bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating the Chronology of Meniscus Root Tears: Do Medial Meniscus Posterior Root Tears Cause Extrusion or the Other Way Around?
Authors: LaPrade Matthew , Hevesi Mario , Wilbur Ryan , Song Bryant , Rhodes Nicholas , Johnson Adam , Camp Christopher , Stuart Michael , Krych Aaron
Published: July 2021

Objectives:

Meniscus root tears are increasingly being recognized. Meniscus extrusion has previously been associated with medial root tears; however, the relationship between secondary meniscus restraints, such as the meniscotibial (MT) ligament, extrusion, and root tears has yet to be formally evaluated. The purpose of this study was to better understand the association between MT ligament competence, medial meniscus extrusion, and medial meniscus posterior root tears (MMPRT), as well as to determine the progression of meniscus extrusion over time.

Methods:

Serial MRI’s from our institution were reviewed for patients who showed evidence of medial meniscus extrusion and MMPRT on at least one of 2+ available MRI’s. All patients were symptomatic at the time of diagnosis. All MRI’s were analyzed independently by two board-certified musculoskeletal radiologists. MT ligament disruption, medial meniscus extrusion, and MMPRT presence was recorded for each MRI. The time between MRI’s, presence of insufficiency fractures, and Outerbridge classification for the medial femur and tibia were also evaluated.

Results:

27 knees in 26 patients were included in this study, with a total of 63 MRI’s analyzed (21 knees with 2 MRI’s, 3 with 3 MRI’s, and 3 with 4 MRI’s). All patients demonstrated clear medial meniscus extrusion and meniscotibial ligament disruption prior to the subsequent development of MMPRTs (p < 0.001). Mean extrusion at the time of initial MRI was 3.3 ± 1.1 mm, and increased significantly to 5.5 ± 1.8 mm at the time of first imaging with an identified MMPRT (p < 0.001). The average time between initial MRI and the first identification of MMPRT on a later MRI was 1.7 ± 1.6 years.

Conclusions:

In a sample of 27 symptomatic knees with serial MRI’s both before and after MMPRT diagnosis, all patients demonstrated MT ligament disruption and associated meniscus extrusion prior to the development of subsequent medial meniscus root tears. These findings suggest that MT ligament disruption and medial meniscus extrusion represent early and predisposing events contributing to MMPRT. Therefore, this provides a possible explanation of why meniscus extrusion is not corrected with medial meniscus root repair.
Survivorship and Patient-Reported Outcomes After Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis: Minimum 10-Year Follow-up
Authors: Arner Justin , Elrick Bryant , Nolte Philip , Horan Marilee , Millett Peter , Haber Daniel
Published: July 2021

Objectives:

Glenohumeral osteoarthritis (GHOA) remains a common cause of shoulder pain, loss of shoulder range of motion, and upper extremity dysfunction. Few long-term outcome studies exist evaluating glenohumeral osteoarthritis (GHOA) treatment with arthroscopic management. The purpose of this study was to determine outcomes, risk factors for failure, and survivorship for the comprehensive arthroscopic management (CAM) procedure for the treatment of GHOA at minimum 10-year follow-up. It was hypothesized that while some patients would progress to total shoulder arthroplasty (TSA), the majority of patients would demonstrate sustained improvement in patient-reported outcomes and satisfaction without conversion to TSA at long term follow-up.

Methods:

The CAM procedure was performed on a consecutive series of patients with advanced GHOA who opted for joint preservation surgery that otherwise met criteria for total shoulder arthroplasty (TSA). At minimum 10-year follow-up, pre- and post-operative outcome measures collected included the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Short Form–12 (SF-12) Physical Component Summary (PCS), visual analog scale for pain, and satisfaction scores. Kaplan-Meier survivorship analysis was performed with failure defined as progression to arthroplasty.

Results:

Thirty-eight CAM procedures were performed with 10-year minimum follow-up (range, 10-14 years) with a mean age of 53 years (range, 27-68) at time of surgery. Kaplan Meier survivorship curve showing 75.3% CAM survivorship (Comprehensive Arthroscopic Management) for glenohumeral arthritis at 5 years and 63.2% at 10 years in Figure 1. Those who progressed to arthroplasty did so at a mean of 4.7 years (range, 0.8-9.6 years). For those who did not undergo arthroplasty, ASES scores significantly improved post-operatively at both 5 and 10 years (63.3-89.6, p<0.001; 63.3-80.6, p=.007) (Table 1). CAM failure was associated with severe pre-operative humeral head incongruity in 93.8% of failures compared to 50.0.% of patients who did not go onto arthroplasty (p= 0.008). Median satisfaction was 7.5 out of 10.

Conclusions:

Significant improvement in patient reported outcomes were sustained at minimum 10-year follow-up in young patients with GHOA who underwent a CAM procedure. Survivorship rate at minimum 10-year follow-up was 63.2%. Humeral head flattening and severe joint incongruity were risk factors for CAM failure. The CAM procedure is an effective joint preserving treatment for GHOA in appropriately selected patients with sustained positive outcomes at 10 years.

