment research specific to stroke is limited but increasing, and we highlight emerging collaborative multistakeholder partnerships (Living Labs) contributing to this evidence base. We believe that involving engaged and informed clinicians in design and research will help shape better hospitals of the future.
Return to Activity After SARS-CoV-2 Infection: Cardiac Clearance for Children and Adolescents
Authors: Chowdhury Devyani , Fremed Michael A. , Dean Peter , Glickstein Julie S. , Robinson Jeff , Rellosa Neil , Thacker Deepika , Soma David , Briskin Susannah M. , Asplund Chad , Johnson Jonathan , Snyder Christopher
Published: August 2021

Context:

Sedentary behavior and inability to participate in organized physical activity has negatively affected the physical and mental health of children and adolescents; however, cardiac injury and associated risk for sudden cardiac death with return to activity remains a major concern. Guidelines have been proposed for return to activities; however, these fail to address the needs of younger children and those participating in more casual activities. Guidance is needed for primary care providers to facilitate safe return to everyday activity and sports and to help direct appropriate laboratory, electrocardiographic, and anatomical assessment.

Evidence Acquisition:

Review of computerized databases of available literature on SARS-CoV-2 infection in children and postinfection sequelae, risk factors for sudden cardiac death, and previous return to play recommendations.

Study Design:

Clinical guidelines based on available evidence and expert consensus.

Level of Evidence:

Level 4.

Results:

In this report, we review the literature on return to activity after SARS-CoV-2 infection and propose recommendations for cardiac clearance for children and adolescents. Though severe disease and cardiac injury is less common in children than in adults, it can occur. Several diagnostic modalities such as electrocardiography, echocardiography, cardiac magnetic resonance imaging, and serologic testing may be useful in the cardiac evaluation of children after SARS-CoV-2 infection.

Conclusion:

Gradual return to activity is possible in most children and adolescents after SARS-CoV-2 infection and many of these patients can be cleared by their primary care providers. Providing education on surveillance for cardiopulmonary symptoms with return to sports can avoid unnecessary testing and delays in clearance.
Urinary Malondialdehyde as a Biomarker of Type 2 Diabetes Mellitus Treatment in the Primary Care Unit of a Tertiary Care Hospital
Authors: Choosong Thitiworn , Chootong Rattanaporn , Sono Supinya , Noofong Yupa
Published: August 2021

Introduction/Objectives

The examination of Urinary Malondialdehyde (UMDA) as a biomarker in the involvement of inflammatory response and oxidative stress, as a mechanism underlying the development of diabetes; in addition to complications in followed-up patients at a primary healthcare unit. The level of UMDA and its related factors in T2DM patients, between good and poor glycemic control was investigated.

Methods

This analytical cross-sectional study was conducted at the primary care unit, of Songklanagarind Hospital; from May 2020 to August 2020. The voluntary patients were divided into 2 groups, by using a percentage of HbA1c ≤7% as a good control T2DM group, and higher than 7% as a poor control T2DM group. The comparison statistics and logistic regression analysis were performed by using R Program.

Results

A total of 71 patients voluntarily participated in this study, and consisted of: 38 patients with poor glycemic control and 33 patients with good glycemic control. There were no significant differences between the patients; with the exception of smoking habits. The average levels of UMDA of the good control group (2.43 ± 0.91 μg/mL) were slightly lower than the poor control group (2.60 ± 0.96 μg/mL): P-value >.05. Patients who had underlying diseases, smoking, or drinking habits displayed significantly different levels of UMDA. Being a non-smoking patients, and having a higher level of HDL-C with significant protective factors, while having increased level of FBS and triglyceride were pointedly negative factors of oxidative stress status.

Conclusion

Patients who had good control of T2DM produced better health outcomes than the poor control group. UMDA, FBS, HDL-C, and triglyceride levels could be applied as follow-up criteria in T2DM patients within a primary healthcare setting.
Creating Organizational Authenticity and Identification: Effect of Leaders’ Motivating Language and Impact on Employee Advocacy
Authors: Yue Cen April
Published: August 2021

This study surveyed 482 employees in the United States to test the impact of leaders’ motivating language on employee advocacy. In addition, the study tested the mediating role of perceived organizational authenticity and employee organizational identification. Results suggested that motivating language is not directly related to employee advocacy. However, an indirect relationship is observed through two mediating processes: (1) serial mediation of organizational authenticity and organizational identification and (2) single mediation of organizational identification.
Postacute COVID‐19 Laryngeal Injury and Dysfunction
Authors: Neevel Andrew J. , Smith Joshua D. , Morrison Robert J. , Hogikyan Norman D. , Kupfer Robbi A. , Stein Andrew P.
Published: August 2021

Objective

Patients with COVID‐19 are at risk for laryngeal injury and dysfunction secondary to respiratory failure, prolonged intubation, and other unique facets of this illness. Our goal is to report clinical features and treatment for patients presenting with voice, airway, and/or swallowing concerns postacute COVID‐19.

Study Design

Case series.

Setting

Academic tertiary care center.

