bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Trustworthiness on the Usage of M-banking Apps: A Study on Bangladeshi Consumers
Authors: Khan Md. Rahat , Rana Sudhir , Hosen Md. Imran
Published: April 2021

The objective of this study is to find out the impact of trustworthiness on the usage of mobile banking (M-banking) apps in the capital city of Bangladesh. A structured questionnaire was distributed using the snowball sampling technique. Confirmatory factor analyses and structural equation modeling (using SPSS Statistics 20.0 and AMOS 26.0) were used on 362 responses found suitable for the study. The analytical results reveal that all three components of trustworthiness (ability, benevolence, and integrity) have a positive impact on M-banking app usage. Although banks have realized the importance of consumer convenience, they struggle to create trustworthiness. Thus, this study showcases that this positive trustworthiness amongst M-banking app users would be helpful in enhancing the usage of apps.
An Examination of the Link between Leader Motivating Language and Follower Interactional Justice
Authors: Alikaj Albi , Hanke Doreen
Published: April 2021

The study examines the relationship between leaders’ use of motivating language and their workers’ perceived interactional justice, that is, interpersonal and informational justice. The study also examines the influence of workers’ levels of power distance and uncertainty avoidance orientations on these relationships. We test the proposed model by conducting structural equation modeling using data from a sample of 505 participants. The findings show a positive relationship between leaders’ use of motivating language and their workers’ perceived interpersonal and informational justice. Furthermore, the study confirms our hypotheses that workers’ power distance orientation negatively moderates the relationship between leaders’ use of motivating language and workers’ perceived interpersonal justice and that workers’ uncertainty avoidance orientation negatively moderates the relationship between leaders’ use of motivating language and workers’ perceived informational justice.
Introduction to Special Topic: Rural Education Finance and Policy
Authors: Stoddard Christiana , Toma Eugenia F.
Published: April 2021

This special topic takes stock of the current state of rural education finance and policy research. Taken together the articles in this special topic highlight a major point. Rural districts and schools not only differ from those in urban areas but also differ from one another. This is perhaps not surprising given the heterogeneity of school size, community size, demographics, and the degree of rurality of schools across the United States. The articles pose a challenge for policymakers. Policies that serve one state or one rural community may not be relevant or helpful to another. Policy solutions must recognize the diversity of education challenges across and within states.
Root Coverage Predictability in the Treatment of Gingival Recessions on Mandibular Anterior Teeth
Authors: Agusto M. , Salman A. , Parker D. , Choi D. , Schincaglia G.P.
Published: April 2021

Introduction:

Mandibular anterior teeth are most frequently affected by gingival recession. However, data regarding mucogingival treatment aimed at root coverage in this specific location are limited.

Objective:

The purpose of this study was to systematically review the scientific literature and to use the meta-analytic approach to address the following focused question: “What is the effectiveness of different surgical approaches on clinical and patient-related outcomes in the treatment of buccal gingival recessions on mandibular anterior teeth?”

Methods:

Studies were located by searching 3 electronic databases (Medline, Scopus, and Cochrane databases) and cross-referencing. Randomized and nonrandomized studies including at least 1 arm involving the use of pedicle flaps and/or free soft tissue grafts in the treatment of gingival recessions (recession type [RT] 1 and RT2) located on the buccal aspects of mandibular centrals, laterals and canines, were included in the analysis. Primary outcome was mean root coverage (mRC), expressed in percentage, based on a 3- to 12-mo follow-up observation. A Bayesian single-arm network meta-analysis was performed to identify a treatment hierarchy of the different surgical techniques.

Results:

Sixteen studies, with a total of 23 arms, were included in the quantitative analysis. The greatest mRC is associated with laterally positioned flap (LPF) + connective tissue graft (CTG) (91.2%) and tunnel (TUN) + CTG (89.4%), whereas LPF alone, coronally advanced flap (CAF) + CTG, and free gingival graft (FGG) showed lower mRC (79.1%, 78.9%, and 68.5% respectively). TUN + CTG provides significantly greater mRC compared to CAF+CTG. No difference among the procedures could be observed in terms of keratinized tissue width gain.

Conclusions:

Treatment hierarchy generated by an arm-based network meta-analysis model suggested that tunnel and laterally positioned flap, both in combination with connective tissue graft, may provide the greatest mean root coverage in the treatment of mandibular anterior recessions.

Knowledge Transfer Statement:

The results of the present systematic review can be used by clinicians when deciding which approach to adopt when treating buccal gingival recessions on mandibular anterior teeth. In particular, procedures based on a laterally positioned flap or a tunneling technique, both in combination with connective tissue graft, seem to be the most predictable therapeutic decision.
Hot and cold executive functions in the brain: A prefrontal-cingular network
Authors: Salehinejad Mohammad Ali , Ghanavati Elham , Rashid Md Harun Ar , Nitsche Michael A.
Published: April 2021

