bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiological Outcome Measures Indicate Advantages of Precontoured Locking Compression Plates in Elderly Patients With Split-Depression Fractures to the Lateral Tibial Plateau (AO41B3)
Authors: Prall Wolf C. , Kusmenkov Thomas , Rieger Maximilian , Haasters Florian , Mayr Hermann O. , Böcker Wolfgang , Fürmetz Julian
Published: October 2021

Background

Split-depression fractures to the lateral tibial plateau (AO41B3) often feature severe joint surface destructions. Precontoured locking compression plates (LCPs) are designed for optimum support of the reduced joint surface and have especially been emphasized in reduced bone quality. A lack of evidence still inhibits their broad utilization in elderly patients. Thus, aim of the present study was to investigate the implant-specific radiological outcomes of AO41B3-fractures in young versus elderly patients.

Methods

The hospital’s database was screened for isolated AO41B3-factures, open reduction and internal fixation (ORIF), and radiological follow-up ≥12 months. CT-scans, radiographs, and patients’ records were analyzed. Patients were attributed as young (18–49) or elderly (≥50 years). Additional subgrouping was carried out into precontoured LCP and conventional implants. The Rasmussen Radiological Score (RRS) after 12 months was set as primary outcome parameter. The RRS postoperatively and the medial proximal tibial angle (MPTA) postoperatively and after 12 months were secondary outcome parameters.

Results

Fifty nine consecutive patients were included (26 young, 38.2 ± 7.8 years; 33 elderly, 61.3 ± 9.4 years). There were no significant differences regarding mean size and depression depth of the lateral joint surface fragments. Prior to implant-specific subgrouping, the radiological outcome measures revealed no significant differences between young (RRS = 7.7 ± 1.7; MPTA = 90.3 ± 2.3°) and elderly (RRS = 7.2 ± 1.7; MPTA = 90.5 ± 3.3°). After implant-specific subgrouping, the radiological outcome revealed significantly impaired results in young patients with conventional implants (RRS(C) = 6.9 ± 1.6, RRS(LCP) = 8.5 ± 1.5, P = .015; MPTA(C) = 91.5 ± 1.9°, MPTA(LCP) = 89.1 ± 2.1°, P = .01). The effect was even more pronounced in elderly patients, with highly significant deterioration of the radiological outcome measures for conventional implants compared to precontoured LCP (RRS(C) = 5.7 ± 1.6, RRS(LCP) = 8.2 ± .8, P < .001; MPTA(C) = 92.6 ± 4.2°, MPTA(LCP) = 89.2 ± 1.4°, P = .002).

Conclusion

Utilizing precontoured LCP in the treatment of AO41B3-fractures is associated with improved radiological outcomes. This effect is significant in young but even more pronounced in elderly patients. Consequently, precontoured LCP should closely be considered in any AO41B3-fracture, but especially in elderly patients.
Satisfaction and Loyalty in Local Food Festival: Do Switching Barriers Matter?
Authors: Zargar Pouya , Farmanesh Panteha
Published: October 2021

In food tourism context, attracting customers and provision of satisfaction is of necessity. In accord with the call for empirical evidence within the extant literature, this study examines switching barriers and its role as moderator on the relationship between satisfaction and customer loyalty, at a food festival in Delhi, India. Switching barriers can be a vital factor for attracting more tourists into organized festivals, if implied adequately and maintained on a controlled manner. Creating switching barriers can be an effective approach for obtaining long-term visitors from marketing and tourism aspects. A questionnaire was designed specifically using related measures based on the literature. Various regression models were applied to estimate switching barriers’ effects and to further analyze our hypotheses. Interaction plot exhibited suppressing effect of switching barriers on the relationship between customer satisfaction and customer loyalty. The results of this study found that the role of switching barriers is not merely statistically significant, but requires critical attention from organizers.

JEL Classification: M3, M30, M31, M37, M39
The changes of joint-position sense, peroneal strength, postural control, and functional performance ability after the modified Broström procedure for chronic ankle instability
Authors: Choi Seung-Myung , Cho Byung-Ki , Park Woo-Sung , Woo Kyung-Jei
Published: October 2021

Purpose: Residual functional ankle instability regardless of the restoration of mechanical stability after the lateral ligament repair or reconstruction can cause recurrent sprain. The purpose of this study was to identify the sequential changes of joint-position sense, peroneal strength, postural control, and functional performance ability after the modified Broström procedure (MBP) for chronic ankle instability. Methods: A total of 46 patients (46 ankles) who underwent the MBP for chronic ankle instability were eligible for this study and were followed up for 1 year postoperatively. The changes of joint-position sense and peroneal strength were periodically evaluated with an isokinetic dynamometer. Postural control ability was evaluated using a one-leg stance test with eyes closed. The functional performance ability examination comprised a one-leg hop test, a six-meter hop test, and a cross three-meter hop test. Results: The error in joint-position sense significantly improved from a mean 4.3° to 2.8° ( p < 0.001). Peak torque for eversion significantly improved from a mean 18.2 Nm to 21.2 Nm ( p = 0.024). Balance retention time significantly improved from a mean 4.7 s to 6.4 s ( p < 0.001). Among the functional performance tests, only the one-leg hop test showed a significant improvement postoperatively ( p = 0.031). At 1 year postoperatively, the recovery ratios compared to the unaffected ankle were 67.9% in joint-position sense ( p < 0.001), 86.9% in peroneal strength ( p = 0.012), and 74.4% in postural control ( p < 0.001), with significant side-to-side differences. Conclusion: Although joint-position sense, peroneal strength, postural control, and functional performance ability were significantly improved after the MBP, recovery ratios compared to the unaffected ankle were insufficient up to 1 year postoperatively. Level of Evidence: Level IV (prospective case series)
China’s Belt and Road Projects in Central Asia
Authors: Manish  , Behera Alok
Published: October 2021

