bluuebunny/crossref_metadata_2025 huggingface dataset:
Benefits and Challenges Associated with the Implementation of Lean in Transportation Agencies
Authors: Parajuli Manish , Harper Christofer M. , Senior Bolivar , Grigg Neil
Published: September 2021

The highway construction industry constantly looks to increase productivity while public transportation agencies face challenges of shrinking budgets and staff numbers, even as the work continues to increase in size and demand. As a paradigm to maximize value and minimize waste with the resources available, Lean offers promise to enhance productivity, quality, and service. This study investigates the implementation of Lean by evaluating Lean conditions, practices, benefits, and challenges as expressed by U.S. and UK public transportation highway agencies as well as comparing the implementation of Lean between these agencies. Using a comprehensive literature review and formal interviews with six state departments of transportation along with Highways England from the UK, the findings show that Lean is intended to make process improvements to boost products and services to consumers. By creating a culture of continuous improvement, transportation agencies can improve their processes and increase their efficiencies and performance. Conversely, transportation agencies struggle to educate their employees and stakeholders in their understanding and practices of Lean, which causes confusion and ineffectiveness. Comparing the U.S. and UK transportation agencies, the approach to Lean implementation differs from a top-down approach for U.S. agencies to a bottom-up approach for Highways England. Furthermore, Highways England has an established tool for measuring Lean while development of quantifiable Lean measures is in its infancy in U.S. agencies. Overall, while the sample is limited, this exploratory study provides information for transportation agencies to use in consideration of implementing Lean.
Analysis of Port Accidents and Calibration of Heinrich’s Pyramid
Authors: Majumdar Arnab , Manole Iulia , Nalty Ryan
Published: September 2021

Academics and the maritime industry have used the Heinrich Pyramid for decades to justify overall safety theory, risk assessments, and accident prevention strategies. Most use Heinrich’s original severity ratios (1:29:300) for accident causation development in a factory setting. However, to use the Pyramid effectively and mitigate risks/hazards, it must be calibrated to represent specific industry reality. This paper, for the first time, focuses on calibration of Heinrich’s Pyramid to maritime accident data, using databases from the Marine Accident Investigation Branch of the Department for Transport. This research clusters five years (2013–2017) of accident data, using K-Means clustering on categorical variables and severity levels of accidents, similar logic to Heinrich’s analysis. This approach and descriptive statistics provide new ratios between accident severity classifications for casualties with a ship (CS) and occupational accidents (OAs) separately. Results show that the data do not appear to fall into Heinrich’s Pyramid shape and yield a vastly different and lower ratio to that of Heinrich’s. Especially concerning was that Very Serious and Serious accidents occurred at a 1:5 ratio for CS and 4:1 for OA, very different from Heinrich’s 1:29. Although these results calculated a new ratio, it may not represent reality owing to accident reporting requirements under UK law, a lack of an agreed taxonomy of risk and hazard definitions, and likely underreporting of less severe accidents. This is proven because, in 2017, CS data became pyramid shaped, after a decrease in the number of accidents and a 17% increase in near-misses.
Preparing for the future: How organizations can prepare boards, leaders, and risk managers for artificial intelligence
Authors: Dixit Arun , Quaglietta Jennifer , Gaulton Catherine
Published: September 2021

Artificial Intelligence (AI) is the notion of machines mimicking complex cognitive functions usually associated with humans, such as reasoning, predicting, planning, and problem-solving. With constantly growing repositories of data, improving algorithmic sophistication and faster computing resources, AI is becoming increasingly integrated into everyday use. In healthcare, AI represents an opportunity to increase safety, improve quality, and reduce the burden on increasingly overstretched systems. As applications expand, the need for responsible oversight and governance becomes even more important. Artificial intelligence in the delivery of healthcare carries new opportunities and challenges, including the need for greater transparency, the impact AI tools may have on a larger number of patients and families, and potential biases that may be introduced by the way an AI platform was developed and built. This study provides practical guidance in the development and implementation of AI applications in healthcare, with a focus on risk identification, management, and mitigation.
Boosting Understanding and Identification of Scientific Consensus Can Help to Correct False Beliefs
Authors: van Stekelenburg Aart , Schaap Gabi , Veling Harm , Buijzen Moniek
Published: September 2021

Some people hold beliefs that are opposed to overwhelming scientific evidence. Such misperceptions can be harmful to both personal and societal well-being. Communicating scientific consensus has been found to be effective in eliciting scientifically accurate beliefs, but it is unclear whether it is also effective in correcting false beliefs. Here, we show that a strategy that boosts people’s understanding of and ability to identify scientific consensus can help to correct misperceptions. In three experiments with more than 1,500 U.S. adults who held false beliefs, participants first learned the value of scientific consensus and how to identify it. Subsequently, they read a news article with information about a scientific consensus opposing their beliefs. We found strong evidence that in the domain of genetically engineered food, this two-step communication strategy was more successful in correcting misperceptions than merely communicating scientific consensus. The data suggest that the current approach may not work for misperceptions about climate change.
How can new energy vehicles affect air quality in China?— From the perspective of crude oil price
Authors: Wang Qiu-Su , Su Chi-Wei , Hua Yu-Fei , Umar Muhammad
Published: September 2021