[Table: see text]
The beneficial effect of intra-articular injection of losartan on the microfracture mediated cartilage repair is dose dependent
Authors: Gao Xueqin , Utsunomiya Hajime , Scibetta Alex , Ravuri Sudheer , Ruzbarsky Joseph , Talwar Camille , Arner Justin , Lowe Walter , Philippon Marc , Huard Johnny , Logan Catherine
Published: July 2021

Objectives:

1. To determine the dosage and beneficial effects of intra-articular injection of losartan on microfracture-mediated cartilage repair and normal cartilage homeostasis.

Methods:

Rabbits were divided into 5 groups (n=6):a microfracture group (MFX) and 4 different losartan treatment cohorts received varying dosages of IA losartan (0.1,1,10 and 100 mg/knee). An osteochondral defect (5mm) was created in the trochlear groove cartilage and 5 microfracture perforations were performed in the osteochondral defect. Both injured and contralateral knee joints were injected with losartan IA at days 0,14 and 28 after surgery. Rabbits were sacrificed at 6 weeks after surgery for analysis including gross observation, micro computed tomography, histology analysis and reverse transcription quantitative PCR.

Results:

Micro computed tomography analysis and gross observation demonstrated comparable subchondral bone healing and hyaline-like appearing cartilage morphology in the 0.1, 1 and 10mg/knee losartan IA injection groups relative to the MFX group. Conversely, IA injection of losartan at 100mg/knee dosage showed neither bony defect healing nor cartilage repair. Histology revealed higher O’Driscoll scores and hyaline cartilage regeneration in the 1mg/knee cohort when compared to the MFX group. In contrast,100mg/knee losartan showed the lowest histology score and no cartilage repair. IA injection of losartan at the doses of 0.1,1 and 10mg/knee did not cause adverse effects on uninjured cartilage while 100mg/knee dose induced cartilage damage. Q-PCR results showed down-regulation of the TGFβ signaling pathway after losartan injection.

Conclusions:

Intra-articular injection of losartan at the dose 1mg/knee was most effective for enhancement of microfracture-mediated cartilage repair without adversely affecting uninjured cartilage. Conversely, high dose (100mg/knee) IA injection of losartan inhibited cartilage repair in osteochondral defect and was chondrotoxic to normal articular cartilage.
Midterm Outcomes Following Hip Labral Augmentation
Authors: Ruzbarsky Joseph , Arner Justin , Briggs Karen , Philippon Marc , Soares Rui
Published: July 2021

Objectives:

Arthroscopic hip labral preservation techniques have evolved over the last decade. Arthroscopic hip labral augmentation with iliotibial band (ITB) autograft placed into a labral defect with viable circumferential fibers is a novel treatment option to restore the hip suction seal and improve functionality. The purpose of this study is to determine midterm (3-5 year follow up) outcomes of arthroscopic hip labral augmentation procedure.

Methods:

Patients who underwent arthroscopic hip labral augmentation from August 2011 to March 2017 were prospectively evaluated. Pre- and post-operative patient reported outcome scores were compared and included SF12 PCS, SF12 MCS, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) (Activities of Daily Living (ADL) and Sport). Post-operative Tegner Activity Scale and patient satisfaction (1 – 10) were also evaluated.

Results:

One hundred and six patients underwent arthroscopic hip labral augmentation with minimum 3-year follow-up. Mean follow-up was 5-year follow-up (range, 3 to 9.2 years). All patient reported outcomes improved after labral augmentation (SF12 PCS 39±8 vs. 50±10, p>0.01; mHHS 59±15 vs. 79±21, p<0.01; WOMAC 31±16 vs. 16±17, p<0.01; HOS ADL 64±17 vs. 84±21, p<0.01; HOS Sport 41±22 vs. 71±29, p<0.01). Median post-operative Tegner score was 4. Median post-operative patient satisfaction was 9 out of 10 (range, 1-10). In terms of survivorship, 12 patients (11%) required revision surgery and 6 (5.7%) converted to total hip arthroplasty (THA).

Conclusions:

Arthroscopic hip labral augmentation is a successful treatment option for patients that have viable circumferential fibers present at the time of arthroscopy. This technique continues to show improved patient reported outcomes and is another hip labral preservation technique that may help reestablish the intra-articular fluid suction seal.
Born Free? South African Young Adults, Inequality, and Reconciliation in Stellenbosch
Authors: Du Toit Nadine Bowers , Forster Dion , Roux Elisabet le , Weber Shantelle
Published: July 2021

Despite the demise of apartheid, economic inequality remains racially skewed in South Africa. For young people born either shortly before or after 1994, the official demise of apartheid—termed “born frees”—we must ask whether they are indeed “free” of the social and economic constraints of the past. How does ongoing inequality color notions of reconciliation and restitution twenty-five years later? This article focuses on the context of Christian young adults living in Stellenbosch, one of the most unequal towns in South Africa. We explore their lived experiences and theologizing on these issues arising from empirical research in Stellenbosch.
Racism Awareness in Mission: Touchstone or Cultural Blind Spot?
Authors: Kim Kirsteen
Published: July 2021

In his history of the Edinburgh 1910 World Missionary Conference, Brian Stanley suggests that contemporary use of “culture” in mission may be vulnerable to the same critique as was the use of “race” in the colonial missions. However, sensitivity to culture and context in postwar and postcolonial missiology has encouraged diversity, interculturality, and movements for greater equity. Drawing from contemporary missiology and critical race theory, this article asks whether attention to “culture” and “context” has mitigated racism in mission or tended to obscure it.
Central Retinal Vein Occlusion: The Effect of Antiplatelet and Anticoagulant Agents
Authors: Thomas George N. , Kiew Sieh Yean , Singh Pali , Dmitriev Pauline , Thomas Akshay S. , Fekrat Sharon
Published: July 2021

Purpose:

This work evaluates the effect of antiplatelet and anticoagulant agents on clinical outcomes, optical coherence tomography (OCT) parameters, and macular ischemia in eyes with central retinal vein occlusion (CRVO).

