bluuebunny/crossref_metadata_2025 huggingface dataset:
Compression treatment in acute symptomatic proximal deep venous thrombosis – Results of a worldwide survey
Authors: Rabe Daniel , Partsch Hugo , Heidl Gerhard , Hirschl Mirko , Kundi Michael , Rabe Eberhard , Pannier Felizitas
Published: March 2021

Objectives

The aim of this study was to illustrate how compression is performed worldwide in proximal DVT and if compression management has changed recently.

Methods

A global online survey, consisting of 36 questions, was used. The survey was solicited from membership lists of Union Internationale de Phlébologie (UIP) membership societies. For differences between the continents in comparison to Western Europe odds ratios and 95% Confidence Intervals (95%CI) where calculated.

Results

We received 626 answers from 41 countries. Compression is routinely used in proximal DVT in all regions (82.8%). 81.4% start compression immediately after diagnosis. In the acute phase of DVT reduction of pain and swelling (91.7%) and PTS prevention (66.2%) are the main reasons for compression. 33.2% recently changed their compression management with 43.5% starting compression earlier and 7.0% later.

Conclusions

Compression is still used routinely in proximal DVT in addition to anticoagulation. The changes in international guidelines towards the non-routine use of compression in proximal DVT have not caused significant changes in DVT management.
Effects of a home-based rehabilitation program in community-dwelling older people after discharge from hospital: A subgroup analysis of a randomized controlled trial
Authors: Katri Maria Turunen , Laura Aaltonen-Määttä , Erja Portegijs , Timo Rantalainen , Sirkka Keikkala , Marja-Liisa Kinnunen , Sarianna Sipilä , Riku Nikander
Published: March 2021

Objective:

To examine whether pre-admission community mobility explains the effects of a rehabilitation program on physical performance and activity in older adults recently discharged from hospital.

Design:

A secondary analysis of a randomized controlled trial.

Setting:

Home and community.

Participants:

Community-dwelling adults aged ⩾60 years recovering from a lower limb or back injury, surgery or other disorder who were randomized to a rehabilitation ( n = 59) or standard care control ( n = 58) group. They were further classified into subgroups that were not planned a priori: (1) mild, (2) moderate, or (3) severe pre-admission restrictions in community mobility.

Interventions:

The 6-month intervention consisted of a motivational interview, goal attainment process, guidance for safe walking, a progressive home exercise program, physical activity counselling, and standard care.

Measurements:

Physical performance was measured with the Short Physical Performance Battery and physical activity with accelerometers and self-reports. Data were analysed by generalized estimating equation models with the interactions of intervention, time, and subgroup.

Results:

Rehabilitation improved physical performance more in the intervention ( n = 30) than in the control group ( n = 28) among participants with moderate mobility restriction: score of the Short Physical Performance Battery was 4.4 ± 2.3 and 4.2 ± 2.2 at baseline, and 7.3 ± 2.6 and 5.8 ± 2.9 at 6 months in the intervention and control group, respectively (mean difference 1.6 points, 95% Confidence Interval 0.2 to 3.1). Rehabilitation did not increase accelerometer-based physical activity in the aforementioned subgroup and did not benefit those with either mild or severe mobility restrictions.

Conclusions:

Pre-admission mobility may determine the response to the largely counselling-based rehabilitation program.
Household plastic waste habits and attitudes: A pilot study in the city of Valencia
Authors: Roche Cerasi Isabelle , Sánchez Francisco V , Gallardo Iris , Górriz Miguel Á , Torrijos Paula , Aliaga César , Franco Jerónimo
Published: March 2021

Bearing in mind that only 42% of plastic packaging post-consumer waste is recycled in Europe, the European Directive 2018/852 established the key target of a 55% plastic packaging waste recycling rate by 2030. For this reason, PlastiCircle, funded by the European Union’s Horizon 2020 research and innovation program project, aims to foster the recycling of packaging, improve all stages of the waste collection, and promote responsible consumption. Three European cities have been selected as locations for pilot implementation: Valencia (Spain), Utrecht (The Netherlands) and Alba Iulia (Romania). The main objective of the present study has been to evaluate the participants’ opinion and attitudes on plastic recycling. This paper presents the results from the district of San Marcelino in the city of Valencia, the first PlastiCircle pilot to face the challenges of encouraging households to participate more in plastic waste sorting and recycling.
Shaming or Courage? A Scholarly Examination of a Press Release
Authors: Morrow Mary R.
Published: March 2021

