bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Worker Experiences of and Perspectives on Engaging Men in HIV Care: A Qualitative Study in Cape Town, South Africa
Authors: Mbokazi Nonzuzo , Madzima Rutendo , Leon Natalie , Lurie Mark N , Cornell Morna , Schmidt Bey-Marrie , Colvin Christopher J.
Published: June 2020

Men generally fare worse than women across the HIV cascade. While we know much about how men perceive the health services, we know little about how health workers (HWs) themselves have experienced engaging with men and what strategies they have used to improve this engagement. We interviewed 12 HWs in public health care services in Cape Town to better understand their experiences and perspectives. Health workers felt there were significant gaps in men’s engagement with HIV care and identified masculine gender norms, the persistent impact of HIV stigma, and the competing priorities of employment as key barriers. They also highlighted a number of health service-related challenges, including a poor perception of the patient–provider relationship, frustration at low service quality, and unrealistic expectations of the health services. Health workers also described several strategies for more effectively engaging men and for making the health services both more male friendly and more people friendly.
From Enrolment Rates to Collaborative Knowledge Production: A Critique to the Internationalization of Higher Education in Canada
Authors: Heringer Rebeca
Published: June 2020

Although not a new phenomenon, the evolvement, range and characteristics of the modern process of internationalization are worthy of attention. Despite many potential benefits of having a multicultural campus, internationalizing higher education requires more than the physical presence of international students. As stated on the literature, this process must value transnational knowledge as an asset to the educational experience, thus promoting collaborative knowledge production between teachers and students. Nonetheless, there is a paucity of studies done from the point of view of educators depicting how they perceive their graduate international students and internationalization itself. Therefore, through the perspectives of 10 professors at a mid-sized western Canadian university, this critical phenomenological research offers an analysis of the present condition of higher education in Canada. More specifically, this paper deconstructs some of the challenges of internationalization, in which graduates are to be recognized as active agents of circulation and production of knowledge and not just mere figures or passive recipients of information. Finally, questions about the complexity of incorporating epistemic diversity in a meaningful way through internationalization are proposed.
The Ophthalmology Chief Resident: Does Surgical Volume Correlate With Likelihood of Selection?
Authors: Richards Nikisha Q , Osardu Reginald K
Published: June 2020

Purpose:

Investigate whether number of logged Accreditation Council for Graduate Medical Education (ACGME) surgical cases correlates with likelihood of Virginia Commonwealth University Health System (VCUHS) ophthalmology residents being selected as the chief resident.

Design:

Retrospective study.

Participants:

VCUHS ophthalmology residents from 2006 to 2016.

Methods:

Analyze association between chief resident selection and logged cases.

Main outcome measures:

Review number of archived logged ACGME surgical cases of all residents between the years 2006 and 2017. Review chief resident selected each year 2006-2016.

Results:

Our analysis correctly predicted the chief resident in 2 of the 10 years analyzed.

Conclusion:

Those residents performing the most surgical procedures in each respective class were not more likely to be selected as chief resident.
Risk factors for women’s non-utilization of decentralized primary health care facilities for postnatal care in rural western Ethiopia
Authors: Tolera Habtamu , Gebre-Egziabher Tegegne , Kloos Helmut
Published: June 2020

Objective:

Evidence suggests postnatal care contributes to reductions in maternal mortality. In Ethiopia, the proportion of women who do not utilize postnatal care after birth is high and the frequency of postnatal checks falls short of the four visits recommended by World Health Organization. This study examined risk factors associated with non-utilization of decentralized local health facilities, namely, health posts, health centers, and a primary hospital, for postnatal care services in Gida Ayana Woreda in rural western Ethiopia.

Methods:

In this study, 454 mothers were examined for the following risk factors: kebele (the smallest administrative unit in Ethiopia) in which decentralized health care facilities were located, postnatal woman’s age, antenatal care service visit, experience of postnatal complications, knowledge of postnatal complications, knowledge of the recommended number of postnatal care visits, knowledge of the availability/provision of postnatal care, and health extension workers’ home visits. Bivariate and multivariable logistic regression analyses were applied to identify predictors of non-utilization of decentralized local facilities for postnatal care services.

Results:

Over half (55.7%) of the women did not utilize postnatal care within 42 days of delivery, and only 10.0% utilized the care considered appropriate according to World Health Organization guidelines. After adjusting for various potential confounding factors, we found the following risks to be strongly associated with non-utilization of decentralized health care facilities for postnatal care services: some outer rural administrative decentralization entities such as Angar, Lalistu, and Ejere kebeles; age 35 years or older (adjusted odds ratio = 3.4, 95% confidence interval: 1.4–8.3), not receiving antenatal care during this pregnancy (adjusted odds ratio = 2.0, 95% confidence interval: 1.1–3.7), no experience of any postnatal complications (adjusted odds ratio = 3.3, 95% confidence interval: 1.7–6.4), and no knowledge of at least one postnatal complication (adjusted odds ratio = 2.0, 95% confidence interval: 1.2–3.3). Risk factors highly but less strongly associated with women’s non-utilization of postnatal care services were no knowledge of the standard number of postnatal care visits recommended, no knowledge about the availability/provision of services at a local health facility, and no home visit from health extension worker by day 3 post-delivery.