This article aims to understand the evolving nature of China’s Belt and Road Initiative (BRI) in Central Asia. It examines how the BRI gives China an access to the abundant energy resources in Central Asia, alongside the trade connectivity, industry, infrastructure development, and expanding regional markets and facilitating regional cooperation, etc. While doing so, the article examines 261 small-and large-scale Chinese infrastructure projects in five Central Asian republics. As we understand, China’s BRI investments focus on rail and road connectivity projects, energy connectivity projects, trade promotion and industrial development, and people-to-people projects. This gives greater influence to China in the Central Asian region, thereby leading to a competition among the major powers such as Russia, the USA and India.
Voice Analysis of Cancer Experiences Among Patients With Breast Cancer: VOICE-BC
Authors: Law Ernest H , Auil Maria J , Spears Patricia A , Berg Kiersten , Winnette Randall
Published: October 2021

Patient experience literature in early-stage breast cancer (eBC) is limited. This study used a mixed-methods approach to examine patient conversations from public online forums to identify and evaluate eBC-related themes. Among 60,000 eBC-related posts published September 2014–2019, text from a random subset of 15,000 posts was extracted and grouped into linguistically similar, mutually exclusive clusters using an advanced natural language processing (NLP) algorithm. Clusters were characterized using four quantitative metrics: betweenness centrality (linguistic similarity to other areas of the cluster network), sentiment (general attitude toward a topic), recency (average date of posts), and volume (total number of posts). This analysis represented 3906 unique users (67% and 33% obtained from cancer–specific and general health/nonhealth forums, respectively). Of the 27 clusters identified, most important were “discussing recurrence & progression,” “understanding diagnosis & prognosis,” and “understanding cancer, biomarkers, and treatments.” Several major themes related to recurrence risk, diagnosis, monitoring, and treatment were identified. Additional emphasis on communicating the disease recurrence risk and shared decision-making could strengthen patient-clinician partnerships.
Defining Industrial Heritage in the Indian Context
Authors: Tipnis Aishwarya , Singh Mandeep
Published: October 2021

The narrative of Indian industrialization is unique, a country that is both industrializing and de-industrializing simultaneously and that is struggling in the discovery of its own identity within the myriad political, ethnic, social and economic discourses. The massive push given to industry in this contemporary era has a definitive impact on the urban landscape. The contemporary political economy is in the process of disinvestment of State assets, which are cornerstones of the narratives of Indian industrialization, their loss and comprehensive redevelopment have a significant impact on place identity in urban areas. While the idea of urban heritage conservation is very nascent, the concept of industrial heritage conservation is largely non-existent in India.

The industrial timeline of India is different from the global timeline; the lack of an official definition, and therefore a lack of an official legislation, for recognition and legal protection of industrial sites in India has an impact on the perception of what constitutes Indian industrial heritage. Most industrial heritage sites are vulnerable to loss or replacement on the pretext of being considered too ordinary to be preserved.

This article presents a chronological narrative of industrialization and defines a framework for identifying typologies of industrial heritage sites in the Indian context, building a case for recognizing, protecting and sustainable development.
Narrative therapy and the autism spectrum: A model for clinicians
Authors: Monteiro Marilyn J
Published: October 2021

Narrative therapy practices have a long history of application to a wide range of mental health conditions. This paper discusses a novel narrative approach specific to autism and the application of narrative therapy constructs for clinicians working with families who have a member with a diagnosis of autism spectrum brain style differences. The author introduces a visual framework and descriptive language as a reference point to think and talk about autism within the context of narrative family therapy. This framework guides clinicians toward supporting an individualized narrative of the pattern of strengths and differences that are part of the autism spectrum brain style. The narrative approach outlined in this paper provides the entry point for clinicians to guide families toward the development of strength-based narratives that foster connections and resiliency within the family. A narrative therapy model is introduced with three key features highlighted: structuring the session to accommodate for autism spectrum brain style differences, using descriptive language to support the development of alternative narratives, and highlighting key narrative shifts taken from family therapy sessions. Readers are provided with a case study that illustrates the use of narrative therapy structures when working with this unique population of families.
ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure
Authors: Oczkowski Simon , Ergan Begüm , Bos Lieuwe , Chatwin Michelle , Ferrer Miguel , Gregoretti Cesare , Heunks Leo , Frat Jean-Pierre , Longhini Federico , Nava Stefano , Navalesi Paolo , Ozsancak Uğurlu Aylin , Pisani Lara , Renda Teresa , Thille Arnaud W. , Winck João Carlos , Windisch Wolfram , Tonia Thomy , Boyd Jeanette , Sotgiu Giovanni , Scala Raffaele
Published: October 2021

Background

High-flow nasal cannula (HFNC) has become a frequently used noninvasive form of respiratory support in acute settings; however, evidence supporting its use has only recently emerged. These guidelines provide evidence-based recommendations for the use of HFNC alongside other noninvasive forms of respiratory support in adults with acute respiratory failure (ARF).