Executive functions, or cognitive control, are higher-order cognitive functions needed for adaptive goal-directed behaviours and are significantly impaired in majority of neuropsychiatric disorders. Different models and approaches are proposed for describing how executive functions are functionally organised in the brain. One popular and recently proposed organising principle of executive functions is the distinction between hot (i.e. reward or affective-related) versus cold (i.e. purely cognitive) domains of executive functions. The prefrontal cortex is traditionally linked to executive functions, but on the other hand, anterior and posterior cingulate cortices are hugely involved in executive functions as well. In this review, we first define executive functions, their domains, and the appropriate methods for studying them. Second, we discuss how hot and cold executive functions are linked to different areas of the prefrontal cortex. Next, we discuss the association of hot versus cold executive functions with the cingulate cortex, focusing on the anterior and posterior compartments. Finally, we propose a functional model for hot and cold executive function organisation in the brain with a specific focus on the fronto-cingular network. We also discuss clinical implications of hot versus cold cognition in major neuropsychiatric disorders (depression, schizophrenia, anxiety disorders, substance use disorder, attention-deficit hyperactivity disorder, and autism) and attempt to characterise their profile according to the functional dominance or manifest of hot–cold cognition. Our model proposes that the lateral prefrontal cortex along with the dorsal anterior cingulate cortex are more relevant for cold executive functions, while the medial–orbital prefrontal cortex along with the ventral anterior cingulate cortex, and the posterior cingulate cortex are more closely involved in hot executive functions. This functional distinction, however, is not absolute and depends on several factors including task features, context, and the extent to which the measured function relies on cognition and emotion or both.
Thirty states of renewability: Controversial energies and the politics of incumbent industry
Authors: Behrsin Ingrid , Knuth Sarah , Levenda Anthony
Published: April 2021

Renewable energy advocates have positioned a wide array of technologically novel energy sources as fossil fuel alternatives. These efforts to usher in renewable energy transitions have long been shaped by definitional contestations. Political ecological scholarship tells us that such definitions are meaningful. Indeed, labeling energy sources as renewable has become a power-laden act, which may spark innovation, yet simultaneously creates openings for problematic classifications and unjust socio-ecological relations. However, we still know too little about how such classification politics are taking shape within green industrial policy formation; particularly, how they encounter incumbent industries and industrial regions. In this paper, we argue that these theoretical questions are crucial for an emerging industrial political ecology and explore three recent developments in the US context. A country that has notoriously avoided open and coordinated national industrial policy, the United States has approached the renewable energy economy in a similarly geographically fragmented fashion. We highlight a central yet under-examined tool in US energy-industrial policy: the renewable portfolio standard. Mandated by 30 states, renewable portfolio standards are the US’s central mechanism for renewable energy procurement—yet renewable portfolio standards diverge substantially from state to state in terms of the energy sources they classify and incentivize as renewable. We argue that industrial interests and state governments have together capitalized upon renewable portfolio standards’ malleability to support regionally significant sectors, including “dirty” industries and industrial wastes. These industries, often controversially, thereby position themselves for rebranding and new forms of value capture.
Implementation and effectiveness of drive-through medication pick-up and home delivery services. A patient safety initiative during COVID-19 pandemic
Authors: AlAbbasi Haneen K , Thorakkattil Shabeer A , Mohiuddin Syed I , Nemr Habib S , Jabbour Rita , Al-Ghamdi Fuad
Published: April 2021

Introduction

With the emergence of the first COVID-19 case in Saudi Arabia, Johns Hopkins Aramco Healthcare has immediately executed the appropriate protocols in response to this severe global crisis. The pharmacy department at Johns Hopkins Aramco Healthcare continues to play an essential role in providing the safest, efficient, and effective service to its eligible patients. In response to the COVID-19 pandemic, the pharmacy department acted by implementing a drive-through pharmacy and home delivery services as new person-centered services to ensure patient safety. These two new services were initiated to protect both the pharmacist and the patient from COVID-19 infections as they ensure social distancing and reduce patients’ visits to the walk-in pharmacies, hence providing valuable and convenient services during this pandemic.

Objective

This article aims to describe the implementation processes and effectiveness of drive-through medication pick-up and home-delivery services as a patient safety initiative during the COVID-19 pandemic.

Method

The implementation process of the drive-through and home delivery services are explained in detail. The utilization of these two services is evaluated by measuring the number of patients and prescriptions between April 2020 and August 2020.

Result

The increased utilization of drive-through medication pick-up and home delivery services in terms of the number of patients and prescriptions ensures patient safety by minimizing infection risk.

Conclusion

The increase in the utilization of drive-through medication pick-up and home delivery services reflects its successful implementation during the COVID-19 pandemic. Both services meet the pandemic’s social-distancing requirements and minimize risks of infections, which will ensure patient safety during the COVID-19 pandemic.
“The priests do their best to inflame the people.” Religious actors in Ireland, 1800–1845: Instigators of violence or peacemakers?
Authors: Wendling Karina Bénazech
Published: April 2021

After the 1801 Act of Union uniting Ireland and Great Britain, and the broken promises made to Catholics, Daniel O’Connell founded the Catholic Association which combined religious and political demands. Despite the pacifying dimension of the movement, the decades preceding the Great Hunger (1845–1851) saw several episodes of violence, before reaching a climax during the revolutionary movement of 1848. Relying on Philippe Braud’s definition of political violence and the study of British and Catholic authorities’ correspondence among other sources, this article intends to shed light on the different dynamics at work in the rise in violence. It also examines the various attempts to readjust to and withdraw from acts of violence, to move beyond ambiguities and better assess the role played by religious agents.
Highly efficient generation of bacterial leaf blight-resistant and transgene-free rice using a genome editing and multiplexed selection system
Authors: Yu Kun , Liu Zhiqiang , Gui Huaping , Geng Lizhao , Wei Juan , Liang Dawei , Lv Jian , Xu Jianping , Chen Xi
Published: April 2021

Background

Rice leaf blight, which is a devastating disease worldwide, is caused by the bacterium Xanthomonas oryzae pv. oryzae (Xoo). The upregulated by transcription activator-like 1 (UPT) effector box in the promoter region of the rice Xa13 gene plays a key role in Xoo pathogenicity. Mutation of a key bacterial protein-binding site in the UPT box of Xa13 to abolish PXO99-induced Xa13 expression is a way to improve rice resistance to bacteria.