Conclusion:

The risk factors for women’s non-utilization of decentralized health care facilities for postnatal care identified in this study need to be considered in interventions for enhancing the utilization of the service and reducing maternal and newborn deaths in rural western Ethiopia. Strengthening of postnatal care services, especially in the more remote kebeles, should include upgrading of the referral system and expansion of counseling of women by health extension workers.
How I treat relapsed acute lymphoblastic leukemia in the pediatric population
Authors: Hunger Stephen P. , Raetz Elizabeth A.
Published: June 2020

Relapsed acute lymphoblastic leukemia (ALL) has remained challenging to treat in children, with survival rates lagging well behind those observed at initial diagnosis. Although there have been some improvements in outcomes over the past few decades, only ∼50% of children with first relapse of ALL survive long term, and outcomes are much worse with second or later relapses. Recurrences that occur within 3 years of diagnosis and any T-ALL relapses are particularly difficult to salvage. Until recently, treatment options were limited to intensive cytotoxic chemotherapy with or without site-directed radiotherapy and allogeneic hematopoietic stem cell transplantation (HSCT). In the past decade, several promising immunotherapeutics have been developed, changing the treatment landscape for children with relapsed ALL. Current research in this field is focusing on how to best incorporate immunotherapeutics into salvage regimens and investigate long-term survival and side effects, and when these might replace HSCT. As more knowledge is gained about the biology of relapse through comprehensive genomic profiling, incorporation of molecularly targeted therapies is another area of active investigation. These advances in treatment offer real promise for less toxic and more effective therapy for children with relapsed ALL, and we present several cases highlighting contemporary treatment decision-making.
High-flow nasal cannula improves clinical efficacy of airway management in patients undergoing awake craniotomy
Authors: Yi Ping , Li Qiong , Yang Zhoujing , Cao Li , Hu Xiaobing , Gu Huahua
Published: June 2020

Background

Awake craniotomy requires specific sedation procedure in an awake patient who should be able to cooperate during the intraoperative neurological assessment. Currently, limited number of literatures on the application of high-flow nasal cannula (HFNC) in the anesthetic management for awake craniotomy has been reported. Hence, we carried out a prospective study to assess the safety and efficacy of humidified high-flow nasal cannula (HFNC) airway management in the patients undergoing awake craniotomy.

Methods

Sixty-five patients who underwent awake craniotomy were randomly assigned to use HFNC with oxygen flow rate at 40 L/min or 60 L/min, or nasopharynx airway (NPA) device in the anesthetic management. Data regarding airway management, intraoperative blood gas analysis, intracranial pressure, gastric antral volume, and adverse events were collected and analyzed.

Results

Patients using HFNC with oxygen flow rate at 40 or 60 L/min presented less airway obstruction and injuries. Patients with HFNC 60 L/min maintained longer awake time than the patients with NPA. While the intraoperative PaO2and SPO2were not significantly different between the HFNC and NPA groups, HFNC patients achieved higher PaO2/FiO2than patients with NPA. There were no differences in Brain Relaxation Score and gastric antral volume among the three groups as well as before and after operation in any of the three groups.

Conclusion

HFNC was safe and effective for the patients during awake craniotomy.

Trial registration

Chinese Clinical Trial Registry,CHiCTR1800016621. Date of Registration: 12 June 2018.
Mental health of postgraduate trainees in primary care: a cross-sectional study
Authors: Bugaj Till J. , Krug Katja , Rentschler Annalena , Nikendei Christoph , Szecsenyi Joachim , Schwill Simon
Published: June 2020

Background

General Practitioners (GPs) are increasingly affected by stress-related complaints and burnout. Although many studies have addressed this issue, little is known about the stress burden and burnout rates of postgraduate trainees specialising in General Practice (GP). This cross-sectional study was performed to explore the prevalence and risk of depression, stress and burnout in a large cohort of GP trainees.

Methods

All GP trainees enrolled in the postgraduate training programme KWBW Verbundweiterbildungplus© in southwest Germany were invited to participate. A paper-based survey for the purpose of psychosocial screening was used: Prevalence of depression, perceived stress and burnout were measured with the depression module of the Patient Health Questionnaire (PHQ-9), Perceived Stress Questionnaire (PSQ-20) and Maslach Burnout Inventory (MBI). Additionally, linear regression models were used to analyse the association between sociodemographic characteristics and mental health scales.

Results

N = 211 GP trainees participated in this study (response rate 95%). 75.3% (n = 159) of the participants were female and median age was 34 (IQR 32; 39). GP trainees had a mean PHQ-9 sum score of 5.4 (SD 3.4). Almost 11% (n = 23) reported symptoms of a moderate or moderately severe depression. PSQ-20 revealed moderate level of distress, whereas 20.8% (n = 42) showed a high level of perceived stress with a sum-score higher than .59. GP trainees showed moderate rates of burnout and only 2.5% (n = 5) scored high in all three dimensions of the MBI score. GP trainees showed increased levels of depression, perceived stress and burnout when compared with age-matched general population. Being a woman led to a higher PHQ-9 sum score (p < .05). Higher age was associated with less depersonalisation in the MBI (p < .05).

