bluuebunny/crossref_metadata_2025 huggingface dataset:
The Potential Role of Intensity-Modulated Proton Therapy in Hepatic Carcinoma in Mitigating the Risk of Dose De-Escalation
Authors: Cozzi Luca , Comito Tiziana , Loi Mauro , Fogliata Antonella , Franzese Ciro , Franceschini Davide , Clerici Elena , Reggiori Giacomo , Tomatis Stefano , Scorsetti Marta
Published: December 2020

Purpose:

To investigate the role of intensity-modulated proton therapy (IMPT) for hepatocellular carcinoma (HCC) patients to be treated with stereotactic body radiation therapy (SBRT) in a risk-adapted dose prescription regimen.

Methods:

A cohort of 30 patients was retrospectively selected as “at-risk” of dose de-escalation due to the proximity of the target volumes to dose-limiting healthy structures. IMPT plans were compared to volumetric modulated arc therapy (VMAT) RapidArc (RA) plans. The maximum dose prescription foreseen was 75 Gy in 3 fractions. The dosimetric analysis was performed on several quantitative metrics on the target volumes and organs at risk to identify the relative improvement of IMPT over VMAT and to determine if IMPT could mitigate the need of dose reduction and quantify the consequent potential patient accrual rate for protons.

Results:

IMPT and VMAT plans resulted in equivalent target dose distributions: both could ensure the required coverage for CTV and PTV. Systematic and significant improvements were observed with IMPT for all organs at risk and metrics. An average gain of 9.0 ± 11.6, 8.5 ± 7.7, 5.9 ± 7.1, 4.2 ± 6.4, 8.9 ± 7.1, 6.7 ± 7.5 Gy was found in the near-to-maximum doses for the ribs, chest wall, heart, duodenum, stomach and bowel bag respectively. Twenty patients violated one or more binding constraints with RA, while only 2 with IMPT. For all these patients, some dose de-intensification would have been required to respect the constraints. For photons, the maximum allowed dose ranged from 15.0 to 20.63 Gy per fraction while for the 2 proton cases it would have been 18.75 or 20.63 Gy.

Conclusion:

The results of this in-silico planning study suggests that IMPT might result in advantages compared to photon-based VMAT for HCC patients to be treated with ablative SBRT. In particular, the dosimetric characteristics of protons may avoid the need for dose de-escalation in a risk-adapted prescription regimen for those patients with lesions located in proximity of dose-limiting healthy structures. Depending on the selection thresholds, the number of patients eligible for treatment at the full dose can be significantly increased with protons.
Local Antibiotic Delivery Systems in the Surgical Treatment of Diabetic Foot Osteomyelitis: Again, No Benefit?
Authors: Chatzipapas Christos , Kougioumtzis Ioannis E. , Karaglani Makrina , Panagopoulos Periklis , Panopoulou Maria , Papazoglou Dimitrios , Drosos Georgios I. , Papanas Nikolaos
Published: December 2020

This retrospective study aimed to compare the outcomes and healing parameters of 3 groups of surgical treatment combined with and without local antibiotic administration in diabetic foot osteomyelitis (DFO). Overall, 25 patients with DFO who met the criteria were included in the study. Surgical debridement was used with systemic antibiotic administration alone (group A; n = 8) or combined with local application of antibiotic-loaded polymethylmethacrylate beads (group B; n = 9) or antibiotic-loaded hydroxyapatite and calcium sulfate beads (group C; n = 8). In total, 87.5% patients in group A, 100% in group B, and 87.5% in group C healed ( P = .543). Median time to healing was 17 weeks in group A, 18 weeks in group B, and 19 weeks in group C ( P = .094). One patient (12.5%) in group A was amputated. DFO recurrence rate was 12.5% in group A and 12.5% in group C ( P = .543). Median hospitalization was 9 days in group A, 8 days in group B, and 9 days in group C ( P = .081). In conclusion, adjunctive local antibiotic therapy was not shown to improve outcomes in surgically treated DFO.
Acupuncture for Cancer Related Pain: Protocol for a Pragmatic Randomised Wait-List Controlled Trial
Authors: Zhao Qi , Zheng Suyang , Delaney Geoff P. , Moylan Eugene , Agar Meera R. , Koh Eng-Siew , Lai Hezheng , Birling Yoann , Zhang George Shengxi , Wang Kang , Ma Yong , Zhu Xiaoshu
Published: December 2020

Background:

Acupuncture has been proved effective for cancer related pain (CRP) in China, America and some other countries. However, there is relative lack of evidence to support the use of acupuncture for CRP in Australia.

Objectives:

To assess the effectiveness and safety of acupuncture for management of CRP in a real-world setting and to understand cancer patients’ experience of undergoing acupuncture for CRP.

Methods:

A pragmatic randomised controlled trial will be conducted in South Western Sydney Local Health District (SWSLHD) in NSW, Australia. Adults with cancer related pain (n = 106) will be randomised in a 1:1 ratio to receive the acupuncture intervention up front versus after a wait list period of 4 weeks. Pain level (by Numerical Rating Scale), analgesic use, auricular acupressure frequency and adverse events will be assessed at baseline, mid-treatment and post-treatment. Expectancy on trial outcome (by Credibility and Expectancy questionnaire) will be assessed at baseline. The perspective of the participants (by an interview) will be recorded after the last intervention.