Methods:

A retrospective longitudinal cohort study was performed to evaluate patients with CRVO. Demographics, OCT parameters before and after treatment, macular ischemia on fluorescein angiography, and clinical outcomes including the number of injections received were analyzed.

Results:

A total of 365 patients with CRVO were identified. The average follow-up was 36 months. Antiplatelet or anticoagulant agent use was not associated with a significant difference in visual acuity (VA), prevalence of macular edema, or central subfield thickness on OCT at presentation or final visit. The use of 81-mg aspirin alone was associated with an increased prevalence of foveal hemorrhage at presentation. Patients who were taking an antiplatelet agent, an anticoagulation agent, or both and had an ischemic CRVO with logMAR VA of less than 1.0 experienced improved VA at the final study visit. Patients given antiplatelet or anticoagulant agents had a similar incidence of neovascular sequelae compared with patients not administered these agents.

Conclusions:

In eyes with CRVO, the use of antiplatelet or anticoagulant agents at CRVO onset was not associated with significantly different functional outcomes, except in ischemic CRVO eyes with VA of less than 20/200. The use of 81-mg aspirin was associated with foveal hemorrhage at CRVO presentation. Otherwise, the use of any antiplatelet agent or anticoagulation was not associated with any CRVO structural outcomes.
Pediatric uveitis: a retrospective analysis at a tertiary eye care hospital in South India
Authors: Raveendra Murthy Sowmya , Ganesh Sailatha , C.K. Minija , Dubey Nidhi
Published: July 2021

Purpose:

To analyze the demographics, etiology, complications, treatment modalities, and visual outcomes in pediatric uveitis patients at a tertiary eye care hospital.

Methods:

A retrospective review of medical records of pediatric uveitis patients who presented with us from January 2014 to January 2020 was evaluated.

Results:

Out of the 178 pediatric uveitis patients, 65 children were included in the study. The most common age group was 6–10 years (46%). Of the included patients, 36 (55.4%) were male and 29 (44.6%) were female. Presentation was bilateral in 39 (60%) and unilateral in 26 (40%). Anterior uveitis was seen in 19 (29.23%), intermediate in 18 (27.69%), posterior in 16 (24.62%), and panuveitis in 12 (18.46%) patients. There were 2 cases of masquerades. Non-infectious uveitis was the most commonly seen, in 48 (73.84%) of total cases, among which 21 (43.75%) were idiopathic and 7 (14.58%) were associated with juvenile idiopathic (JIA) arthritis. Infectious uveitis was present in 17 (26.15%); the most common etiology was toxoplasmosis. Baseline visual acuity was low in 22 (33.84%) children. After initiating treatment, 37 (56.92%) showed improvement in vision and 10 (15.38%) had worsening of vision. Intraocular pressure (IOP) rise was seen in 5 (7.69%) children; 51 (78.46%) children required medical management and 16 (24.61%) children required surgical intervention; 46 (70.76%) children had uveitis related complications out of which most of them 30 (65.21%) were present at baseline.

Conclusions:

Anterior and intermediate uveitis were the most common types observed in our study. Toxoplasmosis was the most common type of infectious uveitis and JIA the most common cause in non-infectious type apart from idiopathic uveitis. Posterior uveitis had low visual acuity at baseline and follow-up. Children presented to us with poor visual acuity and complications at baseline, hence an early referral to a tertiary eye hospital and management accordingly can improve the quality of vision and visual rehabilitation.
Reliability of Focused Assessment With Sonography for Trauma in the Diagnosis of Blunt Torso Trauma
Authors: Ullah Najeeb , Bacha Raham , Manzoor Iqra , Gilani Syed Amir , Gilani Syed Muhammad Yousaf Farooq , Haider Zeeshan
Published: July 2021

Objective:

Focused assessment with sonography for trauma (FAST) is a widely used imaging technique for the diagnosis of blunt abdominal trauma and has its limitations and advantages. A meta-analysis was completed to evaluate the reliability of FAST, in the diagnosis of blunt torso trauma.

Materials and Methods:

A search was completed with Google Scholar, PubMed, National Center for Biotechnology Information (NCBI), MEDLINE, and Medscape databases, from 1993 up to 2020. Eligible studies were included for information about FAST examination of abdominal trauma. The animal research was excluded from this review process. The eligible studies were first categorized and then data analysis was performed, according to specific pathologic conditions. This literature review retrieved studies’ sample size, application, sensitivity, and a specificity of diagnosis using FAST for abdominal trauma.

Results:

In total, 100 articles were identified through the database search. Besides, five articles were identified through other sources. Then, screening was performed, and as such, 46 published studies were included that had a qualitative synthesis.