Conclusions

The results of our study suggest that GP trainees considerably suffer from stress. Some GP trainees were even affected by depression or burnout. To detect and support colleagues at risk, trainees should be supported by early preventive measures such as anti-stress or resilience trainings and mentoring during their training. Prospective longitudinal studies are needed to understand the character and the course of the stress burden among GP trainees.
Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke
Authors: Ha Sang Hee , Kim Yeon-Jung , Heo Sung Hyuk , Chang Dae-il , Kim Bum Joon
Published: June 2020

Background

Deep vein thrombosis (DVT) is an important complication of ischemic stroke, although the incidence of DVT is regarded as being lower in Asian than in non-Asian patients. Here, we investigated the incidence and factors associated with DVT in Asian patients with ischemic stroke.

Methods

Acute ischemic stroke patients received lower extremity ultrasonography (LEUS) to diagnose the presence of DVT. Clinical characteristics and laboratory results, including D-dimer level, were compared between patients with and without DVT. Independent risk factors for DVT were investigated using multivariable analysis. Similar analysis was performed to identify factors associated with elevated D-dimer level (> 0.5 mg/dl) in acute ischemic stroke patients.

Results

During the study period, 289 patients were enrolled, and 38 (13.1%) showed DVT. Female sex (OR = 2.579, 95% CI = 1.224–5.432; p = 0.013) and a high National Institutes of Health Stroke Scale (NIHSS) score (OR = 1.191 95% CI = 1.095–1.294; p = 0.005) were independently associated with the presence of DVT, although D-dimer level was not. Stroke mechanism, especially cardioembolic stroke (OR = 3.777, 95% CI = 1.532–9.313; p = 0.004; reference: large artery atherosclerosis), NIHSS score (OR = 1.087, 95% CI = 1.002–1.179; p = 0.001) and thrombolysis (OR = 12.360, 95% CI 2.456–62.213; p = 0.002) were independently associated with elevated abnormal D-dimer levels.

Conclusion

The severity of ischemic stroke, but not the D-dimer level, was associated with the presence of DVT in Asian ischemic stroke patients. D-dimer level was influenced by the stroke mechanism. LEUS in patients with severe neurological deficit, rather than screening with D-dimer, may be more beneficial for diagnosing DVT in Asian patients with acute ischemic stroke.
Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: A retrospective study
Authors: Wang Chenggong , Xu Can , Li Mingqing , Li Hui , Xiao Han , Zhong Da , Liu Hua
Published: June 2020

Background

Traditional methods for minimally invasive internal fixation (MIIF) of calcaneal fractures require extensive intraoperative fluoroscopy, and fracture recovery is usually not ideal. We developed a new surgical procedure using digital surgical simulation and constructed a patient-specific instrument (PSI) for calcaneal fracture that we used during the operation. This study investigated whether PSI-assisted MIIF of calcaneal fracture enables rapid and accurate execution of the preoperative plan.

Methods

We retrospectively analyzed patients with Sanders type III or IV fresh calcaneal fractures who had undergone PSI-assisted MIIF at our hospital from January 2016 to December 2018. We analyzed perioperative data including intraoperative fluoroscopy time, concurrence of internal fixation actual usage (IFAU) with the preoperative plan, surgery time, and complications. We also compared pre- and postoperative actual measurements from X-ray radiographs and computed tomography images including Böhler, Gissane, and calcaneus valgus angles; subtalar joint width; and calcaneal volume overlap ratio with the preoperative design. All patients had been followed up and their American Orthopedic Foot and Ankle Score (AOFAS) score was available.

Results

Mean intraoperative fluoroscopy time was 3.95 ± 1.78 h; IFAU in 16 patients (16 ft) was the same as the preoperative plan; mean surgery time was 28.16 ± 10.70 min; and none of the patients developed complications. Böhler, Gissane, and calcaneus valgus angles and subtalar joint width did not differ between pre- and postoperative plans; however, the actual preoperative values of each of these parameters differed significantly from those measured postoperatively. The calcaneal volume overlap ratio with the preoperative design was 91.2% ± 2.3%. AOFAS scores increased with time, with significant differences in the score at each time point.

Conclusions

The newly developed PSI-assisted calcaneal fracture MIIF method can rapidly and accurately execute the preoperative plan.
Patterns of recurrence in adenocarcinoma of the esophagogastric junction: a retrospective study
Authors: Xu Haitao , Zhang Lianguo , Miao Jing , Liu Shuai , Liu Hongjian , Jia Teng , Zhang Qingguang
Published: June 2020

Background

The prognosis of adenocarcinoma of the esophagogastric junction (AEG) is poor. Understanding the postoperative recurrence pattern of AEG is helpful to verify the effectiveness of treatment and optimize subsequent treatment, so as to improve prognosis.

Methods

This single-center retrospective study included patients with stage III AEG who underwent surgical treatment between January 2009 and December 2016. According to the different postoperative treatment arm, patients were divided into surgery and surgery plus chemotherapy groups. Recurrence-free survival was used as the outcome to compare the recurrence site and pattern between the groups.