Expected outcomes:

We hypothesise that acupuncture will relieve cancer related pain at mid-treatment and post-treatment. We also hypothesise that few adverse events will be provoked by acupuncture.

Trial registration:

Australia New-Zealand Clinical Trial Registry (ACTRN12620000325909).
High-Efficiency Production of Radiopharmaceuticals via Droplet Radiochemistry: A Review of Recent Progress
Authors: Wang Jia , van Dam R. Michael
Published: December 2020

New platforms are enabling radiochemistry to be carried out in tiny, microliter-scale volumes, and this capability has enormous benefits for the production of radiopharmaceuticals. These droplet-based technologies can achieve comparable or better yields compared to conventional methods, but with vastly reduced reagent consumption, shorter synthesis time, higher molar activity (even for low activity batches), faster purification, and ultra-compact system size. We review here the state of the art of this emerging direction, summarize the radiotracers and prosthetic groups that have been synthesized in droplet format, describe recent achievements in scaling up activity levels, and discuss advantages and limitations and the future outlook of these innovative devices.
Qualitative Vignette Experiments: A Mixed Methods Design
Authors: Harrits Gitte Sommer , Møller Marie Østergaard
Published: December 2020

Despite emerging interest in mixing experimental and qualitative methods, a gap exists in integrating qualitative vignettes and experimental design. We present a novel mixed methods design, the qualitative vignette experiment, defined as the use of vignettes designed to introduce experimentally controlled variation in information within qualitative semistructured interviews. We argue that this design can provide context-rich data on causal mechanisms. This article contributes to the debate on integration in mixed methods research and is useful for scholars studying human practice and the link between macro-structural conditions and micro-interpretive processes. The design builds on an integrated ontology of critical realism and a complementary epistemological foundation of postpositivism and interpretivism. This means that researchers have to adhere to multiple validity criteria.
Association Between D-Dimer Level and In-Hospital Death of Pulmonary Embolism Patients
Authors: Song Zi-Kai , Wu Haidi , Xu Xiaoyan , Cao Hongyan , Wei Qi , Wang Junfeng , Wang Xingwen , Zhang Xue , Tang Minglong , Yang Shuo , Liu Yang , Qin Ling
Published: December 2020

To investigate whether D-dimer level could predict pulmonary embolism (PE) severity and in-hospital death, a total of 272 patients with PE were divided into a survival group (n = 249) and a death group (n = 23). Comparisons of patient characteristics between the 2 groups were performed using Mann-Whitney U test. Significant variables in univariate analysis were entered into multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to determine the predictive value of D-dimer level alone or together with the simplified Pulmonary Embolism Severity Index (sPESI) for in-hospital death. Results showed that patients in the death group were significantly more likely to have hypotension (P = 0.008), tachycardia (P = 0.000), elevated D-dimer level (P = 0.003), and a higher sPESI (P = 0.002) than those in the survival group. Multivariable logistic regression analysis showed that D-dimer level was an independent predictor of in-hospital death (OR = 1.07; 95% CI, 1.003-1.143; P = 0.041). ROC curve analysis showed that when D-dimer level was 3.175 ng/ml, predicted death sensitivity and specificity were 0.913 and 0.357, respectively; and when combined with sPESI, specificity (0.838) and area under the curve (0.740) were increased. Thus, D-dimer level is associated with in-hospital death due to PE; and the combination with sPESI can improve the prediction level.
Reducing Primary Care Provider Burnout With Pharmacist-Delivered Comprehensive Medication Management
Authors: White Nicole
Published: December 2020

Primary care physicians have among the highest rates of burnout of any medical specialty in the United States. Team-based care is an organizational approach to meet the increasing demands on the primary care system, including the well-being of its providers. Physicians report that pharmacist-delivered comprehensive medication management improves patient care efficiency, decreases workload and provides additional work-based social support, among other benefits. Physician perspectives as well as resources for implementing physician-pharmacist collaborations are discussed.
Challenging Power Dynamics and Eliciting Marginalized Adolescent Voices Through Qualitative Methods
Authors: Pincock Kate , Jones Nicola
Published: December 2020

Eliciting adolescents’ voices through qualitative research necessitates research methods which challenge the power dynamics that marginalize young people and thus inhibit them from sharing their perspectives. In lower- and middle-income countries where younger adolescents in particular are often discouraged from expressing their voices, this is especially important. Methodological tools which are adaptable, interesting and create space within the research process for participation and freedom of expression are critical when eliciting the “voices” of young people aged 10–14 years, who are often less visible or accessible and thus marginalized both socially and within research processes. For example, adolescents with disabilities or those out of school may require methodological adaptations to ensure meaningful participation.