Highly efficient generation and selection of transgene-free edited plants are helpful to shorten and simplify the gene editing-based breeding process. Selective elimination of transgenic pollen of T0 plants can enrich the proportion of T1 transgene-free offspring, and expression of a color marker gene in seeds makes the selection of T2 plants very convenient and efficient. In this study, a genome editing and multiplexed selection system was used to generate bacterial leaf blight-resistant and transgene-free rice plants.

Results

We introduced site-specific mutations into the UPT box using CRISPR/Cas12a technology to hamper with transcription-activator-like effector (TAL) protein binding and gene activation and generated genome-edited rice with improved bacterial blight resistance. Transgenic pollen of T0 plants was eliminated by pollen-specific expression of the α-amylase gene Zmaa1, and the proportion of transgene-free plants increased from 25 to 50% among single T-DNA insertion events in the T1 generation. Transgenic seeds were visually identified and discarded by specific aleuronic expression of DsRed, which reduced the cost by 50% and led to up to 98.64% accuracy for the selection of transgene-free edited plants.

Conclusion

We demonstrated that core nucleotide deletion in the UPT box of the Xa13 promoter conferred resistance to rice blight, and selection of transgene-free plants was boosted by introducing multiplexed selection. The combination of genome editing and transgene-free selection is an efficient strategy to accelerate functional genomic research and plant breeding.
The impact of left ventricular geometry on left atrium phasic function in obstructive sleep apnea syndrome: a multimodal echocardiography investigation
Authors: Zhang Yong , Shui Wen , Tian Yun , Zhang Zhenxia , Li Juan , Wang Jian
Published: April 2021

Background

Left ventricular geometry and left atrium (LA) enlargement are risk factors for cardiovascular disease. However, reports on the relationship between left ventricular geometry and LA volume yielded contradictory findings, and LA phasic function remains unclear. Hence, this study aimed to investigate the influence of left ventricular geometry on LA volume and phasic function in patients with obstructive sleep apnea syndrome (OSAS) via a multimodal echocardiographic approach.

Methods

In this cross-sectional study, 221 patients with OSAS (age 20–68 years, mean age 45.27 ± 12.50 years) underwent clinical evaluation, polysomnography, and multimodal echocardiographic examination with two-dimensional echocardiography (2DE), two-dimensional speckle-tracking echocardiography (2D-STE) and three-dimensional echocardiography (3DE). Based on conventional classification of left ventricular geometry, patients with OSAS were divided into four groups: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH).

Results

Based on 2DE and 3DE, the LA volumes and indices gradually increased from NG to CH. Additionally, 2DE and 3DE LA maximum volume index (LAVImax) were higher in patients with CH and EH than in patients with NG and CR (P < 0.05). The reservoir function, estimated by LA total emptying fraction (LA TotEF) was lower in patients with CH than in patients with NG in 2DE and 3DE (both, P < 0.05). Also, LA conduit function, evaluated by LA passive emptying fraction (LA PassEF) was lower in patients with CH than in patients with NG and CR, and in patients with EH than in those with NG in 2DE and 3DE (all, P < 0.05). The LA booster pump function, evaluated by LA active emptying fraction (LA ActEF) showed no statistically significant difference in 2DE; however, it was greater in patients with CH than in those with NG in 3DE. Similar results were obtained by 2D-STE, and CH was significantly associated with LA strain during systole (LAS-S, β = − 0.546, 95%CI: − 6.371–(− 3.444); P < 0.001), early diastole (LAS-E, β = − 0.636, 95%CI: − 9.532–(− 5.710); P < 0.001), and late diastole (LAS-A, β = − 0.450, 95%CI: 1.518–3.909; P < 0.001) in multiple linear regression.

Conclusions

The LA phasic function changed with left ventricular geometry via multimodal echocardiography. CH had the most notable negative effect on the maximum volume and phasic function of the LA.
LASSO type penalized spline regression for binary data
Authors: Mullah Muhammad Abu Shadeque , Hanley James A. , Benedetti Andrea
Published: April 2021

Background

Generalized linear mixed models (GLMMs), typically used for analyzing correlated data, can also be used for smoothing by considering the knot coefficients from a regression spline as random effects. The resulting models are called semiparametric mixed models (SPMMs). Allowing the random knot coefficients to follow a normal distribution with mean zero and a constant variance is equivalent to using a penalized spline with a ridge regression type penalty. We introduce the least absolute shrinkage and selection operator (LASSO) type penalty in the SPMM setting by considering the coefficients at the knots to follow a Laplace double exponential distribution with mean zero.

Methods

We adopt a Bayesian approach and use the Markov Chain Monte Carlo (MCMC) algorithm for model fitting. Through simulations, we compare the performance of curve fitting in a SPMM using a LASSO type penalty to that of using ridge penalty for binary data. We apply the proposed method to obtain smooth curves from data on the relationship between the amount of pack years of smoking and the risk of developing chronic obstructive pulmonary disease (COPD).