From the perspective of crude oil price, this paper investigates the effects of new energy vehicles on air quality by applying a time-varying parameter–stochastic volatility–vector autoregression model. NEVs benefits from the continuous adjustment and improvement of subsidy standards by the Chinese government, and the share of new energy vehicles in the market has been continuously improved. The empirical results show that the increase in new energy vehicles can reduce PM2.5 emissions, which is also consistent with the energy and environment theoretical model, and replacing traditional energy with new energy is helpful for controlling environmental pollution. Oil price has a direct negative impact on PM2.5 concentration, and the influence of new energy vehicles on air quality is also regulated by changes in oil price. A high oil price leads to an increase in driving costs, and consumers are more inclined to purchase new energy vehicles, which achieves the purpose of improving air quality to a certain extent. To improve the air quality, the relevant departments should adjust the subsidy policy of new energy vehicles according to the change in oil price and appropriately increase gasoline or diesel consumption taxes to provide development space for the new energy vehicle market.
An Ego-Centric Model of Criminal Arrest Among Mental Health Court Participant Network
Authors: Jaggers Jeremiah W. , Kondrat David C. , Candida Kelli E. , Miller Keith
Published: September 2021

People with serious mental illness are disproportionately represented among prison/jail populations. Mental health courts (MHC) serve as an alternative to incarceration. In this study, we explore the extent to which MHC participants have members of their social network who were reported as having a history of arrests. Multilevel logistic regression demonstrated friends who used drugs, race, and network density were all predictive of MHC participants’ friends who have a history of arrest. Results demonstrate an association between MHC participation and arrest among individuals in their social network. Given the importance of social support in recovery from mental illness and in desisting from crime, such limitations can be problematic. MHC participants may be disinclined to engage with the very individuals who are able to provide social and emotional support.
Tourism recovery amid COVID-19: The case of Lombardy, Italy
Authors: Provenzano Davide , Volo Serena
Published: September 2021

Travel restrictions and social distancing imposed to curb the spread of the new coronavirus have been strongly hitting tourism since March 2020. Tourism forecasting literature addressed the effects of shocks in contexts characterized by a predictable route to recovery. COVID-19 is without precedents. In this article, monthly overnight stays for the period January 2010 to December 2020 are used to estimate the impact of the pandemic in Lombardy, Italy’s most affected region. A model-based approach is implemented, and the number of overnight stays up to December 2023 is forecasted. Four models are compared. Estimation results from an augmented SARIMA model suggest that, provided a new lockdown is averted, the domestic segment will recover in a relatively short period of time, whereas international tourism might need an external intervention to speed up its recovery process.
Perceived discrimination among Spanish Roma: The role of religion
Authors: Aísa Rosa María , Larramona Gemma
Published: September 2021

This article aims to show that Roma people in Spain are targeted for discrimination because of perceptions about their religious beliefs, as well as for reasons linked to their socio-economic status. Data on the Spanish Roma population have been, used and analysis reveals that Evangelical Roma people have a higher probability of perceiving discrimination than those Roma who profess the majority religion in Spain, that is, Catholicism, once other socio-economic and demographic factors are controlled for. We recommend that this manifested higher degree of discrimination towards Evangelical Roma should be addressed by Spanish institutions and organizations promoting the rights of ethnic minorities by considering intersectional discrimination which allows for a more respectful and egalitarian approach to the diversity of Roma people. Additionally, Evangelical churches should be considered as active actors in an inter-culture dialogue.
Embodied meaning-making in the experiences and behaviours of persons with dementia
Authors: Isene Tor-Arne , Thygesen Hilde , Danbolt Lars J , Stifoss-Hanssen Hans
Published: September 2021

Background

The aim of the study was to explore and articulate how meaning-making appears and how meaningfulness is experienced in persons with severe dementia. Although there is little knowledge about meaning-making and experience of meaningfulness for this group, this article assumes that persons with dementia are as much in need of meaningfulness in life as any others, and hence, that they are involved in the process of meaning-making.

Methods

The study was conducted using a qualitative method with exploratory design. Ten patients with severe dementia at a specialized dementia ward at an old age psychiatric department in hospital were observed through participant observation performed over four months. The field-notes from the observation contained narratives carrying with them a dimension of meaning played out in an everyday setting and thus named Meaning-making dramas. The narratives were analyzed looking for expressions where experiences of meaning-making and meaningfulness could be identified.

Results

The narratives demonstrate that persons with severe dementia are involved in processes of meaning-making. The narratives include expressions of meaning-making, and of interactions that include apparent crises of meaning, but also transitions into what may be interpreted as meaningfulness based on experiences of significance, orientation and belonging. The role of the body and the senses has proved significant in these processes. The findings also suggest that experiences of meaning contribute to experience of personhood.

