bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of Lactulose to Treat Hyperammonemia in ICU Patients Without Chronic Liver Disease or Significant Hepatocellular Injury
Authors: Cutler Nathan S. , Sadowski Brett W. , MacGregor Drew A.
Published: June 2021

Objectives:

To review ICU patients with elevated ammonia without a clear hepatic etiology, to compare outcomes between those who received lactulose and those who did not.

Design:

Retrospective observational study.

Setting:

Medical, surgical, and subspecialty intensive care units at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina between December 2012 and August 2016.

Patients:

Adults with ammonia levels above 50 μmol/L, excluding those with known chronic liver disease, inborn error of metabolism, active use of valproic acid, total bilirubin ≥ 2 μmol/L, or alanine aminotransferase ≥ 100 units/L.

Interventions:

Comparison in ICU length of stay (LOS), hospital LOS, in-hospital mortality, and mortality at 30 and 90 days.

Measurements and Main Results:

Criteria for inclusion were met in 103 cases. Mean ammonia level was 75 μmol/L, with undetermined etiology in the majority of subjects. Lactulose was given in 48 cases (46.6%), with a median of 9.5 doses given. There were no significant differences in outcomes between the lactulose and non-lactulose groups. Among subjects with multiple data points, lactulose did not have a dose-dependent effect on ammonia level, and was not associated with faster ammonia normalization compared to non-lactulose. When analyzed separately, patients with moderate hyperammonemia (60-99 μmol/L) who received lactulose had longer hospital and ICU length of stay compared to non-lactulose (417.8 hours vs. 208.4 hours, P = 0.003, and 229.2 hours vs. 104.7 hours, P = 0.025; respectively), though confounders were present.

Conclusions:

Routine use of lactulose to treat mild to moderate hyperammonemia in this patient population was not associated with improved outcomes.
Troubling Trade-offs Between Women’s Work and Intimate Partner Violence: Evidence From 19 Developing Countries
Authors: Zafar Sameen , Zia Saima , Amir-ud-Din Rafi
Published: June 2021

The empirical link between women’s employment status and their experience of different types of intimate partner violence (IPV) is not very apparent. Using Demographic and Health Surveys (DHS) data from 19 developing countries in South Asia, Sub-Saharan Africa, and the Middle East, we found that working women were significantly more likely to experience IPV than their stay-at-home counterparts. Given the great diversity in women’s employment with respect to economic returns and working conditions, we disaggregated women’s employment into three categories vis-à-vis agriculture jobs (AJ), blue-collar jobs (BJ), and white-collar jobs (WJ). The disaggregated analysis revealed that women engaged in all three job categories were significantly more likely to experience IPV. After controlling for potential endogeneity of women’s employment, we found that women’s work increased the risk of less severe physical violence (LSPV) and emotional violence (EV) but reduced the risk of sexual violence (SV). Endogeneity-adjusted disaggregated analysis showed that women engaged in BJ and WJ faced an increased risk of LSPV but reduced risk of SV. In contrast, women undertaking AJ faced a smaller risk of severe physical violence (SPV) and SV. This study contradicts some long-held beliefs that women’s work is a sufficient condition for protecting them from IPV. The public policy should not assume that women’s earnings automatically protect them against the risk of IPV. While encouraging a greater female labor force participation rate is important in its own right, women’s risk of IPV is context-specific.
Police are Influenced by Anchoring and Risk When Allocating Resources for Scenario-based Intimate Partner Violence Cases
Authors: Kebbell Mark R.
Published: June 2021

Sixty-six police officers were given four intimate partner violence (IPV) scenarios to rate for risk of future violence. At the start of the experiment, participants were provided with either a low-risk or high-risk “anchor” scenario of police attending an IPV incident. Next, participants were given three counterbalanced scenarios: high, medium, and low risk. Half the participants were given a structured professional judgment tool to guide their decisions. Participants given the low-risk anchor rated the following scenarios as being of greater risk than those given the high-risk anchor. Participants were consistent in identifying high-, medium-, and low-risk scenarios and the tool made no difference to these ratings. Participants were more confident in their higher risk judgments than their lower risk judgments. Officers distributed a disproportionately high amount of resources to the high-risk offenders and the results suggest that police officers can make decisions consistent with Risk-Need-Responsivity principles. However, anchoring effects and working in a context where violence is more severe and frequent has the potential to bias perceptions and make officers less sensitive to risk.
Evaluation of Weight-Based Dose During Transition From Immediate-Release to Extended-Release Tacrolimus in Kidney Transplant Recipients
Authors: Magid Mackenzie , Sanoff Scott , Lee Hui-Jie , Yang Zidanyue , Byrns Jennifer
Published: June 2021

Background:

Manufacturer recommendations for conversion from immediate-release to extended-release tacrolimus, Envarsus XR®, suggests 80% of the total daily dose of the immediate-release formulation. This conversion has not consistently achieved therapeutic levels in the kidney transplant population.