Results

The LASSO penalty performs as well as ridge penalty for simple shapes of association and outperforms the ridge penalty when the shape of association is complex or linear.

Conclusion

We demonstrated that LASSO penalty captured complex dose-response association better than the Ridge penalty in a SPMM.
Isolation of non-tuberculous mycobacteria among tuberculosis patients, a study from a tertiary care hospital in Lahore, Pakistan
Authors: Karamat Asifa , Ambreen Atiqa , Ishtiaq Aamira , Tahseen Sabira , Rahman Muhammad Aqeelur , Mustafa Tehmina
Published: April 2021

Background

There is scarce knowledge on the prevalence of diseases caused by non-tuberculous mycobacteria (NTM) in Pakistan. In the absence of culture and identification, acid-fast bacilli (AFB) causing NTM disease are liable to be misinterpreted as tuberculosis (TB). Introduction of nucleic acid amplification testing for Mycobacterium tuberculosis complex (MTBC) offers improved diagnostic accuracy, compared with smear microscopy, and also assists in differentiating MTBC from other mycobacteria. This study aimed to investigate the prevalence of NTM among patients investigated for TB and describe NTM disease and treatment outcomes at a tertiary care hospital in Pakistan.

Methods

This is a retrospective study, data on NTM isolates among culture-positive clinical samples over 4 years (2016–19) was retrieved from laboratory records. Information on clinical specimens processed, AFB smear results, and for the AFB positive isolates, results of species identification for MTBC, and for NTM isolates, results of species characterization and drug susceptibility testing was collected. Additional clinical data including patient characteristics, treatment regimens, and outcomes were collected for patients with NTM disease treated at Gulab Devi Hospital, Lahore.

Results

During the study period, 12,561 clinical specimens were processed for mycobacterial culture and 3673 (29%) were reported positive for AFB. Among these 3482 (95%) were identified as MTBC and 191 (5%) as NTM. Among NTM, 169 (88%) were isolated from pulmonary and 22 (12%) from extrapulmonary specimens. Results of NTM speciation were available for 60 isolates and included 55% (n = 33) M. avium complex and 25% (n = 15) M. abscesses. Among these patients, complete clinical records were retrieved for 12 patients with pulmonary disease including nine infected with M. avium complex and three with M. abscessus. All 12 patients had a history of poor response to standard first-line anti-TB treatment. Ten patients were cured after 18 months of treatment, whereas, one with M. abscessus infection died and another was lost to follow up.

Conclusion

In TB endemic areas, NTM can be misdiagnosed as pulmonary TB leading to repeated failed anti-TB treatment and increased morbidity, emphasizing the need for improved diagnosis.
Comparison of 5-year outcomes between trabeculectomy combined with phacoemulsification and trabeculectomy followed by phacoemulsification: a retrospective cohort study
Authors: Arimura Shogo , Iwasaki Kentaro , Orii Yusuke , Takamura Yoshihiro , Inatani Masaru
Published: April 2021

Background

We aimed to compare the outcomes of trabeculectomy combined with phacoemulsification and those of trabeculectomy followed by phacoemulsification.

Methods

A total of 141 patients with primary open-angle glaucoma, exfoliation glaucoma, and glaucoma secondary to uveitis glaucoma who underwent trabeculectomy followed by (n = 48) or combined with (n = 93) phacoemulsification were included. We analyzed data collected from the Collaborative Bleb-Related Infection Incidence and Treatment Study, a prospective cohort study conducted in 34 clinical centers that included 1249 eyes. The main outcome was the cumulative probability of success based on intraocular pressure (IOP) within 5 years. Surgical failure was defined as a case in which additional glaucoma surgery is required or one of the following criteria are met: preoperative IOP > 21 (A), > 18 (B), or > 15 mmHg (C). The secondary outcomes were cumulative probability of success, risk factors of surgical failure, and Δ visual acuity. However, the data on phacoemulsification during the 5-year follow-up were censored.

Results

No significant difference was found in the cumulative probability of success as the main outcome. When the data on phacoemulsification during the 5-year follow-up were censored, the probabilities of success of trabeculectomy followed by phacoemulsification were significantly higher for criteria A (p = 0.02), B (p <  0.01), and C (p <  0.01). Lower preoperative IOP, younger age, and trabeculectomy combined with phacoemulsification were associated with poorer outcome. Trabeculectomy followed by phacoemulsification had significantly worse Δ logMAR visual acuity at 6 and 12 months (p <  0.01).

Conclusion

The cumulative probability of success after trabeculectomy combined with or followed by phacoemulsification remained unchanged. Combining phacoemulsification with trabeculectomy adversely affected the cumulative probability of success after trabeculectomy. The visual acuity improvements observed in the early postoperative period after combining phacoemulsification with trabeculectomy disappeared within 5 years.
A longitudinal and geospatial analysis of COVID-19 tweets during the early outbreak period in the United States
Authors: Cuomo Raphael E. , Purushothaman Vidya , Li Jiawei , Cai Mingxiang , Mackey Tim K.
Published: April 2021

Introduction

Early reports of COVID-19 cases and deaths may not accurately convey community-level concern about the pandemic during early stages, particularly in the United States where testing capacity was initially limited. Social media interaction may elucidate public reaction and communication dynamics about COVID-19 in this critical period, during which communities may have formulated initial conceptions about the perceived severity of the pandemic.

