bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrated control strategy of tractor hydromechanical continuously variable transmission
Authors: Xia Guang , Zong Huayu , Tang Xiwen , Zhao Linfeng , Sun Baoqun
Published: September 2020

Given the transmission efficiency fluctuation and response lag problem of hydromechanical continuous variable transmission combined with the complex and variable working environment of a tractor, an integrated control strategy of engine throttle compensation–hydromechanical continuous variable transmission speed regulation is adopted for dual-flow transmission control. On the basis of the estimation of working resistance, a fuzzy algorithm is used to design the throttle compensation law. Considering the maximum driving power of a tractor as the target of variable speed control, an hydromechanical continuous variable transmission efficiency model is established, and the control law of an hydromechanical continuous variable transmission displacement ratio with the maximum driving power of the tractor under any working condition is determined. On the basis of the wavelet neural network proportional–integral–derivative algorithm, the control law of the hydromechanical continuous variable transmission speed regulation is designed, and the parameters of proportional–integral–derivative control are corrected in real time during the control process. Based on MATLAB/Simulink modelling and simulation and the real vehicle verification test, results showed that the influence of hydromechanical continuous variable transmission efficiency fluctuation on the driving power of the entire vehicle, the response lag of the pump-controlled motor system, and the effect of the leakage on the variable speed control and the fluctuation of the working resistance are solved by studying the hydromechanical continuous variable transmission variable speed transmission control strategy. This strategy improves the stability of the tractor speed and ensured the quality of the work, thereby improving the ability of the tractor to adapt to complex working environments.
Effects of inlet guide vane and blade pitch angles on the performance of a submersible axial-flow pump
Authors: Kim Youn-Sung , Shim Hyeon-Seok , Kim Kwang-Yong
Published: September 2020

This study investigates the effects of inlet guide vane (IGV) and blade pitch angles on the steady and unsteady performance of a submersible axial-flow pump. To analyze the interaction between the IGVs and the rotor blades, both steady and unsteady three-dimensional Reynolds-averaged Navier-Stokes equations were used with shear stress transport turbulence closure. Hexahedral meshes were used in the computational domain. The numerical results for performance curves showed good agreement with experimental data. The results showed that the steady and unsteady performance characteristics were dependent on both the IGV and blade pitch angles. Adjusting these angles affected the total pressure rise and thus caused variation in the efficiency in overload conditions. But adjusting these angles affected the unsteady pressure fluctuations in partial-load conditions. Detailed flow analyses were performed to find the root-cause of these phenomena.
The Arabic LupusPRO: A Cross-Cultural Validation of a Disease-Specific Patient-Reported Outcome Tool for Quality of Life in Lupus Patients
Authors: Elkaraly Nourhan Elameen , Nasef Samah Ismail , Omar Aziza Sayed , Fouad Ahmed Mahmoud , Jolly Meenakshi , Mohamed Aly Elsayed
Published: September 2020

Objective

To translate and cross-culturally adapt the Arabic version of LupusPRO v.1.8 and to test its reliability and validity.

Methods

LupusPRO was translated into the Arabic language following a standard procedure with forward-backward translation and was tested in patients with systemic lupus erythematosus (SLE) before use. The Arabic version was administered to 107 Egyptian SLE patients, along with a validated Arabic version of RAND 36-Item Health Survey 1.0 (SF-36). The internal consistency and test-retest reliability were determined. Validity was assessed by correlating LupusPRO scores with SF-36, Safety of Estrogens in Lupus Erythematosus National Assessment–Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). The conceptual framework of the Arabic LupusPRO was evaluated using confirmatory factor analysis (CFA).

Results

Among the 107 SLE patients, 95% were women with a median (range) age of 32 (18-55) years, median (range) SELENA-SLEDAI of 6 (0-23) and median (range) SDI of 0 (0-6). The Cronbach's alpha for the Arabic LupusPRO ranged from 0.71 to 0.98, except for the social support domain (0.65). Test-retest reliability ranged from 0.95 to 0.99. Convergent validity with corresponding domains of SF 36 was satisfactory. For criterion validity, there was a weak but significant correlation between several LupusPRO domains with SELENA-SLEDAI. CFA showed a good model fit.

Conclusion

The Arabic version of LupusPRO v1.8 is a reliable and valid tool for measuring quality of life among Arabic speaking SLE patients.
Posteromedial Approach for Osteochondral Lesions of the Talus
Authors: Tosun Bilgehan
Published: September 2020

Background:

Medial malleolar osteotomy is an established procedure for accessing the medial localized osteochondral lesions of the talus. The purpose of this study was to describe a single approach, which allows perpendicular access to the lesion without a malleolar osteotomy.

Methods:

Six patients were treated surgically for medial localized talar osteochondral lesions. Four patients had stage III and 2 patients had stage IV lesions. A single posteromedial approach was used for accessing the medial talar dome.

Results:

The method of treatment was mosaicplasty in 4 patients and osteochondral fragment fixation in 2 patients. One patient who was treated with a fragment fixation procedure showed screw loosening. Incorporation of the osteochondral grafts was proved by magnetic resonance imaging in all mosaicplasty cases.