Results

In total, were 306 patients enrolled, 123 in the surgery group and 183 in the surgery plus chemotherapy group. During follow-up (median 17.1 months) of 24 months after surgery, 62.0% of patients had tumor recurrence. The overall recurrence rates in the surgery and surgery plus chemotherapy groups were 86.9% and 77.0%, respectively. The recurrence patterns of both groups were mainly distant metastasis. Postoperative chemotherapy reduced the incidence of hematogenous dissemination from 51.2 to 42.0%. Multivariate Cox analysis showed that the pN stage increased the risk of recurrence, while surgery plus chemotherapy reduced the risk.

Conclusions

Patients with AEG have a risk of hematogenous dissemination after surgery. Postoperative treatment arm and pN stage were independent risk factors in patients with AEG. Surgery plus chemotherapy can improve recurrence-free survival and reduce distant metastasis, but they do not have a beneficial role in controlling local recurrence.
The importance of social factors in the association between physical activity and depression in children
Authors: Conley May I. , Hindley Isabella , Baskin-Sommers Arielle , Gee Dylan G. , Casey B. J. , Rosenberg Monica D.
Published: June 2020

Background

Physical activity is associated with reduced depression in youth and adults. However, our understanding of how different aspects of youth activities—specifically, the degree to which they are social, team-oriented, and physical—relate to mental health in children is less clear.

Methods

Here we use a data-driven approach to characterize the degree to which physical and non-physical youth activities are social and team-oriented. We then examine the relationship between depressive symptoms and participation in different clusters of youth activities using mixed effect models and causal mediation analyses in 11,875 children from the Adolescent Brain Cognitive Development (ABCD) Study. We test our hypotheses in an original sample (n = 4520, NDA release 1.1) and replication sample of participants (n = 7355, NDA release 2.0.1).

Results

We show and replicate that social–physical activities are associated with lower depressive symptoms. Next, we demonstrate that social connections, measured by number of close friends, partially mediate the association between social–physical activities and lower depressive symptoms.

Conclusions

Our results provide a rubric for using data-driven techniques to investigate different aspects of youth activities and highlight the social dynamics of physical activities as a possible protective factor against depression in childhood.
Antithyroid drugs and birth defects
Authors: Andersen Stine Linding , Andersen Stig
Published: June 2020

Antithyroid drugs (ATDs) are preferred for the treatment of hyperthyroidism caused by Graves’ disease in pregnant women. The drugs have been a recognized treatment for decades, and a general risk of side effects is known. For the use of ATDs in pregnancy, a concern about teratogenic side effects has been brought forward since the 1970s. In more recent years, a number of large observational studies have added new evidence and quantified the risk of birth defects associated with different types of ATDs. The findings that both Methimazole (MMI) and Propylthiouracil (PTU) are associated with birth defects have challenged the clinical recommendations on the treatment of hyperthyroidism in pregnancy, and certain aspects remain unclarified. In this review, the current evidence on the risk of birth defects associated with the use of ATDs in early pregnancy is described, and determinants of causality are discussed. This includes the current evidence of a biological gradient and the role of maternal thyroid function per se. Finally, clinical aspects of the timing and type of treatment is discussed, and future perspectives are addressed. Current evidence corroborates a risk of birth defects associated with MMI while more evidence is needed to determine the teratogenic potential of PTU. Detailed assessment of type and timing of exposure in large cohorts are needed. Moreover, studies investigating alternative or new treatments are warranted.
Identifying epigenetic biomarkers of established prognostic factors and survival in a clinical cohort of individuals with oropharyngeal cancer
Authors: Langdon Ryan , Richmond Rebecca , Elliott Hannah R. , Dudding Tom , Kazmi Nabila , Penfold Chris , Ingarfield Kate , Ho Karen , Bretherick Andrew , Haley Chris , Zeng Yanni , Walker Rosie M. , Pawlita Michael , Waterboer Tim , Gaunt Tom , Smith George Davey , Suderman Matthew , Thomas Steve , Ness Andy , Relton Caroline
Published: June 2020

Background

Smoking status, alcohol consumption and HPV infection (acquired through sexual activity) are the predominant risk factors for oropharyngeal cancer and are thought to alter the prognosis of the disease. Here, we conducted single-site and differentially methylated region (DMR) epigenome-wide association studies (EWAS) of these factors, in addition to ∼ 3-year survival, using Illumina Methylation EPIC DNA methylation profiles from whole blood in 409 individuals as part of the Head and Neck 5000 (HN5000) study. Overlapping sites between each factor and survival were then assessed using two-step Mendelian randomization to assess whether methylation at these positions causally affected survival.

Results

Using the MethylationEPIC array in an OPC dataset, we found novel CpG associations with smoking, alcohol consumption and ~ 3-year survival. We found no CpG associations below our multiple testing threshold associated with HPV16 E6 serological response (used as a proxy for HPV infection). CpG site associations below our multiple-testing threshold (PBonferroni< 0.05) for both a prognostic factor and survival were observed at four gene regions:SPEG(smoking),GFI1(smoking),PPT2(smoking) andKHDC3L(alcohol consumption). Evidence for a causal effect of DNA methylation on survival was only observed in theSPEGgene region (HR per SD increase in methylation score 1.28, 95% CI 1.14 to 1.43,P2.12 × 10−05).