Shame is an ethical tenet of the humanbecoming ethos, dignity. While shame is a difficult concept to discuss, it is used by some disciplines to transform society. Shaming has become the norm in 2020 society with the advent of social media. A recent press release noted that nursing is complicit with racism if they do not speak up against it. The press release is examined using Milton’s straight talk of nursing ethics and Parse’s leading-following model to determine if shaming was used to transform nursing related to racism or if it was a nurse leader’s act of courage.
The Reflection, Feedback, and Restructuring Model for Role Development in Nursing Education
Authors: Schuler Monika S.
Published: March 2021

An integral component of transitioning to the nursing practice setting is in assimilating and sometimes reformulating and reconceptualizing the knowledge gained in the classroom with what is seen and experienced in practice. An inability to do so may inhibit role development and result in difficult transitions to practice. A constructivist approach was utilized in the development of a new model that describes the process of learning and role development in the clinical and simulation setting. This approach involved reviewing the literature, reanalyzing themes, development of multiple schematics, continual review, personal observations of students in the clinical and simulation settings, and feedback from peer educators. The resulting reflection, feedback, and restructuring model describes an inductive, iterative process strongly influenced by feedback. This conceptual model may be a useful tool to guide nurse educators in facilitating role development and the transition from the classroom to the clinical setting for the nursing student.
More Than Words? Embracing a Practice–Care Distinction for Nursing Practice Education
Authors: Thoun Deborah S. , Tschanz Coby L.
Published: March 2021

In this paper, authors draw on distinctions between nursing practice and nursing care to inform abstraction and assignment of pre-licensure practice experience hours. Authors discuss an imperative to develop understandings of practice education and practice experience hours that reflect nursing as a basic human science, with implications for the enrichment of student scholarship and flourishing.
Shame in Teaching-Learning: A Humanbecoming Perspective
Authors: Yancey Nan Russell
Published: March 2021

In a discussion on the phenomenon of shame, intriguing questions are raised for consideration by teachers of nursing. Raising concerns about the perceived emergence of societal norms that seem to encourage the shaming of others along with technology and social media platforms that enable public shaming brings one to ponder the meaning of shame in the sciencing and art of teaching-learning in nursing, especially in an era of virtual learning. From the unique perspective of humanbecoming, reflections on selected stories of the student experience of shame give rise to several suggestions for faculty to be with students in moving beyond moments of potential shame in the unfolding of new possibilities. These stories and suggestions are offered to nurse faculty and academic administrators for continuing discussion and as an opportunity for shared learning.
Dysfunctional Career Thoughts and the Sophomore Slump Among Students With Learning Disabilities
Authors: Dipeolu Abiola , Hargrave Stephanie , Leierer Stephen J. , Tineo Yajaira A. Cabrera , Longoria Ashley , Escalante Madelyn
Published: March 2021

The present study sought to underline the need for expanded transitioning college programming to the 2nd year by examining dysfunctional career thoughts among college students with learning disabilities (LDs). Multivariate analysis of variance (MANOVA) was used to examine the mean differences between 93 college sophomores and seniors with LD on the three subscales of the Career Thoughts Inventory (CTI). Findings from the MANOVA showed significant mean differences among groups. Follow-up analysis found that sophomores showed significantly higher dysfunctional career thoughts than seniors. Seniors displayed substantially lower mean scores on the CTI subscales than sophomores. Findings support the need to extend transition programming that includes addressing students’ dysfunctional career thoughts beyond the 1st year to help ease college transition difficulties and thus promote persistence and retention of students with LD. Research and practice implications are presented for career scholars and practitioners working with college students with LD.
Afro-descendant women Bolsa Familia and Supplemental Nutrition Assistance Program in Brazil and the United States
Authors: Mitchell-Walthour Gladys , Santos Fernanda Barros dos
Published: March 2021