Conclusion:

A single posteromedial approach was sufficient in the posteromedial localized osteochondral lesion of the talus. As the lesion was approached by soft tissue exposure only, a malleolar osteotomy was not required. Thus, osteotomy-related complications were avoided.

Level of Evidence:

Level IV, retrospective case series.
Significant interaction between high-dose methotrexate and high-dose piperacillin-tazobactam causing reversible neurotoxicity and renal failure in an osteosarcoma patient
Authors: Krämer Irene , Rosentreter Jelena , Fried Marius , Kühn Michael
Published: September 2020

Introduction

Pharmacokinetic interaction of high-dose methotrexate (MTX) and other concomitantly administered renally secreted medicinal products may lead to insufficient methotrexate serum level decrease and significant MTX toxicity.

Case report

We report the case of an 18-year-old male patient treated with high-dose MTX for an osteosarcoma and with high-dose piperacillin-tazobactam at the same time. MTX serum levels were severely elevated 24 hours after the MTX infusion and did not decrease in accordance with the specific calcium folinate rescue protocol. The patient experienced renal failure accompanied by neurological symptoms, most consistent with MTX-related renal and CNS toxicity. Management and outcome: After discontinuation of piperacillin-tazobactam, intensified calcium folinate rescue therapy, and IV hydration, the MTX serum levels decreased appropriately, and toxicity symptoms resolved.

Discussion

Severe MTX-related toxicity, caused by drug-drug interaction, suggests that the concomitant use of high-dose MTX and high-dose piperacillin-tazobactam should be avoided generally.
Feasibility, Acceptability, and Effectiveness of a New Cognitive-Behavioral Intervention for College Students with ADHD
Authors: Solanto Mary V. , Scheres Anouk
Published: September 2020

Objective

This purpose of this study was to assess the feasibility, acceptability, and effectiveness of a new group cognitive-behavioral treatment (CBT) to enhance executive function (EF) in college students with ADHD.

Methods

Eighteen students meeting rigorous DSM-5 criteria for ADHD were enrolled in two nine-member groups. The treatment targeted time-awareness, distractibility, procrastination, and failure to plan, and included strategies to facilitate academic EF skills.

Results

Eighty-four percent of students attended nine or more of the 12 weekly sessions. Repeated measures analyses of change from pre- to posttreatment yielded improvement in clinician- and self-ratings of DSM-5 ADHD inattentive symptoms, with robust effect sizes. Also improved were scores on standardized scales of time-management, concentration, and total EF.

Discussion

Results provide support for the feasibility, acceptability, and effectiveness of a CBT program in reducing inattentive symptoms and enhancing EF in college students with ADHD, and warrant investigation on a larger scale.
Intravitreal slow-releasing dexamethasone implant for idiopathic neuroretinitis
Authors: Çekiç Osman , Gülkaş Samet
Published: September 2020

Introduction:

The purpose of this report is to describe a successful management of idiopathic neuroretinitis with intravitreal dexamethasone implant.

Method:

Interventional case report.

Clinical Case:

A 34-year-old man with an acute painless unilateral vision loss, optic disc swelling, and a macular edema was diagnosed as idiopathic neuroretinitis, and he underwent 0.7 mg dexamethasone intravitreous implant injection. Macular edema responded quickly and visual acuity improved from 20/50 to 20/25 within 2 weeks and to 20/20 within a month. One month after the injection, optic disc edema disappeared. No recurrence occurred and visual acuity was stable at 20/20 during 3 years of follow-up.

Conclusion:

Idiopathic neuroretinitis can be treated with intravitreal dexamethasone implant.
Awareness, Knowledge, and Utility of RCT Data vs RWE: Results From a Survey of US Cardiologists: Real-world Evidence in Clinical Decision Making
Authors: Villines Todd C , Cziraky Mark J , Amin Alpesh N
Published: September 2020

Real-world evidence (RWE) provides a potential rich source of additional information to the body of data available from randomized clinical trials (RCTs), but there is a need to understand the strengths and limitations of RWE before it can be applied to clinical practice. To gain insight into current thinking in clinical decision making and utility of different data sources, a representative sampling of US cardiologists selected from the current, active Fellows of the American College of Cardiology (ACC) were surveyed to evaluate their perceptions of findings from RCTs and RWE studies and their application in clinical practice. The survey was conducted online via the ACC web portal between 12 July and 11 August 2017. Of the 548 active ACC Fellows invited as panel members, 173 completed the survey (32% response), most of whom were board certified in general cardiology (n = 119, 69%) or interventional cardiology (n = 40, 23%). The survey results indicated a wide range of familiarity with and utilization of RWE amongst cardiologists. Most cardiologists were familiar with RWE and considered RWE in clinical practice at least some of the time. However, a significant minority of survey respondents had rarely or never applied RWE learnings in their clinical practice, and many did not feel confident in the results of RWE other than registry data. These survey findings suggest that additional education on how to assess and interpret RWE could help physicians to integrate data and learnings from RCTs and RWE to best guide clinical decision making.
High-intensity interval training reduces neutrophil-to-lymphocyte ratio in persons with multiple sclerosis during inpatient rehabilitation
Authors: Joisten Niklas , Proschinger Sebastian , Rademacher Annette , Schenk Alexander , Bloch Wilhelm , Warnke Clemens , Gonzenbach Roman , Kool Jan , Bansi Jens , Zimmer Philipp
Published: September 2020