Materials and methodology

The European Respiratory Society task force panel included expert clinicians and methodologists in pulmonology and intensive care medicine. The task force used the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methods to summarise evidence and develop clinical recommendations for the use of HFNC alongside conventional oxygen therapy (COT) and noninvasive ventilation (NIV) for the management of adults in acute settings with ARF.

Results

The task force developed eight conditional recommendations, suggesting the use of 1) HFNC over COT in hypoxaemic ARF; 2) HFNC over NIV in hypoxaemic ARF; 3) HFNC over COT during breaks from NIV; 4) either HFNC or COT in post-operative patients at low risk of pulmonary complications; 5) either HFNC or NIV in post-operative patients at high risk of pulmonary complications; 6) HFNC over COT in nonsurgical patients at low risk of extubation failure; 7) NIV over HFNC for patients at high risk of extubation failure unless there are relative or absolute contraindications to NIV; and 8) trialling NIV prior to use of HFNC in patients with COPD and hypercapnic ARF.

Conclusions

HFNC is a valuable intervention in adults with ARF. These conditional recommendations can assist clinicians in choosing the most appropriate form of noninvasive respiratory support to provide to patients in different acute settings.
Scan-based competing death risk model for re-evaluating lung cancer computed tomography screening eligibility
Authors: Schreuder Anton , Jacobs Colin , Lessmann Nikolas , Broeders Mireille J.M. , Silva Mario , Išgum Ivana , de Jong Pim A. , van den Heuvel Michel M. , Sverzellati Nicola , Prokop Mathias , Pastorino Ugo , Schaefer-Prokop Cornelia M. , van Ginneken Bram
Published: October 2021

Background

A baseline computed tomography (CT) scan for lung cancer (LC) screening may reveal information indicating that certain LC screening participants can be screened less, and instead require dedicated early cardiac and respiratory clinical input. We aimed to develop and validate competing death (CD) risk models using CT information to identify participants with a low LC risk and a high CD risk.

Methods

Participant demographics and quantitative CT measures of LC, cardiovascular disease and chronic obstructive pulmonary disease were considered for deriving a logistic regression model for predicting 5-year CD risk using a sample from the National Lung Screening Trial (n=15 000). Multicentric Italian Lung Detection data were used to perform external validation (n=2287).

Results

Our final CD model outperformed an external pre-scan model (CD Risk Assessment Tool) in both the derivation (area under the curve (AUC) 0.744 (95% CI 0.727–0.761) and 0.677 (95% CI 0.658–0.695), respectively) and validation cohorts (AUC 0.744 (95% CI 0.652–0.835) and 0.725 (95% CI 0.633–0.816), respectively). By also taking LC incidence risk into consideration, we suggested a risk threshold where a subgroup (6258/23 096 (27%)) was identified with a number needed to screen to detect one LC of 216 (versus 23 in the remainder of the cohort) and ratio of 5.41 CDs per LC case (versus 0.88). The respective values in the validation cohort subgroup (774/2287 (34%)) were 129 (versus 29) and 1.67 (versus 0.43).

Conclusions

Evaluating both LC and CD risks post-scan may improve the efficiency of LC screening and facilitate the initiation of multidisciplinary trajectories among certain participants.
Computed tomography-based radiomics decodes prognostic and molecular differences in interstitial lung disease related to systemic sclerosis
Authors: Schniering Janine , Maciukiewicz Malgorzata , Gabrys Hubert S. , Brunner Matthias , Blüthgen Christian , Meier Chantal , Braga-Lagache Sophie , Uldry Anne-Christine , Heller Manfred , Guckenberger Matthias , Fretheim Håvard , Nakas Christos T. , Hoffmann-Vold Anna-Maria , Distler Oliver , Frauenfelder Thomas , Tanadini-Lang Stephanie , Maurer Britta
Published: October 2021

Background

Radiomic features calculated from routine medical images show great potential for personalised medicine in cancer. Patients with systemic sclerosis (SSc), a rare, multiorgan autoimmune disorder, have a similarly poor prognosis due to interstitial lung disease (ILD). Here, our objectives were to explore computed tomography (CT)-based high-dimensional image analysis (“radiomics”) for disease characterisation, risk stratification and relaying information on lung pathophysiology in SSc-ILD.

Methods

We investigated two independent, prospectively followed SSc-ILD cohorts (Zurich, derivation cohort, n=90; Oslo, validation cohort, n=66). For every subject, we defined 1355 robust radiomic features from standard-of-care CT images. We performed unsupervised clustering to identify and characterise imaging-based patient clusters. A clinically applicable prognostic quantitative radiomic risk score (qRISSc) for progression-free survival (PFS) was derived from radiomic profiles using supervised analysis. The biological basis of qRISSc was assessed in a cross-species approach by correlation with lung proteomic, histological and gene expression data derived from mice with bleomycin-induced lung fibrosis.