Conclusions

Part of the effect of smoking on survival in those with oropharyngeal cancer may be mediated by methylation at theSPEGgene locus. Replication in data from independent datasets and data from HN5000 with longer follow-up times is needed to confirm these findings.
Bone up on spinal osseous lesions: a case review series
Authors: Nguyen Trinh T. , Thelen Jarett C. , Bhatt Alok A.
Published: June 2020

Spinal osseous neoplasms are frequently encountered and can be challenging when present as solitary lesions. Familiarity with the range of benign and malignant spinal pathology can help the radiologist formulate a comprehensive differential diagnosis. This article focuses on the spectrum of extradural spinal tumors, accounting for the majority of primary spinal tumors, by comparing the epidemiology, pathophysiology, clinical presentation, and characteristic imaging appearance of these lesions. The discussion includes the commonly encountered benign lesions, such as vertebral venous vascular malformation and enostosis, as well as malignant lesions including metastases and lymphoma. The article also includes other less-encountered primary spinal tumors such as plasmacytoma, osteoid osteoma, osteoblastoma, giant cell tumor, eosinophilic granuloma, chordoma, chondrosarcoma, osteosarcoma, Ewing’s sarcoma, and angiosarcoma. Familiarity with the characteristic imaging features can help the radiologist reach an accurate diagnosis and obviate the need for unnecessary invasive procedures such as biopsy and surgery.
Unfractionated heparin displaces sFlt-1 from the placental extracellular matrix
Authors: Moore Kyle H. , Chapman Heather , George Eric M.
Published: June 2020

Soluble vascular endothelial growth factor receptor-1 (sFlt-1) is an anti-angiogenic protein which is secreted by numerous cell types and acts as a decoy receptor for the angiogenic protein vascular endothelial growth factor (VEGF). Despite its physiologic importance in maintaining angiogenic balance, excess sFlt-1 levels are associated with the pathogenesis of many diseases, especially those with angiogenic imbalance, endothelial dysfunction, and hypertension. Although sFlt-1 is a soluble protein, it contains a binding site for the extracellular matrix component heparan sulfate. This allows cells to retain and localize sFlt-1 in order to prevent excessive VEGF signaling. During pregnancy, placental syncytiotrophoblasts develop a large extracellular matrix which contains significant amounts of heparan sulfate. Consequently, the placenta becomes a potential storage site for large amounts of sFlt-1 bound to extracellular heparan sulfate. Additionally, it should be noted that sFlt-1 can bind to the anticoagulant unfractionated heparin due to its molecular mimicry to heparan sulfate. However, it remains unknown whether unfractionated heparin can compete with heparan sulfate for binding of localized sFlt-1. In this study, we hypothesized that administration of unfractionated heparin would displace and solubilize placental extracellular matrix(ECM)-bound sFlt-1. If unfractionated heparin can displace this large reservoir of sFlt-1 in the placenta and mobilized it into the maternal circulation, we should be able to observe its effects on maternal angiogenic balance and blood pressure. To test this hypothesis, we utilized in vitro, ex vivo, and in vivo methods. Using the BeWo placental trophoblast cell line, we observed increased sFlt-1 in the media of cells treated with unfractionated heparin compared to controls. The increase in media sFlt-1 was found in conjunction with decreased localized cellular Flt (sFlt-1 and Flt-1) as measured by total cell fluorescence. Similar results were observed using ex vivo placental villous explants treated with unfractionated heparin. Real-time quantitative PCR of the explants showed no change in sFlt-1 or heparanase-1 mRNA expression, eliminating increased production and enzymatic cleavage of heparan sulfate as causes for sFlt-1 media increase. Timed-pregnant rats given a continuous infusion of unfractionated heparin exhibited an increased mean arterial pressure as well as decreased bioavailable VEGF compared to vehicle-treated animals. These data demonstrate that chronic unfractionated heparin treatment is able to displace matrix-bound sFlt-1 into the maternal circulation to such a degree that mean arterial pressure is significantly affected. Here we have shown that the placental ECM is a storage site for large quantities of sFlt-1, and that it should be carefully considered in future studies concerning angiogenic balance in pregnancy.
Emergency department utilization by people living with HIV released from jail in the US South
Authors: Puing Alfredo G. , Li Xilong , Rich Josiah , Nijhawan Ank E.
Published: June 2020

Background

Incarceration is disruptive to HIV care, often resulting in poor retention in care for people living with HIV (PLWH) after jail release. This gap in HIV care might result in potentially preventable emergency department (ED) utilization. We analyzed demographic, incarceration, socioeconomic and clinical data for PLWH released from the Dallas County Jail to the community (1450 incarcerations, 1155 unique individuals) between January 2011 and November 2013.

Results

The study population consisted of predominantly men (77%), with a mean age of 39 years, 67% were black and 14% were Hispanic; half of the releasees visited the ED at least once during the first-year post-jail. In adjusted analyses, female gender, family awareness of HIV status, serious mental illness, and late engagement to HIV care were significantly associated with higher ED utilization. Compared to the general Dallas population, PLWH released from jail had a 5-fold higher proportion of ED visits classified as related to substance use or mental health.

