bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Features and Risk Factors for In-Hospital Mortality From COVID-19 Infection at a Tertiary Care Medical Center, at the Onset of the US COVID-19 Pandemic
Authors: Bhargava Ashish , Szpunar Susanna M. , Sharma Mamta , Fukushima Elisa Akagi , Hoshi Sami , Levine Miriam , Gandhi Nikhil , Zhao Wei , Michael Somero , Tanveer Farah , Youssef Dima , Coyle Meredith , Leonard Johnson , Saravolatz Louis
Published: March 2021

Background:

Mortality from COVID-19 has been associated with older age, black race, and comorbidities including obesity, Understanding the clinical risk factors and laboratory biomarkers associated with severe and fatal COVID-19 will allow early interventions to help mitigate adverse outcomes. Our study identified risk factors for in-hospital mortality among patients with COVID-19 infection at a tertiary care center, in Detroit, Michigan.

Methods:

We conducted a single-center, retrospective cohort study at a 776-bed tertiary care urban academic medical center. Adult inpatients with confirmed COVID-19 (nasopharyngeal swab testing positive by real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay) from March 8, 2020, to June 14, 2020, were included. Clinical information including the presence of comorbid conditions (according to the Charlson Weighted Index of Comorbidity (CWIC)), initial vital signs, admission laboratory markers and management data were collected. The primary outcome was in-hospital mortality.

Results:

Among 565 hospitalized patients, 172 patients died for a case fatality rate of 30.4%. The mean (SD) age of the cohort was 64.4 (16.2) years, and 294 (52.0%) were male. The patients who died were significantly older (mean [SD] age, 70.4 [14.1] years vs 61.7 [16.1] years; P < 0.0001), more likely to have congestive heart failure (35 [20.3%] vs 47 [12.0%]; P = 0.009), dementia (47 [27.3%] vs 48 [12.2%]; P < 0.0001), hemiplegia (18 [10.5%] vs 18 [4.8%]; P = 0.01) and a diagnosis of malignancy (16 [9.3%] vs 18 [4.6%]; P = 0.03).From multivariable analysis, factors associated with an increased odds of death were age greater than 60 years (OR = 2.2, P = 0.003), CWIC score (OR = 1.1, P = 0.023), qSOFA (OR = 1.7, P < 0.0001), WBC counts (OR = 1.1 , P = 0.002), lymphocytopenia (OR = 2.0, P = 0.003), thrombocytopenia (OR = 1.9, P = 0.019), albumin (OR = 0.6 , P = 0.014), and AST levels (OR = 2.0, P = 0.004) on admission.

Conclusions:

This study identified risk factor for in-hospital mortality among patients admitted with COVID-19 in a tertiary care hospital at the onset of U.S. Covid-19 pandemic. After adjusting for age, CWIC score, and laboratory data, qSOFA remained an independent predictor of mortality. Knowing these risk factors may help identify patients who would benefit from close observations and early interventions.
“For Everyone” Means “For No One:”: Membership Tensions in Community Collaboration
Authors: Cooper Katherine R.
Published: March 2021

Prior research suggests that tensions are particularly salient in nonprofit and interorganizational contexts but rarely considers the impacts of managing these tensions. This manuscript applies a constitutive view of tensions to a community collaboration. Applied tensional analysis suggests interrelated membership tensions identified by organizational partners (grassroots/grasstops and inclusion/exclusion). Partners respond in conscious and latent ways (branding/blaming) as they seek to include organizational and community members and ultimately rely on contradictory messages (affirmation/admonition) to retain members. Findings present theoretical and practical implications for tension management, as well as constitutive implications for nonprofits dependent on organizational and community involvement to enact social change.
Does a Diversified Crop Portfolio Make Farmers More Efficient? A Stochastic Production Frontier Analysis of Farm-level Data from Assam, India
Authors: Mandal Raju , Maity Shrabanti
Published: March 2021

The agriculture sector in India is beset with twin limitations of shrinking cultivable area and absence of major technological breakthroughs in the recent past. In such a situation, a judicious management of the farm in the form of adjustment in a crop portfolio can be quite useful to maximise output and minimise wastage of resources. This article seeks to examine whether a diversified crop portfolio makes the farmers more efficient using farm-level survey data collected from geographically diverse areas of Assam, a state in northeast India. The results of a stochastic production frontier analysis show that adoption of a diversified crop portfolio across crops and seasons makes the farmers more efficient in cultivation by helping them reduce weather-induced damages to crops and reap better returns from farming. This efficiency-enhancing effect of crop diversification is found to be heterogeneous among the regions. However, too much diversification reduces the efficiency of farmers. The results have important implications for Assam where floods cause extensive damage to crops every year. Moreover, access to extension services and government support are found to make the farmers more efficient. On the other hand, fixed-rent form of tenancy reduces efficiency of the farmers while household size has a positive impact on the same.
Not Whodunit But Whydunit: Story Characters’ Motivations Influence Audience Interest in Services
Authors: Hamby Anne , van Laer Tom
Published: March 2021