Methods

Tweets were collected from the Twitter public API stream filtered for keywords related to COVID-19. Using a pre-existing training set, a support vector machine (SVM) classifier was used to obtain a larger set of geocoded tweets with characteristics of user self-reporting COVID-19 symptoms, concerns, and experiences. We then assessed the longitudinal relationship between identified tweets and the number of officially reported COVID-19 cases using linear and exponential regression at the U.S. county level. Changes in tweets that included geospatial clustering were also assessed for the top five most populous U.S. cities.

Results

From an initial dataset of 60 million tweets, we analyzed 459,937 tweets that contained COVID-19-related keywords that were also geolocated to U.S. counties. We observed an increasing number of tweets throughout the study period, although there was variation between city centers and residential areas. Tweets identified as COVID-19 symptoms or concerns appeared to be more predictive of active COVID-19 cases as temporal distance increased.

Conclusion

Results from this study suggest that social media communication dynamics during the early stages of a global pandemic may exhibit a number of geospatial-specific variations among different communities and that targeted pandemic communication is warranted. User engagement on COVID-19 topics may also be predictive of future confirmed case counts, though further studies to validate these findings are needed.
Nutritional status of children and adolescents in three Serbian enclaves in Kosovo and Metohija
Authors: Fabiano Valentina , Barcellini Lucia , Sartorio Marco Ugo Andrea , Pendezza Erica , Leone Alessandro , Meneghin Fabio , Dilillo Dario , Zuccotti Gian Vincenzo
Published: April 2021

Objective

To evaluate nutritional status of children and adolescents living in three Serbian enclaves in Kosovo and Metohija.

Methods

We conducted an observational cross-sectional, population-based study, enrolling children and adolescents who underwent a pediatric screening performed in the three Serbian enclaves of Gračanica, Gornje Kusce and Velika Hoča in Kosovo and Metohija. Children and adolescents (5–19 years) of all ethnic groups were evaluated in one of the three free outpatient medical facilities in rural villages in Kosovo. Body weight and height were measured, height-for-age z- scores (HAZ) and BMI-for-age z-scores (BAZ) indicators were analyzed. The anthropometric indicators HAZ and BAZ distributions were compared between sex and ages using Fisher’s exact test. A two-sample Z-test for proportions was used to detect differences in individual categories of height- and BMI-for-age categories across sexes and age classes.

Results

Three hundred twenty-eight children and adolescents (184 females, 56.1% and 144 males, 43.9%) aged between 5 and 19 years were enrolled in the study. 241/328 participants showed a normal linear growth; with significantly more girls (78.3%) than boys (67.4%) being in the normal category. Similarly, a significant difference in BAZ distribution between sexes was noted, with more females being in the normal BMI category compared to males (63.0% vs 50.0%, respectively). Underweight and severe underweight subjects showed a prevalence of 1.5 and 0.6%, respectively. Overweight and obesity prevalence was 19.5 and 9.1%, respectively, which was comparable to World Health Organization overweight and obesity prevalence data for Serbia.

Conclusions

Prevalence of undernutrition and severe undernutrition in children and adolescents living in three Serbian enclaves in Kosovo and Metohija is small. By contrast, a tendency to an increase in overweight and obesity, especially in the male population, was noted.
Survival rate in patients with ICU-acquired infections and its related factors in Iran’s hospitals
Authors: Etemad MEDSKorosh , Khani Yousef , Hashemi-Nazari Seyed-Saeed , Izadi Neda , Eshrati Babak , Mehrabi Yadollah
Published: April 2021

Background

Hospital-acquired infections (HAIs) are a well-known cause of morbidity and mortality in hospitalized patients. This study aimed at investigating the survival rate in patients with ICU-acquired infections (ICU-AIs) and its related factors in Iran’s hospitals.

Methods

Data were obtained from the Iranian Nosocomial Infections Surveillance (INIS), which registers all necessary information on the main types of infection from different units of each included hospital. One thousand one hundred thirty-four duplicate cases were removed from the analysis using the variables of name, father’s name, age, hospital code, infection code, and bedridden date. From 2016 to 2019, 32,998 patients diagnosed with ICU-AI from about 547 hospitals. All patients were followed up to February 29, 2020.

Results

The median age of patients with ICU-AIs was 61 (IQR = 46) years. 45.5, 20.69, 17.63, 12.08, and 4.09% of infections were observed in general, surgical, internal, neonatal and pediatric ICUs, respectively. Acinetobacter (16.52%), E.coli (12.01%), and Klebsiella (9.93%) were the major types of microorganisms. From total, 40.76% of infected patients (13,449 patients) died. The 1, 3, 6-months and overall survival rate was 70, 25.72, 8.21 1.48% in ICU-AI patients, respectively. The overall survival rate was 5.12, 1.34, 0.0, 51.65, and 31.08% for surgical, general, internal, neonatal and pediatric ICU, respectively. Hazard ratio shows a significant relationship between age, hospitalization-infection length, infection type, and microorganism and risk of death in patients with ICU-AI.