Conclusion:

FAST has a high sensitivity and specificity in the diagnosis of blunt abdominal trauma. However, a large range of sensitivity and specificity of FAST in the evaluation of torso trauma reveal that sonography is operator, technique, and equipment dependent.
Identification and validation of a novel locus, Qpm-3BL, for adult plant resistance to powdery mildew in wheat using multilocus GWAS
Authors: Du Xijun , Xu Weigang , Peng Chaojun , Li Chunxin , Zhang Yu , Hu Lin
Published: July 2021

Background

Powdery mildew (PM), one of the major diseases in wheat, severely damages yield and quality, and the most economical and effective way to address this issue is to breed disease-resistant cultivars. Accordingly, 371 landraces and 266 released cultivars in Henan Province were genotyped by a 660 K microarray and phenotyped for adult plant resistance (APR) to PM from 2017 to 2020, and these datasets were used to conduct multilocus genome-wide association studies (GWASs).

Results

Thirty-six varieties showed stable APR in all the environments, and eleven quantitative trait nucleotides (QTNs) were found by multiple methods across multiple environments and best linear unbiased prediction (BLUP) values to be significantly associated with APR. Among these stable QTNs, four were previously reported, three were newly discovered in this study, and the others need to be further investigated. The major and newly discovered QTN, Qpm-3BL, was located at chr03BL_AX-109,052,670, while another newly discovered QTN, Qpm-1BL, was located between chr01BL_AX-108,771,002 and chr01BL_AX-110,117,322. Five and eight landraces were identified to be resistant based on Qpm-1BL (haplotype TC) and Qpm-3BL (allele T), respectively. To validate Qpm-3BL, a new kompetitive allele-specific PCR (KASP) marker was developed to scan 155 F2 individuals, and the average resistance score supported the value of Qpm-3BL in marker-assisted breeding. Near Qpm-3BL, PmBMYD was identified by KEGG, gene expression and comparative genomics analyses to be a candidate. Its resistance mechanism may involve gene tandem repeats.

Conclusions

This study reveals a previously unknown gene for PM resistance that is available for marker-assisted breeding.
Effects of lower limb resistance exercise on muscle strength, physical fitness, and metabolism in pre-frail elderly patients: a randomized controlled trial
Authors: Lai Xiaoxing , Bo Lin , Zhu Hongwei , Chen Baoyu , Wu Zhao , Du Hongdi , Huo Xiaopeng
Published: July 2021

Background

Few studies examined interventions in frail elderly in China, while the awareness of applying interventions to prevent frailty in pre-frail elderly is still lacking. This study aimed to explore the effects of lower limb resistance exercise in pre-frail elderly in China.

Methods

This was a randomized controlled trial of patients with pre-frailty. The control group received routine care, while the exercise group received a 12-week lower limb resistance exercise based on routine care. The muscle strength in the lower limbs, physical fitness, and energy metabolism of the patients was evaluated at admission and after 12 weeks of intervention.

Results

A total of 60 pre-frail elderly were included in this study. The patients were divided into the exercise group (n = 30) and control group (n = 30) by random grouping. There were 17 men and 13 women aged 65.3 ± 13.4 in the exercise group, and 15 men and 15 women aged 67.6 ± 11.9 years in the control groups. The Barthel index was 80.3 ± 10.6 and 85.1 ± 11.6, respectively. The characteristics of the two groups were not significantly different before intervention (all p > 0.05). The results of repeated measurement ANOVA showed that there was statistically significant in crossover effect of group * time (all p < 0.05), that is, the differences of quadriceps femoris muscle strength, 6-min walking test, 30-s sit-to-stand test, 8-ft “up & go” test, daily activity energy expenditure and metabolic equivalent between the intervention group and the control group changed with time, and the variation ranges were different. The main effects of time were statistically significant (all p < 0.05), namely, femoris muscle strength, 6-min walking test, 30-s sit-to-stand test, 8-ft “up & go” test, daily activity energy expenditure and metabolic equivalent of the intervention group and the control group were significantly different before and after intervention. The main effects of groups were statistically significant (p < 0.05), namely, femoris muscle strength, 6-min walking test, 30-s sit-to-stand test, daily activity energy expenditure and metabolic equivalent before and after intervention were significantly different between the intervention group and the control group, while there was no significant differences in 8-ft “up & go” test between groups.

Conclusion

Lower limb resistance exercise used for the frailty intervention could improve muscle strength, physical fitness, and metabolism in pre-frail elderly.

Trial registration

ChiCTR, ChiCTR2000031099. Registered 22 March 2020, http://www.chictr.org.cn/edit.aspx?pid=51221&htm=4
The 30-days hospital readmission risk in diabetic patients: predictive modeling with machine learning classifiers
Authors: Shang Yujuan , Jiang Kui , Wang Lei , Zhang Zheqing , Zhou Siwei , Liu Yun , Dong Jiancheng , Wu Huiqun
Published: July 2021

Background and objectives

Diabetes mellitus is a major chronic disease that results in readmissions due to poor disease control. Here we established and compared machine learning (ML)-based readmission prediction methods to predict readmission risks of diabetic patients.

Methods

The dataset analyzed in this study was acquired from the Health Facts Database, which includes over 100,000 records of diabetic patients from 1999 to 2008. The basic data distribution characteristics of this dataset were summarized and then analyzed. In this study, 30-days readmission was defined as a readmission period of less than 30 days. After data preprocessing and normalization, multiple risk factors in the dataset were examined for classifier training to predict the probability of readmission using ML models. Different ML classifiers such as random forest, Naive Bayes, and decision tree ensemble were adopted to improve the clinical efficiency of the classification. In this study, the Konstanz Information Miner platform was used to preprocess and model the data, and the performances of the different classifiers were compared.