Service providers and consumer well-being advocates often share stories to promote audience interest in relevant behavior. This research examines how characters’ motivations for engaging in service-related behavior in such stories influence consumers’ interest in services. Across five studies, we show that audiences are more interested in services after reading about a character who acts for intrinsically (vs. extrinsically) motivated reasons. We show that this occurs because the audience identifies more with intrinsically motivated characters. We also examine how consequences of characters’ actions (both for others and for themselves when they make miscalibrated decisions) shape an audience’s service interest in targeted ways, specifically encouraging interest in services that help people while avoiding unintended negative consequences. The results of this work suggest that stories can be an effective way to encourage consumers’ interest in services that enhance personal and societal well-being and identify critical story elements that influence their success in doing so.
Walking Corpse Syndrome: A trauma-related idiom of distress amongst Sri Lankan Tamils
Authors: Affleck William , Thamotharampillai Umaharan , Hinton Devon
Published: March 2021

This article introduces Walking Corpse Syndrome, a common idiom of distress in Tamil Sri Lanka that is characterized by a variety of cognitive difficulties, feelings that an individual is functioning reflexively or impulsively, and acute attacks of dissociation that are accompanied with the sensation of empty-headedness. Walking Corpse Syndrome demonstrates some overlap with Western nosology, although it appears to be its own unique illness category, most likely of Ayurvedic provenance. The article comprises two studies. One is a secondary interview analysis of community members that aimed to identify the key symptoms of Walking Corpse Syndrome, allowing us to determine the local ethnopsychology of the syndrome and to elicit illustrative vignettes. The other study is a survey of Sri Lankan Tamil psychiatrists that aimed to investigate their understanding and experience of the disorder. This article outlines how, in certain cultural contexts, such syndromes emphasise the loss of attentional capacity and forgetfulness; it highlights the importance of “thinking a lot” as an idiom across cultures; and it details the many ways that Walking Corpse Syndrome is a key idiom of distress to assess in order to give adequate mental healthcare to Sri Lankan Tamil populations.
COVID-19: Antiviral agents and enzyme inhibitors/receptor blockers in development
Authors: Jogalekar Manasi P , Veerabathini Anurag , Patel Ankit B
Published: March 2021

Novel 2019 coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) and coronavirus disease 2019 (COVID-19), the respiratory syndrome it causes, have shaken the world to its core by infecting and claiming the lives of many people since originating in December 2019 in Wuhan, China. World Health Organization and several states have declared a pandemic situation and state of emergency, respectively. As there is no treatment for COVID-19, several research institutes and pharmaceutical companies are racing to find a cure. Advances in computational approaches have allowed the screening of massive antiviral compound libraries to identify those that may potentially work against SARS-CoV-2. Antiviral agents developed in the past to combat other viruses are being repurposed. At the same time, new vaccine candidates are being developed and tested in preclinical/clinical settings. This review provides a detailed overview of select repurposed drugs, their mechanism of action, associated toxicities, and major clinical trials involving these agents.
Mean Absolute Relative Difference of Blood Glucose Monitoring Systems and Relationship to ISO 15197
Authors: Freckmann Guido , Mende Jochen , Pleus Stefan , Waldenmaier Delia , Baumstark Annette , Jendrike Nina , Haug Cornelia
Published: March 2021

Background:

The analytical quality of a blood glucose monitoring system (BGMS) is often assessed according to the requirements described in the international standard ISO 15197. However, the mean absolute relative difference (MARD) is sometimes used as well. This analysis aims at providing empirical data from BGMS evaluation studies conducted according to ISO 15197 and at providing an estimation of how MARD and percentage of measurement results within ISO accuracy limits are related.

Methods:

Results of 77 system accuracy evaluations conducted according to ISO 15197 were used to calculate MARD between BGMS and a laboratory comparison method’s results (glucose oxidase or hexokinase method). Additionally, bias and 95%-limits of agreement (LoA) using the Bland and Altman method were calculated.

Results:

MARD results ranged from 2.3% to 20.5%. The lowest MARD of a test strip lot that showed <95% of results within ISO limits was 6.1%. The distribution of MARD results shows that only 3.6% of test strip lots with a MARD equal to or below 7% showed <95% of results within ISO limits (2.2% of all test strip lots). Bias of test strip lots that showed ≥95% of results within the limits ranged from −10.3% to +7.4%. The half-width of the 95%-LoA of test strip lots that showed ≥95% of results within the limits ranged from 4.8% to 24.0%.

Conclusion:

There is a threshold MARD that may allow an estimate whether ISO 15197 requirements are fulfilled, but this statement cannot be made with certainty.
Heritage-based tribalism in Big Data ecologies: Deploying origin myths for antagonistic othering
Authors: Bonacchi Chiara , Krzyzanska Marta
Published: March 2021

This article presents a conceptual and methodological framework to study heritage-based tribalism in Big Data ecologies by combining approaches from the humanities, social and computing sciences. We use such a framework to examine how ideas of human origin and ancestry are deployed on Twitter for purposes of antagonistic ‘othering’. Our goal is to equip researchers with theory and analytical tools for investigating divisive online uses of the past in today’s networked societies. In particular, we apply notions of heritage, othering and neo-tribalism, and both data-intensive and qualitative methods to the case of people’s engagements with the news of Cheddar Man’s DNA on Twitter. We show that heritage-based tribalism in Big Data ecologies is uniquely shaped as an assemblage by the coalescing of different forms of antagonistic othering. Those that co-occur most frequently are the ones that draw on ‘Views on Race’, ‘Trust in Experts’ and ‘Political Leaning’. The framings of the news that were most influential in triggering heritage-based tribalism were introduced by both right- and left-leaning newspaper outlets and by activist websites. We conclude that heritage-themed communications that rely on provocative narratives on social media tend to be labelled as political and not to be conducive to positive change in people’s attitudes towards issues such as racism.
Data diaries: A situated approach to the study of data
Authors: Tkacz Nathaniel , Henrique da Mata Martins Mário , Porto de Albuquerque João , Horita Flávio , Dolif Neto Giovanni
Published: March 2021