This article focuses on the ethical, practical and data quality issues that emerge when engaging with young adolescents that are marginalized both in research and within their own communities, and the need to ensure complementarity between the process of the research and its broader objective of expanding adolescent capabilities. Bearing in mind these challenges, this paper reflects on the methodological toolkit developed by the Gender and Adolescence: Global Evidence (GAGE) research project as a means for eliciting a diversity of adolescent voices and ensuring that socially excluded adolescents are not “left behind,” nor included on a merely tokenistic basis. We suggest that the strengths of the GAGE methodological toolkit lie in its grounding within broader research objectives vis-à-vis expanding adolescent capabilities and challenging structures and norms which marginalize young people. The flexibility, reflexivity and importantly the enjoyability of these methods led to adolescents both feeling at ease, able and willing to contribute their voices to the research—as well as empowered to use their voices in other areas of their lives.
A Qualitative Study on How Social Workers From Regional and Metropolitan Queensland, Australia Perceive the Impact of the National Prioritisation System on Hospital Discharge Planning: A Study Protocol
Authors: Dimla Bernadette , Wood Denise , Parkinson Lynne
Published: December 2020

In 2012, the Australian Commonwealth Government introduced a series of reforms for the aged care sector including the implementation of the National Prioritisation System for a flexible, accessible and demand-driven approach to home care services for older people. Nevertheless, an increasing number of older people continue to wait for months to be assigned home care packages on the national prioritisation queue, a component of the National Prioritisation System. There is limited evidence on the impact of the national prioritisation queue on discharge planning practices of social workers in supporting older people returning home from hospital admission. The aim of the research described in this paper is to explore the perceptions of social workers from rural and urban health services areas on how the introduction of the national prioritisation queue has influenced discharge planning of older people who are still waiting assignment of home care packages.

This study protocol establishes the need for this qualitative study and provides an overview of the theoretical framework underpinning the research; discusses and describes the methods for sampling/recruitment and data collection, the approach to be utilised for qualitative analysis and the planned dissemination strategy.

Understanding how social workers respond to the perceived challenges to discharge planning posed by the national prioritisation queue and the implications arising from the research have the potential to inform the development of best practice approaches and further enhance social work response to identified issues.
Capturing the Shadow and Light of Researcher Positionality: A Picture-Prompted Poly-Ethnography
Authors: Kassan Anusha , Nutter Sarah , Green Amy R. , Arthur Nancy , Russell-Mayhew Shelly , Sesma-Vasquez Monica
Published: December 2020

Acknowledging researcher positionality and engaging in ongoing reflexivity are important components of qualitative research. In this manuscript, we share our experiences of examining our positionality and engaging in reflexive practice related to a research project with newcomer women in Canada. As a team of researchers from diverse backgrounds, we engaged in a picture-prompted poly-ethnographic conversation to better understand our attitudes, assumptions, and biases in relation to the topic of our research and gain a better understanding of what were asking of participants. Using thematic analysis, we uncovered four themes: 1) researchers bring multiple identities, 2) researchers bring privilege/power, 3) understanding what we call home, and 4) walking in participants’ shoes. We discuss these themes in detail, highlighting their implications for reflexive research with newcomer communities.
Measurement of unidirectional pose accuracy and repeatability of the collaborative robot UR5
Authors: Pollák Martin , Kočiško Marek , Paulišin Dušan , Baron Petr
Published: December 2020

The article describes the measurement of unidirectional pose accuracy and repeatability of a collaborative robot. The objective of the measurements is to investigate and evaluate unidirectional accuracy of the six-axis collaborative robot UR5 of the company Universal Robots. The measurement methodology was based on outlining an imaginary ISO cube placed in the robot’s workspace, in which the robot’s tool centre point (TCP) attained five measurement points in thirty measurement cycles. A video camera and six linear incremental sensors with six evaluation units were used for the measurement. The measured values are presented and applied according to the ISO 9283 standard. On the basis of the measurement, we verified technical specifications of unidirectional pose accuracy and repeatability of the robotic arm UR5 specified by its producer.
A study on the influence of pick geometry on rock cutting based on full-scale cutting test and simulation
Authors: Li Xuefeng
Published: December 2020

In this paper, series of full-scale cutting tests and cutting simulations are carried out to investigate the influence of installation parameter and geometry of the pick on cutting performance. The discrete element method is used to simulate the rock cutting process. A general process to calibrate macro properties of rock including uniaxial compressive strength (UCS), elastic modulus, Poisson’s ratio, cohesion and internal friction angle is proposed and used to complete the calibration of coal model. The cutting simulations are performed using picks with different tip angles and rake angles. The results show that the peak cutting force (PCF) decreases with the increase of rake angle following an inverse proportional function when the rake angle is positive, while it varies following a parabolic curve in the condition of negative rake angle. Moreover, the crack mode changes from primarily shear failure to primarily tensile failure with the increase of rake angle. Finally, a multiple-attribute index is proposed to evaluate the cutting performance and select the optimum cutting parameters.
Optimization of the setup position of a workpiece for five-axis machining to reduce machining time
Authors: Wei Ching-chih , Lee Wei-chen
Published: December 2020