Conclusions

Further efforts are needed to improve the transition from incarceration to community-based HIV care, substance use disorder treatment and mental health services, and to directly address re-engagement in HIV care for out-of-care PLWH who visit the ED.
A Phase 2, Multicenter Study of Nevanimibe for the Treatment of Congenital Adrenal Hyperplasia
Authors: El-Maouche Diala , Merke Deborah P , Vogiatzi Maria G , Chang Alice Y , Turcu Adina F , Joyal Elizabeth G , Lin Vivian H , Weintraub Lauren , Plaunt Marianne R , Mohideen Pharis , Auchus Richard J
Published: June 2020

Context

Patients with classic congenital adrenal hyperplasia (CAH) often require supraphysiologic glucocorticoid doses to suppress adrenocorticotropic hormone (ACTH) and control androgen excess. Nevanimibe hydrochloride (ATR-101), which selectively inhibits adrenal cortex function, might reduce androgen excess independent of ACTH and thus allow for lower glucocorticoid dosing in CAH. 17-hydroxyprogesterone (17-OHP) and androstenedione are CAH biomarkers used to monitor androgen excess.

Objective

Evaluate the efficacy and safety of nevanimibe in subjects with uncontrolled classic CAH.

Design

This was a multicenter, single-blind, dose-titration study. CAH subjects with baseline 17-OHP ≥4× the upper limit of normal (ULN) received the lowest dose of nevanimibe for 2 weeks followed by a single-blind 2-week placebo washout. Nevanimibe was gradually titrated up if the primary outcome measure (17-OHP ≤2× ULN) was not met. A total of 5 nevanimibe dose levels were possible (125, 250, 500, 750, 1000 mg twice daily).

Results

The study enrolled 10 adults: 9 completed the study, and 1 discontinued early due to a related serious adverse event. At baseline, the mean age was 30.3 ± 13.8 years, and the maintenance glucocorticoid dose, expressed as hydrocortisone equivalents, was 24.7 ± 10.4 mg/day. Two subjects met the primary endpoint, and 5 others experienced 17-OHP decreases ranging from 27% to 72% during nevanimibe treatment. The most common side effects were gastrointestinal (30%). There were no dose-related trends in adverse events.

Conclusions

Nevanimibe decreased 17-OHP levels within 2 weeks of treatment. Larger studies of longer duration are needed to further evaluate its efficacy as add-on therapy for CAH.
Disease Control and Gender Predict the Socioeconomic Effects of Acromegaly: A Nationwide Cohort Study
Authors: Dal Jakob , Nielsen Eigil H , Rasmussen Ulla-Feldt , Andersen Marianne , Feltoft Claus L , Vestergaard Peter , Stochholm Kirstine , Jørgensen Jens Otto L
Published: June 2020

Context

Acromegaly is an insidious disease associated with severe somatic morbidity but data on socioeconomic status are scarce.

Objective

To study the socioeconomic status in acromegaly in a population-based follow-up study.

Methods

All incident cases of acromegaly (n = 576) during the period 1977-2010 were included. For every patient, 100 persons were sampled from the general population matched for date of birth and gender (comparison cohort). Cox regression and hazard ratios (HR), conditional logistic regression and linear regression with 95% confidence intervals (CI) were used.

Outcome Measures

Retirement, social security benefit, annual income, cohabitation, separation, parenthood and educational level.

Results

The proportion of retired individuals was significantly higher in patients with acromegaly after the time of diagnosis (HR, 1.43; 95% CI, 1.26-1.62) and also during the 5-year pre-diagnostic period (HR, 1.15; 95% CI, 1.03-1.28). More individuals with acromegaly received social security benefit compared with the comparison cohort during the initial period after the time of diagnosis. Among patients who maintained a job, the annual income was similar to the comparison cohort. Compared with the background population, cohabitation was lower (HR, 0.69; 95% CI, 0.50-0.95) as was parenthood (HR, 0.56; 95% CI, 0.39-0.80), whereas neither educational level (HR, 0.61; 95% CI, 0.35-1.06) nor separation (HR, 1.13; 95% CI, 0.86-1.47) were different. Female gender and insufficient disease control were associated with a significantly worse socioeconomic status.

Conclusions

1) Socioeconomic status is impaired in patients with acromegaly even before a diagnosis of acromegaly. 2) Females and patients without disease remission have worse outcomes. 3) Early diagnosis and effective treatment of acromegaly could be important factors in mitigating the negative impact on socioeconomic factors.
TBR-760, a Dopamine-Somatostatin Compound, Arrests Growth of Aggressive Nonfunctioning Pituitary Adenomas in Mice
Authors: Halem Heather A , Hochgeschwender Ute , Rih Jeong Keun , Nelson Richard , Johnson G Allan , Thiagalingam Arunthi , Culler Michael D
Published: June 2020