In persons with multiple sclerosis (PwMS), the neutrophil-to-lymphocyte ratio (NLR) is associated with disability status, symptomatology and disease activity. High-intensity interval training (HIIT) improves many symptoms in PwMS and may positively influence disease progression. Here, we present results from a randomized controlled trial during inpatient rehabilitation on immediate (single bout) and training (3-week intervention) effects of HIIT versus moderate continuous training on NLR and related cellular inflammation markers. Only HIIT reduced the NLR over the 3-week intervention period. These training effects might be due to repetitive inflammatory states with compensatory anti-inflammatory counterbalancing after each HIIT session.
Explaining the asset growth anomaly in the restaurant industry: Motivations and consequences
Authors: Mun Sung Gyun , Jang SooCheong (Shawn)
Published: September 2020

Many business leaders have the tendency to vigorously pursue rapid firm growth, but this focus is often criticized as problematic in terms of operating performance. Accordingly, this study suggested that the asset growth anomaly is an inevitable phenomenon for growing restaurant firms: operating profitability increases as assets grow to the optimum level and then decreases after this level. However, most restaurant firms invest their capital below the optimum level, and only a small number of restaurant firms increase their assets too rapidly. Further, the amount of a chief executive officer’s (CEO’s) bonus payments motivates their investments in asset growth, while the amount of stock options increases the probability of overinvestment practices in restaurant firms. Therefore, even though overinvestment practices are not apparent in most restaurant firms, an appropriate proportion of equity-based incentives is beneficial to prevent overinvestment practices by a few restaurant firms to avoid negatively impacting shareholders’ wealth.
Balanced time perspective as a facilitator of immigrants’ psychological adaptation: A study among Ukrainian immigrants in Poland
Authors: Marczak Michalina , Sorokowski Piotr , Sobol Małgorzata
Published: September 2020

The perception of time plays a fundamental role in the organisation of basic psychological processes, and as such may also influence migrants’ psychological wellbeing. This paper investigates the relationship between the perception of time and immigrants’ psychological adaptation (i.e., affective aspects of migration) based on a sample of 238 Ukrainians residing in Poland. To assess time perception, we drew primarily from time perspective theory, which defines time perspective as a measure of the degree to which individuals non-consciously construe the past, the present, and the future. Psychological adaptation was assessed, focusing on participants’ basic psychological needs satisfaction, their satisfaction with life, and their psychological condition. We observed a relatively strong negative relationship between negative past and fatalistic present time perspectives and psychological adaptation. Additionally, we found that a more balanced and less negative temporal profile was related to significantly better psychological adaptation of immigrants. We discuss these results in light of the cultural validity of time perspective theory, the destructive impact of negative time perspective on migrants’ psychological wellbeing, and the potential applications of time perspective-based therapy in integration interventions for immigrants.
A tropical field study on outdoor bioclimatic comfort of people with different thermal histories
Authors: Shang Chunjing , Chen Yanxi , Cai Jianhong , Zhang Zhongjun
Published: September 2020

Several studies reported that the long-term thermal history of the human body affects its thermal comfort and preferences. We conducted a tropical field study in Sanya city, China; 1512 questionnaires were collected from tourists. The tourists had five thermal histories associated with five different climate regions (cold, severely cold, hot summer, cold winter, hot summer and warm winter and temperate regions). Our results showed that the human body's long-term thermal history had distinct influences on their thermal sensation, thermal comfort and preferences at their destination. Greater difference in a subject's thermal history from that of the tourist destination showed greater difference in the bioclimatic comfort and thermal preference. The neutral physiological equivalent temperature (nPET) of tourists with thermal histories in the severely cold and cold regions was 25.6°C and 25.9°C, respectively. The nPET was 1.4°C and 1.7°C higher than that of the temperate regions, respectively. The relationship between thermal acceptability vote and thermal comfort vote showed that the tourists with thermal histories in the severely cold and cold regions were more sensitive to environmental changes than those with histories from the other regions.
Overdosing on iron: Elevated iron and degenerative brain disorders
Authors: D’Mello Santosh R , Kindy Mark C
Published: September 2020

All cells in organisms ranging from yeast to humans utilize iron as a cofactor or structural element of proteins that function in diverse and critical cellular functions. However, deregulation of the homeostatic mechanisms regulating iron metabolism resulting in a reduction or excess of iron within the cell or outside of it can have serious effects to the health of cells and the organism. This review provides a brief overview of the molecular and cellular mechanisms regulating iron physiology, including the molecules and processes regulating iron uptake, its storage and utilization, its recycling, and its release from the cell, such that the cellular iron levels are sufficient to meet metabolic demand but below those that cause permanent damage. The major focus of review is on the pathological consequences of dysregulation of these homeostatic mechanisms, focusing on the brain. Current advances on the role of iron accumulation to the pathogenesis of rare neurological disorders caused by genetic mutations as well as to the more prevalent and age-associated neurodegenerative diseases are described.