Five-axis machining is commonly used for complicated features due to its advantage of rotary movement. However, the rotary movement introduces nonlinear terms in the kinematic transform. The nonlinear terms are related to the distance between the cutter location (CL) data and the intersection of the two rotary axes. This research studied the possible setup positions after the toolpaths have been generated, and the objective was to determine the optimal setup position of a workpiece with minimal axial movements to reduce the machining time. We derived the kinematic transform for each type of five-axis machines, and then, defined an optimization problem that described the relationship between the workpiece setup position and the pseudo-distance of the axial movements. Eventually, an optimization algorithm was proposed to search for the optimal workpiece setup position within the machinable domain, which is already concerned with over-traveling and machine interference problems. In the end, we verified the optimal results with a case study with a channel feature, which was real cutting on a table-table type five-axis machine. The results show that we can save the axial movements up to 16.76% and the machining time up to 10.70% by setting up the part at the optimal position.
A rare case of fibromuscular dysplasia involving multiple vascular beds
Authors: Renz Christian , Tehrani Nader , Malach Lillian , Soult Michael , Blecha Matthew , Bechara Carlos F
Published: December 2020

Objective

Fibromuscular dysplasia rarely involves vessels other than the renal and carotid arteries. We present a case of a rare fibromuscular dysplasia involving multiple vascular beds in a young female patient with history of spontaneous coronary artery (SCAD).

Methods

This is a case report with review of the literature using PubMed search for other cases of fibromuscular dysplasia that involves multiple vascular beds and its association with SCAD. The patient agreed to publish her case including her images.

Results

Fibromuscular dysplasia involving multiple vascular beds in a young female patient with prior coronary dissection is rarely reported in the literature.

Conclusion

Fibromuscular dysplasia affecting multiple vascular beds is rare but should be suspected in patients with SCAD, particularly young female patients.
Age-related changes in gaze behaviour during social interaction: An eye-tracking study with an embodied conversational agent
Authors: Pavic Katarina , Oker Ali , Chetouani Mohamed , Chaby Laurence
Published: December 2020

Previous research has highlighted age-related differences in social perception, in particular emotional expression processing. To date, such studies have largely focused on approaches that use static emotional stimuli that the participant has to identify passively without the possibility of any interaction. In this study, we propose an interactive virtual environment to better address age-related variations in social and emotional perception. A group of 22 young (18–30 years) and 20 older (60–80 years) adults were engaged in a face-to-face conversation with an embodied conversational agent. Participants were invited to interact naturally with the agent and to identify his facial expression. Their gaze behaviour was captured by an eye-tracking device throughout the interaction. We also explored whether the Big Five personality traits (particularly extraversion) and anxiety modulated gaze during the social interaction. Findings suggested that age-related differences in gaze behaviour were only apparent when decoding social signals (i.e., listening to a partner’s question, identifying facial expressions) and not when communicating social information (i.e., when speaking). Furthermore, higher extraversion levels consistently led to a shorter amount of time gazing towards the eyes, whereas higher anxiety levels led to slight modulations of gaze only when participants were listening to questions. Face-to-face conversation with virtual agents can provide a more naturalistic framework for the assessment of online socio-emotional interaction in older adults, which is not easily observable in classical offline paradigms. This study provides novel and important insights into the specific circumstances in which older adults may experience difficulties in social interactions.
Distraction by auditory novelty during reading: Evidence for disruption in saccade planning, but not saccade execution
Authors: Vasilev Martin R , Parmentier Fabrice BR , Kirkby Julie A
Published: December 2020

Novel or unexpected sounds that deviate from an otherwise repetitive sequence of the same sound cause behavioural distraction. Recent work has suggested that distraction also occurs during reading as fixation durations increased when a deviant sound was presented at the fixation onset of words. The present study tested the hypothesis that this increase in fixation durations occurs due to saccadic inhibition. This was done by manipulating the temporal onset of sounds relative to the fixation onset of words in the text. If novel sounds cause saccadic inhibition, they should be more distracting when presented during the second half of fixations when saccade programming usually takes place. Participants read single sentences and heard a 120 ms sound when they fixated five target words in the sentence. On most occasions ( p = .9), the same sine wave tone was presented (“standard”), while on the remaining occasions ( p = .1) a new sound was presented (“novel”). Critically, sounds were played, on average, either during the first half of the fixation (0 ms delay) or during the second half of the fixation (120 ms delay). Consistent with the saccadic inhibition hypothesis (SIH), novel sounds led to longer fixation durations in the 120 ms compared to the 0 ms delay condition. However, novel sounds did not generally influence the execution of the subsequent saccade. These results suggest that unexpected sounds have a rapid influence on saccade planning, but not saccade execution.
An efficient non-probabilistic importance analysis method based on MDRM and Taylor series expansion
Authors: Wang Wenxuan , Wang Xiaoyi
Published: December 2020

The input variable of engineering structure inevitable has certain uncertainty. How to quantify the influence of those uncertainties on the uncertainty of structural response is an important issue in structural design. Non-probabilistic reliability importance analysis is one of the methods to quantify this influence when variable data information is insufficient. Although the method has great advantages for variables with insufficient data information, there is no efficient calculation method at present, and the excessive computational cost seriously hinders its application in actual engineering structures. In this paper, the multiplicative dimensional reduction method, Taylor series expansion and unary quadratic function are combined to put forward an efficient algorithm to estimate two non-probabilistic reliability importance indices. With the proposed method, all the calculation processes used to solve the extreme value of function are replaced by an approximate analytical solution. Since the proposed method is an approximate analytical solution, the calculation efficiency is extremely high. Three examples are investigated to verify the accuracy and efficiency of the proposed method.
Evaluating the clinical and cost-effectiveness of permissive hypotension in critically ill patients aged 65 years or over with vasodilatory hypotension: Protocol for the 65 randomised clinical trial
Authors: Richards-Belle Alvin , Mouncey Paul R , Grieve Richard D , Harrison David A , Sadique M Zia , Henry Doreen , Whitman Chris , Camsooksai Julie , Gordon Anthony C , Young J Duncan , Rowan Kathryn M , Lamontagne François
Published: December 2020