Conclusions

Based on the results, it seems that the nosocomial infections surveillance system should be more intelligent. This intelligence should act differently based on related factors such as the age of patients, hospitalization-infection length, infection type, microorganism and type of ward. In other words, this system should be able to dynamically provide the necessary and timely warnings based on the factors affecting the survival rate of infection due to the identification, intervention and measures to prevent the spread of HAIs based on a risk severity system.
Targeted lateral positioning decreases lung collapse and overdistension in COVID-19-associated ARDS
Authors: Mlček Mikuláš , Otáhal Michal , Borges João Batista , Alcala Glasiele Cristina , Hladík Dominik , Kuriščák Eduard , Tejkl Leoš , Amato Marcelo , Kittnar Otomar
Published: April 2021

Background

Among the challenges for personalizing the management of mechanically ventilated patients with coronavirus disease (COVID-19)-associated acute respiratory distress syndrome (ARDS) are the effects of different positive end-expiratory pressure (PEEP) levels and body positions in regional lung mechanics. Right-left lung aeration asymmetry and poorly recruitable lungs with increased recruitability with alternating body position between supine and prone have been reported. However, real-time effects of changing body position and PEEP on regional overdistension and collapse, in individual patients, remain largely unknown and not timely monitored. The aim of this study was to individualize PEEP and body positioning in order to reduce the mechanisms of ventilator-induced lung injury: collapse and overdistension.

Methods

We here report a series of five consecutive mechanically ventilated patients with COVID-19-associated ARDS in which sixteen decremental PEEP titrations were performed in the first days of mechanical ventilation (8 titration pairs: supine position immediately followed by 30° targeted lateral position). The choice of lateral tilt was based on X-Ray. This targeted lateral position strategy was defined by selecting the less aerated lung to be positioned up and the more aerated lung to be positioned down. For each PEEP level, global and regional collapse and overdistension maps and percentages were measured by electrical impedance tomography. Additionally, we present the incidence of lateral asymmetry in a cohort of forty-four patients.

Results

The targeted lateral position strategy resulted in significantly smaller amounts of overdistension and collapse when compared with the supine one: less collapse along the PEEP titration was found within the left lung in targeted lateral (P = 0.014); and less overdistension along the PEEP titration was found within the right lung in targeted lateral (P = 0.005). Regarding collapse within the right lung and overdistension within the left lung: no differences were found for position. In the cohort of forty-four patients, ventilation inequality of > 65/35% was observed in 15% of cases.

Conclusions

Targeted lateral positioning with bedside personalized PEEP provided a selective attenuation of overdistension and collapse in mechanically ventilated patients with COVID-19-associated ARDS and right-left lung aeration/ventilation asymmetry.

Trial registration

Trial registration number: NCT04460859
Bilateral pulmonary embolism without deep venous thrombosis was observed after knee arthroscopy: a case report
Authors: Li Yuan , Chen You-Xia , Deng Xiang-Tian , Yang Shun-cheng , Su Zhi-Yuan , Ao Yu-Nong , Zhou Peng , Deng Fu-Yuan , Li Zhong , Liu Jun-Cai
Published: April 2021

Background

Symptomatic pulmonary embolism (PE) after knee arthroscopy is extremely rare. If the embolism is not treated promptly, the patient may die. Bilateral pulmonary embolism with associated pulmonary infarct without concomitant deep vein thrombosis has never been reported following routine knee arthroscopy.

Case presentation

A 50-year-old female patient with no other risk factors other than hypertension, obesity, varicose veins in the ipsilateral lower extremities and elevated triglyceride (TG) presented to our ward. She had experienced sudden chest tightness, polypnea and fainting after going to the bathroom the morning of the second postoperative day and received emergency medical attention. Colour ultrasonography of the extremities showed no deep vein thrombosis. Lung computed tomography angiography (CTA) showed multiple embolisms scattered in both pulmonary artery branches. Thus, emergency interventional thrombolysis therapy was performed, followed by postoperative symptomatic treatment with drugs with thrombolytic, anticoagulant and protective activities. One week later, lung CTA showed a significant improvement in the PEs compared with those in the previous examination. Since the aetiology of PE and no obvious symptoms were discerned, the patient was discharged.

Conclusion

Although knee arthroscopy is a minimally invasive and quick procedure, the risk factors for PE in the perioperative period should be considered and fully evaluated to enhance PE detection. Moreover, a timely diagnosis and effective treatment are important measures to prevent and cure PE after knee arthroscopy. Finally, clear guidelines regarding VTE thromboprophylaxis following knee arthroscopy in patients with a low risk of VTE development are needed.
Analysis of inferior nasal turbinate width and concha bullosa in subjects with nasal septum deviation: a cone beam tomography study
Authors: Shetty Shishir Ram , Al Bayatti Saad Wahby , Al-Rawi Natheer Hashim , Marei Hesham , Reddy Sesha , Abdelmagyd Hossam Abdelatty , Narasimhan Sangeetha , Al Kawas Sausan , Mathew Asok
Published: April 2021

Background

In individuals with nasal septal deviation (NSD), compensatory hypertrophy of the nasal turbinates occurs as a protective mechanism of the nasal passage from dry and cold air. NSD associated nasal turbinate hypertrophy is usually recurrent, requiring repetitive imaging. Therefore, a multiplanar imaging modality with a low radiation dose is best suited for long-term follow-up of this condition. This study aimed to evaluate the association of width of inferior turbinates and presence of concha bullosa with the degree of NSD using Cone beam computed tomography (CT).