This article adapts the ethnographic medium of the diary to develop a method for studying data and related data practices. The article focuses on the creation of one data diary, developed iteratively over three years in the context of a national centre for monitoring disasters and natural hazards in Brazil (Cemaden). We describe four points of focus involved in the creation of a data diary – spaces, interfaces, types and situations – before reflecting on the value of this method. We suggest data diaries (1) are able to capture the informal dimension of data-intensive organisations; (2) enable empirical analysis of the specific ways that data intervene in the unfolding of situations; and (3) as a document, data diaries can foster interdisciplinary and inter-expert dialogue by bridging different ways of knowing data.
Prevalence of sarcopenia and the association of sarcopenia, premorbid factors, early functional outcome and 1-year mortality in Hong Kong Chinese fragility hip fracture patients
Authors: Au Ivan Long Yin , Chan Wai Lan Daisy , Tiu Kwok Leung , Lee Kin Bong , Li Wilson , Chan Andy Chi Ming
Published: March 2021

Background/purpose:

Sarcopenia is a predictor of fall, which is a leading cause of fragility hip fractures (FHF). Dual energy X-ray absorptiometry (DXA) is a costly measurement method for sarcopenia. Rehabilitation and prognosis can be determined by early functional outcomes. Meanwhile, 1-year mortality of FHF patients is high.

Aims:

(i) To report the prevalence of sarcopenia. (ii) To investigate the relationships of sarcopenia, premorbid factors, early functional outcomes and 1-year mortality in Hong Kong Chinese FHF patients.

Methods:

FHF patients admitted to Queen Elizabeth Hospital in Hong Kong from April 2016 to March 2017 were reviewed, including outcomes of relative appendicular skeletal muscle mass index (RASM), handgrip strength (HGS), New Mobility Score (NMS), Modified Functional Ambulation Classification (MFAC), Modified Barthel Index (MBI), Cumulated Ambulation Score (CAS), Elderly Mobility Scale (EMS) and 1-year mortality.

Results:

One hundred sixty nine FHF patients, aged 82.68 ± 7.32 years, were reviewed. Prevalence of sarcopenia in male and female were 71.4% and 37.7%, respectively. RASM was correlated with HGS of both dominant ( r = 0.366, p < 0.001) and non-dominant side ( r = 0.383, p < 0.001), NMS ( rs = 0.239, p < 0.001), MFAC ( rs = 0.192, p = 0.013), MBI ( rs = 0.182, p = 0.018) and CAS ( rs = 0.183, p = 0.019). RASM was not significantly correlated with EMS-1 ( rs = 0.050, p = 0.525) and EMS-DC ( rs = 0.092, p = 0.249). There was significant correlation between Sarcopenia and EMS-DC ( rrb = −0.226, p = 0.004). Sarcopenia was marginally not associated with 1-year mortality ( χ 2 = 3.745, p = 0.053). One-year mortality of FHF patients with Sarcopenia and without Sarcopenia were 16.5% and 7.1%, respectively. FHF patients with Sarcopenia were not statistically significant to be more likely to face mortality within 1 year ( R 2 = 0.030, OR = 2.638, p = 0.060).

Conclusions:

Prevalence of sarcopenia was high in FHF patients and RASM was correlated with HGS and NMS, which can be easily administered as screening tools. Sarcopenia was correlated with early functional outcome but not with 1-year mortality. Early detection of Sarcopenia is crucial for early implementation of rehabilitation and treatment.
Integrating Peer Learning Activities and Problem-Based Learning in Clinical Nursing Education
Authors: Putri Suci Tuty , Sumartini Sri
Published: March 2021

Introduction

The implementation of nursing clinical learning in Indonesia has several challenges that require innovation in the learning method strategy. The method that has been used so far focuses on the hierarchical relationship between lecturers/preceptors and students, so that there are many shortcomings in learning outcomes. The application of the method of active learning with Peer Learning (PL) and Problem Based Learning (PBL) techniques has proven effective in classroom learning, but its rarely found in clinical learning.

Objective

The purpose of this study was to determine the effectiveness of the PL and PBL towards the achievement of clinical learning in nursing students.

Methods

The research method used a true experiment with a posttest only control group design, the sampling technique was taken by randomize control trial. An instrument for clinical learning achievement using AssCE.

Results

The analysis was carried out as descriptive and bivariate. The results showed the mean in the experimental group was 7.059 and the control group was 6.325. Further statistical test results were obtained p-value = 0.001 (p < 0.05) which showed that the average score there were differences in clinical learning achievement development scores.