We examine the impact of class and racial discrimination on Afro-descendant women social welfare beneficiaries in Brazil and the USA. We focus on the cities Salvador, São Paulo, Charlotte, and Milwaukee. We find that in all these cities, more than a majority of social welfare beneficiaries ate dark skinned thus showing that both countries are pigmentocracies where disadvantage is based on skin color, class, and gender. We find that of those admitting they experienced skin color discrimination more than a majority ate dark skinned. Women in the USA are generally more likely to acknowledge skin color discrimination while women in Brazil are more likely to acknowledge class based discrimination.
Vibration suppression of hub motor electric vehicle considering unbalanced magnetic pull
Authors: Li Zhongxing , Liu Chenlai , Song Xinyan , Wang Chengchong
Published: March 2021

For the hub motor electric vehicle (HM-EV), the drive motor is directly integrated with the wheel. The unbalanced magnetic pull (UMP) of hub motor would be generated by magnet gap deformation under road surface roughness excitation. The longitudinal and vertical dynamic performances of the HM-EV system are therefore deteriorated. Firstly, to analyze and optimize the longitudinal and vertical dynamic performance of the HM-EV system, a new ten-degree-of-freedom mathematical quarter HM-EV system model equipped with air suspension model, permanent magnet brushless direct current (PM BLDC) hub motor model and rigid ring tire model is proposed. The UMP of PM BLDC hub motor is taken into consideration in this model. A HM-EV system model validation test bench is constructed. The accuracy of the model is verified by experiment. Secondly, based on quarter HM-EV system model, the BP neural network is adopted to calculate the longitudinal and vertical UMP. The relative error between results calculated by BP neural networks and electromagnetic formula is less than 5% and root-mean-square error (RMSE) is less than 2. With proposed BP neural networks calculation method, UMP calculation time is shortened by 70.3%. Finally, the adjustable force is introduced and model predictive control (MPC) method is used to suppress the longitudinal and vertical vibration of HMEV system. Two control methods, namely model predictive control (MPC) and constrained optimal control (COC) are proposed. The simulation results show that by applying MPC, the RMS value of evaluation indexes are decreased by 17.21%–44.10% respectively, which is better than COC (−14.42%–17.21%). With MPC, longitudinal and vertical vibration are suppressed. Comparison of two UMP calculation methods with MPC controller is conducted. The relative errors of evaluation indexes are within 3.85%. Therefore, the driving safety and riding comfort of the HM-EV are improved compared to the passive suspension and COC active suspension.
Analysis of a self-supporting bamboo structure with flexible joints
Authors: Seixas Mario , Moreira Luís Eustáquio , Stoffel Patrick , Bina João , Ripper José Luiz Mendes , Ferreira Jorge Lucas , Ghavami Khosrow
Published: March 2021

Self-supporting bamboo structures are ultralight architectural modules applying bamboo round poles, tensile pantographic grids and textile membranes. The structural system applies articulated flexible joints in polyester ropes and locking bio-composite bandage rings, keeping bamboo bars free of torsion stresses. An experimental 1:3 scale prototype and a full-scale structure were fabricated to make previsions about the physical and mechanical behavior of the structure. The experimental results were verified applying a numerical model for the structure. In turn, the flexible joints were analyzed theoretically. The computer model was analyzed using the finite element SAP2000 program. The numerical results were in close agreement with the experimental results specifically for the structural behavior of the flexible joints.
Analysis of vehicle ride comfort applying a 2SPS+SR parallel seat mechanism
Authors: Yan Bijuan , Zhang Jie
Published: March 2021

The violent vibration may cause discomfort to the driver and operation instability in different directions including fore-aft, lateral, and vertical when construction vehicles are driven or operated on off-roads. To improve ride comfort, a novel kind of 2SPS+SR parallel seat mechanism is proposed in this article. First, to verify the motion state of one translation and two rotations, the model of this new seat mechanism was built and analyzed using UG software. Furthermore, the acceleration and power spectrum density between the conventional seat and the 2SPS+SR parallel seat were compared in three directions of vertical, pitching, and rolling when the vehicle was driven on different three-dimensional roads. Then, the comparisons of the weighted vibration level and the root mean square of the total weighted acceleration on different roads were illustrated to denote the ride comfort of the construction vehicle. The results show that this 2SPS+SR parallel seat mechanism could improve the ride comfort of construction vehicles. The results will provide theoretical support for further research on the control of vehicle vibration.
Protective effect of Coenzyme Q10 on oxidative ovarian and uterine damage induced by methotrexate in rats
Authors: Kiremitli T , Kiremitli S , Akselim B , Yilmaz B , Mammadov R , Tor IH , Yazici GN , Gulaboglu M
Published: March 2021