Results

Radiomic profiling identified two clinically and prognostically distinct SSc-ILD patient clusters. To evaluate the clinical applicability, we derived and externally validated a binary, quantitative radiomic risk score (qRISSc) composed of 26 features that accurately predicted PFS and significantly improved upon clinical risk stratification parameters in multivariable Cox regression analyses in the pooled cohorts. A high qRISSc score, which identifies patients at risk for progression, was reverse translatable from human to experimental ILD and correlated with fibrotic pathway activation.

Conclusions

Radiomics-based risk stratification using routine CT images provides complementary phenotypic, clinical and prognostic information significantly impacting clinical decision making in SSc-ILD.
Clinical value of bronchodilator response for diagnosing asthma in steroid-naïve adults
Authors: Tuomisto Leena E. , Ilmarinen Pinja , Lehtimäki Lauri , Niemelä Onni , Tommola Minna , Kankaanranta Hannu
Published: October 2021

Spirometry and testing for bronchodilator response have been recommended to detect asthma, and a bronchodilator response (BDR) of ≥12% and ≥200 mL has been suggested to confirm asthma. However, the clinical value of bronchodilation tests in newly diagnosed steroid-naïve adult patients with asthma remains unknown.

We evaluated the sensitivity of BDR in forced expiratory volume in 1 s (FEV1) as a diagnostic test for asthma in a real-life cohort of participants in the Seinäjoki Adult Asthma Study. In the diagnostic phase, 369 spirometry tests with bronchodilation were performed for 219 steroid-naïve patients. The fulfilment of each test threshold was assessed. According to the algorithm of the National Institute for Health and Care Excellence, we divided the patients into obstructive (FEV1/forced vital capacity (FVC) <0.70) and non-obstructive (FEV1/FVC ≥0.70) groups.

Of the overall cohort, 35.6% fulfilled ΔFEV1 ≥12% and ≥200 mL for the initial FEV1, 18.3% fulfilled ΔFEV1 ≥15% and ≥400 mL for the initial FEV1, and 36.1% fulfilled ΔFEV1 ≥9% of predicted FEV1at least once. One-third (31%) of these steroid-naïve patients was obstructive (pre-bronchodilator FEV1/FVC <0.7). Of the obstructive patients, 55.9%, 26.5% and 48.5%, respectively, met the same thresholds. In multivariate logistic regression analysis, different thresholds recognised different kinds of asthma patients.

In steroid-naïve adult patients, the current BDR threshold (ΔFEV1 ≥12% and ≥200 mL) has low diagnostic sensitivity (36%) for asthma. In obstructive patients, sensitivity is somewhat higher (56%) but far from optimal. If the first spirometry test with bronchodilation is not diagnostic but asthma is suspected, spirometry should be repeated, and other lung function tests should be used to confirm the diagnosis.
The moderating effect of gender on the relationships between obesity, well-being, and stress perception in Korean adolescents
Authors: Su-Jung Nam , Jong-Ho Park
Published: October 2021

Background

Children and adolescents with obesity are more likely to become adults with obesity. Therefore, obesity prevention in adolescence is essential for eliminating complications associated with obesity, which can affect health throughout the lifespan. This study examined the influences of adolescents’ obesity based on BMI and that of obesity based on adolescents’ perception of their well-being and stress, as well as the moderating effect of gender on these influences.

Methods

Data were analyzed for 61,861 adolescents aged 12–18, who participated in the 2019 Korean Adolescent Health Behavior Survey, an online self-administered questionnaire. Adolescents’ obesity based on perception was based on their self-rating as underweight, healthy weight, or obese. Chi-squared tests were used to determine whether well-being and stress perception were related to obesity based on BMI and obesity based on perception, and a general linear model was used to examine the main and interaction effects of obesity based on BMI, obesity based on perception, and gender on well-being and stress perception.

Results

Obesity based on BMI and obesity based on perception coincided in 58.7% of the sample. However, the degree of obesity was overestimated and underestimated by 19.2 and 24.3% of the sample, respectively. Obesity based on BMI and obesity based on perception varied by gender, age, economic status, and academic achievement. The main effect of obesity based on BMI was not statistically significant on both well-being and stress perception, and only the main effect of obesity based on perception was statistically significant on stress perception. The interaction between obesity based on perception and gender was significant for well-being and stress perception. Herein, males scored higher on well-being and lower on stress perception. However, the association patterns were similar for males and females, with significant differences between underweight, healthy weight, and overweight/obese; however, for only females, there was no difference in well-being scores between underweight and those who perceived themselves as having a healthy weight.

Conclusion

The well-being and stress perception are influenced by obesity based on perception rather than obesity based on BMI, and this influence varies according to gender in adolescents.
Biomechanical analysis of reduction technique for lumbar spondylolisthesis: anterior lever versus posterior lever reduction method
Authors: Lin Yu-Tsung , Su Kuo-Chih , Chen Kun-Hui , Pan Chien-Chou , Shih Cheng-Min , Lee Cheng-Hung
Published: October 2021

Background

Reduction of lumbar spondylolisthesis during spinal fusion surgery is important for improving the fusion rate and restoring the sagittal alignment. Despite the variety of reduction methods, the fundamental mechanics of lumbar spondylolisthesis reduction remain unclear. This study aimed to investigate the biomechanical behavior while performing spondylolisthesis reduction with the anterior and posterior lever reduction method.