Conclusion

Clinical learning using peer learning and PBL methods can directly improve various aspects of student competency achievement.
Global analysis of expression, maturation and subcellular localization of mouse liver transcriptome identifies novel sex-biased and TCPOBOP-responsive long non-coding RNAs
Authors: Goldfarb Christine N. , Waxman David J.
Published: March 2021

Background

While nuclear transcription and RNA processing and localization are well established for protein coding genes (PCGs), these processes are poorly understood for long non-coding (lnc)RNAs. Here, we characterize global patterns of transcript expression, maturation and localization for mouse liver RNA, including more than 15,000 lncRNAs. PolyA-selected liver RNA was isolated and sequenced from four subcellular fractions (chromatin, nucleoplasm, total nucleus, and cytoplasm), and from the chromatin-bound fraction without polyA selection.

Results

Transcript processing, determined from normalized intronic to exonic sequence read density ratios, progressively increased for PCG transcripts in going from the chromatin-bound fraction to the nucleoplasm and then on to the cytoplasm. Transcript maturation was similar for lncRNAs in the chromatin fraction, but was significantly lower in the nucleoplasm and cytoplasm. LncRNA transcripts were 11-fold more likely to be significantly enriched in the nucleus than cytoplasm, and 100-fold more likely to be significantly chromatin-bound than nucleoplasmic. Sequencing chromatin-bound RNA greatly increased the sensitivity for detecting lowly expressed lncRNAs and enabled us to discover and localize hundreds of novel regulated liver lncRNAs, including lncRNAs showing sex-biased expression or responsiveness to TCPOBOP a xenobiotic agonist ligand of constitutive androstane receptor (Nr1i3).

Conclusions

Integration of our findings with prior studies and lncRNA annotations identified candidate regulatory lncRNAs for a variety of hepatic functions based on gene co-localization within topologically associating domains or transcription divergent or antisense to PCGs associated with pathways linked to hepatic physiology and disease.
Deep learning assisted multi-omics integration for survival and drug-response prediction in breast cancer
Authors: Malik Vidhi , Kalakoti Yogesh , Sundar Durai
Published: March 2021

Background

Survival and drug response are two highly emphasized clinical outcomes in cancer research that directs the prognosis of a cancer patient. Here, we have proposed a late multi omics integrative framework that robustly quantifies survival and drug response for breast cancer patients with a focus on the relative predictive ability of available omics datatypes. Neighborhood component analysis (NCA), a supervised feature selection algorithm selected relevant features from multi-omics datasets retrieved from The Cancer Genome Atlas (TCGA) and Genomics of Drug Sensitivity in Cancer (GDSC) databases. A Neural network framework, fed with NCA selected features, was used to develop survival and drug response prediction models for breast cancer patients. The drug response framework used regression and unsupervised clustering (K-means) to segregate samples into responders and non-responders based on their predicted IC50 values (Z-score).

Results

The survival prediction framework was highly effective in categorizing patients into risk subtypes with an accuracy of 94%. Compared to single-omics and early integration approaches, our drug response prediction models performed significantly better and were able to predict IC50 values (Z-score) with a mean square error (MSE) of 1.154 and an overall regression value of 0.92, showing a linear relationship between predicted and actual IC50 values.

Conclusion

The proposed omics integration strategy provides an effective way of extracting critical information from diverse omics data types enabling estimation of prognostic indicators. Such integrative models with high predictive power would have a significant impact and utility in precision oncology.
Whole-genome analysis of probiotic product isolates reveals the presence of genes related to antimicrobial resistance, virulence factors, and toxic metabolites, posing potential health risks
Authors: Wang Ying , Liang Qian , Lu Bian , Shen Hong , Liu Shuyan , Shi Ya , Leptihn Sebastian , Li Hong , Wei Jin , Liu Chengzhi , Xiao Hailong , Zheng Xiaoling , Liu Chao , Chen Huan
Published: March 2021

Background

Safety issues of probiotic products have been reported frequently in recent years. Ten bacterial strains isolated from seven commercial probiotic products on market were evaluated for their safety, by whole-genome analysis.

Results

We found that the bacterial species of three probiotic products were incorrectly labeled. Furthermore, six probiotic product isolates (PPS) contained genes for the production of toxic metabolites, while another three strains contained virulence genes, which might pose a potential health risk. In addition, three of them have drug-resistance genes, among which two strains potentially displayed multidrug resistance. One isolate has in silico predicted transferable genes responsible for toxic metabolite production, and they could potentially transfer to human gut microflora or environmental bacteria. Isolates of Lactobacillus rhamnosus and Bifidobacterium animalis subsp. lactis are associated with low risk for human consumption. Based on a comparative genome analysis, we found that the isolated Enterococcus faecium TK-P5D clustered with a well-defined probiotic strain, while E. faecalis TK-P4B clustered with a pathogenic strain.

Conclusions

Our work clearly illustrates that whole-genome analysis is a useful method to evaluate the quality and safety of probiotic products. Regulatory quality control and stringent regulations on probiotic products are needed to ensure safe consumption and protect human health.
Effect of ultrasound-guided transversus abdominis plane block with rectus sheath block on patients undergoing laparoscopy-assisted radical resection of rectal cancer: a randomized, double-blind, placebo-controlled trial
Authors: Liang Min , Xv Xia , Ren Chunguang , Yao Yongxing , Gao Xiujuan
Published: March 2021

Background

Many patients complain of pain following laparoscopic surgery. Clinicians have used ultrasound-guided posterior transversus abdominis plane block (TAPB) and rectus sheath block (RSB) for multimodal analgesia after surgery. We investigated the analgesic effects of US-guided posterior TAPB with RSB on postoperative pain following laparoscopy-assisted radical resection of early-stage rectal cancer.