Methotrexate (MTX) has toxic effects on the uterus and ovaries via oxidative stress. Coenzyme Q10 (CoQ10) is an important component in electron transport in the mitochondria and an antioxidant in cellular metabolism through the inhibition of lipid peroxidation. The aim of this study was to investigate the preventive effects of CoQ10 on MTX-induced utero-ovarian damage and oxidative stress in rats.

In this experimental study, 30 albino Wistar female rats were divided randomly into three groups. Once a day for a month, 10 mg/kg of CoQ10 was orally administered to the rats in the MTX+CoQ10 group, while the same volume of olive oil was administered orally to the other two groups. One hour thereafter, 20 mg/kg of MTX was injected intraperitoneally into the rats in the MTX and MTX+CoQ10 groups; the remaining group was the control. At the end of the month, biochemical and histopathologic examinations were performed on the extracted uteri and ovaries. In the uterine ovarian tissues of the animals in the MTX group, there was an increase in oxidative stress mediators and a decrease in antioxidant and anti-inflammatory mediators, but these trends were reversed in the MTX+CoQ10 group, demonstrating the antioxidant effects of CoQ10. MTX leads to oxidative stress-related ovarian and uterine injury, and CoQ10 may be useful for protecting ovarian and uterine tissue from such injury.
Psychometric Properties of the Korean Version of the Patient Knowledge Questionnaire-Osteoarthritis
Authors: Kim Jung-Suk , Kim Chun-Ja , Schlenk Elizabeth A.
Published: March 2021

This study examined the psychometric properties of the Korean version of the Patient Knowledge Questionnaire-Osteoarthritis (PKQ-OA-K). A cross-sectional survey was conducted with 157 adults with osteoarthritis from the outpatient clinic at a university hospital in Korea. The overall correct answer rate for the PKQ-OA-K was 60.4%; notably, the drug therapy subscale had the lowest median score percentage (42.9%). For structural validity, exploratory factor analysis identified the PKQ-OA-K as two-dimensional, explaining 52.4% of the total variance. Confirmatory factor analysis showed that the two-factor model adequately fit the data. The PKQ-OA-K was positively correlated with education level ( r = 0.24) and osteoarthritis outcomes ( r = 0.17), thus verifying the hypotheses of construct validity. The intraclass correlation coefficient for test-retest reliability was 0.52; alpha was 0.44. The PKQ-OA-K has excellent validity but imperfect reliability for adults with osteoarthritis. This study recommends cautious use of the PKQ-OA-K to assess Korean patients’ knowledge of osteoarthritis.
Influence of RFC1 c.80A>G Polymorphism on Methotrexate-Mediated Toxicity and Therapeutic Efficacy in Rheumatoid Arthritis: A Meta-analysis
Authors: Naushad Shaik Mohammad , Alrokayan Salman A. , Almajhdi Fahad N. , Hussain Tajamul
Published: March 2021

Background:

Methotrexate (MTX) is an antirheumatic drug, transported by reduced folate carrier-1 (RFC1). The most common RFC1 gene variant, c.80 A>G (rs1051266) is ambiguously linked to adverse effects of MTX therapy in some rheumatoid arthritis (RA) patients.

Objective:

The purpose of meta-analysis was to summarize all major published studies on c.80 A>G SNP to clarify this ambiguity in MTX therapy.

Methods:

A total of 18 studies representing 3592 RA patients comprising 699 men and 2893 women were included. Both fixed and random effect models were applied to study the data.

Results:

The RFC1 80A-allele showed null association with MTX-mediated toxicity in both fixed (odds ratio [OR] = 0.91; 95% CI = 0.80-1.03) and random effects (OR = 0.89; 95% CI: 0.71-1.11) models. Because heterogeneity was observed in this association ( P = 0.0006), data were segregated based on use of folate therapy. In 7 studies (n = 1191) where folate was used along with MTX, RFC1 AA patients showed reduced risk for MTX-mediated toxicity (OR = 0.67; 95% CI: 0.50-0.89; P = 0.0006). The RFC1 80A-allele was found to increase the efficacy of MTX therapy by 1.53-fold (95% CI: 1.24-1.88), whereas the 80AA-genotype increased the efficacy by 1.85-fold (95% CI: 1.41-2.42). No publication bias was observed in these associations.