Conclusions

The relevance to clinical practice indicates that working from a person-centred approach in dementia care also includes paying attention to the dimension of meaning. This dimension is important both for the person living with dementia and for the people caring for them. Acknowledging meaning as a central human concern, it is crucial to seek understanding and knowledge about the significance of meaning in vulnerable groups such as persons with dementia.
Toward a Next-Generation Digital Chest Tube
Authors: DeArmond Daniel T. , Holt Lucas M. , Wang Andrew P. , Errico Kristen N. , Das Nitin A.
Published: September 2021

Chest tubes in patients who have undergone pulmonary resection with pleural air leak are painful, impair ventilatory mechanics, and increase hospital length of stay and costs. Despite these well-documented concerns, current protocols for chest tube management in this setting are not well supported by evidence. Excessive suction applied to chest tubes has been associated with prolonged air leak due to alveolar over-distension, and most practitioners intuit that suction should be minimized to the lowest level needed to maintain desired pleural apposition. Unfortunately, there is no evidence-based protocol for the establishment of minimal adequate suction. Digital suction devices in current clinical use can identify air leak resolution preventing the delay of chest tube removal but cannot guide suction minimization while an air leak persists. We recently described a monitor of lung expansion in a porcine model of pleural air leak that could detect loss of pleural apposition continuously in real-time based on electrical impedance readings obtained directly from the surface of the lung via chest tube-embedded electrodes. The value of the impedance signal was “in-range” when pleural apposition was present but became abruptly “out-of-range” when pneumothorax due to inadequate suction developed. These findings suggested that a digitally controlled suction pump system could be programmed to recognize the development of pneumothorax and automatically identify and set the minimum level of suction required to maintain pleural apposition. We present here preliminary proof of concept for this system.
Subjective Social Capital and Loneliness for the Elderly: The Moderator Role of Line and Facebook Use
Authors: Hsu Long-Jing , Yueh Hsiu-Ping , Hsu Shih-Hsien
Published: September 2021

Social media has become a vital source of communication for older adults, but its impact is still an ongoing debate. This study investigated the moderating effect of Line and Facebook use on social capital and loneliness in older adults, aged 55 or more, using data obtained from the 2018 Taiwan Communication Survey (TCS). Results from binary logistic regression indicated that older adult users of Line have a lower possibility of being lonely than those who do not use Line. Consistent with past studies, this study found that Line could be a form of social media that has a positive effect on the relationship between social capital and loneliness. Conversely, this article argues that Facebook does not have such a moderation effect. Overall, this study advances understanding of the impact of Facebook and Line on social capital and loneliness. The results are informative for future research on the effects of social media on the elderly.
Drivers of Organic Food Purchase Intention in a Developing Country: The Mediating Role of Trust
Authors: Ayyub Samia , Asif Muhammad , Nawaz Muhammad Asim
Published: September 2021

The study’s objective is to explore the predictors of organic food purchase intention in a nascent organic market in one of the developing countries in South Asia. Further, the study also attempts to establish the mediating role of trust in organic food purchase intention.

The quantitative data is collected from two cities of Pakistan through a structured questionnaire. A total of 325 responses are collected, out of which 312 responses are considered for further analysis. Structural equation modeling technique is used to test the hypothesis. “Personal attributes” is found to be a more significant predictor of organic food purchase intention than other attributes. Trust in organic food partially mediate personal attributes and product attributes with organic food purchase intention. The study contributes to understanding the primary attributes responsible for the purchase of organic food in a nascent organic market and establishes trust. This study also provides guidelines for the policymakers to shift their focus to organic farming, which will bring considerable benefits to health and the environment and a profitable business because consumer’s intentions coincide.
Portraits of the Nigerian Soldier in Isidore Okpewho’s The Last Duty and Festus Iyayi’s Heroes
Authors: Onwuka Edwin
Published: September 2021

An essential feature of Nigerian literatures is their capacity to exploit history and social experience to bring to light the human condition in society without compromising literary aesthetics. Thus, Nigerian novels often appear to be more educative than entertaining by their ability to illuminate social realities far more effectively than historical or sociological texts. This is evident in the representations of soldiers in Nigerian novels which are highly influenced by historical and social circumstances. This paper carries out a comparative and descriptive analysis of portrayals of Nigerian soldiers in Isidore Okpewho’s The Last Duty and Festus Iyayi’s Heroes from a new historical perspective. Most studies on the military in Nigerian novels often focus on their actions in war situations and their disruptive and undemocratic activities in politics. However, these studies frequently explore the military as a group with little attention to the texts as expositions on character types in the Nigerian military. This study therefore contributes to criticism on the nexus between literary representation, history, and society. It further highlights historical and social contexts of military explorations in Nigerian novels and their impacts on the perception of the Nigerian soldier in society. These are aimed at showing that depictions of the military in Nigerian novels go beyond their capacities for disruptions and destructions in society; they represent artistic probing of the nature and character of persons in the Nigerian military.
Implementing an Electronic Clinical Decision Support Tool Into Routine Care: A Qualitative Study of Stakeholders’ Perceptions of a Post-Mastectomy Breast Reconstruction Tool
Authors: Boateng Jessica , Lee Clara N. , Foraker Randi E. , Myckatyn Terence M. , Spilo Kimi , Goodwin Courtney , Politi Mary C.
Published: September 2021