Methods

Seventy-eight adults scheduled for laparoscopy-assisted radical resection of rectal cancer were enrolled in this double-blind placebo-controlled trial. Patients were randomized into 3 groups: the TR Group underwent US-guided bilateral posterior TAPB (40 mL 0.33% ropivacaine) with RSB (20 mL 0.33% ropivacaine); the T Group underwent US-guided bilateral posterior TAPB alone; and the Control Group received saline alone. All patients also had access to patient-controlled intravenous analgesia (PCIA) with sufentanil. The primary outcome was postoperative sufentanil consumption at 0–24, 24–48, and 48–72 h. The secondary outcomes were postoperative pain intensity and functional activity score at rest and while coughing for the same three time periods, intraoperative medication dosage, use of rescue analgesia, recovery parameters, and adverse effects.

Results

The three groups had no significant differences in baseline demographic and perioperative data, use of intraoperative medications, recovery parameters, and adverse effects. The TR group had significantly lower postoperative use of PCIA and rescue analgesic than in the other two groups (P < 0.05), but the Control Group and T Group had no significant differences in these outcomes.

Conclusions

Postoperative US-guided posterior TAPB with RSB reduced postoperative opioid use in patients following laparoscopy-assisted radical resection of rectal cancer.

Trial registration

The trial was registered withchictr.org(ChiCTR2000029326) on January 25, 2020.
A 2 miRNAs-based signature for the diagnosis of atherosclerosis
Authors: Han Xiujiang , Wang Huimin , Li Yongjian , Liu Lina , Gao Sheng
Published: March 2021

Background

Atherosclerosis (AS) is a leading cause of vascular disease worldwide. MicroRNAs (miRNAs) play an essential role in the development of AS. However, the miRNAs-based biomarkers for the diagnosis of AS are still limited. Here, we aimed to identify the miRNAs significantly related to AS and construct the predicting model based on these miRNAs for distinguishing the AS patients from healthy cases.

Methods

The miRNA and mRNA expression microarray data of blood samples from patients with AS and healthy cases were obtained from the GSE59421 and GSE20129 of Gene Expression Omnibus (GEO) database, respectively. Weighted Gene Co-expression Network Analysis (WGCNA) was performed to evaluate the correlation of the miRNAs and mRNAs with AS and identify the miRNAs and mRNAs significantly associated with AS. The potentially critical miRNAs were further optimized by functional enrichment analysis. The logistic regression models were constructed based on these optimized miRNAs and validated by threefold cross-validation method.

Results

WGCNA revealed 42 miRNAs and 532 genes significantly correlated with AS. Functional enrichment analysis identified 12 crucial miRNAs in patients with AS. Moreover, 6 miRNAs among the identified 12 miRNAs, were selected using a stepwise regression model, in which four miRNAs, including hsa-miR-654-5p, hsa-miR-409-3p, hsa-miR-485-5p and hsa-miR-654-3p, were further identified through multivariate regression analysis. The threefold cross-validation method showed that the AUC of logistic regression model based on the four miRNAs was 0.7308, 0.8258, and 0.7483, respectively, with an average AUC of 0.7683.

Conclusion

We identified a total of four miRNAs, including hsa-miR-654-5p and hsa-miR-409-3p, are identified as the potentially critical biomarkers for AS. The logistic regression model based on the identified 2 miRNAs could reliably distinguish the patients with AS from normal cases.
A retrospective study of alectinib versus ceritinib in patients with advanced non–small-cell lung cancer of anaplastic lymphoma kinase fusion in whom crizotinib treatment failed
Authors: Kuo Chih-Hsi Scott , Tung Pi-Hung , Huang Allen Chung-Cheng , Wang Chin-Chou , Chang John Wen-Cheng , Liu Chien-Ying , Chung Fu-Tsai , Fang Yueh-Fu , Guo Yi-Ke , Yang Cheng-Ta
Published: March 2021

Background

Crizotinib is the approved treatment for advanced non-small cell lung cancers (NSCLCs) of anaplastic lymphoma kinase (ALK) fusion. Failure of crizotinib treatment frequently involves drug intolerance or resistance. Comparison of using second-generation ALK inhibitors in this setting remains lacking.

Methods

Sixty-five ALK-positive advanced NSCLC patients receiving second-generation ALK inhibitors following treatment failure of crizotinib were retrospectively analyzed for the therapeutic efficacy.

Results

Forty-three (66.2%) and 22 (33.8%) patients received alectinib and ceritinib, respectively. Comparing alectinib to ceritinib treatment: the 12-month progression-free survival (PFS) rate (61.0% [95% confidence interval, 47.1 to 78.9%] vs. 54.5% [95% CI, 37.3 to 79.9%]); the hazard ratio (HR) for disease progression or death, 0.61 (95% CI, 0.31–1.17; p = 0.135). Multivariate Cox regression showed ECOG PS (0–1 vs. 2–3 HR 0.09 [95% CI, 0.02–0.33]; p < 0.001) and cause of crizotinib treatment failure (resistance vs. intolerance HR 2.75 [95% CI, 1.26–5.99]; p = 0.011) were the independent predictors for the PFS of second-generation ALK inhibitors. Treatment of alectinib, compared to ceritinib, was associated with a lower incidence of CNS progression (cause-specific HR, 0.10; 95% CI 0.01–0.78; p = 0.029) and a higher efficacy in patients whose cause of crizotinib treatment failure was intolerance (HR 0.29 [95% CI, 0.08–1.06]; p = 0.050). The most commonly noted adverse events were elevated AST/ALT in 10 (23.3%) patients treated with alectinib and diarrhea in 8 (36.4%) patients treated with ceritinib.