Conclusion and Relevance:

RFC1 c.80 A>G is an important pharmacogenetic determinant of MTX therapy in RA. The RFC1 80A-allele robustly increased therapeutic efficacy and safety when folate was used along with MTX. Findings are relevant to decision-making in the clinical use of MTX as a treatment for RA patients harboring the RFC1 gene variant.
“If You Are Born a Girl in This Crisis, You Are Born a Problem”: Patterns and Drivers of Violence Against Women and Girls in Conflict-Affected South Sudan
Authors: Ellsberg Mary , Murphy Maureen , Blackwell Alexandra , Macrae Mairi , Reddy Dashakti , Hollowell Clare , Hess Tim , Contreras-Urbina Manuel
Published: March 2021

This article presents the results of a qualitative study on the context and different forms of violence committed against women and girls in South Sudan. The study documents many forms of sexual and physical violence against women and girls in South Sudan, including conflict-related sexual violence, intimate partner violence, nonpartner sexual violence, child and forced marriage, and abduction. Violence occurred during three overarching contexts: armed conflict, gender inequality, and the economic crisis. The custom of bride price, combined with the economic crisis, is a key driver of many other forms of violence.
Performance of the Wells score in predicting deep vein thrombosis in medical and surgical hospitalized patients with or without thromboprophylaxis: The R-WITT study
Authors: Trihan Jean-Eudes , Adam Michael , Jidal Sara , Aichoun Isabelle , Coudray Sarah , Laurent Jeremy , Chaussavoine Laurent , Chausserie Sebastien , Guillaumat Jerome , Lanéelle Damien , Perez-Martin Antonia
Published: March 2021

The Wells score had shown weak performance to determine pre-test probability of deep vein thrombosis (DVT) for inpatients. So, we evaluated the impact of thromboprophylaxis on the utility of the Wells score for risk stratification of inpatients with suspected DVT. This bicentric cross-sectional study from February 1, 2018 to January 31, 2019 included consecutive medical and surgical inpatients who underwent lower limb ultrasound study for suspected DVT. Wells score clinical predictors were assessed by both ordering and vascular physicians within 24 h after clinical suspicion of DVT. Primary outcome was the Wells score’s accuracy for pre-test risk stratification of suspected DVT, accounting for anticoagulation (AC) treatment (thromboprophylaxis for ⩾ 72 hours or long-term anticoagulation). We compared prevalence of proximal DVT among the low, moderate and high pre-test probability groups. The discrimination accuracy was defined as area under the receiver operating characteristics (ROC) curve. Of the 415 included patients, 30 (7.2%) had proximal DVT. Prevalence of proximal DVT was lower than expected in all pre-test probability groups. The prevalence in low, moderate and high pre-test probability groups was 0.0%, 3.1% and 8.2% ( p = 0.22) and 1.7%, 4.2% and 25.8% ( p < 0.001) for inpatients with or without AC, respectively. Area under ROC curves for discriminatory accuracy of the Wells score, for risk of proximal DVT with or without AC, was 0.72 and 0.88, respectively. The Wells score performed poorly for discrimination of risk for proximal DVT in hospitalized patients with AC but performed reasonably well among patients without AC; and showed low inter-rater reliability between physicians. ClinicalTrials.gov Identifier: NCT03784937.
Pilot study of contrast-free MRI reveals significantly impaired calf skeletal muscle perfusion in diabetes with incompressible peripheral arteries
Authors: Zheng Jie , Li Ran , Zayed Mohamed A , Yan Yan , An Hongyu , Hastings Mary K
Published: March 2021