Objective. To explore barriers and facilitators to implementing an evidence-based clinical decision support (CDS) tool (BREASTChoice) about post-mastectomy breast reconstruction into routine care. Materials and Methods. A stakeholder advisory group of cancer survivors, clinicians who discuss and/or perform breast reconstruction in women with cancer, and informatics professionals helped design and review the interview guide. Based on the Consolidated Framework for Implementation Research (CFIR), we conducted qualitative semistructured interviews with key stakeholders (patients, clinicians, informatics professionals) to explore intervention, setting characteristics, and process-level variables that can impact implementation. Interviews were transcribed, coded, and analyzed based on the CFIR framework using both inductive and deductive methods. Results. Fifty-seven potential participants were contacted; 49 (85.9%) were eligible, and 35 (71.4%) were enrolled, continuing until thematic saturation was reached. Participants consisted of 13 patients, 13 clinicians, and 9 informatics professionals. Stakeholders thought that BREASTChoice was useful and provided patients with an evidence-based source of information about post-mastectomy breast reconstruction, including their personalized risks. They felt that BREASTChoice could support shared decision making, improve workflow, and possibly save consultation time, but were uncertain about the best time to deliver BREASTChoice to patients. Some worried about cost, data availability, and security of integrating the tool into an electronic health record. Most acknowledged the importance of showing clinical utility to gain institutional buy-in and encourage routine adoption. Discussion and Conclusion. Stakeholders felt that BREASTChoice could support shared decision making, improve workflow, and reduce consultation time. Addressing key questions such as cost, data integration, and timing of delivering BREASTChoice could build institutional buy-in for CDS implementation. Results can guide future CDS implementation studies.
Tangled, tangy, microbial threads: Textural methods for rendering past, present, and future sensory memories
Authors: Harris Anna
Published: September 2021

How to render sensory memory? In this article, I speculate on the possibilities of textural methods which attend closely to textile forms, specifically embroidery, as a way to explore this enduring question in multimodal research. To open up concerns about bodily relations between humans, as well as the more-than-human bodies we share worlds with, this article focuses on sensory memory fragments of encounters with the microbial conglomerations of sourdough bread starter. I offer three bubbling, sour-sweet texts: 1) an archived auto-ethnographic account of learning how to make a sourdough starter; 2) a social-media inspired piece on the sticky home archives of quarantine; and 3) a future speculative citizen science project. These fragments co-exist with microbes I have embroidered on ancient linens. From the tangy strings of sourdough histories, and the tangled threads in cloth I draw concrete methodological suggestions for new directions in textural research projects, such as material fieldnotes and crafted data. In doing so, I join other authors in this special issue in the call for multimodal forms of ethnographic storytelling about sensory memory, in this case one that attends not only to messy entanglements with bodies but also their textural, material, layered histories extending into the depth of their surfaces.
Synthesis and structure of calumetite-like SrCu4(OH)8Cl2⋅3.5H2O
Authors: Crichton Wilson A. , Müller Harald , Leoni Matteo
Published: September 2021

The synthesis and structure of the title compound, 1, is presented, refined using Rietveld against powder X-ray diffraction data. 1 crystallises dominantly in a pseudotetragonal C-centred orthorhombic lattice with dimensions a = 6.6791(6) Å, b = 15.5006(6) Å, c = 6.6811(6) Å and V = 691.70(10) Å3. The structural model proposed here refined by Rietveld is Sr0.928(8)Cu4(OH)8Cl2⋅3.60(21)H2O in space group Cmcm (63), with Z = 2. The chemistry and diffraction pattern of 1 are similar to that for the known Ca analogue, calumetite. The copper sites are arranged with square planar coordination at ¼ and ¾ height and are bonded to four (protonated) oxygens at an average of 1.966 Å (effective coordination of 3.82 Å). The more distant Cl sites (at Cu−Cl = 3.190(6) Å) complete the heavily Jahn–Teller distorted Cu[(OH)4,Cl2] polyhedra. The ½-occupied Sr sites are 8 coordinated to four protonated oxygens shared with the Cu-layer (at 2 × 2.438(8) Å, 2 × 2.566(15) Å) and by 4 bonds to the proposed water sites (Sr−Ow = 2.760(9) Å). The structure of 1 is predisposed towards defects, based on a notional tetragonal, P4/nmm, substructure with asub ≈ a1, csub = b½ dimensions. Average diffraction models have been further elaborated in order to resolve additional peaks (and peak-shapes) using DIFFaX+.
Association of allele-specific methylation of the ASNS gene with asparaginase sensitivity and prognosis in T-ALL
Authors: Akahane Koshi , Kimura Shunsuke , Miyake Kunio , Watanabe Atsushi , Kagami Keiko , Yoshimura Kentaro , Shinohara Tamao , Harama Daisuke , Kasai Shin , Goi Kumiko , Kawai Tomoko , Hata Kenichiro , Kiyokawa Nobutaka , Koh Katsuyoshi , Imamura Toshihiko , Horibe Keizo , Look A. Thomas , Minegishi Masayoshi , Sugita Kanji , Takita Junko , Inukai Takeshi
Published: September 2021