Impact statement

Brain degenerative disorders, which include some neurodevelopmental disorders and age-associated diseases, cause debilitating neurological deficits and are generally fatal. A large body of emerging evidence indicates that iron accumulation in neurons within specific regions of the brain plays an important role in the pathogenesis of many of these disorders. Iron homeostasis is a highly complex and incompletely understood process involving a large number of regulatory molecules. Our review provides a description of what is known about how iron is obtained by the body and brain and how defects in the homeostatic processes could contribute to the development of brain diseases, focusing on Alzheimer’s disease and Parkinson’s disease as well as four other disorders belonging to a class of inherited conditions referred to as neurodegeneration based on iron accumulation (NBIA) disorders. A description of potential therapeutic approaches being tested for each of these different disorders is provided.
Hsa-miR-30e-3p inhibits influenza B virus replication by targeting viral NA and NP genes
Authors: Khongnomnan Kritsada , Saengchoowong Suthat , Mayuramart Oraphan , Nimsamer Pattaraporn , Pisitkun Trairak , Poovorawan Yong , Payungporn Sunchai
Published: September 2020

Influenza B virus is a member of the Orthomyxoviridae family which can infect humans and causes influenza. Although it is not pandemic like influenza A virus, it nevertheless affects millions of people worldwide annually. MicroRNAs are small non-coding RNAs regulating gene expression at posttranscriptional level. They play various important roles in cellular processes including response to viral infection. MiRNA profiles from our previous study suggested that miR-30e-3p was one of the upregulated miRNAs that responded to influenza B virus infection. In this study, in silico prediction and in vitro investigation proved that this miRNA can directly target NA and NP genes of the influenza B virus and inhibit its replication. This finding might be useful for using miRNA as an alternative therapeutics for influenza virus infection.
Arterio-Hepatic Venous Fistula Following Liver Biopsy: A Rare Case Report and Literature Review
Authors: Dutta Souradeep , Chapa Uday Kumar , Ansari Mohd Irfan , Vaka Sivaranjith , Jain Ankit , Abhinaya Reddy , Nagarajan Krishnan , Ramakrishnaiah Vishnu Prasad Nelamangala
Published: September 2020

Arterio-hepatic venous fistula (AHVF) is an exceedingly rare phenomenon compared to arterio-portal venous fistula with only 8 cases reported in world literature. Many listed causes can be attributed to the development of there are no reported cases of AHVF following a core-needle biopsy. We report a case of 38 year-old-female with EHPVO, who underwent splenectomy with a proximal splenorenal shunt. She had an injury to left hepatic artery, consequent to a blind intra-operative core needle biopsy from the liver, which led to the development of a fistulous connection between left hepatic artery and middle hepatic vein causing high output cardiac failure. She was successfully managed with trans-arterial embolization. The present review emphasizes the possibility of AHVF following a liver biopsy and the role of digital subtraction angiography in the diagnosis, therapeutic intravascular interventions, and follow-up.
Investigation of suspended nanoliquid flow of Eyring–Powell fluid with gyrotactic microorganisms and density number
Authors: Haq Fazal , Khan Muhammad Ijaz , Khan Sohail A , Hayat T
Published: September 2020

The aim of the current investigation is to discuss the behavior of mixed convection magnetohydrodynamic flow of Eyring–Powell nanoliquid subjected to gyrotactic microorganisms over a stretchable cylinder. Energy communication is developed through the first law of thermodynamics and deliberated in the manifestation of viscous dissipation. Furthermore, Brownian motion and thermophoresis effects are also considered. Nonlinear system of partial differential equations is altered into ordinary one due to employing transformations. The given systems are then solved through ND-solve technique. Impact of influential variables on velocity, motile microorganism’s temperature, and concentration is deliberated graphically. Skin friction coefficient, mass transfer rate, density number, and Nusselt number are numerically computed versus different influential variables. Velocity and temperature have opposite impact for curvature parameter. For higher estimation of fluid parameter, temperature and velocity fields boost up.
Mechanisms underpinning the efficacy of faecal microbiota transplantation in treating gastrointestinal disease
Authors: Segal Jonathan P. , Mullish Benjamin H. , Quraishi Mohammed N. , Iqbal Tariq , Marchesi Julian R. , Sokol Harry
Published: September 2020

Faecal microbiota transplantation (FMT) is currently a recommended therapy for recurrent/refractory Clostridioides difficile infection (CDI). The success of FMT for CDI has led to interest in its therapeutic potential in many other disorders. The mechanisms that underpin the efficacy of FMT are not fully understood. Importantly, FMT remains a crucial treatment in managing CDI and understanding the mechanisms that underpin its success will be critical to improve its clinical efficacy, safety and usability. Furthermore, a deeper understanding of this may allow us to expose FMT’s full potential as a therapeutic tool for other disease states. This review will explore the current understanding of the mechanisms underlying the efficacy of FMT across a variety of diseases.
Digital Methods for Hashtag Engagement Research
Authors: Omena Janna Joceli , Rabello Elaine Teixeira , Mintz André Goes
Published: September 2020