Patients with diabetes mellitus (DM) are more likely to have densely calcified lesions in the below-the-knee tibial arteries. However, the relationship between peripheral arterial calcification and local skeletal muscle perfusion has not been explored. Thirty subjects were prospectively recruited into three groups in this pilot study: (1) Non-DM: 10 people without DM; (2) DM, ABI < 1.3: 10 people with DM and normal ankle–brachial index (ABI) (0.9–1.3); and (3) DM, ABI ⩾ 1.3: 10 people with DM and ABI ⩾ 1.3. All subjects underwent calf perfusion measurements at rest and during an isometric plantarflexion contraction exercise within the magnetic resonance imaging (MRI) system. The noncontrast MRI techniques were applied to quantitatively assess skeletal muscle blood flow (SMBF) and oxygen extraction fraction (SMOEF) in medial gastrocnemius and soleus muscles. Both SMBF and SMOEF reserves were calculated as the ratio of the exercise value to the resting value. Exercise SMBF and SMOEF values in the medial gastrocnemius muscle were lower in the two DM groups than in the non-DM group ( p < 0.05). The SMBF reserve in medial gastrocnemius was significantly lower in the DM, ABI ⩾ 1.3 group compared to the DM, ABI < 1.3 group ( p < 0.05). This study demonstrates that people with DM and calcified arteries had lower perfusion in gastrocnemius muscle compared to those without DM and those with DM and a normal ABI.
Gaming the gift: The affective economy of League of Legends ‘fair’ free-to-play model
Authors: Jarrett Josh
Published: March 2021

With its release in late 2009, League of Legends (Riot Games) has influenced the game industry in several profound ways. Known for its vast popularity and its pivotal role in pioneering live streaming and electronic sports, League of Legends is also noteworthy for its model of ‘fair’ free-to-play. Described by Riot Games and many industry professionals as ‘fair’ due to its lack of any ‘pay-to-win’ content ( Graft, 2013 ; Nutt, 2014 ), this model of free-to-play has gone on to influence a paradigmatic shift towards ‘games as a service’. In this study, the model of ‘fair’ free-to-play is critically framed as a lucrative affective economy involving reciprocal gift exchanges between players and commercial games developers. Drawing on 49 qualitative Reddit responses from players who buy in-game skins, this study positions the microtransactions of League of Legends as a notable example of affective economics that is bound up in reciprocal forms of commercial exchange. Framing this hybrid model of co-creative relations alongside examples from game, fan and Internet studies, it is the critical aim of this study to frame the microtransactions of League of Legends as an instance of affective valorisation. Paralleling the affective economics of various digital platforms, it is the view of this study that microtransactions in games should be considered as part of the same political economy of the Internet.
Normotensive presentation in primary aldosteronism: A report of two cases
Authors: Jia Minyue , Yu Hanxiao , Liu Zhenjie , He Minzhi , Zhong Shan , Xu Xiaohong , Song Xiaoxiao
Published: March 2021

Normotensive patients with primary aldosteronism (PA) are relatively rare. Herein, we report two patients with normotensive PA and present a literature review to improve an understanding of the disease. Patient 1, a 56-year-old man, presented with recurrent hypokalemia that lasted for more than 2 years. Patient 2 was a 33-year-old man who presented with sexual dysfunction and was diagnosed with a prolactinoma combined with adrenal insufficiency and hypogonadism. Neither of these patients had hypertension that was detectable on repeated manual measurements. In both patients, a typical biological profile of PA was demonstrated that included hypokalemia with kaliuresis, elevated plasma aldosterone concentration (PAC), suppressed plasma renin concentration, and a high aldosterone-to-renin ratio. Both patients did not have sufficiently suppressed PAC on the saline infusion test, confirming the diagnosis of PA. Computed tomography of the adrenal gland and adrenal venous sampling suggested an aldosteronoma, which was confirmed by lateralized hypersecretion of aldosterone. After removal of the benign adenoma, the biochemical abnormalities were corrected. As hypertension is not necessarily a sign of PA, we propose that all patients with hypokalemia should be screened for PA in order to prevent cardiovascular complications while balancing economics and effectiveness.
Phase difference and stability of a shaft mounted a dry friction damper: Effects of viscous internal damping and gyroscopic moment
Authors: Huang Zhonghe , Tan Jianping , Lu Xiong
Published: March 2021