Objectives:

To determine if a reliable weight-based dosing strategy could be utilized to transition kidney transplant patients from immediate-release to extended-release tacrolimus. This may help establish a safe protocol to guide transition between formulations.

Methods:

Retrospective, single-center study of adult kidney transplant recipients between July 2015 and December 2018. Excluded patients received dual organs, lacked appropriately drawn tacrolimus levels, or were prescribed interacting medications. Patients were identified by querying prescriptions for extended-release tacrolimus and chart review was performed to exclude any patients without sufficient follow-up after transition.

Results:

30 patients who transitioned from immediate-release tacrolimus to tacrolimus XR were included in the final analysis. The median weight-based dose of tacrolimus XR that achieved a therapeutic level among the cohort was 0.158 mg/kg/day (Q1-Q3: 0.0587-0.221), which was about 80% of the original median weight-based immediate-release tacrolimus dose. Therapeutic dosing strategies were widely variable, represented by an R2 of 0.33 on linear regression. There was a statistically significant difference in median weight-based dosing strategies among patients of various racial backgrounds (p = 0.0148).

Conclusions:

A weight-based dose of tacrolimus XR could not reliably predict a therapeutic level among the total cohort due to the wide inter-patient variability. The median weight-based rate of conversion from immediate-release to extended-release tacrolimus was 80%.
Dynamics of part motion on a linear vibratory feeder
Authors: Balaji B , Gupta Burela Ramesh , Ponniah Ganeshthangaraj
Published: June 2021

The motion of a part on a curved surface mounted upon a linear vibratory feeder is of great importance in mass production. In this article, the conveying surface or track is modelled by a bilinear surface inclined to all axes with the curvature varying throughout the surface. An experimental test rig is fabricated to study the part motion on the feeder surface. Dynamics of the part on the surface is derived and the path traced by the part is obtained numerically. The numeric model closely correlates with experimental results. Based on the control parameters two distinct regimes—slide and hop—are presented, highlighting their relation to frequency and amplitude of vibration of the feeder.
Cyberbullying, student nurses’ ethical awareness and the Covid-19 pandemic
Authors: Kim Ka Young , Choi Jeong Sil
Published: June 2021

Background:

The global COVID-19 pandemic has increased cyber communication, causing nursing students’ clinical practice to be held in cyberspace. Thus, it is essential to ensure that nursing students develop comprehensive cyber ethics awareness. Moreover, cyberbullying is becoming more widespread and is an increasingly relevant new concept.

Objectives:

This study aimed to assess the experiences of cyberbullying among nursing students during clinical practice and determine the effects of cyberbullying victimization and cyber environments on their cyber ethics awareness.

Research design:

Data for this descriptive cross-sectional study were collected in July 2020 using a self-reported questionnaire and analyzed using hierarchical regression.

Participants and research context:

The study included data from 291 nursing students with more than 6 months of clinical experience who were enrolled in two nursing universities in two cities in South Korea.

Ethical considerations:

This study was conducted after obtaining approval from the Institutional Review Board of G University. Written, informed consent was obtained from all participants.

Results:

Cyberbullying victimization experiences during clinical practice were few. The most common cyberbullies of work- and person-related cyberbullying were nurses and classmates, respectively.

Discussion:

Cyber ethics awareness was affected by cyber anonymity and the perceived seriousness of cyberbullying; cyberbullying related to clinical practices was a new factor that significantly affected cyber ethics awareness.

Conclusions:

Hospitals and nursing universities should develop a multi-dimensional, comprehensive, and effective nursing intervention education program to be integrated into the nursing curriculum to enhance cyber ethics awareness and reduce cyberbullying of nursing students.
Motivations for Mobilization: Comparing Urban and Suburban Residents’ Participation in the Politics of Planning and Development
Authors: Moore Aaron A.
Published: June 2021

This paper compares and contrasts suburban and urban residents’ attitudes and behavior toward development by comparing the frequency and motivation for mobilization of residents in the suburbs of Surrey, British Columbia, and Brampton, Ontario, with residents of their respective metropolitan urban cores. It finds that suburban residents engage less in planning politics than their urban counterparts and that they are more likely to oppose development than urban residents. However, while some variation exists in the concerns suburban and urban residents raise when they express their opposition to development, overall, the concerns of residents in suburbs and urban cores are largely the same. The data suggest that what differences exist between suburban and urban residents in the politics of urban development and planning likely arise due to the varying nature and prevalence of development encroaching on existing neighborhoods, rather than from underlying cultural differences.
Polynomial stability for the equations of porous elasticity in one-dimensional bounded domains
Authors: Júnior D. S. Almeida , Ramos A. J. A. , Freitas M. M. , Dos Santos M. J. , Arwadi T. El
Published: June 2021

In this paper, we consider a porous–elastic system where the dissipation mechanisms act on the elastic and on the porous structures. Here, we consider the one-dimensional porous–elastic system defined on bounded domains in space and we proved the polynomial stability when a particular relationship between the damping parameters is equal to zero. We also prove the optimality of the rate of polynomial decay.
Genes and environment in multiple sclerosis: Impact of temporal changes in the sex ratio on recurrence risks
Authors: Sadovnick A Dessa , Yee Irene M , Criscuoli Maria , DeLuca Gabriele C
Published: June 2021

Objective:

To evaluate the impact of temporal increase of female to male (F:M) sex ratio for persons with multiple sclerosis (MS) on the familial risk (empiric recurrence risks or RRs) for biological relatives of affected individuals.