Asparaginase therapy is a key component of chemotherapy for patients with T-cell acute lymphoblastic leukemia (T-ALL). Asparaginase depletes serum asparagine by deamination into aspartic acid. Normal hematopoietic cells can survive due to asparagine synthetase (ASNS) activity, whereas leukemia cells are supposed to undergo apoptosis due to silencing of the ASNS gene. Because the ASNS gene has a typical CpG island in its promoter, its methylation status in T-ALL cells may be associated with asparaginase sensitivity. Thus, we investigated the significance of ASNS methylation status in asparaginase sensitivity of T-ALL cell lines and prognosis of childhood T-ALL. Sequencing of bisulfite polymerase chain reaction products using next-generation sequencing technology in 22 T-ALL cell lines revealed a stepwise allele-specific methylation of the ASNS gene, in association with an aberrant methylation of a 7q21 imprinted gene cluster. T-ALL cell lines with ASNS hypermethylation status showed significantly higher in vitro l-asparaginase sensitivity in association with insufficient asparaginase-induced upregulation of ASNS gene expression and lower basal ASNS protein expression. A comprehensive analysis of diagnostic samples from pediatric patients with T-ALL in Japanese cohorts (N = 77) revealed that methylation of the ASNS gene was associated with an aberrant methylation of the 7q21 imprinted gene cluster. In pediatric T-ALL patients in Japanese cohorts (n = 75), ASNS hypomethylation status was significantly associated with poor therapeutic outcome, and all cases with poor prognostic SPI1 fusion exclusively exhibited ASNS hypomethylation status. These observations show that ASNS hypomethylation status is associated with asparaginase resistance and is a poor prognostic biomarker in childhood T-ALL.
An IDO1-related immune gene signature predicts overall survival in acute myeloid leukemia
Authors: Ragaini Simone , Wagner Sarah , Marconi Giovanni , Parisi Sarah , Sartor Chiara , Nanni Jacopo , Cristiano Gianluca , Talami Annalisa , Olivi Matteo , Ocadlikova Darina , Ciciarello Marilena , Corradi Giulia , Ottaviani Emanuela , Papayannidis Cristina , Paolini Stefania , Vadakekolathu Jayakumar , Cavo Michele , Rutella Sergio , Curti Antonio
Published: September 2021

The contribution of the bone marrow (BM) immune microenvironment to acute myeloid leukemia (AML) development is well-known, but its prognostic significance is still elusive. Indoleamine 2,3-dioxygenase 1 (IDO1), which is negatively regulated by the BIN1 proto-oncogene, is an interferon-γ-inducible mediator of immune tolerance. With the aim to develop a prognostic IDO1-based immune gene signature, biological and clinical data of 982 patients with newly diagnosed, nonpromyelocytic AML were retrieved from public datasets and analyzed using established computational pipelines. Targeted transcriptomic profiles of 24 diagnostic BM samples were analyzed using the NanoString’s nCounter platform. BIN1 and IDO1 were inversely correlated and individually predicted overall survival. PLXNC1, a semaphorin receptor involved in inflammation and immune response, was the IDO1-interacting gene retaining the strongest prognostic value. The incorporation of PLXNC1 into the 2-gene IDO1-BIN1 score gave rise to a powerful immune gene signature predicting survival, especially in patients receiving chemotherapy. The top differentially expressed genes between IDO1lowand IDO-1high and between PLXNC1lowand PLXNC1high cases further improved the prognostic value of IDO1 providing a 7- and 10-gene immune signature, highly predictive of survival and correlating with AML mutational status at diagnosis. Taken together, our data indicate that IDO1 is pivotal for the construction of an immune gene signature predictive of survival in AML patients. Given the emerging role of immunotherapies for AML, our findings support the incorporation of immune biomarkers into current AML classification and prognostication algorithms.
Delayed headache after COVID-19 vaccination: a red flag for vaccine induced cerebral venous thrombosis
Authors: García-Azorín David , Do Thien Phu , Gantenbein Andreas R. , Hansen Jakob Møller , Souza Marcio Nattan P. , Obermann Mark , Pohl Heiko , Schankin Christoph J. , Schytz Henrik Winther , Sinclair Alexandra , Schoonman Guus G. , Kristoffersen Espen Saxhaug
Published: September 2021

Background

Headache is a frequent symptom following COVID-19 immunization with a typical onset within days post-vaccination. Cases of cerebral venous thrombosis (CVT) have been reported in adenovirus vector-based COVID-19 vaccine recipients.

Findings

We reviewed all vaccine related CVT published cases by April 30, 2021. We assessed demographic, clinical variables and the interval between the vaccination and onset of headache. We assessed whether the presence of headache was associated with higher probability of death or intracranial hemorrhage.

We identified 77 cases of CVT after COVID-19 vaccination. Patients’ age was below 60 years in 74/77 (95.8%) cases and 61/68 (89.7%) were women. Headache was described in 38/77 (49.4%) cases, and in 35/38 (92.1%) was associated with other symptoms. Multiple organ thrombosis was reported in 19/77 (24.7%) cases, intracranial hemorrhage in 33/77 (42.9%) cases and 19/77 (24.7%) patients died. The median time between vaccination and CVT-related headache onset was 8 (interquartile range 7.0–9.7) days. The presence of headache was associated with a higher odd of intracranial hemorrhage (OR 7.4; 95% CI: 2.7–20.8, p < 0.001), but not with death (OR: 0.51, 95% CI: 0.18–1.47, p = 0.213).