Results

A total of 100,244 records were included in the model construction after the data preprocessing and normalization. A total of 23 attributes, including race, sex, age, admission type, admission location, length of stay, and drug use, were finally identified as modeling risk factors. Comparison of the performance indexes of the three algorithms revealed that the RF model had the best performance with a higher area under receiver operating characteristic curve (AUC) than the other two algorithms, suggesting that its use is more suitable for making readmission predictions.

Conclusion

The factors influencing 30-days readmission predictions in diabetic patients, including number of inpatient admissions, age, diagnosis, number of emergencies, and sex, would help healthcare providers to identify patients who are at high risk of short-term readmission and reduce the probability of 30-days readmission. The RF algorithm with the highest AUC is more suitable for making 30-days readmission predictions and  deserves further validation in clinical trials.
Study on the semi-supervised learning-based patient similarity from heterogeneous electronic medical records
Authors: Wang Ni , Huang Yanqun , Liu Honglei , Zhang Zhiqiang , Wei Lan , Fei Xiaolu , Chen Hui
Published: July 2021

Background

A new learning-based patient similarity measurement was proposed to measure patients’ similarity for heterogeneous electronic medical records (EMRs) data.

Methods

We first calculated feature-level similarities according to the features’ attributes. A domain expert provided patient similarity scores of 30 randomly selected patients. These similarity scores and feature-level similarities for 30 patients comprised the labeled sample set, which was used for the semi-supervised learning algorithm to learn the patient-level similarities for all patients. Then we used the k-nearest neighbor (kNN) classifier to predict four liver conditions. The predictive performances were compared in four different situations. We also compared the performances between personalized kNN models and other machine learning models. We assessed the predictive performances by the area under the receiver operating characteristic curve (AUC), F1-score, and cross-entropy (CE) loss.

Results

As the size of the random training samples increased, the kNN models using the learned patient similarity to select near neighbors consistently outperformed those using the Euclidean distance to select near neighbors (all P values < 0.001). The kNN models using the learned patient similarity to identify the top k nearest neighbors from the random training samples also had a higher best-performance (AUC: 0.95 vs. 0.89, F1-score: 0.84 vs. 0.67, and CE loss: 1.22 vs. 1.82) than those using the Euclidean distance. As the size of the similar training samples increased, which composed the most similar samples determined by the learned patient similarity, the performance of kNN models using the simple Euclidean distance to select the near neighbors degraded gradually. When exchanging the role of the Euclidean distance, and the learned patient similarity in selecting the near neighbors and similar training samples, the performance of the kNN models gradually increased. These two kinds of kNN models had the same best-performance of AUC 0.95, F1-score 0.84, and CE loss 1.22. Among the four reference models, the highest AUC and F1-score were 0.94 and 0.80, separately, which were both lower than those for the simple and similarity-based kNN models.

Conclusions

This learning-based method opened an opportunity for similarity measurement based on heterogeneous EMR data and supported the secondary use of EMR data.
Acute care nurses’ perceptions of leadership, teamwork, turnover intention and patient safety – a mixed methods study
Authors: Zaheer Shahram , Ginsburg Liane , Wong Hannah J. , Thomson Kelly , Bain Lorna , Wulffhart Zaev
Published: July 2021

Background

This study contributes to a small but growing body of literature on how context influences perceptions of patient safety in healthcare settings. We examine the impact of senior leadership support for safety, supervisory leadership support for safety, teamwork, and turnover intention on overall patient safety grade. Interaction effects of predictors on perceptions of patient safety are also examined.

Methods

In this mixed methods study, cross-sectional survey data (N = 185) were collected from nurses and non-physician healthcare professionals. Semi-structured interview data (N = 15) were collected from nurses. The study participants worked in intensive care, general medicine, mental health, or the emergency department of a large community hospital in Southern Ontario.

Results

Hierarchical regression analyses showed that staff perceptions of senior leadership (p < 0.001), teamwork (p < 0.01), and turnover intention (p < 0.01) were significantly associated with overall patient safety grade. The interactive effect of teamwork and turnover intention on overall patient safety grade was also found to be significant (p < 0.05). The qualitative findings corroborated the survey results but also helped expand the characteristics of the study’s key concepts (e.g., teamwork within and across professional boundaries) and why certain statistical relationships were found to be non-significant (e.g., nurse interviewees perceived the safety specific responsibilities of frontline supervisors much more broadly compared to the narrower conceptualization of the construct in the survey).

Conclusions

The results of the current study suggest that senior leadership, teamwork, and turnover intention significantly impact nursing staff perceptions of patient safety. Leadership is a modifiable contextual factor and resources should be dedicated to strengthen relational competencies of healthcare leaders. Healthcare organizations must also proactively foster inter and intra-professional collaboration by providing teamwork educational workshops or other on-site learning opportunities (e.g., simulation training). Healthcare organizations would benefit by considering the interactive effect of contextual factors as another lever for patient safety improvement, e.g., lowering staff turnover intentions would maximize the positive impact of teamwork improvement initiatives on patient safety.
Metamorphic development of the olfactory system in the red flour beetle (Tribolium castaneum, Herbst)
Authors: Trebels Björn , Dippel Stefan , Goetz Brigitte , Graebner Maria , Hofmann Carolin , Hofmann Florian , Schmid Freya-Rebecca , Uhl Mara , Vuong Minh-Phung , Weber Vanessa , Schachtner Joachim
Published: July 2021

Background

Insects depend on their olfactory sense as a vital system. Olfactory cues are processed by a rather complex system and translated into various types of behavior. In holometabolous insects like the red flour beetle Tribolium castaneum, the nervous system typically undergoes considerable remodeling during metamorphosis. This process includes the integration of new neurons, as well as remodeling and elimination of larval neurons.