Vasodilatory shock is common in critically ill patients and vasopressors are a mainstay of therapy. A meta-analysis suggested that use of a higher, as opposed to a lower, mean arterial pressure target to guide titration of vasopressor therapy, could be associated with a higher risk of death in older critically ill patients. The 65 trial is a pragmatic, multi-centre, parallel-group, open-label, randomised clinical trial of permissive hypotension (a mean arterial pressure target of 60 -65 mmHg during vasopressor therapy) versus usual care in critically ill patients aged 65 years or over with vasodilatory hypotension. The trial is conducted in 2600 patients from 65 United Kingdom adult, general critical care units. The primary outcome is all-cause mortality at 90 days. An economic evaluation is embedded. The 65 trial received favourable ethical opinion from the South Central - Oxford C Research Ethics Committee and approval from the Health Research Authority. The results will be presented at national and international conferences and published in peer-reviewed medical journals. Trial registration: ISRCTN10580502
The clinical effect of smoking and environmental factors in spontaneous pneumothorax: a case-crossover study in an Inland province
Authors: Kim Dohun , Eom Sang-Yong , Shin Chang-Seob , Kim Yong-Dae , Kim Si-Wook , Hong Jong-Myeon
Published: December 2020

Background:

The factors that trigger spontaneous pneumothorax have not been sufficiently evaluated. The purpose of this study is to analyze the relationship between the development of spontaneous pneumothorax and meteorological parameters, including air pollutants.

Methods:

This is a retrospective study using the medical records of 379 patients who were admitted for spontaneous pneumothorax (SP) over a period of 4 years. Meteorological and air pollution data were obtained from the National Meteorological Office and the Ministry of Environment. We employed a case-crossover design to evaluate the short-term association between SP and meteorological factors including air pollutants. Conditional logistic regression was used to analyze bi-directional matched data.

Results:

Increase of relative humidity (RH) and of carbon monoxide (CO) were associated with the risk of pneumothorax, with odds ratio (OR) for RH = 1.18 (1.02–1.36), CO = 1.23 (1.02–1.48). Moreover, as air pressure (AP) decreased, risk of pneumothorax increased, with OR = 1.30 (1.05–1.59) but others did not. In the stratified analysis, the effect of RH was positive in ex-smokers (OR = 3.31) and non-smokers (OR = 1.32), but negative in current smokers (OR = 0.72). The effect of AP was significant in younger patients (OR = 1.33), males (OR = 1.40), and non-smokers (OR = 1.36). CO was related only with non-smokers (OR = 1.35)

Conclusion:

The triggering factors for spontaneous pneumothorax were relative humidity, carbon monoxide, and air pressure. The effect of the trigger was prominent in patients who were younger (<45 years), non- or ex-smokers, and male. The reviews of this paper are available via the supplemental material section.
Primary sclerosing cholangitis: A new case of cirrhosis in pregnancy
Authors: Sujana Kumar Vidya , Qumosani Karim , Taylor Taryn , Sun Dongmei
Published: December 2020

Cirrhosis is a multisystemic condition in which pregnancy is uncommon; however, the combination may lead to a higher incidence of spontaneous fetal loss and complications such as progressive jaundice, ascites and variceal bleeding. Here we present a 21-year-old woman who presented at 14 weeks’ gestation with new jaundice and a two-month history of melena consistent with pre-existing cirrhosis of unclear aetiology. She delivered a healthy male infant at 34 weeks and five days of gestation vaginally with good haemostasis. In the literature, maternal mortality rates have been reported in up to 61% of these women, however, this risk is likely lower now with modern endoscopic therapies and improved access to blood products. There is limited information about labour and delivery in cirrhosis, although the best outcomes to date have been described in well-compensated women.
Differences in RAAS/vitamin D linked to genetics and socioeconomic factors could explain the higher mortality rate in African Americans with COVID-19
Authors: Martín Giménez Virna Margarita , Ferder León , Inserra Felipe , García Joxel , Manucha Walter
Published: December 2020