TBR-760 (formerly BIM-23A760) is a chimeric dopamine (DA)-somatostatin (SST) compound with potent agonist activity at both DA type 2 (D2R) and SST type 2 (SSTR2) receptors. Studies have shown that chimeric DA-SST compounds are more efficacious than individual DA and/or SST analogues, either alone or combined, in inhibiting secretion from primary cultures of human somatotroph and lactotroph tumor cells. Nonfunctioning pituitary adenomas (NFPAs) express both D2R and SSTR2 and, consequently, may respond to TBR-760. We used a mouse model with the pro-opiomelanocortin (POMC) gene knocked out that spontaneously develops aggressive NFPAs. Genomic microarray and DA and SST receptor messenger RNA expression analysis indicate that POMC KO mouse tumors and human NFPAs have similar expression profiles, despite arising from different cell lineages, establishing POMC KO mice as a model for study of NFPAs. Treatment with TBR-760 for 8 weeks resulted in nearly complete inhibition of established tumor growth, whereas tumors from vehicle-treated mice increased in size by 890 ± 0.7%. Comparing TBR-760 with its individual DA and SST components, TBR-760 arrested tumor growth. Treatment with equimolar or 10×-higher doses of the individual SST or DA agonists, either alone or in combination, had no significant effect. One exception was the lower dose of DA agonist that induced modest suppression of tumor growth. Only the chimeric compound TBR-760 arrested tumor growth in this mouse model of NFPA. Further, significant tumor shrinkage was observed in 20% of the mice treated with TBR-760. These results support the development of TBR-760 as a therapy for patients with NFPA.
Reversible Human
Authors: Ahuja Neel
Published: June 2020

This article explores the history and practice of rectal feeding, an anachronistic obstetric practice used recently as a form of medical rape in US Central Intelligence Agency prisons. The article outlines how racialized themes of counterterrorist interrogation intersect with behavioralist logics of torture in CIA uses of rectal feeding on Muslim prisoners captured in Pakistan and Afghanistan, linking these prisoners to US security state fears of domestic Black Muslims. Exploring how fantasies of the plastic reorientation of prisoners’ bodies and minds frames state conceptions of rectal feeding and other forms of torture, the article further argues that understanding the racialization of Islam in the current wars requires analysis of the racial materiality of interventions that exploit the plastic potentials of the body.
Plasticity and Fungibility
Authors: Hantel Max
Published: June 2020

This article critically examines the role of neurobiology in the work of Sylvia Wynter through her own “pieza framework.” Wynter argues that the pieza, the figure of exchange invented at the beginning of the slave trade, haunts contemporary political economy through multiple forms of human fungibility. Reading this intervention alongside and against her deployment of neural plasticity, the author reconsiders the relationship between race, gender, and class in the field of Wynter studies and argues for recentering the pieza framework in struggles against racial capitalism. Wynter warns how quickly a vision of the world otherwise can become a source of neoliberal regeneration and how a new critique of political economy must begin with the ruthless rejection of fungibility in its many guises.
Embodied Social Cognition and Comparative Literature
Authors: Zunshine Lisa
Published: June 2020

There is a growing sense among scholars working in cognitive literary studies that their assumptions and methodologies increasingly align them with another paradigmatically interdisciplinary field: comparative literature. This introduction to the special issue on cognitive approaches to comparative literature explores points of alignment between the two fields, outlining possible cognitivist interventions into debates that have been animating comparative literature, such as those concerning “universals,” politics of translatability (especially in the context of world literature), and practices of thinking across the boundaries of media. It discusses both fields’ indebtedness to cultural studies, as well as cognitive literary theorists’ commitment to historicizing and their sustained focus on the embodied social mind.
Narrative Universals, Emotion, and Ethics
Authors: Hogan Patrick Colm
Published: June 2020

Some recent writers on ethics, prominently Jonathan Haidt, have seen emotion and narrative as central to moral judgment and behavior. However, much of this work is not clear about the precise nature of emotion and narrative or the relation of the two to each other and to ethics. Research in distinct narrative traditions — a form of comparative literary study — offers a possible solution. The author has argued that a number of prototype-based story structures recur across a broad range of genetically and areally distinct traditions. These structures derive from emotion systems and general principles of emotion modulation and involve ideals that are both hedonic and ethical. We may better understand the complex relations among narrative, emotion, and morality in terms of these story universals, their sources in emotion systems, and their associated ideals, which collectively predict a range of ethical responses to any given situation. In addition, even the usual ethical orientations of emotions and prototypes may be altered through the particularization of stories. In this way, emotional response and initial emplotment bias ethical response and evaluation, but the former do not simply determine the latter. The author illustrates these points by the sometimes surprising similarities relating European, Chinese, and Indian works.
Measuring the Stomach of a Gentleman with the Heart-Mind of a Pipsqueak
Authors: Lee Haiyan
Published: June 2020

This article seeks to historicize the affinity between narrative fiction and the cognitive function known as theory of mind. The author believes this affinity holds true mostly in modern commercial societies structured by stranger sociality, cosmopolitanism, and social mobility. Elsewhere, both temporally and culturally, theory of mind is certainly present and useful but not always prized in social life and does not animate expressive culture to the same extent. Such societies are structured by kinship sociality that presumes relatively stable identity and valorizes guileless “characters” who effortlessly embody socially shared values. The hierarchical structures of these societies also place a greater premium on theory of mind for subordinates than for the powerful, hence attaching a tinge of opprobrium to its exercise. In literature this translates into the moral ambivalence concerning “crafty” figures. The author presents her arguments with reference primarily to premodern Chinese literary classics. For comparative purposes she also brings into discussion the Sanskrit play Shakuntala and a King Solomon legend. In the coda, she asks if the importance of theory of mind is overstated when in social life we resort to a much wider range of folk psychological heuristics.
Who Is He to Speak of My Sorrow?
Authors: Zunshine Lisa
Published: June 2020