Results

We find that the sensory neurons of the larval antennae are reused in the adult antennae. Further, the larval antennal lobe gets transformed into its adult version. The beetle’s larval antennal lobe is already glomerularly structured, but its glomeruli dissolve in the last larval stage. However, the axons of the olfactory sensory neurons remain within the antennal lobe volume. The glomeruli of the adult antennal lobe then form from mid-metamorphosis independently of the presence of a functional OR/Orco complex but mature dependent on the latter during a postmetamorphic phase.

Conclusions

We provide insights into the metamorphic development of the red flour beetle’s olfactory system and compared it to data on Drosophila melanogaster, Manduca sexta, and Apis mellifera. The comparison revealed that some aspects, such as the formation of the antennal lobe’s adult glomeruli at mid-metamorphosis, are common, while others like the development of sensory appendages or the role of Orco seemingly differ.
Expression of the human molecular chaperone domain Bri2 BRICHOS on a gram per liter scale with an E. coli fed-batch culture
Authors: Schmuck Benjamin , Chen Gefei , Pelcman Josef , Kronqvist Nina , Rising Anna , Johansson Jan
Published: July 2021

Background

The human Bri2 BRICHOS domain inhibits amyloid formation and toxicity and could be used as a therapeutic agent against amyloid diseases. For translation into clinical use, large quantities of correctly folded recombinant human (rh) Bri2 BRICHOS are required. To increase the expression and solubility levels of rh Bri2 BRICHOS it was fused to NT*, a solubility tag derived from the N-terminal domain of a spider silk protein, which significantly increases expression levels and solubility of target proteins. To increase the expression levels even further and reach the g/L range, which is a prerequisite for an economical production on an industrial scale, we developed a fed-batch expression protocol for Escherichia coli.

Results

A fed-batch production method for NT*-Bri2 BRICHOS was set up and systematically optimized. This gradual improvement resulted in expression levels of up to 18.8 g/L. Following expression, NT*-Bri2 BRICHOS was purified by chromatographic methods to a final yield of up to 6.5 g/L. After removal of the NT*-tag and separation into different oligomeric species, activity assays verified that different assembly states of the fed-batch produced rh Bri2 BRICHOS have the same ability to inhibit fibrillar and non-fibrillar protein aggregation as the reference protein isolated from shake flask cultures.

Conclusions

The protocol developed in this work allows the production of large quantities of rh Bri2 BRICHOS using the solubility enhancing NT*-tag as a fusion partner, which is required to effectively conduct pre-clinical research.
Liver enzyme elevation and eosinophilia with atorvastatin: a case of probable DRESS without cutaneous symptoms
Authors: Zereshkian Arman , Waserman Susan
Published: July 2021

Background

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially life-threatening hypersensitivity reaction to medication. While a relatively rare phenomenon, early identification and discontinuation of the offending agent is pivotal to patient management. To our knowledge this is the first reported case of probable atorvastatin induced DRESS syndrome without rash.

Case presentation

An adult female presented with 4 days of persistent fevers, abdominal and flank pain, malaise, and generalized muscle weakness without any cutaneous reaction following 20 days of therapy with atorvastatin. She was febrile (38.5 °C), at presentation with a heart rate of 72, and blood pressure of 93/51 mmHg. Her laboratory investigations at their peak demonstrated an Alkaline Phosphatase (ALP) of 792 U/L, Alanine aminotransferase (ALT) of 265 U/L, gamma glutamyl transferase (GGT) of 236 U/L, total bilirubin at 21 mg/dL, eosinophils 3100 cells/µL, leukocytes 20.2 K/µL, hemoglobin of 12.5 gm/dL. During her admission she had normal creatinine and troponin. Her serology for Hepatitis A, B and C were negative. Cytomegalovirus, Epstein-Barr viral serologies were negative. Antinuclear Antibody (ANA), rheumatoid factor, anti-neutrophil cytoplasmic antibody (ANCA), mitochondrial antibody, and smooth muscle antibody were negative. The patient was initially diagnosed as having pyelonephritis due to nonspecific bilateral flank pain but given ongoing fevers and lack of clinical and laboratory improvement with antibiotics, a diagnosis of atorvastatin induced DRESS syndrome was considered probable, and atorvastatin was discontinued. The patients’ clinical status improved gradually without any further therapy and her liver enzymes and eosinophils normalized over the course of a month.

Conclusion

In patients who present with systemic organ involvement and eosinophilia, even without cutaneous manifestations, clinicians should apply the RegiSCAR criteria for DRESS syndrome. This can then help guide treatment with discontinuation of offending agent, or treatment with systemic corticosteroids.
Testosterone and depressive symptoms during the late menopause transition
Authors: Sander Bethany , Muftah Amira , Sykes Tottenham Laurie , Grummisch Julia A. , Gordon Jennifer L.
Published: July 2021

Background

The menopause transition is associated with an increased risk of depression. While the mechanisms behind this increased risk are not well understood, the changing perimenopausal hormonal environment has been hypothesized to play a role. The current study examined the potential influence of testosterone and the ratio of testosterone to estradiol as a potential contributor to depressed mood in the menopause transition.