This article seeks to contribute to the field of digital research by critically accounting for the relationship between hashtags and their forms of grammatization—the platform techno-materialization process of online activity. We approach hashtags as sociotechnical formations that serve social media research not only as criteria in corpus selection but also displaying the complexity of the online engagement and its entanglement with the technicity of web platforms. Therefore, the study of hashtag engagement requires a grasping of the functioning of the platform itself (technicity) along with the platform grammatization. In this respect, we propose the three-layered (3L) perspective for addressing hashtag engagement. The first contemplates potential differences between high-visibility and ordinary hashtag usage culture, its related actors, and content. The second focuses on hashtagging activity and the repurposing of how hashtags can be differently embedded into social media databases. The last layer looks particularly into the images and texts to which hashtags are brought to relation. To operationalize the 3L framework, we draw on the case of the “impeachment-cum-coup” of Brazilian president Dilma Rousseff. When cross-read, the three layers add value to one another, providing also difference visions of the high-visibility and ordinary groups.
Handling informative dropout in longitudinal analysis of health-related quality of life: application of three approaches to data from the esophageal cancer clinical trial PRODIGE 5/ACCORD 17
Authors: Cuer B. , Mollevi C. , Anota A. , Charton E. , Juzyna B. , Conroy T. , Touraine C.
Published: September 2020

Background

Health-related quality of life (HRQoL) has become a major endpoint to assess the clinical benefit of new therapeutic strategies in oncology clinical trials. Typically, HRQoL outcomes are analyzed using linear mixed models (LMMs). However, longitudinal analysis of HRQoL in the presence of missing data remains complex and unstandardized. Our objective was to compare the modeling alternatives that account for informative dropout.

Methods

We investigated three alternative methods—the selection model (SM), pattern-mixture model (PMM), and shared-parameters model (SPM)—in relation to the LMM. We first compared them on the basis of methodological arguments highlighting their advantages and drawbacks. Then, we applied them to data from a randomized clinical trial that included 267 patients with advanced esophageal cancer for the analysis of four HRQoL dimensions evaluated using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire.

Results

We highlighted differences in terms of outputs, interpretation, and underlying modeling assumptions; this methodological comparison could guide the choice of method according to the context. In the application, none of the four models detected a significant difference between the two treatment arms. The estimated effect of time on HRQoL varied according to the method: for all analyzed dimensions, the PMM estimated an effect that contrasted with those estimated by the SM and SPM; the LMM estimated effects were confirmed by the SM (on two of four HRQoL dimensions) and SPM (on three of four HRQoL dimensions).

Conclusions

The PMM, SM, or SPM should be used to confirm or invalidate the results of LMM analysis when informative dropout is suspected. Of these three alternative methods, the SPM appears to be the most interesting from both theoretical and practical viewpoints.

Trial registration

This study is registered withClinicalTrials.gov, numberNCT00861094.
Continuity of care is associated with satisfaction with local health care services
Authors: Lautamatti E. , Sumanen M. , Raivio R. , Mattila K. J.
Published: September 2020

Background

Satisfaction is a major element in assessing quality of care. It has decreased in Finland in recent decades as well as continuity of care. We investigated which demographic, health-related, and local health care service factors, especially continuity of care, are associated with the population’s satisfaction with local health care services.

Methods

The data are part of the Health and Social Support (HeSSup) study’s follow-up questionnaire in 2012. The study is based on a random Finnish population sample. Satisfaction was studied based on the question “How satisfied are you with your local health care services?” Demographic factors, obesity, self-assessed health status, depressive mood (BDI-12 questionnaire), New York Heart Association class, and chronic diseases were asked in the questionnaire. Questions describing local health care services were also presented. We assessed the association of an assigned and named GP and the respondents’ proactivity in contacting the same doctor with satisfaction. We used crosstabulation and binary logistic regression in the analyses.

Results

The Health and Social Support study was answered in 2012 by 15,993 participants (45.4%) and majority (61.3%) was satisfied with their local health care services. An assigned and named GP (OR 1.79; 95% CI 1.67–1.92) and the respondent’s proactivity in contacting the same doctor (OR 1.23; 95% CI 1.15–1.32) were associated with satisfaction in the adjusted multivariate analysis. BDI score < 19 had the strongest association with satisfaction (OR 1.91; 95% CI 1.65–2.23). Older participants, males, and those in a relationship were more likely to be satisfied.

Conclusions

A named GP in primary care proved to have a positive correlation with patient satisfaction. Depression was associated with decreased satisfaction. A named GP indicates continuity of care, and it should be seriously considered when planning treatment for patients with chronic conditions.
A health concept with a social potential: an interview study with nursing home residents
Authors: Vikström Sofia , Grönstedt Helena K. , Cederholm Tommy , Franzén Erika , Seiger Åke , Faxén-Irving Gerd , Boström Anne-Marie
Published: September 2020

Background

A qualitative, interview-based study was embedded in a randomized intervention trial, the Older People Exercise and Nutrition (OPEN) study. Participants in the OPEN study were encouraged to conduct sessions of sit-to-stand (STS) exercises combined with Oral Nutritional Supplements (ONS) intake. The aim was to describe the older persons’ perceptions and experiences of being given the daily opportunity to perform the STS exercise and drink ONS.

Methods

In-depth interviews were conducted in six nursing homes with the participants using a semi-structured interview guide. One or two individual interviews were performed with each included participant. Twenty-three NH residents (16 women and 7 men) participated in the qualitative study. Their ages ranged between 76 and 96 years, and their Mini Mental State Examination (MMSE) scored between 8 and 29. The transcribed interviews and field notes written during the visits were analyzed inductively following a constant comparative method described in Grounded Theory.