Methods

We developed an L4–L5 spondylolisthesis model using sawbones. Two spine surgeons performed the simulated reduction with a customized Cobb elevator. The following data were collected: the torque and angular motion of Cobb, displacement of vertebral bodies, change of lordotic angle between L4 and L5, total axial force and torque applied on the model, and force received by adjacent disc.

Results

Less torque value (116 N-cm vs. 155 N-cm) and greater angular motion (53o vs. 38o) of Cobb elevator were observed in anterior lever reduction. Moreover, the total axial force received by the entire model was greater in the posterior lever method than that in the anterior lever method (40.8 N vs. 16.38 N). Besides, the displacement of both vertebral bodies was greater in the anterior lever method.

Conclusions

The anterior lever reduction is a more effort-saving method than the posterior lever reduction method. The existing evidence supports the biomechanical advantage of the anterior reduction method, which might be one of the contributing factors to successfully treating high-grade lumbar spondylolisthesis with short-segment instrumentation.
Prevalence and location of endplate fracture and subsidence after oblique lumbar interbody fusion for adult spinal deformity
Authors: Inoue Gen , Saito Wataru , Miyagi Masayuki , Imura Takayuki , Shirasawa Eiki , Ikeda Shinsuke , Mimura Yusuke , Kuroda Akiyoshi , Yokozeki Yuji , Inoue Sho , Akazawa Tsutomu , Nakazawa Toshiyuki , Uchida Kentaro , Takaso Masashi
Published: October 2021

Background

Recently, Oblique lumbar interbody fusion (OLIF) is commonly indicated to correct the sagittal and coronal alignment in adult spinal deformity (ASD). Endplate fracture during surgery is a major complication of OLIF, but the detailed location of fracture in vertebral endplate in ASD has not yet been determined. We sought to determine the incidence and location of endplate fracture and subsidence of the OLIF cage in ASD surgery, and its association with fusion status and alignment.

Methods

We analyzed 75 levels in 27 patients were analyzed using multiplanar CT to detect the endplate fracture immediately after surgery and subsidence at 1 year postoperatively. The prevalence was compared between anterior and posterior, approach and non-approach sides, and concave and convex side. Their association with fusion status, local and global alignment, and complication was also investigated.

Results

Endplate fracture was observed in 64 levels (85.3%) in all 27 patients, and the incidence was significantly higher in the posterior area compared with the anterior area (85.3 vs. 68.0%, p=0.02) of affected vertebra in the sagittal plane. In the coronal plane, there was no significant difference in incidence between left (approach) and right (non-approach) sides (77.3 and 81.3%, respectively), or concave and convex sides (69.4 and 79.6%) of wedged vertebra. By contrast, cage subsidence at 1 year postoperatively was noted in 14/75 levels (18.7%), but was not associated with endplate fracture. Fusion status, local and global alignment, and complications were not associated with endplate fracture or subsidence.

Conclusion

Endplate fracture during OLIF procedure in ASD cases is barely avoidable, possibly induced by the corrective maneuver with ideal rod counter and cantilever force, but is less associated with subsequent cage subsidence, fusion status, and sustainment of corrected alignment in long fusion surgery performed even for elderly patients.
Effects of the Mental Health and Welfare Law revision on schizophrenia patients in Korea: an interrupted time series analysis
Authors: Heo Jongho , Yoon Nan-He , Shin Soyoun , Yu Soo-Young , Lee Manwoo
Published: October 2021

Background

High rates of involuntary hospitalization and long lengths of stay have been problematic in Korea. To address these problems, the Mental Health and Welfare Law was revised in 2016, mainly to protect patient rights by managing involuntary admissions. The aim of this study was to evaluate the impact of the revised Mental Health and Welfare Law on deinstitutionalization by using routinely collected data from hospital admissions and continuity of mental health service use after hospital discharge as proxy measures of deinstitutionalization.

Methods

We used monthly-aggregated claims-based data with a principal or secondary diagnosis of schizophrenia from 2012 to 2019, collected by the National Health Insurance Service. Outcome variables included rates of first admission; discharges; re-admissions within 7, 30, and 90 days; outpatient visits after discharge within 7 and 30 days; and continuity of visits, at least once a month for 6 months after discharge. Using interrupted time series analysis, we estimated the change in levels and trends of the rates after revision, controlling for baseline level and trend.

Results

There was no significant change in first admission and discharge rates after the revision. Immediately after the revision, however, the rates of re-admission within 7 and 30 days dropped significantly, by 2.24% and 1.99%, respectively. The slopes of the re-admission rate decreased significantly, by 0.10% and 0.14%, respectively. The slopes of the re-admission rate within 90 days decreased (0.001%). The rates of outpatient visits within 7 and 30 days increased by 1.98% and 2.72%, respectively. The rate of continuous care showed an immediate 4.0% increase.