This article suggests that comparative literature scholars may benefit from the awareness that different communities around the world subscribe to different models of mind and that works of fiction can thus be fruitfully analyzed in relation to those local ideologies of mind. Taking as her starting point the “opacity of mind” doctrine, found in the South Pacific and Melanesia, the author compares cultural practices originating in communities in which people think but do not talk publicly about others’ internal states, to those originating in communities in which people both think and talk about them, indeed, in which public speculation about other people’s intentions is (mostly) rewarded. While the immediate analysis centers on a very specific and limited set of case studies from English, Chinese, and Russian novels and Bosavi performance genres, the author’s larger goal is to begin to articulate opportunities and challenges of using research in theory of mind for the comparative study of literature.
Coming of Age with Anne Moody
Authors: Boisseau Tracey Jean
Published: June 2020

This essay offers a close reading of Anne Moody’s widely read but under-theorized memoir of the civil rights movement, Coming of Age in Mississippi (1968). This essay’s focus mirrors a main focus in Moody’s narrative: her relationship with her mother. Much of the body of literary criticism, as well as historical writings dealing with African American mother-daughter conflict, centers on the observation that Black mothers have often found themselves in conflict with daughters whom they seek to protect by schooling them in accommodationist behavior to better survive in the face of white racism and violence. To strand the analysis there, however, leaves one unable to understand the historically specific nature of the acute generational conflict between Moody and her mother and leaves one without structural explanation for young people’s unprecedented involvement in the 1950s–1960s civil rights movement. This article explores Anne Moody’s daughterly point of view as expressed in her writing to understand why and how Anne was able to develop a distinct sense of self and consciousness, one that alienated her from her mother and laid the groundwork for her activist leadership as well as that of her generational cohort.
Harvesting Hope
Authors: Sierra Becerra Diana Carolina
Published: June 2020

This 2018 report reviews the organizing model of the Pioneer Valley Workers Center (PVWC), an organization based in Western Massachusetts that builds the collective power of immigrants and workers. It illustrates how the PVWC practices participatory democracy and solidarity. The report also discusses the challenges facing its organizational structures and campaigns, including its Worker Committees, a decision-making body composed mainly of immigrant workers; Sanctuary in the Streets, a rapid response network against workplace abuse, the deportation apparatus, and hate crimes; and an ongoing campaign in solidarity with Lucio Peréz, an undocumented Guatemalan man who defied deportation and took sanctuary at a local congregation.
Impact of supervised exercise training on pulmonary function parameters, exercise capacity and Irisin Biomarker in Interstitial lung disease patients
Authors: Alyami Rahma Mohammad , Alhwaikan Abdulrahman Mohammed , Alharbi Abdullah Rashed , AL-Nafisah Ghada
Published: June 2020

Objectives: To assess the impact of supervised exercise training (SET) on pulmonary function Parameters, exercise capacity and Irisin biomarker in Interstitial Lung Disease (ILD) patients.

Methods: Ten (10) patients with ILD and 18 healthy controls of age between 30-40+ years were selected for 8-weekSET program. Before and after SET all subjects performedexercise capacity six minutes’ walk test (6MWT), heart rate (HR) changes were recorded, shortness of Breath Respiratory Questionnaire (SOBQ) was obtained and Irisin levels were measuredby Enzyme-Linked Immunosorbent Assay (ELISA).This interventional study was carried out atDepartment of Physiology, Faculty of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, from October 2018 to February 2019.

Results: Mean six minutes’ walk distance (6MWD) was 395±68.4 m at 1st visit increased significantly (p=0.001) to 458.8±87.1 mat 15 visit. However, 6MWD values found significantly higher in controls (517.4±84.1 m; 561.7±81.6 m; p=0.013) thanILD patients. Overall change (difference between post and pre exercise) in HRvalue was recorded lower in ILD patients (30-35 bpm) as compared to controls (40-45 bpm). Moreover, ILD patients had overall higher SOBQ score than controls. Pre SET Irisin levelsofILD patients (4.24 ± 1.73 pg/ml) and controls (3.43±1.04pg/ml) werefound unchangedafter SET (4.48±2.02pg/ml, 3.39 ±1.41pg/ml,p=0.677, p=0.093) respectively. However, patients Irisin values were foundhigher as compared to controls before and after SET.

Conclusion: Exercise capacity and Dyspneain patients with ILD were improved after 8-week of SET program. No major changes in Irisin levels among patients with ILD and controls were observed. Additional research requires to be carried out on large number of subjects to deterMinutese the advantages of exercise in ILD.

doi: https://doi.org/10.12669/pjms.36.5.1795

How to cite this:Alyami RM, Alhwaikan AM, Alharbi AR, AL-Nafisah G. Impact of supervised exercise training on pulmonary function parameters, exercise capacity and Irisin Biomarker in Interstitial lung disease patients. Pak J Med Sci. 2020;36(5):1089-1095.  doi: https://doi.org/10.12669/pjms.36.5.1795

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