Results

The exercise and nutritional intervention was described as highly practical by the NH residents, who claimed it also had a social aspect as they felt acknowledged and empowered to engage others in the combined intervention. Experiences of the intervention ranged from neutral to mainly positive and could be sorted into 5 categories: 1. Perceived hopes and expectations, 2. Health-related driving forces, 3. Appreciated daily activities, 4. A concept easy to perform and integrate into daily life, 5. A beneficial health concept for all. The intervention created perceived benefits on various health aspects due to participants feeling energized and stronger. An overall theme was identified as A health concept with a social potential, as participants feel acknowledged and strong enough to help others.

Conclusions

The intervention was described by participants as a health concept that could potentially be beneficial for a broader spectrum of NH residents. The findings indicate that health concepts, such as STS/ONS, might contribute to a more meaningful day for older people, even vulnerable NH residents approaching the end of life.

Trial registration

ClinicalTrials.govIdentifier: NCT02702037. Date of trial registration February 26, 2016.
Bundled care in acute kidney injury in critically ill patients, a before-after educational intervention study
Authors: Koeze Jacqueline , van der Horst Iwan C. C. , Wiersema Renske , Keus Frederik , Dieperink Willem , Cox Eline G. M. , Zijlstra Jan G. , van Meurs Matijs
Published: September 2020

Background

Acute kidney injury (AKI) often occurs in critically ill patients. AKI is associated with mortality and morbidity. Interventions focusing on the reduction of AKI are suggested by the Kidney Disease: Improving Global Outcomes guideline. We hypothesized that these educational interventions would improve outcome in patients admitted to the Intensive Care Unit (ICU).

Methods

This was a pragmatic single-centre prospective observational before-after study design in an ICU in a tertiary referral hospital. All consecutive patients admitted to the ICU irrespective their illness were included. A ‘Save the Kidney’ (STK) bundle was encouraged via an educational intervention targeting health care providers. The educational STK bundle consisted of optimizing the fluid balance (based on urine output, serum lactate levels and/or central venous oxygen saturation), discontinuation of diuretics, maintaining a mean arterial pressure of at least 65 mmHg with the potential use of vasopressors and critical evaluation of the indication and dose of nephrotoxic drugs. The primary outcome was the composite of mortality, renal replacement therapy (RRT), and progression of AKI. Secondary outcomes were the components of the composite outcome the severity of AKI, ICU length of stay and in-hospital mortality.

Main results

The primary outcome occurred in 451 patients (33%) in the STK group versus 375 patients (29%) in the usual care group, relative risk (RR) 1.16, 95% confidence interval (CI) 1.03–1.3, p < 0.001. Secondary outcomes were, ICU mortality in 6.8% versus 5.6%, (RR 1.22, 95% CI 0.90–1.64, p = 0.068), RRT in 1.6% versus 3.6% (RR 0.46, 95% CI 0.28–0.76, p = 0.002), and AKI progression in 28% versus 24% (RR 1.18, 95% CI 1.04–1.35, p = 0.001).

Conclusions

Providing education to uniformly apply an AKI care bundle, without measurement of the implementation in a non-selected ICU population, targeted at prevention of AKI progression was not beneficial.
Head and neck CT angiography to assess the internal carotid artery stealing pathway
Authors: Wang Dongxu , Li Zheng , Zheng Xiaoyang , Cong Houyi , Zhang Tianyu , Wang Zhenghua , Wang Yuguang , He Jun
Published: September 2020

Background

Common carotid artery occlusive disease (CCAOD) could form internal carotid artery steal pathways. Based on the diagnostic results of digital subtraction angiography (DSA), head and neck computed tomography angiography (CTA) was used to find the internal carotid artery stealing pathway after CCAOD.

Methods: The clinical and imaging data of 18 patients with CCAOD were retrospectively analyzed. DSA and CTA was used to evaluate internal carotid artery steal pathways.

Results

Of the 18 patients with CCAOD, 10 patients found internal carotid artery steal pathways. There were 7 males and 3 females. Vascular ultrasound examination of all patients: The affected side had no blood flow in common carotid artery (CCA), and had retrograde blood flow in the external carotid artery (ECA). The blood flow of the affected side was decreased in the internal carotid artery (ICA), but it was antegrade. DSA diagnosed 10 cases of CCA occlusion and CTA diagnosed 10 cases of CCA occlusion. DSA and CTA found 6 internal carotid artery blood stealing pathways: ① Vertebral artery → occipital artery → external carotid artery → internal carotid artery (6 cases); ② Thyrocervical trunk → ascending cervical artery → occipital artery → external carotid artery → internal carotid artery (7 cases); ③ Costocervical trunk → deep cervical artery → occipital artery → external carotid artery → internal carotid artery (6 cases); ④ Affected side thyroid neck trunk → inferior thyroid artery → superior thyroid artery → external carotid artery → internal carotid artery (2 cases); ⑤ Contralateral external carotid artery → contralateral superior thyroid artery → affected superior thyroid artery → external carotid artery → neck Internal artery (2 cases); ⑥ Parathyroid neck → superficial cervical artery → occipital artery → external carotid artery → internal carotid artery (1 case).