Conclusion

Delayed onset of headache following an adenovirus vector-based COVID-19 vaccine is associated with development of CVT. Patients with new-onset headache, 1 week after vaccination with an adenovirus vector-based vaccine, should receive a thorough clinical evaluation and CVT must be ruled out.
Analysis of multivariate longitudinal immuno-epidemiological data using a pairwise joint modelling approach
Authors: Lubyayi Lawrence , Mawa Patrice A. , Cose Stephen , Elliott Alison M. , Levin Jonathan , Webb Emily L.
Published: September 2021

Background

Immuno-epidemiologists are often faced with multivariate outcomes, measured repeatedly over time. Such data are characterised by complex inter- and intra-outcome relationships which must be accounted for during analysis. Scientific questions of interest might include determining the effect of a treatment on the evolution of all outcomes together, or grouping outcomes that change in the same way. Modelling the different outcomes separately may not be appropriate because it ignores the underlying relationships between outcomes. In such situations, a joint modelling strategy is necessary. This paper describes a pairwise joint modelling approach and discusses its benefits over more simple statistical analysis approaches, with application to data from a study of the response to BCG vaccination in the first year of life, conducted in Entebbe, Uganda.

Methods

The study aimed to determine the effect of maternal latentMycobacterium tuberculosisinfection (LTBI) on infant immune response (TNF, IFN-γ, IL-13, IL-10, IL-5, IL-17A and IL-2 responses to PPD), following immunisation with BCG. A simple analysis ignoring the correlation structure of multivariate longitudinal data is first shown. Univariate linear mixed models are then used to describe longitudinal profiles of each outcome, and are then combined into a multivariate mixed model, specifying a joint distribution for the random effects to account for correlations between the multiple outcomes. A pairwise joint modelling approach, where all possible pairs of bivariate mixed models are fitted, is then used to obtain parameter estimates.

Results

Univariate and pairwise longitudinal analysis approaches are consistent in finding that LTBI had no impact on the evolution of cytokine responses to PPD. Estimates from the pairwise joint modelling approach were more precise. Major advantages of the pairwise approach include the opportunity to test for the effect of LTBI on the joint evolution of all, or groups of, outcomes and the ability to estimate association structures of the outcomes.

Conclusions

The pairwise joint modelling approach reduces the complexity of analysis of high-dimensional multivariate repeated measures, allows for proper accounting for association structures and can improve our understanding and interpretation of longitudinal immuno-epidemiological data.
Risk factors for revascularization and in-stent restenosis in patients with triple-vessel disease after second-generation drug-eluting stent implantation: a retrospective analysis
Authors: Zeng MengYing , Yan XiaoWei , Wu Wei
Published: September 2021

Objectives

Coronary artery disease (CAD) is a common cardiac disease with high morbidity and mortality, and triple-vessel disease (TVD) is a severe type of CAD. This study investigated risk factors for revascularization and in-stent restenosis (ISR) in TVD patients who underwent second-generation drug-eluting stent implantation.

Methods

A retrospective clinical study was conducted, and 246 triple-vessel disease (TVD) patients with 373 vessels after second-generation drug-eluting stent (DES) implantation who received follow-up coronary angiography (CAG) were consequently enrolled. According to the follow-up angiography, patients were categorized into the revascularization group and nonrevascularization group as well as the in-stent restenosis (ISR) group and non-ISR group. Univariate and multivariate logistic regression analyses were used to identify risk factors for revascularization and ISR. Receiver operating characteristic (ROC) curve with area under the curve (AUC) analysis was performed to assess the predictive power of these risk factors.

Results

In the median follow-up period of 28.0 (14.0, 56.0) months, 142 TVD patients (57.7%) with 168 vessels underwent revascularization, and ISR occurred in 43 TVD patients (17.5%) with 47 vessels after second-generation DES implantation. Compared to the nonrevascularization group, the revascularization group presented with an increased rate of current smoking and higher levels of TC, LDL-C, HDL-C, non-HDL-c, ApoB, neutrophils, and Hs-CRP as well as a longer follow-up of months but with a lower level of HDL-C. In addition, patients in the ISR group had an older age, longer follow-up (months) and elevated rates of current smoking and stage 4–5 chronic kidney disease (CKD4-5). In multivariate analysis, current smoking and higher non-HDL-c were independent risk factors for revascularization. In addition, older age, current smoking and CKD4-5 were considered independent risk factors for ISR. Importantly, the receiver operating characteristic curve showed that non-HDL-C and age displayed predictive power for revascularization and ISR, respectively.