COVID-19 is said to be a pandemic that does not distinguish between skin color or ethnic origin. However, data in many parts of the world, especially in the United States, begin to show that there is a sector of society suffering a more significant impact from this pandemic. The Black population is more vulnerable than the White population to infection and death by COVID-19, with hypertension and diabetes mellitus as probable predisposing factors. Over time, multiple disparities have been observed between the health of Black and White populations, associated mainly with socioeconomic inequalities. However, some mechanisms and pathophysiological susceptibilities begin to be elucidated that are related directly to the higher prevalence of multiple diseases in the Black population, including infection and death by COVID-19. Plasma vitamin D levels and evolutionary adaptations of the renin-angiotensin-aldosterone system (RAAS) in Black people differ considerably from those of other races. The role of these factors in the development and progression of hypertension and multiple lung diseases, among them SARS-CoV-2 infection, is well established. In this sense, the present review attempts to elucidate the link between vitamin D and RAAS ethnic disparities and susceptibility to infection and death by COVID-19 in Black people, and suggests possible mechanisms for this susceptibility.
Increased urinary markers of kidney damage in the institutionalized frail elderly due to recurrent urinary tract infections
Authors: Lorenzo-Gómez María-Fernanda , Flores-Fraile María-Carmen , Márquez-Sánchez Magaly , Flores-Fraile Javier , González-Casado Ignacio , Padilla-Fernández Bárbara , Valverde-Martínez Sebastián , Hernández Sánchez Teresa , Muller-Arteaga Carlos , García-Cenador María-Begoña
Published: December 2020

Objective:

To characterize the impact on kidney injury of recurrent urinary tract infections (RUTI) in the frail elderly.

Methods:

Prospective observational study in 200 frail elderly subjects for 1 year. Groups: GA ( n = 100): subjects without RUTI, GB ( n = 100): subjects with RUTI. Variables: age, concomitant diseases, glomerular filtration rate (GFR), urine neutrophil gelatinase-associated lipocalin (NGAL) at the beginning (NGAL-1) and end (NGAL-2) of the study, urine N-acetyl glucosaminidase (NAG) at the beginning (NAG-1) and the end (NAG-2) of the study, urine transforming growth factor-beta 1 (TGFβ-1). Descriptive statistics, Mann–Whitney test, Chi-squared test, Fisher’s exact test, and multivariate analysis were used.

Results:

Mean age was 84.33 (65–99) years old, with no difference between GA and GB. Mean NGAL-1 was 1.29 ng/ml (0.04–8). There was lower in GA than in GB. Mean NGAL-2 was 1.41 ng/ml (0.02–9.22). NGAL-2 was lower in GA than in GB. Mean NAG-1 was 0.38 UU.II/ml (0.01–2.63. NAG-1 in GA was lower than in GB. Mean NAG-2 was 0.44 UU.II/ml (0–3.41). NAG-2 was lower in GA compared with GB. Mean TGFβ-1 was 23.43 pg/ml (0.02–103.76). TGFβ-1 was lower in GA than GB. There were no differences in the presence of secondary diagnoses between GA and GB. NAG-2 and NGAL-1 were the most determining factors of renal function; in GA it was NGAL-2, followed by NAG-1; in GB it was NGAL-1, followed by NAG-2.

Conclusion:

Frail elderly with RUTI have higher urinary levels of renal injury markers, specifically NGAL, NAG, and TGFβ-1, chronically in periods between urinary tract infection (UTI). Urinary markers of renal injury, specifically NGAL, NAG, and TGFβ-1, identify early deterioration of renal function, compared with serum creatinine, or albuminuria, in frail elderly with recurrent urinary infections.
Antibiotic usage and stewardship in patients with COVID-19: too much antibiotic in uncharted waters?
Authors: Evans Terry John , Davidson Harriet Claire , Low Jen Mae , Basarab Marina , Arnold Amber
Published: December 2020

Background:

Antimicrobial usage and stewardship programmes during COVID-19 have been poorly studied. Prescribing practice varies despite national guidelines, and there is concern that stewardship principles have suffered.

Aim:

To analyse antibiotic prescriptions during the COVID-19 pandemic at a teaching hospital and to propose improved approaches to stewardship.

Methods:

We reviewed COVID-19 admissions to medical wards and intensive care units (ICUs) in a London teaching hospital to assess initial antibiotic usage and evidence of bacterial co-infection, and to determine if our current antibiotic guidelines were adhered to.

Findings:

Data from 130 inpatients (76% medical and 24% ICU) were obtained. On admission, 90% were treated with antibiotics. No microbiological samples taken on admission provided definitive evidence of respiratory co-infection. In 13% of cases, antibiotics were escalated, usually without supporting clinical, radiological or laboratory evidence. In 16% of cases, antibiotics were stopped or de-escalated within 72 h. Blood results and chest radiographs were characteristic of COVID-19 in 20% of ward patients and 42% of ICU patients. Overall mortality was 25% at 14 days – similar to rates described for the UK as a whole.

Conclusion:

The majority of patients received antibiotics despite limited evidence of co-infection. Most patients received narrower spectrum antibiotics than recommended by NICE. As understanding of the natural history of COVID-19 infections progresses, stewardship programmes will need to evolve; however, at this point, we feel that a more restrictive antibiotic prescribing approach is warranted. We propose strategies for effective stewardship and estimate the effect this may have on antibiotic consumption.
Skin manifestations in spondyloarthritis
Authors: Meier Katharina , Schloegl Alexandra , Poddubnyy Denis , Ghoreschi Kamran
Published: December 2020