Methods

The CBCT scans of 100 patients with NSD were selected as per convenience sampling and were evaluated by two maxillofacial radiologists. The width of the non-hypertrophied inferior turbinate (NHT) on the convex side of the NSD, and hypertrophic inferior turbinates (HT) on the concave side of the NSD were measured at three locations. The septal deviation angle (SDA) and the presence of concha bullosa (CB) were determined.

Results

A significant difference was observed in the anterior, middle, posterior, and mean widths between HT and NHT (p < 0.001). There was a significant difference in the widths of the HT and NHT among different types of NSD. A strong positive correlation (r = 0.71,p < 0.001) was found between SDA and the mean width of the HT. Age (P = 0.71) and gender (P = 0.65) had no significant difference among different types of NSD. Regression analysis revealed that the presence of CB (p = 0.01) and middle width of the HT (p < 0.001) are significant predictors of SDA and type of NSD.

Conclusion

The results of the present study reveal that the middle width of the HT and the presence of CB influence the degree of NSD. The present study results recommend the use of CBCT as a substitutive low radiation dose imaging modality for evaluation of NSD, CB, and associated inferior turbinate hypertrophy.
Effect of heart rate on left ventricular longitudinal myocardial function in type 2 diabetes mellitus
Authors: Yamauchi Yuki , Tanaka Hidekazu , Yokota Shun , Mochizuki Yasuhide , Yoshigai Yuko , Shiraki Hiroaki , Yamashita Kentaro , Tanaka Yusuke , Shono Ayu , Suzuki Makiko , Sumimoto Keiko , Matsumoto Kensuke , Hirota Yushi , Ogawa Wataru , Hirata Ken-ichi
Published: April 2021

Background

Left ventricular (LV) longitudinal myocardial dysfunction is considered a marker of preclinical LV dysfunction in patients with type 2 diabetes mellitus (T2DM). High heart rate (HR) is associated with cardiovascular outcomes, but the effect of HR on LV longitudinal myocardial function in T2DM patients is uncertain.

Methods

We studied 192 T2DM patients with preserved LV ejection fraction (LVEF), and 81 age-, sex-, and LVEF-matched healthy volunteers. HR was measured as the average HR during echocardiography, and high HR was defined as resting HR ≥ 70 beats/minute. LV longitudinal myocardial function was assessed as global longitudinal strain (GLS). The predefined cutoff for subclinical LV dysfunction was set at GLS < 18%.

Results

GLS in T2DM patients with high HR was significantly lower than that in T2DM patients with low HR (16.3% ± 4.2% vs. 17.8% ± 2.8%; P = 0.03), whereas GLS in normal subjects with high and low HR was similar (20.3 ± 1.7% vs. 20.3 ± 2.0%; P = 0.99). Multivariable logistic regression analysis showed that high HR (odds ratio: 1.04; 95% confidence interval: 1.01–1.07; P = 0.01) was independently associated with GLS < 18% in T2DM patients as well as HbA1c, T2DM duration, LVEF, body mass index, and mitral inflow E and mitral e’ annular velocity ratio. One sequential logistic model evaluating the associations between GLS < 18% and clinical variables in T2DM patients showed an improvement with the addition of LVEF and E/e’ (P < 0.001) and a further improvement with the addition of high HR (P < 0.001).

Conclusion

Compared with normal subjects, resting HR was associated with LV longitudinal myocardial function in asymptomatic T2DM patients with preserved LVEF. Our findings provide new insights on the management of T2DM patients.
Early and long-term prognosis in patients with and without type 2 diabetes after carotid intervention: a Swedish nationwide propensity score matched cohort study
Authors: Zabala Alexander , Gottsäter Anders , Lind Marcus , Svensson Ann-Marie , Eliasson Björn , Bertilsson Rebecka , Ekelund Jan , Nyström Thomas , Jonsson Magnus
Published: April 2021

Objectives

To investigate early and long-term outcomes after treatment of carotid artery stenosis in patients with type 2 diabetes (T2D) compared to patients without T2D.

Design/method

This observational nationwide population-based retrospective cohort study investigated all T2D patients treated for carotid stenosis registered in the National Swedish Vascular Surgery and the National Diabetes Registries. Data was collected prospectively for all patients after carotid intervention, during 2009–2015. We estimated crude early (within 30-days) hazard ratios (HRs) risk of stroke and death, and long-term HRs risk, adjusted for confounders with 95% confidence intervals (CIs), for stroke and death and major adverse cardiovascular events (MACE) by using inverse probability of treatment weighting matching.

Results

A total of 1341 patients with T2D and 4162 patients without T2D were included; 89% treated for symptomatic carotid stenosis, 96% with carotid endarterectomy. There was an increased early risk, HRs (95% CI), for stroke in T2D patients 1.65 (1.17–2.32), whereas risk for early death 1.00 (0.49–2.04) was similar in both groups. During a median follow-up of 4.3 (T2D) and 4.6 (without T2D), with a maximum of 8.0 years; after propensity score matching there was an increased HRs (95% CI) of stroke 1.27 (1.05–1.54) and death 1.27 (1.10–1.47) in T2D patients compared to patients without T2D. Corresponding numbers for MACE were 1.21 (1.08–1.35).