Conclusion

Current smoking is an independent risk factor for both revascularization and in-stent restenosis. Higher non-HDL-c is independently related to revascularization; moreover, increased age and CKD4-5 are potential risk factors for ISR in TVD patients after second-generation drug-eluting stent implantation.
Exploring women’s experiences of participation in shared decision-making during childbirth: a qualitative study at a reference hospital in Spain
Authors: López-Toribio María , Bravo Paulina , Llupià Anna
Published: September 2021

Background

Women’s engagement in healthcare decision-making during childbirth has been increasingly emphasised as a priority in maternity care, since it increases satisfaction with the childbirth experience and provides health benefits for women and newborns. The birth plan was developed as a tool to facilitate communication between health professionals and women in Spain, but their value in routine practice has been questioned. Besides, little is known about women’s experiences of participation in decision-making in the Spanish context. Thus, this study aimed to explore women’s experiences of participation in shared decision-making during hospital childbirth.

Methods

An exploratory qualitative study using focus groups was carried out in one maternity unit of a large reference hospital in Barcelona, Spain. Participants were first-time mothers aged 18 years or older who had had a live birth at the same hospital in the previous 12 months. Data collected were transcribed verbatim and analysed using a six-phase inductive thematic analysis process.

Results

Twenty-three women participated in three focus groups. Three major themes emerged from the data: “Women’s low participation in shared decision-making”, “Lack of information provision for shared decision-making”, and “Suggestions to improve women’s participation in shared decision-making”. The women who were willing to take an active role in decision-making encountered barriers to achieving this and some women did not feel prepared to do so. The birth plan was experienced as a deficient method to promote women’s participation, as health professionals did not use them. Participants described the information given as insufficient and not offered at a timely or useful point where it could aid their decision-making. Potential improvements identified that could promote women’s participation were having a mutually respectful relationship with their providers, the support of partners and other members of the family and receiving continuity of a coordinated and personalised perinatal care.

Conclusion

Enhancing women’s involvement in shared decision-making requires the acquisition of skills by health professionals and women. The development and implementation of interventions that encompass a training programme for health professionals and women, accompanied by an effective tool to promote women’s participation in shared decision-making during childbirth, is highly recommended.
Plasma fibulin-1 levels during pregnancy and delivery: a longitudinal observational study
Authors: Orvik Astrid Bakke , Andersen Malene Rohr , Pedersen Lise , Ritz Christian , Stender Steen , Szecsi Pal Bela
Published: September 2021

Background

Fibulin-1 is an extracellular matrix protein expressed at high levels in the placenta. Elevated circulating fibulin-1 have been observed in women with severe pre-eclampsia, whereas low levels have been found in the fetal membranes, prior to membrane rupture. The aim of the study was primarily to evaluate plasma fibulin-1 during expected normal pregnancy and delivery, and secondarily to explore fibulin-1 levels in women developing pre-eclampsia or preterm premature rupture of fetal membranes (PPROM).

Methods

From the historical longitudinal cohort originally consisting of 801 healthy Danish women with a singleton pregnancy, 128 women (632 samples) were selected. Of these, 107 women had normal pregnancies, nine experienced PPROM, and 12 pre-eclampsia. All samples were analyzed for fibulin-1, and levels were compared with blood donors. Differences in mean fibulin-1 between groups were estimated using a linear mixed model.

Results

The mean concentration of fibulin-1 in 120 blood donors was 15.7 µg/mL, (25th-75th-percentiles, 12.3–18.2), with no significant difference in groups stratified by gender or age. Compared to baseline levels in week 12–20, fibulin-1 levels increased significantly from week 29–34 (estimated difference, 5.6 µg/mL; standard error, 1.7;p < 0.001) and 35–42 (12.5 µg/mL; 1.6;p < 0.001) and normalized after birth. The decrease at delivery tended to be more pronounced after elective (-7.0 µg/mL; 2.3;p = 0.002) and emergency (-5.6 µg/mL; 2.9;p = 0.05) cesarean section than after vaginal delivery (reference group). Women who developed PPROM had lower fibulin-1 levels throughout their pregnancies (-11.6 µg/mL; 4.2;p = 0.006). We did not observe a correlate between late pre-eclampsia and fibulin-1 (-0.2 µg/mL; 3.0;p = 0.9).

Conclusions

Fibulin-1 was above non-pregnant levels at week 12 and increased significantly throughout pregnancy. We observed an association between low levels of fibulin-1 and PPROM. Further studies are needed to examine if fibulin-1 could serve as biomarker for the risk of PPROM. However, its role in late preeclampsia is doubtful.

Trial registration

The study was conducted in accordance with the Declaration of Helsinki. The participants provided written informed consent, including storage for future use. The study was approved on July 18, 2005 by The Danish National Committee on Bioethics (No. KA 05065 and S-20,090,061) and the Danish Data Protection Agency.
Willingness to bear economic costs of measures against SARS-CoV-2 in Germany
Authors: König Hans-Helmut , De Bock Freia , Sprengholz Philipp , Kretzler Benedikt , Hajek André
Published: September 2021

Background

The aim of this study was to assess the willingness of the general population in Germany to bear the economic costs of measures against the spread of SARS-CoV-2.

Methods

Repeated cross-sectional data were taken from three waves of a nationally representative survey of individuals aged 18 to 74 years (wave 8: 21–22 April 2020, N = 976; wave 16: 7–8 July 2020, N = 977; wave 38: 9–10 March 2021). The willingness to accept a reduction of annual household income in order to bear the economic costs of the measures against SARS-CoV-2 served as outcome measure. Two-part models were used including explanatory variables on sociodemographic and (subjectively assessed) potential health hazard caused by COVID-19.