Spondyloarthritides (SpA) like psoriatic arthritis, axial spondyloarthritis/ankylosing spondylitis, reactive arthritis and inflammatory bowel disease (IBD)-associated SpA can present with characteristic skin manifestations. These SpA-associated skin disorders may precede joint involvement, reflect a loss of efficacy of a current systemic treatment or can even be treatment associated. Cutaneous manifestations in SpA not only add additional morbidity with physical impact but also impose a psychosocial burden on affected patients. Psoriasis (PsO) – the main skin disease in SpA – has a variety of clinical presentations, including plaque-type PsO, inverse PsO, guttate PsO, erythrodermic PsO, nail PsO and pustular types. SpA associated with IBD presents with neutrophilic and granulomatous skin disorders, including pyoderma gangrenosum, hidradenitis suppurativa and cutaneous Crohn’s disease. Reactive arthritides has a favourable prognosis and may feature keratoderma blenorrhagicum or balanitis circinatum as typical skin manifestations. Immunologically, SpA-associated skin diseases share interleukin (IL)-17 and IL-23 dysregulation but show distinctive genetic and immunological profiles. Therefore, they vary in their treatment responses to targeted therapies with biologicals or small molecules. In this review, we highlight the clinical presentation of skin manifestations in SpA and discuss therapeutic approaches in this interdisciplinary field.
Higher depression rates and similar cardiovascular comorbidity in psoriatic arthritis compared with rheumatoid arthritis and diabetes mellitus
Authors: Fragoulis George E. , Evangelatos Gerasimos , Tentolouris Nikolaos , Fragkiadaki Kalliopi , Panopoulos Stylianos , Konstantonis George , Iliopoulos Alexios , Chatzidionysiou Katerina , Sfikakis Petros P. , Tektonidou Maria G.
Published: December 2020

Background:

We explore the spectrum of comorbidities in psoriatic arthritis (PsA) patients in comparison with other high comorbidity-burden diseases like rheumatoid arthritis (RA) and diabetes mellitus (DM).

Methods:

Two hundred and fifteen PsA patients, cross-sectionally collected from two tertiary hospitals, were compared with 215 RA and 215 DM patients (age/sex-matched, similar disease duration). Cardiovascular risk factors [hypertension, current smoking, hyperlipidaemia, obesity (body mass index (BMI) ⩾30)], coronary artery disease (CAD), stroke, major adverse cardiac events (MACEs; combined CAD and stroke), depression, osteoporosis and malignancies were recorded. Odds ratios (ORs) for stroke, CAD and MACE were adjusted for age, sex, hypertension, smoking, hyperlipidaemia, BMI, glucocorticoids use and those for depression were adjusted for age, sex, disease duration, skin involvement and smoking. Within the PsA group, associations between comorbidities and demographic/clinical features were assessed.

Results:

Depression [OR (95% confidence interval (CI)): 3.02 (1.57–5.81)], obesity [OR (95% CI): 2.83, (1.65–4.86)] and hyperlipidaemia [OR (95% CI): 1.96 (1.32–2.90)] were more prevalent in PsA compared with RA, while no differences were observed for CAD, stroke, MACE and malignancies. Depression [OR (95% CI): 4.85 (2.37–9.93)] and osteoporosis [OR (95% CI): 6.22 (1.33–29.2)] were more common in PsA than in DM. Hypertension, but not the other cardiovascular risk factors, was more frequent in DM [OR (95% CI) 0.49 (0.33–0.74)]. However, prevalence of stroke, CAD and MACE did not differ between PsA and DM. Within PsA group, depression was associated with age [OR (95% CI): 1.03 (0.99–1.06)], female sex [OR (95% CI): 3.47 (1.51–7.99)] and smoking [OR (95% CI): 2.78 (1.31–5.88)] while MACEs were associated with age [OR (95% CI): 1.08 (1.00–1.17)], male sex [OR (95% CI) for females: 0.26 (0.06–1.23) and hypertension [OR (95% CI): 6.07 (1.12–33.0)]. No differences were recorded in comorbidities between the different PsA phenotypes.

Conclusion:

Depression was more prevalent in PsA compared with RA and DM, while cardiovascular comorbidity was comparable to both groups, supporting the need for their assessment and management.
Transatlantic relations after the Covid-19 pandemic
Authors: Arvanitopoulos Constantine
Published: December 2020

This article analyses how the COVID-19 pandemic has affected the relationship between Europe and the US, and provides suggestions on how transatlantic cooperation should be taken forward. The pandemic has increased public distrust of the US in Europe due to the way the former has chosen to respond to COVID-19. However, this article argues that the pandemic has mainly accelerated existing transatlantic differences rather than creating new ones. To restore the transatlantic relationship, Europe and the US should strengthen their cooperation on common challenges such as climate change, health security, China, terrorism and migration. COVID-19 has highlighted the limitations of nationalist and unilateral policies in confronting global challenges. It may, in the end, provide the impetus for a rejuvenated transatlantic partnership and build a renewed sense of transatlantic solidarity.
Confabulating Research: Performing Memory-Work as Inquiry
Authors: Barros Sandro R. , Hadeer Reyila , Gajasinghe Kasun
Published: December 2020