Conclusion

Second-generation ALK inhibitors in crizotinib-treated patients showed a satifactory efficacy. Alectinib treatment demonstrated a CNS protection activity and a higher PFS in selected patients failing crizotinib treatment.
Protocol for implementation of an evidence based parentally administered intervention for preterm infants
Authors: White-Traut Rosemary , Brandon Debra , Kavanaugh Karen , Gralton Karen , Pan Wei , Myers Evan R. , Andrews Bree , Msall Michael , Norr Kathleen F.
Published: March 2021

Background

Multi-sensory behavioral interventions for preterm infants have the potential to accelerate feeding, growth, and optimize developmental trajectories and increase parents’ interactive engagement with their infants. However, few neonatal intensive care units (NICUs) provide evidence-based standardized early behavioral interventions as routine care. Lack of implementation is a major gap between research and clinical practice. H-HOPE, is a standardized behavioral intervention with an infant- directed component (Massage+) and a parent-directed component (four participatory guidance sessions that focus on preterm infants’ behaviors and appropriate responses). H-HOPE has well documented efficacy. The purpose of this implementation study is to establish H-HOPE as the standard of care in 5 NICUs.

Methods

The study employs a Type 3 Hybrid design to simultaneously examine the implementation process and effectiveness in five NICUs. To stagger implementation across the clinical sites, we use an incomplete stepped wedge design. The five participating NICUs were purposively selected to represent different acuity levels, number of beds, locations and populations served. Our implementation strategy integrates our experience conducting H-HOPE and a well-established implementation model, the Consolidated Framework for Implementation Research (CFIR). The CFIR identifies influences (facilitators and barriers) that affect successful implementation within five domains: intervention characteristics, outer setting (the hospital and external events and stakeholders), inner setting (NICU), implementers’ individual characteristics, and the implementation process. NICUs will use the CFIR process, which includes three phases: Planning and Engaging, Executing, and Reflecting and Evaluating. Because sustaining is a critical goal of implementation, we modify the CFIR implementation process by adding a final phase of Sustaining.

Discussion

This study builds on the CFIR, adding Sustaining H-HOPE to observe what happens when sites begin to maintain implementation without outside support, and extends its use to the NICU acute care setting. Our mixed methods analysis systematically identifies key facilitators and barriers of implementation success and effectiveness across the five domains of the CFIR. Long term benefits have not yet been studied but may include substantial health and developmental outcomes for infants, more optimal parent-child relationships, reduced stress and costs for families, and substantial indirect societal benefits including reduced health care and special education costs.

Trial registration

ClinicalTrials.gov registration number NCT04555590, Registered on 8/19/2020.
Prevalence of negative emotional eating and its associated psychosocial factors among urban Chinese undergraduates in Hong Kong: a cross-sectional study
Authors: Sze Katherine Y. P. , Lee Eric K. P. , Chan Rufina H. W. , Kim Jean H.
Published: March 2021

Background

Emotional eating (EE), defined as eating in response to a range of emotions, has been previously associated with poor diet and obesity. Since there are limited data from non-Western populations, this study aims to examine the prevalence and factors associated with EE among urban Chinese university students.

Methods

A cross-sectional study was conducted on 424 university students (aged 18–24 years) from two large universities in Hong Kong in 2019. Respondents completed an anonymous online questionnaire that contained background questions, an emotional eating subscale of the Dutch Eating Behaviour Questionnaire (DEBQ), and Depression Anxiety and Stress Scales (DASS-21). Two-sample independent t-test and multiple regression analyses were conducted to test the association of study variables with negative emotional eating.

Results

There was over a three-fold higher likelihood of negative EE among females (14.8%) when compared with their male counterparts (4.5%) (OR = 3.7, p < 0.05). Having at least mild depressive symptoms was the only independent factor associated with negative EE among males (OR = 10.1) while for females, negative EE was independently associated with not having a romantic partner (OR = 3.45), having depressive symptoms (OR = 44.5), and having at least mild stress (OR = 5.65). Anxiety levels were not independently associated with negative EE for either gender. Both male and female students with negative EE had significantly lower self-perceived health scores, higher body mass index, and lower life satisfaction scores.

Conclusions

This study revealed that negative EE is prevalent among female Chinese university students and not uncommon among male students. Management of negative EE should be included as a component of university mental health promotion programmes in the region.
Bottom-up innovation for health management capacity development: a qualitative case study in a South African health district
Authors: Orgill Marsha , Marchal Bruno , Shung-King Maylene , Sikuza Lwazikazi , Gilson Lucy
Published: March 2021

Background

As part of health system strengthening in South Africa (2012–2017) a new district health manager, taking a bottom-up approach, developed a suite of innovations to improve the processes of monthly district management team meetings, and the practices of managers and NGO partners attending them. Understanding capacity as a property of the health system rather than only of individuals, the research explored the mechanisms triggered in context to produce outputs, including the initial sensemaking by the district manager, the subsequent sensegiving and sensemaking in the team and how these homegrown innovations interacted with existing social processes and norms within the system.