Methods

Fifty non-depressed perimenopausal women ages 45–55 were recruited for this study. Once every 3 weeks, for a total of four times, the women completed the Centre for Epidemiological Studies-Depression (CES-D) scale for the measurement of depressive symptoms and provided a first-morning urine sample for the measurement of urinary testosterone as well as estrone-3-glucuronide (E1G), a urinary metabolite of estradiol. The week-to-week and mean effects of testosterone, E1G, and the testosterone/E1G ratio on CES-D score were examined. Self-reported sleep quality and vasomotor symptoms were also assessed at each of the four time points.

Results

Testosterone levels rose with increasing months since last menstrual period associated with testosterone levels (β(SE) = 175.3(63.2), p = .006), though this effect was moderated by body mass index (p for the interaction = .001) such that overweight women showed a less pronounced increase over time. Past and current smokers also had higher testosterone levels compared to never smokers. Week-to-week testosterone/E1G ratio was positively associated with CES-D score (β(SE) = 1.57(0.76), p = .041) but not sleep quality or vasomotor symptoms (ps > .05). Mean testosterone/E1G ratio was also positively associated with vasomotor symptom bother (β(SE) = 0.14(0.06), p = .018) and poorer sleep quality (β(SE) = − 0.34(0.09), p = .0001).

Conclusion

These results suggest that, within the context of the menopause transition, times that are characterized by a higher testosterone-to-estradiol ratio may be associated with higher depressive symptoms. Perimenopausal women with a higher average ratio of testosterone relative to estradiol may also experience more sleep difficulties and vasomotor symptom bother.
Review of Lands of the Future edited by Echi Christina Gabbert, Fana Gebresenbet, John G.Galaty and Günther Schlee
Authors: Homewood Katherine
Published: July 2021

Book details

Echi Christina Gabbert, Fana Gebresenbet, John G. Galaty and Günther Schlee, (Eds.) 2021. Lands of the Future. Berghahn Books (in association with Max Planck Institute for Social Anthropology, Halle/Saale) New York and Oxford. 332 pages. Volume 23 in Integration and Conflict Studies. ISBN 978-1-78920-990-7 (hardback) ISBN 978-1-78920-991-4 (e-book).
On algorithms testing positivity of real symmetric polynomials
Authors: Timofte Vlad , Timofte Aida
Published: July 2021

We show that positivity (≥0) on $\mathbb{R}_{+}^{n}$

R
+
n

and on $\mathbb{R}^{n}$

R
n

of real symmetric polynomials of degree at most p in $n\ge 2$
n
≥
2
variables is solvable by algorithms running in polynomial time in the number n of variables. For real symmetric quartics, we find discriminants which lead to the efficient algorithms QE4+ and QE4 running in $O(n)$
O
(
n
)
time. We describe the Maple implementation of both algorithms, which are then used not only for testing concrete inequalities (with given numerical coefficients and number of variables), but also for proving symbolic inequalities.
Comparison of colistin-induced nephrotoxicity between two different formulations of colistin in critically ill patients: a retrospective cohort study
Authors: Feng Jia-Yih , Lee Yi-Tzu , Pan Sheng-Wei , Yang Kuang-Yao , Chen Yuh-Min , Yen David Hung-Tsang , Li Szu-Yuan , Wang Fu-Der
Published: July 2021

Background

Colistin is widely used in the treatment of nosocomial infections caused by carbapenem-resistant gram-negative bacilli (CR-GNB). Colistin-induced nephrotoxicity is one of the major adverse reactions during colistin treatment. Comparisons of colistin-induced nephrotoxicity between different formulations of colistin are rarely reported.

Methods

In this retrospective cohort study, we enrolled intensive care unit–admitted patients if they had culture isolates of CR-GNB and underwent intravenous treatment with colistin. The occurrence of acute kidney injury (AKI) during intravenous treatment with colistin was recorded. The occurrence of colistin-induced nephrotoxicity was compared between two formulations of colistin, Locolin®, and Colimycin®. Treatment outcomes associated with the occurrence of colistin-induced nephrotoxicity were also investigated.

Results

Among 195 patients, 95 who were treated with Locolin® and 100 who were treated with Colimycin® were included for analysis. Patients treated with Locolin® had a higher rate of occurrence of stage 2 (46.3% vs. 32%, p = 0.040) and stage 3 (29.5% vs. 13%, p = 0.005) AKI than did those treated with Colimycin®. In multivariate analysis, the presence of septic shock (adjusted odds ratio [aOR] 2.17, 95% confidence interval [CI] 1.10–4.26) and inappropriate colistin dosage (aOR 2.52, 95% CI 1.00–6.33) were clinical factors associated with colistin-induced nephrotoxicity. Treatment with Colimycin® was an independent factor associated with a lower risk of colistin-induced nephrotoxicity (aOR 0.37, 95% CI 0.18–0.77). The mortality rate was comparable between patients with and without colistin-induced nephrotoxicity.