This study investigates the stability and phase difference of a shaft mounted a dry friction damper with effects of viscous internal damping and gyroscopic moment. The equations of the system with the vibration reduction effect of the dry friction damper on the shaft are derived in the form of the rectangular coordinate and polar coordinate in the vicinity of critical speed. The phase difference characteristics in the rub-impact process and its physical mechanism are analyzed by mathematical derivation. The characteristic equation is studied to investigate the stability of the periodic solution. Effects of different parameters of the system, especially viscous internal damping of the composite shaft and gyroscopic moment on the phase difference and stability regions are presented in detail by analytical and numerical simulation based on a helicopter tailrotor driveline. The experimental investigation is conducted in a test rig to validate theoretical formulas and simulation analysis. The analysis results show that rub impact delays the change of phase difference, viscous internal damping improves the stability of synchronous full annual rub solution, and gyroscopic moment affects the increase of the phase difference.
Evaluation of an evidence-based practice mentorship programme in a paediatric quaternary care setting
Authors: Schuler Ethan , Mott Sandra , Forbes Peter W , Schmid Alexis , Atkinson Carole , DeGrazia Michele
Published: March 2021

Background

Evidence-based practice (EBP) is essential for clinical decision-making, improving care, reducing costs and achieving optimal patient outcomes. The Evidence-based Practice Mentorship Program (EBPMP) is a flexible, self-directed programme whereby participants carry out EBP projects guided by expert mentors.

Aims

To evaluate EBPMP effectiveness and participant experience.

Methods

To evaluate effectiveness, as measured by changes in EBP value, knowledge and implementation, participants completed pre- and post-EBPMP Quick-EBP-Value, Implementation and Knowledge (VIK) surveys. To understand participants’ experiences individual and group interviews were conducted at the end of the programme and analysed using qualitative content analysis.

Results

Most participants were over 50 years old, Caucasian, inpatient staff nurses, baccalaureate prepared, with over 11 years’ experience. Statistically significant improvements were observed in the post Quick-EBP-VIK knowledge and implementation domains. Individual and group participant interviews revealed four categories of importance to the experience: 1. perceived benefits of EBP, 2. time as a barrier to EBP, 3. desire for more cohort interaction and 4. positive mentee–mentor experience.

Conclusions

EBPMP can improve participants’ knowledge and implementation of EBP in an environment that values EBP; however, opportunities exist to implement programme modifications that address barriers identified by participants including project time and increased participant interactions.
Comparative efficacy and safety of Janus kinase inhibitors and biological disease-modifying antirheumatic drugs in rheumatoid arthritis: a systematic review and network meta-analysis
Authors: Weng Chenghua , Xue Leixi , Wang Qing , Lu Wentian , Xu Jiajun , Liu Zhichun
Published: March 2021

Objective:

To evaluate the comparative efficacy and safety of Janus kinase (JAK) inhibitors and biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) and an inadequate response to at least one disease-modifying antirheumatic drug (DMARD).

Methods:

PubMed, Embase, Cochrane library and ClinicalTrials.gov were searched for relevant randomized controlled trials (RCTs) from inception to April 2020. The active drugs included three JAK inhibitors and eight bDMARDs while the control drugs included placebo or conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Outcomes include American College of Rheumatology 20% response (ACR20), Disease Activity Score in 28 joints (DAS28), Health Assessment Questionnaire–Disability Index (HAQ-DI) and discontinuations for adverse events (AEs). We estimated summary odds ratios (ORs) and weighted mean differences (WMDs) using network meta-analysis with random effects.

Results:

Eighty-eight RCTs with 31,566 patients were included. All JAK inhibitors and bDMARDs were more effective than placebo in ACR20 (ORs ranging between 3.05 and 5.61), DAS28 (WMDs ranging between −1.91 and −0.80) and HAQ-DI (WMDs ranging between −0.34 and −0.21). Tocilizumab, certolizumab pegol and upadacitinib showed relatively good efficacy in these three outcomes according to their relative ranking. Notably, tocilizumab was more effective than other active drugs in DAS28 (WMDs ranging between −1.11 and −0.49). Compared with the lower recommended doses, increasing the doses of JAK inhibitors (baricitinib 4 mg versus 2 mg, tofacitinib 10 mg versus 5 mg and upadacitinib 30 mg versus 15 mg) cannot provide significant additional benefits. In terms of discontinuations for AEs, all active drugs showed no significant difference compared with placebo except certolizumab pegol [OR 1.65, 95% credible interval (CrI) 1.06–2.61] and rituximab (3.17, 1.11–10.80).