This collaborative autoethnographic essay centers on memory-work describing the ebbs and flows of boarding school policies’ effects on ethnic minorities in China and language policy decisions on multilingual citizens in Sri Lanka. The text is the product of the authors’ attunement to the role that confabulation plays in shaping collaborative autoethnographic research through the sharing and analysis of life-writing activities—for example, memoirs, journal entries, photographic narratives, and so on. Confabulation guided the authors through questions related to the meanings of self, other, and culture often taken for granted in (auto)ethnographic research. This is a topic expanded upon in the postface, where confabulation as the method, process, and outcome of research is discussed.
Prevalence of Vitamin D Insufficiency and Deficiency in Young, Female Patients With Lower Extremity Musculoskeletal Complaints
Authors: Ammerman Brittany M. , Ling Daphne , Callahan Lisa R. , Hannafin Jo A. , Goolsby Marci A.
Published: December 2020

Background:

Low levels of vitamin D have well-known impacts on bone health, but vitamin D also has a more global role throughout many tissues, including skeletal muscle. The high prevalence of hypovitaminosis D and the vast physiological features of vitamin D have led researchers to examine the influence of vitamin D on physical performance and injury. Because of the critical role of vitamin D in maintaining musculoskeletal health and function, a high rate of hypovitaminosis D among female patients with a variety of musculoskeletal issues could be of high clinical relevance.

Hypothesis:

There is a high prevalence of low vitamin D in female patients with both acute and overuse sports-related issues of both soft tissue and bone.

Study Design:

Prospective cohort study.

Level of Evidence:

Level 3.

Methods:

Female patients, aged 16 to 40 years, presenting with lower extremity injury diagnosed within the past 4 weeks, no use of multivitamin or vitamin D supplement, and no history of malabsorption syndrome met the inclusion criteria. Vitamin D levels were assessed and categorized as normal (≥32 ng/mL) and low, which includes insufficient (20.01-31.9 ng/mL) and deficient (≤20 ng/mL).

Results:

Of the 105 patients enrolled, 65.7% had low vitamin D. Within the low vitamin D cohort, 40.6% were deficient and 59.4% were insufficient. Injuries were grouped into overuse or acute with 74 overuse injuries and 31 acute injuries, exhibiting low vitamin D prevalence of 60.8% and 77.4%, respectively. Patients with ligamentous/cartilaginous injuries exhibited the highest percentage of low vitamin D (76.5%), followed by those with patellofemoral-related complaints (71.0%), muscle/tendon injuries (54.6%), and bone stress injuries (45.5%). In univariable analysis, older age, non-White race, less physical activity, less high-intensity interval training days, less endurance training days, and more rest days showed an association with low vitamin D, but none showed an independent association in multivariable analysis.

Conclusion:

The prevalence of low vitamin D in female patients with various musculoskeletal complaints was high. Clinicians should evaluate for low vitamin D in both acute and overuse injuries.

Clinical Relevance:

In addition to screening, this study suggests that clinicians should evaluate for low vitamin D levels beyond bone stress injuries in the setting of acute and overuse injuries.
Immanuel Wallerstein, the “modern world-system,” and radical human geography
Authors: Agnew John
Published: December 2020

Arguably, one of the major innovations in social science beginning in the 1970 s was Immanuel Wallerstein’s discovery of what he called the “modern world-system.” This was the idea of a progressively global capitalist world-economy spreading out from Western Europe and structured geographically to exploit peripheral areas for the benefit of a capitalist class in the core. This model proved attractive to some radical geographers because of its global reach, historicity, critique of state centrism, and reliance on a spatial conception of distinctive labor processes associated with different geographic zones. As well as providing a review of the overall framework and criticisms directed at it, I also discuss Wallerstein’s efforts at what he called “unthinking” the orthodox social sciences, his critique of Eurocentrism, doubts about the “radical” quality of his historical model, and the range of writing that emerged under the sign of “world-system analysis.” I close with a discussion of the influence of the perspective in human geography, specifically in relation to development geography, efforts at revitalizing regional geography, and political geography. A brief conclusion suggests that the overall perspective not only has not kept pace with “current reality” but that its conception of “hegemony” does not account for the contemporary American impasse in the world economy as well as Wallerstein hoped it would.
The Dawn of the Academic Revolution: An Individual Contribution to Shaping the Future of Universities
Authors: Savic Marko
Published: December 2020

A dramatic global socio-economic transformation is challenging the traditional university models. Disruptive technologies are quickly changing the way we live and work, inducing shifts in occupational structures and pushing demand toward new skills and competences. Several factors such as the rise of neoliberalism and knowledge economy, the 2008 global economic crisis, Fourth Industrial Revolution, the 2020 COVID-19 pandemic, the continuing emergence of online learning, the amount of student debt, and employers’ dissatisfaction are generating pressure to reconsider global higher education systems. The key stakeholder groups—governments, education institutions, employers, and learners are seeking for new models that are more learner-oriented. The power struggle between various tensions within the current volatile, uncertain, complex, and ambiguous landscape generates a range of scenarios for the universities’ futures. Regardless of which scenario prevails, it is likely that academia will undergo a significantly dynamic transformation in the near future. Following a literature review shaped by personal experience in higher education, the author analyzes macro factors that may affect higher education in the forthcoming decade, with the aim of supporting strategic planning by universities. By generating a set of potential scenarios—Transformative, Market, and Fortress, the author identifies three possible futures to add to the debate about the direction and intensity of the required higher education transformation.