Conclusions

The patients with CCAOD can find the internal carotid artery blood stealing pathway through CTA.
WeChat app-based reinforced education improves the quality of opioid titration treatment of cancer-related pain in outpatients: a randomized control study
Authors: Peng Zhiyou , Li Lin , Chen Yuan , Feng Zhiying , Fang Xiangming
Published: September 2020

Background

As inadequate pain communication contributes to difficulties in optimizing outcomes of outpatients, we investigated the effect of reinforced education using WeChat App to the opioid titration treatment of cancer-related pain in the outpatient setting.

Methods

We conducted a prospective study to compare reinforced education using Wechat with care as usual from February to December 2019. Patients in the reinforced education group received reinforced education via Wechat, while those in the control group received care as usual. Effect measurements for both groups are carried out with questionnaires at the baseline and 3 days later. Questionnaires include pain intensity (NRS), treatment-related adverse events, cancer-related quality of life (QOL), sleep (PSQI), satisfaction, anxiety (GAD-7) and depression (PHQ-9). Number of patients whose NRS reduced to less than three points in 24 h was the primary outcomes. Secondary outcomes included treatment-related adverse events, cancer-related quality of life, sleep, satisfaction, anxiety and depression.

Results

Although there was no significant difference regarding pain intensity (NRS) between the two groups at 72 h, the rate of NRS that reduced to less than three points in 24 h was significantly higher in the Wechat group than in the control group. Patients’ satisfaction was significantly higher in the Wechat group than in the control group. There was no significant difference between the two groups regarding the other findings at 72 h, including pain intensity (NRS), cancer-related quality of life (QOL), anxiety (GAD-7), depression (PHQ-9), and sleep (PSQI). However, no significant difference was found between the two groups for constipation, nausea, vomiting, dizziness, somnolence, pruritus, loss of consciousness, and death.

Conclusions

Our results indicated that receiving instructions delivered by Wechat resulted an increased number of patients with good pain control and better satisfaction. The study provided insight into the effectiveness of the reinforced education using a Wechat app delivered by a doctor to outpatients in the titration treatment of cancer-related pain.

Trial registration

This study was registered at chictr.org (Registration number: ChiCTR1900021150, Date of Registration: January 30, 2019).
Young age increases the risk of lymph-node metastasis in patients with muscle-invasive bladder urothelial carcinoma
Authors: Tian Zijian , Meng Lingfeng , Wang Xin , Diao Tongxiang , Hu Maolin , Wang Miao , Liu Ming , Wang Jianye
Published: September 2020

Background

The risk of positive lymph nodes in patients with muscle-invasive bladder urothelial carcinoma (MIBC) can be used to guide treatment recommendations. However, little is known about the effect of age on lymph node positivity (LN+). This study aimed to evaluate the effect of age on LN+ in MIBC.

Methods

We analyzed patients with stage T2–T4 bladder urothelial carcinoma who had not received preoperative radiotherapy, had at least one lymph node examined, and underwent cystectomy between 1998 and 2015. The Cochran–Armitage trend test and logistic univariate and multivariate analyses were used to evaluate the effect of age on LN+ in all T stages.

Results

In total, 15,624 patients with MIBC were identified, including 747 patients aged ≤50 years (4.78%), 2614 patients aged 50–59 years (16.73%), 4914 patients aged 60–69 years (31.45%), 5225 patients aged 70–79 years old (33.44%), and 2124 patients aged > 80 years (13.59%). In T2–T4 staging, LN+ was negatively correlated with age. After adjustment for several covariates, multivariate logistic regression analysis revealed that age was an independent risk factor for LN+.

Conclusions

In this large SEER analysis, Young patients with MIBC have a higher risk of lymph node metastasis. This finding is worthy of further study and may eventually affect the treatment decisions of young patients.
Impact of smoking amount on clinicopathological features and survival in non-small cell lung cancer
Authors: Ban Woo Ho , Yeo Chang Dong , Han Solji , Kang Hye Seon , Park Chan Kwon , Kim Ju Sang , Kim Jin Woo , Kim Seung Joon , Lee Sang Haak , Kim Sung Kyoung
Published: September 2020

Background

Screening for early detection of lung cancer has been performed in high-risk individuals with smoking history. However, researches on the distribution, clinical characteristics, and prognosis of these high-risk individuals in an actual cohort are lacking. Thus, the objective of this study was to retrospectively review characteristics and prognosis of patients with smoking history in an actual lung cancer cohort.

Methods

The present study used the lung cancer cohort of the Catholic Medical Centers at the Catholic University of Korea from 2014 to 2017. Patients with non-small cell lung cancer were enrolled. They were categorized into high and low-risk groups based on their smoking history using the national lung screening trial guideline. Distribution, clinical characteristics, and survival data of each group were estimated.

Results

Of 439 patients, 223 (50.8%) patients were in the high-risk group. Patients in the high-risk group had unfavorable clinical characteristics and tumor biologic features. Overall survival of the high-risk group was significantly shorter than that of the low-risk group with both early (I, II) and advanced stages (III, IV). In multivariate analysis, heavy smoking remained one of the most important poor clinical prognostic factors in patients with lung cancer. It showed a dose-dependent relationship with patients’ survival.