Methods:

Detailed family histories were systematically obtained from people with MS attending the University of British Columbia Hospital MS Clinic. The study cohort was born in 1970 or more recently. Data were collected from 1 September 2015 to 31 January 2019. The study was designed to allow only one proband per family. Age-corrected RRs for biological relatives of probands were calculated based on a modification of the maximum-likelihood approach.

Results:

Data analyses were possible for 746 unique probands (531 females; 215 males) and 19,585 of their biological relatives. RRs were temporally impacted.

Conclusion:

Both genetic sharing and environmental factors are important in determining RRs. It appears that there is an increase in MS risk due to environmental factors in later life (i.e. not shared family environment). Environmental exposures in genetically predisposed individuals might be driving the MS risk. The increase in F:M ratio of RRs for sisters/brothers of female probands over time is likely due to environmental differences.
Mental health of children of health workers during the COVID-19 pandemic: A cross-sectional study
Authors: Almis Habip , Han Almis Behice , Bucak Ibrahim Hakan
Published: June 2021

Children are exposed to large amounts of information and high levels of stress and anxiety from adults around them, the media, and social communication networks during the Covid-19 period. The purpose of this study was to compare the anxiety and depression levels of the children of health workers following the declaration by the World Health Organization (WHO) of Covid-19 as a global pandemic with those of age-matched children of non-health worker parents. This prospective, case-controlled, cross-sectional study was performed between July and September 2020. One hundred forty-six participants were enrolled, 71 children of health worker parents in the study group, and 75 age- and sex-matched children of non-health worker parents in the control group. While no significant difference was determined between the children of health workers and non-health workers in terms of CDI scores, total STAI-C scores were higher among children of health workers (70.36 ± 12.43) than in children of non-health worker parents (65.62 ± 11.83) ( p = .02). This study shows that since their parents work in intensive and high-risk environments during the Covid-19 pandemic, the children of health workers may be at greater psychological risk than other children.
How do managerial perceptions of performance feedback affect innovation?
Authors: Saraf Nilesh , Dasgupta Srabana , Blettner Daniela P
Published: June 2021

Although managers’ perceptions are core to the Performance Feedback Theory, few empirical studies measure managerial perceptions of their organization’s performance and theorize on the (in)consistency between perceptual and objective performance feedback. Based on longitudinal survey data of Canadian organizations, we examine how this (in)consistency affects the propensity for innovation in organizations. Our analysis broadly validates that inconsistency between the two types of feedback dampens innovation. Second, positive perceptions strengthen the relationship between positive objective performance feedback and innovation, leading to increased innovation, whereas negative perceptions strengthen the relationship between negative performance feedback and innovation, echoing the problemistic search hypothesis. We also find that perceptions moderate the effect of objective performance feedback differently in the social and historical dimensions as well above and below the aspiration thresholds.
Addressing Surgical Instrument Oversupply: A Focused Literature Review and Case-Study in Orthopedic Hand Surgery
Authors: Helmkamp Joshua K. , Le Elliot , Hill Ian , Hein Rachel , Mithani Suhail , Codd Patrick , Richard Marc
Published: June 2021

Background

Instrument oversupply drives cost in the operating room (OR). We review previously reported methodologies for surgical instrument reduction and report a pilot methodology for optimizing instrument supply via ethnographic instrument tracking of thumb carpometacarpal (CMC) arthroplasties. Additionally, we report a cost analysis of instrument oversupply and potential savings of tray optimization methods.

Methods

Instrument utilization was tracked over 8 CMC arthroplasties conducted by 2 surgeons at an ambulatory surgery center of a large academic hospital. An optimized supply methodology was designed. A cost analysis was conducted using health-system-specific data and previously published research.

Results

After tracking instrument use in 8 CMC arthroplasties, a cumulative total of 59 out of the 120 instruments in the Hand & Foot (H&F) tray were used in at least 1 case. Two instruments were used in all cases, and another 20 instruments were used in at least 50% of the cases. Using a reduced tray with 59 instruments, potential cost savings for tray reduction in 60 cases were estimated to be $2086 without peel-packing and $2356 with peel-packing. The estimated cost savings were lower than those reported in literature due to a reduced scope and exclusion of OR time cost in the analysis.

Conclusions

Instrument oversupply drives cost at our institution’s ambulatory surgery center. Ethnography is a cost-effective method to track instrument utilization and determine optimal tray composition for small services but is not scalable to large health systems. The time and cost required to observe sufficient surgeries to enable supply reduction to motivate the need for more efficient methods to determine instrument utility.
Midterm outcomes of fenestrated TEVAR using physician-modified endovascular grafts for zone 2
Authors: Bi Jiaxue , Niu Fang , Li Peng , Dai Xiangchen , Zhu Jiechang , Liu Zongwei
Published: June 2021

Objectives

To summarize the experience and midterm outcomes of physician-modified endovascular grafts for zone 2 thoracic endovascular aortic repair.