Conclusions

The risk of colistin-induced nephrotoxicity significantly varied in different formulations of colistin in critically ill patients. Colistin-induced nephrotoxicity was not associated with increased mortality rate.
The 2018 phreatic eruption at Mt. Motoshirane of Kusatsu–Shirane volcano, Japan: eruption and intrusion of hydrothermal fluid observed by a borehole tiltmeter network
Authors: Terada Akihiko , Kanda Wataru , Ogawa Yasuo , Yamada Taishi , Yamamoto Mare , Ohkura Takahiro , Aoyama Hiroshi , Tsutsui Tomoki , Onizawa Shin’ya
Published: July 2021

We estimate the mass and energy budgets for the 2018 phreatic eruption of Mt. Motoshirane on Kusatsu–Shirane volcano, Japan, based on data obtained from a network of eight tiltmeters and weather radar echoes. The tilt records can be explained by a subvertical crack model. Small craters that were formed by previous eruptions are aligned WNW–ESE, which is consistent with the strike of the crack modeled in this study. The direction of maximum compressive stress in this region is horizontal and oriented WNW–ESE, allowing fluid to intrude from depth through a crack with this orientation. Based on the crack model, hypocenter distribution, and MT resistivity structure, we infer that fluid from a hydrothermal reservoir at a depth of 2 km below Kusatsu–Shirane volcano has repeatedly ascended through a pre-existing subvertical crack. The inflation and deflation volumes during the 2018 eruption are estimated to have been 5.1 × 105 and 3.6 × 105 m3, respectively, meaning that 1.5 × 105 m3 of expanded volume formed underground. The total heat associated with the expanded volume is estimated to have been ≥ 1014 J, similar to or exceeding the annual heat released from Yugama Crater Lake of Mt. Shirane and that from the largest eruption during the past 130 year. Although the ejecta mass of the 2018 phreatic eruption was small, the eruption at Mt. Motoshirane was not negligible in terms of the energy budget of Kusatsu–Shirane volcano. A water mass of 0.1–2.0 × 107 kg was discharged as a volcanic cloud, based on weather radar echoes, which is smaller than the mass associated with the deflation. We suggest that underground water acted as a buffer against the sudden intrusion of hydrothermal fluids, absorbing some of the fluid that ascended through the crack.
Contract cheating: an increasing challenge for global academic community arising from COVID-19
Authors: Hill Guzyal , Mason Jon , Dunn Alex
Published: July 2021

Due to COVID-19, universities with limited expertise with the digital environment had to rapidly transition to online teaching and assessment. This transition did not create a new problem but has offered more opportunities for contract cheating and diversified the types of such services. While universities and lecturers were adjusting to the new teaching styles and developing new assessment methods, opportunistic contract cheating providers have been offering $50 COVID-19 discounts and students securing the services of commercial online tutors to take their online exams or to take advantage of real-time assistance from ‘pros’ while sitting examinations. The article contributes to the discourse on contract cheating by reporting on an investigation of the scope and scale of the growing problems related to academic integrity exacerbated by an urgent transition to online assessments during the COVID-19 pandemic. The dark reality is the illegal services are developing at a faster pace than the systems required to curb them, as demonstrated by the results. The all-penetrating issues indicate systemic failures on a global scale that cannot be addressed by an individual academic or university acting alone. Multi-level solutions including academics, universities and the global community are essential. Future research must focus on developing a model of collaboration to address this problem on several levels, taking into account (1) individual academics, (2) universities, (3) countries and (4) international communities.
Validity arguments for patient-reported outcomes: justifying the intended interpretation and use of data
Authors: Hawkins Melanie , Elsworth Gerald R. , Nolte Sandra , Osborne Richard H.
Published: July 2021

Background

Contrary to common usage in the health sciences, the term “valid” refers not to the properties of a measurement instrument but to the extent to which data-derived inferences are appropriate, meaningful, and useful for intended decision making. The aim of this study was to determine how validity testing theory (the Standards for Educational and Psychological Testing) and methodology (Kane’s argument-based approach to validation) from education and psychology can be applied to validation practices for patient-reported outcomes that are measured by instruments that assess theoretical constructs in health.

Methods

The Health Literacy Questionnaire (HLQ) was used as an example of a theory-based self-report assessment for the purposes of this study. Kane’s five inferences (scoring, generalisation, extrapolation, theory-based interpretation, and implications) for theoretical constructs were applied to the general interpretive argument for the HLQ. Existing validity evidence for the HLQ was identified and collated (as per the Standards recommendation) through a literature review and mapped to the five inferences. Evaluation of the evidence was not within the scope of this study.

Results

The general HLQ interpretive argument was built to demonstrate Kane’s five inferences (and associated warrants and assumptions) for theoretical constructs, and which connect raw data to the intended interpretation and use of the data. The literature review identified 11 HLQ articles from which 57 sources of validity evidence were extracted and mapped to the general interpretive argument.

Conclusions

Kane’s five inferences and associated warrants and assumptions were demonstrated in relation to the HLQ. However, the process developed in this study is likely to be suitable for validation planning for other measurement instruments. Systematic and transparent validation planning and the generation (or, as in this study, collation) of relevant validity evidence supports developers and users of PRO instruments to determine the extent to which inferences about data are appropriate, meaningful and useful (i.e., valid) for intended decisions about the health and care of individuals, groups and populations.