Methods

Patients presenting with laryngeal issues following recovery from COVID‐19 were included after evaluation by our laryngology team. Data were collected via retrospective chart review from March 1, 2020, to April 1, 2021. This included details of the patient’s COVID‐19 course, initial presentation to laryngology, and subsequent treatment.

Results

Twenty‐four patients met inclusion criteria. Twenty (83%) patients were hospitalized, and 18 required endotracheal intubation for a median (range) duration of 14 days (6‐31). Ten patients underwent tracheostomy. Patients were evaluated at a median 107 days (32‐215) after their positive SARS‐CoV‐2 test result. The most common presenting concerns were dysphonia (n = 19, 79%), dyspnea (n = 17, 71%), and dysphagia (n = 6, 25%). Vocal fold motion impairment (50%), early glottic injury (39%), subglottic/tracheal stenosis (22%), and posterior glottic stenosis (17%) were identified in patients who required endotracheal intubation. Patients who did not need intubation were most frequently treated for muscle tension dysphonia (67%).

Conclusion

Patients may develop significant voice, airway, and/or swallowing issues postacute COVID‐19. These complications are not limited to patients requiring intubation or tracheostomy. Multidisciplinary laryngology clinics will continue to play an integral role in diagnosing and treating patients with COVID‐19–related laryngeal sequelae.
Incidence of lymphoid neoplasms among atomic bomb survivors by histological subtype, 1950 to 1994
Authors: Fujihara Megumu , Sakata Ritsu , Yoshida Noriaki , Ozasa Kotaro , Preston Dale L. , Mabuchi Kiyohiko
Published: August 2021

Epidemiological data have provided limited and inconsistent evidence on the relationship between radiation exposure and lymphoid neoplasms. We classified 553 lymphoid neoplasm cases diagnosed between 1950 and 1994 in the Life Span Study cohort of atomic bomb survivors into World Health Organization subtypes. Mature B-cell neoplasms represented 58%, mature T-cell and natural killer (NK)-cell neoplasms 20%, precursor cell neoplasms 5%, and Hodgkin lymphoma (HL) 3%, with the remaining 15% classified as non-Hodgkin lymphoid (NHL) neoplasms or lymphoid neoplasms not otherwise specified. We used Poisson regression methods to assess the relationship between radiation exposure and the more common subtypes. As in earlier reports, a significant dose response for NHL neoplasms as a group was seen for males but not females. However, subtype analyses showed that radiation dose was strongly associated with increased precursor cell neoplasms rates, with an estimated excess relative risk per Gy of 16 (95% Confidence interval: 7.0, >533) at age 50. The current data based primarily of tissue-based diagnoses suggest that the association between radiation dose and lymphoid neoplasms as a group is largely driven by the radiation effect on precursor cell neoplasms while presenting no evidence of a radiation dose response for major categories of mature cell neoplasms, either B- or T-/NK-cell, or more specific disease entities (diffuse large B-cell lymphoma, plasma cell myeloma, adult T-cell leukemia/lymphoma) or HL.
The predictive value of PNH clones, 6p CN-LOH, and clonal TCR gene rearrangement for aplastic anemia diagnosis
Authors: Shah Yash B. , Priore Salvatore F. , Li Yimei , Tang Chi N. , Nicholas Peter , Kurre Peter , Olson Timothy S. , Babushok Daria V.
Published: August 2021

Acquired aplastic anemia (AA) is a life-threatening bone marrow aplasia caused by the autoimmune destruction of hematopoietic stem and progenitor cells. There are no existing diagnostic tests that definitively establish AA, and diagnosis is currently made via systematic exclusion of various alternative etiologies, including inherited bone marrow failure syndromes (IBMFSs). The exclusion of IBMFSs, which requires syndrome-specific functional and genetic testing, can substantially delay treatment. AA and IBMFSs can have mimicking clinical presentations, and their distinction has significant implications for treatment and family planning, making accurate and prompt diagnosis imperative to optimal patient outcomes. We hypothesized that AA could be distinguished from IBMFSs using 3 laboratory findings specific to the autoimmune pathogenesis of AA: paroxysmal nocturnal hemoglobinuria (PNH) clones, copy-number–neutral loss of heterozygosity in chromosome arm 6p (6p CN-LOH), and clonal T-cell receptor (TCR) γ gene (TRG) rearrangement. To test our hypothesis, we determined the prevalence of PNH, acquired 6p CN-LOH, and clonal TRG rearrangement in 454 consecutive pediatric and adult patients diagnosed with AA, IBMFSs, and other hematologic diseases. Our results indicated that PNH and acquired 6p CN-LOH clones encompassing HLA genes have ∽100% positive predictive value for AA, and they can facilitate diagnosis in approximately one-half of AA patients. In contrast, clonal TRG rearrangement is not specific for AA. Our analysis demonstrates that PNH and 6p CN-LOH clones effectively distinguish AA from IBMFSs, and both measures should be incorporated early in the diagnostic evaluation of suspected AA using the included Bayesian nomogram to inform clinical application.