Methods

A retrospective analysis was conducted of 51 consecutive patients (mean age 57.6 ± 12.5 years, 39 males) treated with thoracic endovascular aortic repair using physician-modified endovascular grafts for reconstructing the left subclavian artery from November 2015 to December 2019. The primary endpoints during follow-up were the overall mortality, aorta-related mortality, and major complications. The secondary endpoints were reintervention and the patency of the target branches, the demographics and technical details were also described and analyzed.

Results

Sixty-three thoracic stent-grafts were deployed in 51 patients and emergency surgery was performed in 10 patients (19.6%). Technical success was 94.1% (48/51). The incidence of perioperative complications was 15.7%, and the 30-day mortality was 0%. At a mean follow-up of 42.0 ± 14.4 months (range, 14–63 months), all the left subclavian arteries remained patent. All-cause mortality was 3.9% (2/51) and not aorta-related deaths. Estimated survival at one and three years was 98.0 ± 1.9% and 96.0 ± 2.8%, respectively.

Conclusions

The physician-modified endovascular grafts is feasible and effective to preserve left subclavian artery in thoracic endovascular aortic repair for aortic arch pathologies with unhealthy proximal landing zone.
Comparison of the replacement policy in k-out-of-n systems having dependent components
Authors: Ozkut Murat
Published: June 2021

This paper is concerned with two optimization problems for a k-out-of- n system consisting of dependent components such as finding the number of elements in the system that minimize the system’s mean cost rate and the system’s optimal replacement time. In previous studies, either system consisting of independent components or parallel systems, a particular case of the present study, was examined. In particular, we numerically examine how the components’ dependence affects the optimal number of units and replacement time for the system, minimizing mean cost rates. We consider when the components are exchangeable and dependent, that is, the system consists of dependent components. For three vastly used Clayton, Gumbel, and FGM copula functions, comparative numerical results are presented.
Identity Development and Well-Being Among Nonreligious and Christian Emerging Adults in the Central United States
Authors: Booker Jordan A. , Johnson Kristen E.
Published: June 2021

Emerging adulthood is an important period for managing the pressing developmental tasks of identity exploration and formation. Affiliation with a religion can inform how emerging adults understand themselves and commit to aspects of their identity, which may have implications for well-being. The present studies tested the ways in which identification with and commitment to Christianity inform identity development (i.e., exploration and commitment) and well-being (i.e., positive affect, negative affect, life satisfaction) among two samples of central U.S. college adults, both concurrently (Studies 1 and 2) and with a 2-month follow-up (Study 2 only). Across studies, self-identification as a Christian and greater commitment to Christianity were positively associated with identity exploration and subjective well-being. Further, indirect effects were supported between Christian affiliation and well-being, given differences in identity exploration. The current studies motivate a continued focus on social identities as contributors to adjustment in emerging adulthood.
Diving for the Basketball: An Isolated Popliteus Rupture in an Adolescent Female with 6 Year Follow-Up
Authors: Newcomb Nicholas L. , Kenneally Claire M. , Yerdon Heather N. , Barry Piers A.
Published: June 2021

Popliteus tendon injuries most often occur in a traumatic setting with damage to multiple other knee structures. Isolated popliteal injuries, however, are rare. To our knowledge, there are no cases of a female pediatric patient with an intrasubstance popliteal tendon rupture in the current literature. This case report aims to illustrate symptoms, imaging, and treatment of an isolated popliteal tendon rupture in an adolescent female. An athletic 14-year-old female presented with right knee pain 4 weeks after a basketball injury in which she dove for the ball and fell, twisting and striking her knee. She had diffuse pain on both sides of the right knee for 3 weeks and pain with running, jumping or twisting. The knee exam was otherwise unremarkable. A right knee MRI demonstrated a complete rupture of the popliteal tendon. No other knee injuries were visualized. The patient was treated non-operatively and gradually returned to normal activities and sports at 6 weeks post injury. On 6-year follow up, the patient had no residual pain or instability and was able to play basketball without difficulty. Isolated popliteal tendon ruptures are extremely rare and difficult to diagnose given non-specific clinical exam findings. While these ruptures can be difficult to visualize on MRI, imaging can help to clarify the diagnosis by ruling out other injuries with similar clinical presentations. In the case of this young and active patient, diagnosis and full recovery without limitations were achieved with 6 weeks of conservative management.
Disaster Day: A Simulation-Based Disaster Medicine Curriculum for Novice Learners
Authors: Gable Brad D , Misra Asit , Doos Devin M , Hughes Patrick G , Clayton Lisa M , Ahmed Rami A
Published: June 2021

Background:

Mass casualty and multi-victim incidents have increased in recent years due to a number of factors including natural disasters and terrorism. The Association of American Medical Colleges (AAMC) recommends that medical students be trained in disaster preparedness and response. However, a majority of United States medical students are not provided such education.