Results

65.5% (61.6%; 56.9%) of respondents in wave 8 (wave 16; wave 38) were willing to accept a reduction of income, with the likelihood for accepting a reduction of income being positively associated with higher affect (i.e. emotional reaction) and presumed severity regarding COVID-19 in all three waves. The mean maximum percentage of income participants were willing to give up was 3.3% (95% CI: 2.9 to 3.7%) in wave 8, 2.9% (95% CI: 2.5 to 3.3%) in wave 16 and 4.3% (95% CI: 3.6 to 5.0%) in wave 38, with presumed severity of COVID-19 being positively associated with this percentage in all three waves.

Conclusions

The majority of respondents indicated willingness to sacrifice income in order to bear the costs of measures against the spread of SARS-CoV-2, with the potential health hazard caused by COVID-19 being consistently associated with this willingness. However, the proportion of individuals who were willing to give up income slightly decreased throughout the pandemic.
Different microbial and resistance patterns in primary total knee arthroplasty infections – a report on 283 patients from Lithuania and Sweden
Authors: Sebastian Sujeesh , Sezgin Erdem Aras , Stučinskas Justinas , Tarasevičius Šarūnas , Liu Yang , Raina Deepak Bhushan , Tägil Magnus , Lidgren Lars , W-Dahl Annette
Published: September 2021

Background

The microbiology and the susceptibility patterns of infected total knee arthroplasties (TKAs) vary depending on demographic, local antimicrobial stewardship, and surgical factors. We wanted to compare the recent microbial profile and antimicrobial resistance pattern in revisions due to infections after primary TKAs in Sweden and Lithuania. Our hypothesis was that there is a difference in bacteriology and resistance pattern based on patient related, societal and local hospital factors as almost similar praxis have been applied for TKA surgery, short term systemic prophylaxis and routine use of local gentamicin containing bone cement.

Methods

Primary TKAs revised for the first time due to verified or suspected infection were collected nationwide in Sweden during 2018, and in Lithuania between 2011 and 2020 from a single major TKA revision centre in Kaunas. We identified 202 TKAs in Sweden from the Swedish Knee Arthroplasty Register and 84 from Kaunas revised due to infection. We collected available culture reports and evaluated the type of microorganisms with antimicrobial resistance pattern at revision.

Results

The majority of the infected cases in Sweden were early-type prosthetic joint infection (PJI) (44%), whereas late-type PJI (52%) were more common in the Kaunas cases. Gram-positive bacteria prevailed in both Sweden (55%) and Lithuania (80%). Staphylococcus aureus was the most frequent organism identified in both countries (33% in Sweden and 34% in Lithuania). More polymicrobial infections were observed in Sweden than in Lithuania (16 and 6% respectively). Methicillin resistance in Staphylococcus aureus and coagulase-negative staphylococci were higher in Lithuania (4/28 and 19/29) than in Sweden (1/42 and 9/41).

Conclusions

The type of infections, microbial profile, and drug resistance pattern differed between Sweden and Lithuania. Societal and local hospitals factors with emerging resistance in Lithuania are the most plausible explanation for the difference. Lack of complete data on a national level in Lithuania underlines the importance of adding microbiology of PJIs in implant registers for national aggregation and allow cross country comparisons.
Associations between obesity, weight change and decreased renal function in Korean type 2 diabetic patients: a longitudinal follow-up study
Authors: Kim Bo-Yeon , Choi Dug-Hyun , Jung Chan-Hee , Mok Ji-Oh , Kim Chul-Hee
Published: September 2021

Background

We aimed to examine the associations between the risk of decreased renal function, obesity, and weight changes in Korean type 2 diabetic patients with normal renal function.

Methods

Type 2 diabetic patients (n = 1060) who visited the diabetic clinic at Soonchunhyang University Bucheon Hospital between 2001 and 2007 with follow up surveys completed in 2016 to 2017 were recruited into the study. Decreased renal function was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2. Weight change was calculated between baseline and each follow-up survey. Multivariate analysis was used to evaluate the longitudinal association of baseline obesity and weight changes with the risk of decreased renal function.

Results

This study revealed that baseline obesity was associated with the risk of decreased renal function after adjusting for clinical variables in type 2 diabetic patients (odds ratio [OR] 1.40; 95% confidence intervals [CI] 1.08–2.04; p = 0.025). Follow-up (mean = 12 years) revealed that weight gain > 10% was associated with the risk of decreased renal function after adjusting for clinical variables in type 2 diabetic patients with normal renal function at baseline (OR 1.43; CI 1.11–2.00; p = 0.016). Weight loss was not associated with the risk of decreased renal function in type 2 diabetic patients with normal renal function at baseline.

Conclusions

Baseline obesity was associated with the increased risk of decreased renal function in Korean type 2 diabetic patients with normal renal function. Weight gain > 10% independently predicted the risk of decreased renal function. Large prospective studies are needed to clarify causal associations between obesity, weight change, and decreased renal function in patients with type 2 diabetes.