Conclusions

The revision had slight but significant effects on deinstitutionalization, especially decreasing short-term re-admission and increasing immediate outpatient service utilization.
Proposal of standardization of every step of angiographic procedure in bleeding patients from pelvic trauma
Authors: Renzulli Matteo , Ierardi Anna Maria , Brandi Nicolò , Battisti Sofia , Giampalma Emanuela , Marasco Giovanni , Spinelli Daniele , Principi Tiziana , Catena Fausto , Khan Mansoor , Di Saverio Salomone , Carrafiello Giampaolo , Golfieri Rita
Published: October 2021

Trauma accounts for a third of the deaths in Western countries, exceeded only by cardiovascular disease and cancer. The high risk of massive bleeding, which depends not only on the type of fractures, but also on the severity of any associated parenchymal injuries, makes pelvic fractures one of the most life-threatening skeletal injuries, with a high mortality rate. Therefore, pelvic trauma represents an important condition to correctly and early recognize, manage, and treat. For this reason, a multidisciplinary approach involving trauma surgeons, orthopedic surgeons, emergency room physicians and interventional radiologists is needed to promptly manage the resuscitation of pelvic trauma patients and ensure the best outcomes, both in terms of time and costs. Over the years, the role of interventional radiology in the management of patient bleeding due to pelvic trauma has been increasing. However, the current guidelines on the management of these patients do not adequately reflect or address the varied nature of injuries faced by the interventional radiologist. In fact, in the therapeutic algorithm of these patients, after the word “ANGIO”, there are no reports on the different possibilities that an interventional radiologist has to face during the procedure. Furthermore, variations exist in the techniques and materials for performing angioembolization in bleeding patients with pelvic trauma. Due to these differences, the outcomes differ among different published series. This article has the aim to review the recent literature on optimal imaging assessment and management of pelvic trauma, defining the role of the interventional radiologist within the multidisciplinary team, suggesting the introduction of common and unequivocal terminology in every step of the angiographic procedure. Moreover, according to these suggestions, the present paper tries to expand the previously drafted algorithm exploring the role of the interventional radiologist in pelvic trauma, especially given the multidisciplinary setting.
Governance of food and nutrition security in Eswatini: an analysis of government policies and reports
Authors: Phungwayo Thobile , Kushitor Sandra Boatemaa , Koornhof Liesbet
Published: October 2021

Background

Governance of food and nutrition security is vital in achieving sustainable development goals. Yet, the role of governance in shaping and preventing malnutrition risk is complex and poorly understood. This paper examined the governance of food and nutrition security in Eswatini.

Methods

Policy documents, annual reports, and minutes of board meetings from five government ministries were the documents that were used for this study. The data analysis focused on the strength of nutrition governance, actors involved in policymaking, nutrition-specific and sensitive-programs, and multisectoral coordination of programs.

Results

The findings show that Eswatini has medium strength, nutrition governance. The nutrition-specific programs included: micronutrient supplementation and deworming programs, breastfeeding campaigns, and treatment of acute malnutrition. The nutrition-sensitive initiatives included programs on school nutrition, sanitation and hygiene, agriculture production, and healthcare. However, multisectoral coordination was ineffective, as collaborative efforts are not structured, during implementation.

Conclusion

This study examined the governance of food and nutrition security in Eswatini using documents from government ministries. Diverse actors were involved in policy formation and implementation. The strength of nutrition governance was medium and multisectoral coordination was usually ad-hoc. The multiple actors involved in nutrition governance in Eswatini need to intentionally plan to improve multisectoral coordination to achieve higher impact.
Obstetric neonatal emergency simulation workshops in remote and regional South India: a qualitative evaluation
Authors: Zhong Bella , Sarkar Mahbub , Menon Nandakumar , Devi Shylaja , Budanoor Jayaram K. , Beerappa Naresh , Malhotra Atul , Kumar Arunaz
Published: October 2021

Background

Healthcare facilities in remote locations with poor access to a referral centre have a high likelihood of health workers needing to manage emergencies with limited support. Obstetric and neonatal clinical training opportunities to manage childbirth emergencies are scant in these locations, especially in low- and middle-income countries.

Objectives

This study aimed to explore the factors, which influenced healthcare worker experience of attending birth emergencies in remote and regional areas of South India, and the perceived impact of attending the Obstetric and Neonatal Emergency Simulation (ONE-Sim) workshop on these factors.

Design

Qualitative descriptive study using pre- and post-workshop qualitative surveys.

Settings

Primary healthcare facilities in remote/regional settings in three states of South India.

Participants

A total of 125 healthcare workers attended the workshops, with 85 participants completing the pre- and post-workshop surveys included in this study. Participants consisted of medical and nursing staff and other health professionals involved in care at childbirth.

Methods

ONE-Sim workshops (with a learner-centred approach) were conducted across three different locations for interprofessional teams caring for birthing women and their newborns, using simulation equipment and immersive scenarios. Thematic analysis was employed to the free-text responses obtained from the surveys consisting of open-ended questions.

Results

Participants identified their relationship with the patient, the support provided by other health professionals, identifying their gaps in knowledge and experience, and the scarcity of resources as factors that influenced their experience of birth emergencies. Following the workshops, participant learning centred on improving team and personal performance and approaching future emergencies with greater confidence.