Objective:

The goal of this study was to evaluate the effectiveness of a 1 day, immersive, simulation-based Disaster Day curriculum.

Settings and Design:

Learners were first and second year medical students from a single institution.

Materials and Methods:

Our education provided learners with information on disaster management, allowed for application of this knowledge with hands-on skill stations, and culminated in near full-scale simulation where learners could evaluate the knowledge and skills they had acquired.

Statistical analysis used:

To study the effectiveness of our Disaster Day curriculum, we conducted a single-group pretest-posttest and paired analysis of self-reported confidence data.

Results:

A total of 40 first and second year medical students participated in Disaster Day as learners. Learners strongly agreed that this course provided new information or provided clarity on previous training, and they intended to use what they learned, 97.6% and 88.4%, respectively.

Conclusions:

Medical students’ self-reported confidence of key disaster management concepts including victim triage, tourniquet application, and incident command improved after a simulation-based disaster curriculum. This Disaster Day curriculum provides students the ability to apply concepts learned in the classroom and better understand the real-life difficulties experienced in a resource limited environment.
BCL-XL antagonism selectively reduces neutrophil life span within inflamed tissues without causing neutropenia
Authors: Carrington Emma M. , Louis Cynthia , Kratina Tobias , Hancock Manuela , Keenan Christine R. , Iannarella Nadia , Allan Rhys S. , Wardak Ahmad Z. , Czabotar Peter E. , Herold Marco J. , Schenk Robyn L. , White Christine A. , D’Silva Damian , Yang Yuyan , Wong Wesley , Wong Huon , Bryant Vanessa L. , Huntington Nicholas D. , Rautela Jai , Sutherland Robyn M. , Zhan Yifan , Hansen Jacinta , Nhu Duong , Lessene Guillaume , Wicks Ian P. , Lew Andrew M.
Published: June 2021

Neutrophils help to clear pathogens and cellular debris, but can also cause collateral damage within inflamed tissues. Prolonged neutrophil residency within an inflammatory niche can exacerbate tissue pathology. Using both genetic and pharmacological approaches, we show that BCL-XL is required for the persistence of neutrophils within inflammatory sites in mice. We demonstrate that a selective BCL-XL inhibitor (A-1331852) has therapeutic potential by causing apoptosis in inflammatory human neutrophils ex vivo. Moreover, in murine models of acute and chronic inflammatory disease, it reduced inflammatory neutrophil numbers and ameliorated tissue pathology. In contrast, there was minimal effect on circulating neutrophils. Thus, we show a differential survival requirement in activated neutrophils for BCL-XL and reveal a new therapeutic approach to neutrophil-mediated diseases.
Analysis of single-cell RNA sequencing data based on autoencoders
Authors: Tangherloni Andrea , Ricciuti Federico , Besozzi Daniela , Liò Pietro , Cvejic Ana
Published: June 2021

Background

Single-cell RNA sequencing (scRNA-Seq) experiments are gaining ground to study the molecular processes that drive normal development as well as the onset of different pathologies. Finding an effective and efficient low-dimensional representation of the data is one of the most important steps in the downstream analysis of scRNA-Seq data, as it could provide a better identification of known or putatively novel cell-types. Another step that still poses a challenge is the integration of different scRNA-Seq datasets. Though standard computational pipelines to gain knowledge from scRNA-Seq data exist, a further improvement could be achieved by means of machine learning approaches.

Results

Autoencoders (AEs) have been effectively used to capture the non-linearities among gene interactions of scRNA-Seq data, so that the deployment of AE-based tools might represent the way forward in this context. We introduce here scAEspy, a unifying tool that embodies: (1) four of the most advanced AEs, (2) two novel AEs that we developed on purpose, (3) different loss functions. We show that scAEspy can be coupled with various batch-effect removal tools to integrate data by different scRNA-Seq platforms, in order to better identify the cell-types. We benchmarked scAEspy against the most used batch-effect removal tools, showing that our AE-based strategies outperform the existing solutions.

Conclusions

scAEspy is a user-friendly tool that enables using the most recent and promising AEs to analyse scRNA-Seq data by only setting up two user-defined parameters. Thanks to its modularity, scAEspy can be easily extended to accommodate new AEs to further improve the downstream analysis of scRNA-Seq data. Considering the relevant results we achieved, scAEspy can be considered as a starting point to build a more comprehensive toolkit designed to integrate multi single-cell omics.
Delays in reporting and publishing trial results during pandemics: cross sectional analysis of 2009 H1N1, 2014 Ebola, and 2016 Zika clinical trials
Authors: Jones Christopher W. , Adams Amanda C. , Murphy Elizabeth , King Rachel P. , Saracco Benjamin , Stesis Karen R. , Cavanaugh Susan , Roberts Brian W. , Platts-Mills Timothy F.
Published: June 2021

Background

Pandemic events often trigger a surge of clinical trial activity aimed at rapidly evaluating therapeutic or preventative interventions. Ensuring rapid public access to the complete and unbiased trial record is particularly critical for pandemic research given the urgent associated public health needs. The World Health Organization (WHO) established standards requiring posting of results to a registry within 12 months of trial completion and publication in a peer reviewed journal within 24 months of completion, though compliance with these requirements among pandemic trials is unknown.