Conclusions

High-risk individuals had poor clinical outcomes. Patients’ prognosis seemed to be deteriorated as smoking amount increased. Therefore, active screening and clinical attention are needed for high-risk individuals.
Introduction of less invasive surfactant administration (LISA), impact on diagnostic and therapeutic procedures in early life: a historical cohort study
Authors: Bugter I. A. L. , Janssen L. C. E. , Dieleman J. , Kramer B. W. , Andriessen P. , Niemarkt H. J.
Published: September 2020

Background

In preterm infants with Respiratory Distress Syndrome (RDS), Less Invasive Surfactant Administration (LISA) has been established to reduce the need of mechanical ventilation and might improve survival rates without bronchopulmonary dysplasia. The aim of this study was to investigate whether NICU care has changed after introduction of less invasive surfactant administration (LISA), with regard to diagnostic and therapeutic procedures in the first week of life.

Methods

Infants with gestational age < 32 weeks who received surfactant by LISA (June 2014 – December 2017, n = 169) were retrospectively compared to infants who received surfactant after intubation (January 2012 – May 2014, n = 155). Local protocols on indication for surfactant, early onset sepsis, blood transfusions and enteral feeding did not change between both study periods. Besides, as secondary outcome complications of prematurity were compared. Data was collected from electronic patient files and compared by univariate analysis through Students T-test, Mann Whitney-U test, Pearson Chi-Square test or Linear by Linear Association.

Results

All baseline characteristics of both groups were comparable. Compared to controls, LISA patients received a higher total surfactant dose (208 vs.160 mg/kg; p < 0.001), required redosing more frequently (32.5% vs. 21.3%; p = 0.023), but needed less mechanical ventilation (35.5% vs. 76.8%; p < 0.001). After LISA, infants underwent fewer X-rays (1.0 vs. 3.0, p < 0.001), blood gas examinations (3.0 vs. 5.0, p < 0.001), less inotropic drugs (9.5% vs. 18.1%; p = 0.024), blood transfusions (24.9% vs. 41.9%, p = 0.003) and had shorter duration of antibiotic therapy for suspected early onset sepsis (3.0 vs. 5.0 days, p < 0.001). Moreover, enteral feeding was advanced faster (120 vs. 100 mL/kg/d, p = 0.048) at day seven. There were no differences in complications of prematurity.

Conclusion

The introduction of LISA is associated with significantly fewer diagnostic and therapeutic procedures in the first week of life, which emphasizes the beneficial effects of LISA.
Can complex programs be sustained? A mixed methods sustainability evaluation of a national infant and young child feeding program in Bangladesh and Vietnam
Authors: Moucheraud Corrina , Sarma Haribondhu , Ha Tran Thi Thu , Ahmed Tahmeed , Epstein Adrienne , Glenn Jeffrey , Hanh Hoang Hong , Huong Tran Thi Thu , Luies Sharmin Khan , Moitry Aninda Nishat , Nhung Doan Phuong , Payán Denise Diaz , Rahman Mahfuzur , Tariqujjaman Md , Thuy Tran Thi , Tuan Tran , Bossert Thomas J. , Kruk Margaret E.
Published: September 2020

Background

Poor early-life nutrition is a major barrier to good health and cognitive development, and is a global health priority. Alive & Thrive (A&T) was a multi-pronged initiative to improve infant and young child feeding behaviors. It aimed to achieve at-scale child health and nutrition improvements via a comprehensive approach that included nutrition counseling by health workers, policy change, social mobilization and mass media activities. This study evaluated the sustainability of activities introduced during A&T implementation (2009–2014) in Bangladesh and Vietnam.

Methods

This was a mixed methods study that used a quasi-experimental design. Quantitative data (surveys with 668 health workers, and 269 service observations) were collected in 2017; and analysis compared outcomes (primarily dose and fidelity of activities, and capacity) in former A&T intervention areas versus areas that did not receive the full A&T intervention. Additionally, we conducted interviews and focus groups with 218 stakeholders to explore their impressions about the determinants of sustainability, based on a multi-level conceptual framework.

Results

After program conclusion, stakeholders perceive declines in mass media campaigns, policy and advocacy activities, and social mobilization activities – but counseling activities were institutionalized and continued in both countries. Quantitative data show a persisting modest intervention effect: health workers in intervention areas had significantly higher child feeding knowledge, and in Bangladesh greater self-efficacy and job satisfaction, compared to their counterparts who did not receive the full package of A&T activities. While elements of the program were integrated into routine services, stakeholders noted dilution of the program focus due to competing priorities. Qualitative data suggest that some elements, such as training, monitoring, and evaluation, which were seen as essential to A&T’s success, have declined in frequency, quality, coverage, or were eliminated altogether.

Conclusions

The inclusion of multiple activities in A&T and efforts to integrate the program into existing institutions were seen as crucial to its success but also made it difficult to sustain, particularly given unstable financial support and human resource constraints. Future complex programs should carefully plan for institutionalization in advance of the program by cultivating champions across the health system, and designing unique and complementary roles for all stakeholders including donors.