Conclusions

Challenges experienced by healthcare workers across sites in remote and regional South India were generally around patient experience, senior health professional support and resources. The technical and interpersonal skills introduced through the ONE-Sim workshop may help to address some of these factors in practice.
Role of circulating endothelial progenitors in responsiveness to erythropoiesis-stimulating agents in hemodialysis patients
Authors: Ishimitsu Akira , Satonaka Hiroshi , Furuichi Masahito , Murayama Yoshiki , Tojo Akihiro , Ishimitsu Toshihiko
Published: October 2021

Background

Though treatment of anemia in chronic kidney disease (CKD) patients has been improved remarkably by erythropoiesis-stimulating agents (ESA), hypo-responsiveness to ESA poses a persistent problem in a subgroup of CKD patients, especially those on dialysis, with deteriorated mortality or cardiovascular risks. Pathomechanism of this condition including cardiovascular implications has not been sufficiently investigated.

Methods

Clinical parameters of 101 chronic hemodialysis patients which included those hospitalized in our university hospital were examined cross-sectionally. As a marker estimating ESA hypo-responsiveness, erythropoietin resistance index (ERI) was calculated. Numbers of circulating endothelial progenitor cells (EPC) were measured by flow cytometry. Associations among values were analyzed by methods including multiple linear regression.

Results

Majority (93%) of the subjects were hospitalized patients with various comorbidities. ERI (18.4 [7.2–33.0] IU/week/kg/g/dL) and ESA dose (161.6 [75.0–320.9] IU/week/kg) of all the subjects were relatively high. Factors negatively correlated with EPC included age, HD vintage, CRP, pulse rate, ESA dose and ERI, while male sex and systolic blood pressure were positively correlated. By multiple linear regression analysis, age, sex and ERI (standardized coefficient beta − 0.202,p = 0.039) remained as the independently predicting factors of EPC (log CD133/Flk1+ EPC). Darbepoetin alpha was used in 65 patients, especially predominant when requiring higher ESA doses, but by correlation or multivariable analyses, this did not substantially modify the negative association between ERI and EPC.

Conclusions

ERI was independently associated with EPC paucity in a cohort with various comorbidities. This may suggest a link which connects ESA hypo-responsiveness to compromised cardiovascular prognosis of dialysis patients.
Serial dependence in the perceptual judgments of radiologists
Authors: Manassi Mauro , Ghirardo Cristina , Canas-Bajo Teresa , Ren Zhihang , Prinzmetal William , Whitney David
Published: October 2021

In radiological screening, clinicians scan myriads of radiographs with the intent of recognizing and differentiating lesions. Even though they are trained experts, radiologists’ human search engines are not perfect: average daily error rates are estimated around 3–5%. A main underlying assumption in radiological screening is that visual search on a current radiograph occurs independently of previously seen radiographs. However, recent studies have shown that human perception is biased by previously seen stimuli; the bias in our visual system to misperceive current stimuli towards previous stimuli is called serial dependence. Here, we tested whether serial dependence impacts radiologists’ recognition of simulated lesions embedded in actual radiographs. We found that serial dependence affected radiologists’ recognition of simulated lesions; perception on an average trial was pulled 13% toward the 1-back stimulus. Simulated lesions were perceived as biased towards the those seen in the previous 1 or 2 radiographs. Similar results were found when testing lesion recognition in a group of untrained observers. Taken together, these results suggest that perceptual judgements of radiologists are affected by previous visual experience, and thus some of the diagnostic errors exhibited by radiologists may be caused by serial dependence from previously seen radiographs.
Model predictive control of grid-connected PV power generation system considering optimal MPPT control of PV modules
Authors: Zhao Yingying , An Aimin , Xu Yifan , Wang Qianqian , Wang Minmin
Published: October 2021

Because of system constraints caused by the external environment and grid faults, the conventional maximum power point tracking (MPPT) and inverter control methods of a PV power generation system cannot achieve optimal power output. They can also lead to misjudgments and poor dynamic performance. To address these issues, this paper proposes a new MPPT method of PV modules based on model predictive control (MPC) and a finite control set model predictive current control (FCS-MPCC) of an inverter. Using the identification model of PV arrays, the module-based MPC controller is designed, and maximum output power is achieved by coordinating the optimal combination of spectral wavelength and module temperature. An FCS-MPCC algorithm is then designed to predict the inverter current under different voltage vectors, the optimal voltage vector is selected according to the optimal value function, and the corresponding optimal switching state is applied to power semiconductor devices of the inverter. The MPPT performance of the MPC controller and the responses of the inverter under different constraints are verified, and the steady-state and dynamic control effects of the inverter using FCS-MPCC are compared with the traditional feedforward decoupling PI control in Matlab/Simulink. The results show that MPC has better tracking performance under constraints, and the system has faster and more accurate dynamic response and flexibility than conventional PI control.
The cardioprotective effect of intralipid in decreasing the ischemic insults during off-pump coronary artery revascularization
Authors: El Derh Maha Sadek , Twab Samar Mohamed Abdel , Elgouhary Mohamed
Published: October 2021

Background

Off pump coronary artery revascularization (OPCAB) surgeries have benefits over the conventional on pump cardiac surgery, because it avoids the trauma caused by cardiopulmonary bypass (CPB) and minimize aortic manipulation. However, some disadvantages of OPCAB include the concern of ineffective coronary revascularization. Some drugs have shown the ability to protect the myocardium in different studies, by different methods. The usage of intralipid has been shown to make a better functional recovery of the cardiac muscles and help to decrease the myocardial infarct size, it shortens the action potential time, which show polyunsaturated fatty acids diets mechanism as an antiarrhythmic drug, and are associated with low incidence of coronary artery disease.