Methods

This cross-sectional analysis characterizes availability of results in trial registries and publications among registered trials performed during the 2009 H1N1 influenza, 2014 Ebola, and 2016 Zika pandemics. We searched trial registries to identify clinical trials testing interventions related to these pandemics, and determined the time elapsed between trial completion and availability of results in the registry. We also performed a comprehensive search of MEDLINE via PubMed, Google Scholar, and EMBASE to identify corresponding peer reviewed publications. The primary outcome was the compliance with either of the WHO’s established standards for sharing clinical trial results. Secondary outcomes included compliance with both standards, and assessing the time elapsed between trial completion and public availability of results.

Results

Three hundred thirty-three trials met eligibility criteria, including 261 H1N1 influenza trials, 60 Ebola trials, and 12 Zika trials. Of these, 139 (42%) either had results available in the trial registry within 12 months of study completion or had results available in a peer-reviewed publication within 24 months. Five trials (2%) met both standards. No results were available in either a registry or publication for 59 trials (18%). Among trials with registered results, a median of 42 months (IQR 16–76 months) elapsed between trial completion and results posting. For published trials, the median elapsed time between completion and publication was 21 months (IQR 9–34 months). Results were available within 24 months of study completion in either the trial registry or a peer reviewed publication for 166 trials (50%).

Conclusions

Very few trials performed during prior pandemic events met established standards for the timely public dissemination of trial results.
Correlations between apparent diffusion coefficient values of WB-DWI and clinical parameters in multiple myeloma
Authors: Zhang Bei , Bian Bingyang , Zhao Zhiwei , Lin Fang , Zhu Zining , Lou Mingwu
Published: June 2021

Background

Whole-body diffusion-weighted imaging (WB-DWI) is a method for evaluating bone marrow infiltration in multiple myeloma (MM). This study seeks to elucidate the correlation between the apparent diffusion coefficient (ADC) value and some selected clinical parameters.

Methods

A total of 101 Chinese patients with MM who had undergone WB-DWI from May 2017 to May 2019 were enrolled in this study. The ADC values of the MM lesions and the clinical parameters were quantified at the first (baseline) visit and after four-course induction chemotherapy. Multiple linear regression and logistic analyses were carried out to find the implicit inherent relationships within the patients’ data.

Results

The paired Wilcoxon test showed that the ADC values at the baseline visit (ADC0) were significantly lower than the values after four-course induction chemotherapy (ADC4 c) (p < 0.001), including different therapeutic responses. The Revised International Staging System (RISS) stage, type of MM, and β2-microglobulin (β2-MG) were predictors of clinically significant increases or decreases in the ADC values (p < 0.05). Multiple linear regression showed that the ADC0was negatively associated with β2-MG (p < 0.001) and immunoglobulin heavy chain gene rearrangement (p = 0.012), while the RISS Stage III (p = 0.001), type IgG λ (p = 0.005), and albumin were negatively associated with ADC4 c(p = 0.010). The impacts of the therapeutic response were associated with ADC0and immunoglobulin heavy chain gene rearrangement (p < 0.001).

Conclusion

The ADC values of WB-DWI may be associated with clinical parameters of MM including the fluorescence in situ hybridization result, and may be useful in the prognosis of patients with MM.

Trial Registration: ChiCTR2000029587
COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a case series from a tertiary care pediatric hospital in Qatar
Authors: Hasan Mohammad Rubayet , Al Zubaidi Khaled , Diab Karim , Hejazi Yahia , Bout-Tabaku Sharon , Al-Adba Buthaina , Al Maslamani Eman , Janahi Mohammad , Roscoe Diane , Lopez Andres Perez , Tang Patrick
Published: June 2021

Background

Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe complication of coronavirus disease 2019 (COVID-19) in children, which is increasingly being reported worldwide. Here we report the first case series of 7 children diagnosed with MIS-C in Qatar.

Methods

Clinical features and outcomes of COVID-19 positive patients admitted to Sidra Medicine, Qatar from June to October 2020, who met the WHO case definition for MIS-C were reviewed.

Results

The mean age in our case series was 5.6 years, of which 71.4% were males. All patients were previously healthy but had a history of COVID-19 infection. Fever, rash, vomiting and abdominal pain were the most common symptoms (70–100%). The average hospitalization was 12.9 days with no case fatalities. Laboratory findings included lymphopenia and thrombocytopenia in most patients, as well as evidence of coagulopathy and elevated inflammatory markers such as C-reactive protein, ferritin and procalcitonin. Many patients (71.4%) required inotropic support in intensive care, while only one required respiratory support. Although all patients had elevated cardiac biomarkers, cardiovascular involvement was observed in 42.9% of patients with one patient developing a giant coronary aneurysm. All patients received intravenous immunoglobulin (IVIG) and 86% of patients received corticosteroids, with two patients requiring treatment with IL-1 inhibitors.