Conclusions

Patients with T2D run an increased risk for stroke, death, and MACE after carotid intervention. They also have an increased perioperative risk for stroke, but not for death.
Assessment of the endocrine disrupting properties of bisphenol AF: a case study applying the European regulatory criteria and guidance
Authors: Escrivá Laura , Zilliacus Johanna , Hessel Ellen , Beronius Anna
Published: April 2021

Background

Scientific criteria to identify endocrine disruptors (ED) was recently implemented for plant protection products (PPP) and biocidal products (BP). A guidance document has been published by ECHA and EFSA in the context of ED criteria for PPPs and BPs.

Methods

In the present work, a case study was performed on Bisphenol AF (BPAF) to explore the application of the EU criteria and EFSA/ECHA guidance document for the ED assessment of a non-pesticide chemical regulated under REACH. A data dossier was built by a systematic literature search (Web of Science, Pubmed, Embase; n = 511), title/abstract screening (n = 124) and full text examination (n = 88). All the information was extracted and systematically reported for 309 parameters (100 for adversity; 209 for endocrine activity). The reliability of studies was assessed (SciRAP tool).

Results

Data were synthesized into 96 lines of evidence for adversity (n = 57), and endocrine activity (n = 39); and assessed by weight of evidence methodology. The initial analysis of the evidence indicated EATS-mediated adversity in mammals, therefore a mode of action (MoA) was postulated for both male and female adult exposure. Female MoA included estrogen receptor activation and altered steroidogenesis leading to ovarian dysfunction, altered estrous cycling and impaired female fertility. Male MoA was initiated by androgen receptor inhibition and altered steroidogenesis leading to dysfunction of male reproductive organs and impaired male fertility.

Conclusions

The overall conclusion of the ED assessment indicated that BPAF meets the ED criteria for human health. The steps described in the ED guidance document were successfully completed, resulting in a thorough, structured and transparent identification of BPAF as an ED. Advantages and limitations of applying the ED criteria and guidance for a REACH chemical are discussed.
Impact of adverse reactions to first-generation antipsychotics on treatment adherence in outpatients with schizophrenia: a cross-sectional study
Authors: Bahta Merhawi , Ogbaghebriel Azieb , Russom Mulugeta , Tesfamariam Eyasu H. , Berhe Tzeggai
Published: April 2021

Background

Antipsychotics are well-known to cause potentially serious and life-threatening adverse drug reactions (ADRs) that have been reported to be also one of the major reasons for non-adherence. In Eritrea, shortage of psychiatrists and physicians, inadequacy of laboratory setups and unavailability of second-generation antipsychotics in the national list of medicines would seem to amplify the problem. This study’s objective is to determine the impact of adverse effects of first-generation antipsychotics on treatment adherence in outpatients with schizophrenia at Saint Mary Neuro-Psychiatric National Referral Hospital.

Methods

A cross-sectional study design was employed. All eligible adult patients with diagnosed schizophrenia (n = 242) who visited the hospital during the study period were enrolled. Data on ADRs, adherence and other variables were collected from patients using a self-administered questionnaire, interview and through medical cards review. The collected variables were analyzed using SPSS 22.0 with descriptive and multivariable logistic regression analysis. Statistical significance was tested at p value < 0.05.

Results

Greater than one-third (35.5%) of the patients with schizophrenia were non-adherent to treatment. The odds of non-adherence increased 1.06 times for each unit increase in the total ADR score (AOR = 1.06, 95% CI 1.04, 1.09). Patients with extrapyramidal (AOR = 44.69, 95% CI 5.98, 334.30), psychic (AOR = 14.90, 95% CI 1.90, 116.86), hormonal (AOR = 2.60, 95% CI 1.41, 4.80), autonomic (AOR = 3.23, 95% CI 1.37, 7.57) and miscellaneous reactions (AOR = 2.16, 95% CI 1.13, 4.13) were more likely to be non-adherent compared to their counterparts.

Conclusion

Poor treatment adherence was found to be substantial which was attributed to total ADR score, extrapyramidal, hormonal, psychic, autonomic and miscellaneous categories of reactions of the LUNSERS. To improve treatment adherence, early detection and management of adverse effects and inclusion of second-generation antipsychotics are recommended.
Quantitative analysis of doxorubicin hydrochloride and arterolane maleate by mid IR spectroscopy using transmission and reflectance modes
Authors: Bansal Ranju , Singh Ranjit , Kaur Khushpal
Published: April 2021

Background

Environment-friendly fast and accurate mid-infrared spectroscopic methods have been developed for the quantitative analysis of doxorubicin hydrochloride (DOX) and arterolane maleate (ALM) in bulk and marketed formulations. Both transmittance and reflectance modes have been used for the analysis and a comparison has been drawn for better accuracy. The analytical methods were validated in accordance with International Council for Harmonisation (ICH) guidelines

Results

The proposed methods have been successfully developed and validated for the quantification of doxorubicin and arterolane maleate in solid bulk and dosage form. High recovery values in both the modes, while analysing DOX and ALM, indicated good accuracy of the methods. The methods showed excellent repeatability and intermediate precision [% RSD (Relative Standard Deviation < 2.0%]. The assay values of the drugs in solid dosage forms were also found close to the labelled claim.

Conclusion

The proposed Fourier transform infrared (FT-IR) spectroscopic methods were found to be specific, reproducible, valid and could be used as general methods for the quantification of most of the solid drug preparations such as tablets, capsules and powders.