Methods

We divided patients into two groups according to the randomization envelopes: intralipid group (group A) received 1.5 ml/kg intralipid 20% through central venous line after sternotomy over 1 h and during infusion, blood pressure, heart rate, and temperature were monitored all through the infusion time. Control group (group B) received normal saline 0.9% in the same volume over the same duration.

Results

This study showed that infusion of 1.5 ml/kg intralipid after sternotomy in off pump coronary artery revascularization given as preconditioning agent improve the myocardial ischemia reperfusion injury, decrease the need for high doses of nor adrenaline infusion after revascularization, earlier normalization in troponin levels starting 24 h after surgery and higher values of cardiac index were measured in ICU using PICCO.

Conclusions

This study showed the benefits of infusion of 1.5 ml/kg of intralipid after sternotomy, in preconditioning during OPCABG. Preconditioning with intralipid proved to decrease reperfusion injury in myocardium expressed by improvement in cardiac functions (EF and cardiac index) and normalization of specific cardiac marker (cardiac troponin I).
The association between 24-h blood pressure variability and major adverse cardiac events (MACE) in hospitalized patients with acute myocardial infarction: a retrospective cohort study
Authors: Harefa  , Wijaya Ika Prasetya , Muhadi  , Rumende Cleopas Martin , Nasution Sally Aman , Koesnoe Sukamto , Marbun Maruhum Bonar , Shatri Hamzah
Published: October 2021

Background

Acute myocardial infarction (AMI) is major cardiovascular disease that causes high morbidity and mortality. In AMI, ischemia and necrosis affected some cardiomyocytes leading to a decrease in myocardial contractility which is followed by an acute proinflammation reaction and increased sympathetic tone. Meanwhile, high blood pressure variability (BPV) causing an increased left ventricular workload, heart rate, myocardial oxygen demand and induces proinflamations and endothelial dysfunction. Therefore a high BPV and its associated pathological effects are likely to aggravate the physiological function of the heart and affect the emergence of acute cardiac complications in AMI patients. This study aims to investigate the association’s between short-term BPV and major adverse cardiac events (MACE) in AMI patients. This retrospective cohort study used simple random sampling to identify AMI patients who were hospitalized at Cipto Mangunkusumo National Hospital between January 2018 and December 2019. Mann Withney was performed to investigate the association between BPV and MACE.

Results

The average systolic BPV value which was calculated as standard deviation (SD) and average real variability (ARV) was higher in the MACE group than in the non-MACE group. Systolic SD and systolic ARV in the MACE group were 13.28 ± 5.41 mmHg and 9.88 ± 3.81 mmHg respectively. In the non-MACE group, systolic SD and systolic ARV were 10.76 (4.59–26.17) mmHg and 8.65 (3.22–19.35) mmHg respectively. There was no significant association between BPV and MACE. However, there were significant differences between systolic SD and systolic ARV in patients with hypertension who experienced MACE and patients without hypertension who experienced MACE.

Conclusions

The BPV of AMI patients who experience MACE was higher than that of non-MACE AMI patients. There was no significant association between BPV ​​and MACE during the acute phase of AMI.
Clinical outcomes and impact of prognostic factors following adjuvant radiotherapy in oral tongue cancer patients
Authors: Pant Sidharth , Lal Punita , Misra Shagun , Gupta Piyush , Das K. J. Maria , Kumar Senthil , Nautiyal Vipul , Bhawna Kranti , Kumar Shaleen
Published: October 2021

Background

The purpose of the study was to evaluate survival outcomes in post-operative oral tongue cancer patients undergoing adjuvant radiotherapy (RT) at a tertiary cancer care center and to critically review the impact of various clinical-pathological factors on recurrence and survival. Demographic factors, stage of all the histology proven oral tongue cancer, and treatment details were documented. Overall survival (OS) and recurrence-free survival (RFS) were analyzed along with the potential prognostic factors affecting outcome.

Results

One hundred forty-four post-operative oral tongue cancer patients referred to our department for adjuvant treatment were evaluated. Median age at presentation was 45 years. Forty-seven patients had pathological early stage disease (stages I and II) and 95 had locally advanced (stages III and IV) disease while post-op details were not present in 2 patients. At a median follow-up of 87 months (60–124) of alive patients, the median RFS for entire cohort was 62 months while median OS was 74 months respectively. Age, perineural invasion (PNI), and grade of the tumor emerged as independent prognostic factors for OS and RFS. Among patients with early stage disease, depth of invasion (DOI), age, and PNI were found as independent prognostic factors for RFS and OS. In locally advanced disease, higher grade, age, and PNI independently impacted the respective survival end points.

Conclusions

Age (> 45 years), higher grade, and presence of PNI showed inferior survival outcomes across the sub-groups (early versus locally advanced disease). This may warrant adjuvant treatment intensification. DOI > 10 mm was particularly found to worsen survival in early node negative SCC oral tongue patients.