Conclusions

Our report is one of the first reports on MIS-C from Asia. Although clinical features and outcomes are not significantly different from those reported elsewhere, lack of case fatalities in our cohort may indicate that early recognition and prompt medical attention is necessary for a favorable outcome in MIS-C.
Persisting workarounds in Electronic Health Record System use: types, risks and benefits
Authors: Boonstra Albert , Jonker Tess L. , van Offenbeek Marjolein A. G. , Vos Janita F. J.
Published: June 2021

Background

Electronic Health Records (EHRs) are now widely used to create a single, shared, and reliable source of patient data throughout healthcare organizations. However, health professionals continue to experience mismatches between their working practices and what the EHR allows or directs them to do. Health professionals adopt working practices other than those imposed by the EHR to overcome such mismatches, known as workarounds. Our study aims to inductively develop a typology of enduring EHR workarounds and explore their consequences by answering the question: What types of EHR workarounds persist, and what are the user-perceived consequences?

Methods

This single case study was conducted within the Internal Medicine department of a Dutch hospital that had implemented an organization-wide, commercial EHR system over two years ago. Data were collected through observations of six EHR users (see Additional file 1, observation scheme) and 17 semi-structured interviews with physicians, nurses, administrators, and EHR support staff members. Documents were analysed to contextualize these data (see Additional file 2, interview protocol).

Results

Through a qualitative analysis, 11 workarounds were identified, predominantly performed by physicians. These workarounds are categorized into three types either performed while working with the system (in-system workflow sequence workarounds and in-system data entry workarounds) or bypassing the system (out-system workarounds). While these workarounds seem to offer short-term benefits for the performer, they often create threats for the user, the patient, the overall healthcare organization, and the system.

Conclusion

This study increases our understanding of the enduring phenomenon of working around Electronic Health Records by presenting a typology of those workarounds that persist after adoption and by reflecting on the user-perceived risks and benefits. The typology helps EHR users and their managers to identify enduring types of workarounds and differentiate between the harmful and less harmful ones. This distinction can inform their decisions to discourage or obviate the need for certain workarounds, while legitimating others.
A family with Milroy disease caused by the FLT4/VEGFR3 gene variant c.2774 T > A
Authors: Sui Yu , Lu Yongping , Lin Meina , Ni Xiang , Chen Xinren , Li Huan , Jiang Miao
Published: June 2021

Background

Milroy disease (MD) is a rare, autosomal-dominant disorder. Variants in the Fms-related tyrosine kinase 4 (FLT4/VEGFR3) gene cause the symptoms of this disease. In this report, we investigated the variant in a large Chinese family with MD.

Methods

We conducted Sanger sequencing of exons 17–26 of FLT4/VEGFR3 (NM_182925.4). We assessed its pathogenicity based on the ACMG criteria and predicted it with an in silico program.

Results

A heterozygous substitution (NM_182925.4 (FLT4/VEGFR3):c.2774 T>A, p. (Val925Glu)) was detected in all patients with MD but not in any healthy controls. The variant was evaluated as pathogenic according to the ACMG criteria and was predicted to be pathogenic using an in silico program.

Conclusions

In this report, we described a large family with MD caused by a missense variant in FLT4/VEGFR3 (NM_182925.4 (FLT4/VEGFR3_v001):c.2774 T>A, p. (Val925Glu)). There are phenotypic heterogeneities among family members, and further research should be conducted to explore the possible reasons.
Idiopathic pulmonary fibrosis and diabetes mellitus: a meta-analysis and systematic review
Authors: Bai Le , Zhang Li , Pan Tingyu , Wang Wei , Wang Dian , Turner Cassidy , Zhou Xianmei , He Hailang
Published: June 2021

Background

Idiopathic pulmonary fibrosis (IPF) is a chronic diffuse interstitial lung disease, of which the etiology has been poorly understood. Several studies have focused on the relationship between IPF and diabetes mellitus (DM) in the past years but have failed to reach a consensus. This meta-analysis aimed to examine the association between diabetes to IPF.

Methods

We accumulated studies investigating the association between DM and IPF from databases including Medline, Cochrane Library, Embase, Web of Science, and China National Knowledge Infrastructure. RevMan 5.3 and the Newcastle–Ottawa Scale (NOS) were utilized to analyze the data and assess the quality of the included studies. The value of odds ratio (OR) with 95% confidence interval (CI) was used as the measure to estimate the risk of DM in IPF. Heterogeneity was assessed by I2 statistics. We also performed subgroup analysis, meta-regression, and Egger’s test for bias analysis.

Results

Nine case–control studies with 5096 IPF patients and 19,095 control subjects were included in the present meta-analysis, which indicated a positive correlation between DM and IPF (OR 1.65, 95% CI 1.30–2.10; P < 0.0001). Meta-regression and subgroup analysis negated the influence of covariates like cigarette smoking, age and gender, but the heterogeneity existed and could not be fully explained.