Methods

We conducted a realist evaluation, adopting the case study design, over a two-year period (2013–2015) in the district of focus. The initial programme theory was developed from 10 senior manager interviews and a literature review. To understand the processes and mechanisms triggered in the local context and identify outputs, we conducted 15 interviews with managers in the management team and seven with non-state actors. These were supplemented by researcher notes based on time spent in the district. Thematic analysis was conducted using the Context-Mechanism-Outcome configuration alongside theoretical constructs.

Results

The new district manager drew on systems thinking, tacit and experiential knowledge to design bottom-up innovations. Capacity was triggered through micro-practices of sensemaking and sensegiving which included using sticks (positional authority, enforcement of policies, over-coding), intentionally providing justifications for change and setting the scene (a new agenda, distributed leadership). These micro-practices in themselves, and by managers engaging with them, triggered a generative process of buy-in and motivation which influenced managers and partners to participate in new practices within a routine meeting.

Conclusion

District managers are well placed to design local capacity development innovations and must draw on systems thinking, tacit and experiential knowledge to enable relevant ‘bottom-up’ capacity development in district health systems. By drawing on soft skills and the policy resources (hardware) of the system they can influence motivation and buy-in to improve management practices. From a systems perspective, we argue that capacity development can be conceived of as part of the daily activity of managing within routine spaces.
Time spent in prior hospital stay and outcomes for ventilator patients in long-term acute care hospitals
Authors: Demiralp Berna , Koenig Lane , Xu Jing , Soltoff Samuel , Votto John
Published: March 2021

Background

Long-term acute care hospitals (LTACHs) treat mechanical ventilator patients who are difficult to wean and expected to be on mechanical ventilator for a prolonged period. However, there are varying views on who should be transferred to LTACHs and when they should be transferred. The purpose of this study is to assess the relationship between length of stay in a short-term acute care hospital (STACH) after endotracheal intubation (time to LTACH) and weaning success and mortality for ventilated patients discharged to an LTACH.

Methods

Using 2014–2015 Medicare claims and assessment data, we identified patients who had an endotracheal intubation in STACH and transferred to an LTACH with prolonged mechanical ventilation (defined as 96 or more consecutive hours on a ventilator). We controlled for age, gender, STACH stay procedures and diagnoses, Elixhauser comorbid conditions, and LTACH quality characteristics. We used instrumental variable estimation to account for unobserved patient and provider characteristics.

Results

The study cohort included 13,622 LTACH cases with median time to LTACH of 18 days. The unadjusted ventilator weaning rate at LTACH was 51.7%, and unadjusted 90-day mortality rate was 43.7%. An additional day spent in STACH after intubation is associated with 11.6% reduction in the odds of weaning, representing a 2.5 percentage point reduction in weaning rate at 18 days post endotracheal intubation. We found no statistically significant relationship between time to LTACH and the odds of 90-day mortality.

Conclusions

Discharging ventilated patients earlier from STACH to LTACH is associated with higher weaning probability for LTACH patients on prolonged mechanical ventilation. Our findings suggest that delaying ventilated patients’ discharge to LTACH may negatively influence the patients’ chances of being weaned from the ventilator.
Synchronous or sequential cementless bilateral total hip arthroplasty for osseous ankylosed hips with ankylosing spondylitis
Authors: Mou Ping , Zeng Wei Nan , Chen Yu , Zhou Zongke
Published: March 2021

Background

Bilateral osseous ankylosed hips secondary to ankylosis spondylitis (AS) are relatively rare but impact the quality of life hugely. Cementless total hip arthroplasty (THA) for bilateral osseous ankylosed hips with AS is a challenging procedure. No previous literature compares the clinical outcomes of synchronous and sequential bilateral THA for these special patients.

Methods

23 patients (46 hips) were retrospectively analyzed and divided into bilateral THA synchronously (group A) and sequentially (group B). The clinical measurement, radiological assessments, and complications were compared. Independent sample T test was used for data analysis.

Results

Harris Hip Scores (HHS) improved greatly for both groups (P = 0.58) as well as the range of motion (P = 0.64). But group B can realize shorter time (3.6 ± 1.2 days) to walk for the first time postoperatively (P = 0.02). Group A needed more blood transfusions (P = 0.028). For group A, no statistical difference was found in the bilateral inclination of cup (IC) (P = 0.48) and femoral offset (FO) (P = 0.07). For group B, no statistical difference was observed in bilateral IC (P = 0.37) but in bilateral FO (P = 0.04). Group A showed the fewer difference of bilateral IC (P = 0.02), while comparative measurements were found for two groups in the difference of bilateral FO (P = 0.78) and leg length discrepancy (P = 0.83). For both groups, the total hospital expense for each patient was similar and almost all patients were very satisfied with the outcomes. For group A, one patient encountered femoral fracture intraoperatively and another patient encountered hip dislocation and delay union of wound. 3 hips from group A and 3 hips from group B encountered heterotopic ossification.