Conclusion

IPF and DM may be associated, but the causal relationship remains indeterminate till now. Further rigorously designed studies are required to confirm the present findings and investigate the possible mechanisms behind the effect of DM on IPF.
The effects of Taurine supplementation on inflammatory markers and clinical outcomes in patients with traumatic brain injury: a double-blind randomized controlled trial
Authors: Vahdat Mahsa , Hosseini Seyed Ahmad , Soltani Farhad , Cheraghian Bahman , Namjoonia Masih
Published: June 2021

Background

Traumatic brain injury is a public health concern and is the main cause of death among various types of trauma. The inflammatory conditions due to TBI are associated with unfavorable clinical outcomes. Taurine has been reported to have immune-modulatory effects. Thus, the aim of this study was to survey the effect of taurine supplementation in TBI patients.

Methods

In this study, 32 patients with TBI were randomized into two groups. The treatment group received 30 mg/kg/day of taurine in addition to the Standard Entera Meal and the control group received Standard Entera Meal for 14 days. Prior to and following the intervention, the patients were investigated in terms of serum levels of IL-6, IL-10, hs-CRP and TNF-α as well as APACHEII, SOFA and NUTRIC scores, Glasgow coma scale and weight. In addition, the length of Intensive Care Unit stay, days of dependence on ventilator and 30-day mortality were studied. SPSS software (version 13.0) was used for data analysis.

Results

Taurine significantly decreased the serum levels of IL-6 (p = 0.04) and marginally APACHEII score (p = 0.05). In addition, weight loss was significantly lower in taurine group (p = 0.03). Furthermore, taurine significantly increased the GCS (p = 0.03). The groups were not different significantly in terms of levels of IL-10, hs-CRP, and TNF-α, SOFA and NUTRIC scores, 30-day mortality, length of ICU stay and days of dependence on ventilator.

Conclusion

According to the results of the present study, taurine supplementation can reduce the IL-6 levels as one of the important inflammatory markers in these patients; and enhances the clinical outcomes too.

Trial registration

IRCT, IRCT20180514039657N1. Registered 22 June 2018.
Potential roles of N6-methyladenosine (m6A) in immune cells
Authors: Liu Chang , Yang Zhe , Li Rong , Wu Yanju , Chi Ming , Gao Shuting , Sun Xun , Meng Xin , Wang Biao
Published: June 2021

N6-methyl-adenosine (m6A) is one of the most common internal modifications on RNA molecules present in mammalian cells. Deregulation of m6A modification has been recently implicated in many types of human diseases. Therefore, m6A modification has become a research hotspot for its potential therapeutic applications in the treatment of various diseases. The immune system mostly involves different types of immune cells to provide the first line of defense against infections. The immunoregulatory network that orchestrate the immune responses to new pathogens plays a pivotal role in the development of the disease. And m6A modification has been demonstrated to be a major post-transcriptional regulator of immune responses in cells. In this review, we summarize the participants involved in m6A regulation and try to reveal how m6A modification affects the immune responses via changing the immunoregulatory networks.
Fracture of the inferior pole of the patella: tension band wiring versus transosseous reattachment
Authors: Chang Chih-Hsun , Chuang Hao-Chun , Su Wei-Ren , Kuan Fa-Chuan , Hong Chih-Kai , Hsu Kai-Lan
Published: June 2021

Background

The optimal surgical technique for the fixation of inferior pole patellar fracture remains controversial. The aims of this study were (1) to compare clinical and radiological outcomes following fixation of inferior pole patellar fracture by using tension band wire (TBW) and transosseous reattachment (TOR) without excision of the bony fragment and (2) to determine the risk factors for postoperative radiological loss of reduction.

Methods

For this retrospective cohort study, consecutive patients with inferior pole patellar fracture between January 2010 and December 2017 were recruited. The patients were grouped according to their fixation method (TBW or TOR), and demographic data, clinical outcomes, and postoperative Insall–Salvati (IS) ratio were analyzed. Then, the patients were grouped according to radiological loss of reduction, the possible risk factors for loss of reduction were identified, and odds ratios were calculated.

Result

This study included 55 patients with inferior pole patellar fracture; 30 patients were treated using TBW and 25 were treated using TOR. Clinical failure occurred in two patients in the TBW group (7%) and three in the TOR group (12%). The rate of radiological loss of reduction was significant higher in the TOR group, whereas removal of implants was significantly more common in the TBW group. Patella baja was noted immediately after surgery in the TOR group, but the IS ratios of the two groups were similar after 3 months. Fracture displacement of more than 30 mm was the only independent risk factor for postoperative radiological loss of reduction.

Conclusion

For treating inferior pole patellar fracture, both TWB and TOR were effective and had a low clinical failure rate. In 60% of patients undergoing TBW fixation, however, additional surgery was required to remove the implants. Patella baja occurred immediately following TOR, but the patellar height was similar to that in the TBW group after 3 months. Surgeons should be aware of the high risk of postoperative radiological loss of reduction, especially when the fracture displacement is more than 30 mm.