Conclusions

Our retrospective research demonstrated that cementless bilateral THA was a reliable treatment for osseous ankylosed hip due to AS. Synchronous and sequential bilateral THA can realize similarly satisfactory clinical outcomes and radiographic evaluation.
Correction to: Exploring the differences between men’s and women’s perceptions of gender-based violence in rural Tajikistan: a qualitative study
Authors: Wood Elizabeth A. , Wilson Karina E. , Jacobs K. D.
Published: March 2021

An amendment to this paper has been published and can be accessed via the original article 10.1186/s12905-021-01266-9.
Shifting the paradigm: physician-authorized, student-led efforts to provide harm reduction services amidst legislative opposition
Authors: McMullen Timothy P. , Naeim Mahan , Newark Carol , Oliphant Haden , Suchard Jeffrey , Banimahd Faried
Published: March 2021

Background

For over 30 years, syringe services programs (SSPs) have served as an efficacious intervention for the prevention of HIV and Hepatitis C transmission among persons who use drugs. Despite a strong body of evidence for the effectiveness of SSPs as a preventative public health measure, numerous local and state governments in the United States continue to resist the establishment of new SSPs and aggressively pursue the closure of those already in operation.

Commentary

In Orange County, California, local officials have repeatedly mobilized in opposition of the establishment of syringe access – thereby hindering access to healthcare for thousands of predominantly unhoused individuals. The county was previously served by the Orange County Needle Exchange Program from 2016 until 2018 when a civil suit brought by the Orange County Board of Supervisors resulted in the closure of the program. For more than 2 years, persons who inject drugs in Orange County lacked reliable access to clean syringes, placing them at increased risk for contracting HIV and Hepatitis C. Here, we comment on the ongoing effort to restore syringe access in Orange County. This collaborative physician-directed endeavor has brought together students and community volunteers to provide vital harm reduction services to a remarkably underserved population. Since the reestablishment of syringe access in Orange County by the Harm Reduction Institute, new legal barriers have arisen including the passage of new municipal legislation banning the operation of syringe exchanges. We are well-equipped to overcome these obstacles. This work serves as an affirmation of assertions made by previous authors regarding the unique qualifications of medical & graduate students as effective harm reductionists.

Conclusion

Harm reduction services are vital to the health and well-being of people who use drugs. The provision of these services should not be impeded by legislative interference by municipal, county, or state governments.
Short-term effect of electroacupuncture on rehabilitation after arthroscopic triangular fibrocartilage complex repair: a randomised study
Authors: Chang Chiu-Ming , Hsu Cheng-En , Lee Yu-Chen , Yeh Chen-Wei , Chiu Yung-Cheng
Published: March 2021

Background

Electroacupuncture (EA) alleviates chronic pain and acute postoperative pain after several surgical procedures. However, whether EA facilitates postoperative functional recovery after arthroscopic surgery has yet to be determined. This study investigated the short-term effect of EA on a rehabilitation course after arthroscopic triangular fibrocartilage complex (TFCC) repair.

Methods

Forty-two patients undergoing arthroscopic TFCC repair were randomised to an EA group (n= 19) or control group (n= 23). In the EA group, patients received EA treatment and standard active rehabilitation for 4 weeks. In the control group, patients received standard active rehabilitation for 4 weeks. At the end of the treatment and at the follow-up visit 4 weeks after the treatment, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, wrist range of motion (ROM), handgrip strength, and key pinch strength were collected and analysed.

Results

The EA group improved significantly than the control group in terms of DASH scores, all wrist motion arcs, and key pinch strength (P< 0.05) at the end of the 4-week treatment and the follow-up visit another 4 weeks later.

Conclusion

Patients treated with 4 weeks of EA after the arthroscopic TFCC repair had better wrist ROM and DASH scores than patients of control group
A preliminary study exploring the change in ankle joint laxity and general joint laxity during the menstrual cycle in cis women
Authors: Yamazaki Tomomi , Maruyama Sae , Sato Yuki , Suzuki Yukako , Shimizu Sohei , Kaneko Fumiya , Ikezu Masahiro , Matsuzawa Kanta , Edama Mutsuaki
Published: March 2021

Background

The purpose of the present study was to examine the relationship between ankle joint laxity and general joint laxity (GJL) in relation to the menstrual cycle, which was divided into four phases based on basal body temperature and ovulation, assessed using an ovulation kit.

Methods

Participants were 14 female college students (21–22 years) with normal menstrual cycles (cis gender). Anterior drawer stress to a magnitude of 120 N was applied for all participants. Anterior talofibular ligament (ATFL) length was measured as the linear distance (mm) between its points of attachment on the lateral malleolus and talus using ultrasonography. Data on ATFL length from each subject were used to calculate each subject's normalized length change with anterior drawer stress (AD%). The University of Tokyo method was used for evaluation of GJL. AD% and GJL were measured once in each menstrual phase.

Results

There was no statistically significant difference between AD% in each phase. GJL score was significantly higher in the ovulation and luteal phases compared with the early follicular phase. AD% and GJL showed a positive correlation with each other in the ovulation phase.

Conclusions

Although it is unclear whether estrogen receptors are present in the ATFL, the present study suggests that women with high GJL scores might be more sensitive to the effects of estrogen, resulting in ATFL length change in the ovulation phase.