Conclusions:

Tocilizumab, certolizumab pegol and upadacitinib may have relatively good efficacy in patients with RA after treatment failure with csDMARDs. RA patients taking a JAK inhibitor may have a preference for a lower recommended dose.
As in Belarus: The beginning of the end of a reign in Russia
Authors: Guetta Bernard
Published: March 2021

It is now impossible to examine the world’s largest country without acknowledging the new realities which have changed the situation there. The first is that the idea that Russia irresistible is no longer as compelling as it was even two or three years ago and that this has called into question, and even weakened, the Russian president’s authority. The second reality is that it would certainly not be in the interests of the world’s major democracies to allow Russia and China to combine forces against them. The third is that the botched attempt to poison Russian opposition leader Alexei Navalny in 2020 has raised his status to that of an alternative to the incumbent president. However, the most striking of these new developments is that Russia is at a loss as to how to respond to the democratic protests in Belarus because the options available would have major implications for both Putin and Russia itself.
δ-Tocopherol Enhances Docetaxel-Induced Growth Inhibition and Apoptosis in Ovarian Cancer SKOV3 Cells
Authors: Chai Hongjuan , Wu Jugang , Liu Junlei , Liu Ting , Ren Qing , Zheng Xi
Published: March 2021

Docetaxel is the first-line chemotherapeutic drug for ovarian cancer. However, its clinical use is limited owing to its serious side effects. Therefore, it is of great clinical significance to enhance the efficacy of docetaxel at lower doses in a less-toxic manner. In this study, we investigated whether δ-tocopherol could enhance the anti-tumor effects of docetaxel on ovarian cancer SKOV3 cells in vitro. For docetaxel and δ-tocopherol, IC50 values of 1.89 nM and 11.41 µM, respectively, were obtained, in SKOV3 cells. The combination of δ-tocopherol and docetaxel had a synergistic cell growth inhibition effect, with lower cell viability and more cell arrest at the S phase compared to either δ-tocopherol or docetaxel alone. In addition, the combination of δ-tocopherol and docetaxel had a synergistic cell apoptosis induction effect, with more apoptotic cells and reduced anti-apoptotic protein expression compared to either δ-tocopherol or docetaxel alone. Furthermore, we identified 3 hoursub genes (CAT, EP300, CREBBP), which predicted the prognosis of ovarian cancer, which correlated with δ-tocopherol and docetaxel. In conclusion, the combination of δ-tocopherol and docetaxel presented synergistic cell growth inhibition and cell apoptosis induction effects in SKOV3 cells at a low dose, which suggesting that δ-tocopherol could improve the serious side effects of docetaxel.
Decentralization and the Limits to Service Delivery: Evidence From Northern Pakistan
Authors: Khan Sajjad Ali
Published: March 2021

While the relationship between decentralization and service delivery is underpinned by a set of normative theoretical assumptions, yet not only does the empirical evidence concerning this so-called relationship to date remains inconclusive at best but our understanding of the causes of ineffectiveness of decentralization initiatives with respect to service delivery is also striking. This article attempts to contribute to the debates concerning the relationship between decentralization and service delivery through an analysis of decentralization measures undertaken by the Government of Pakistan during the early 21st Century with the announced aims of improving the efficiency and responsiveness of government as well as the delivery of public services. Notwithstanding a decade of decentralized service delivery, wellbeing outcomes across districts in Khyber Pakhtunkhwa province demonstrated remarkable discrepancy such that while some districts witnessed considerable amelioration in their respective composite indices, others experienced a marked deterioration, thus calling into question the normative assumptions that undergird the relationship between decentralization and service delivery. This article seeks to explain this outcome through a comparative case study of two localities in Khyber Pakhtunkhwa province viz districts “Swabi” and “Lower Dir,” both of which had witnessed marked deterioration and amelioration in wellbeing outcomes, respectively, in the ex-post of implementation of the Devolution Plan. Data for the study were collected through in-depth interviews and focus group discussions. The results demonstrate that political dynamics such as the nature of relationship between district governments and the provincial government, extent of political polarization prevalent within or among different levels of the local government system, and the role of bureaucracy turn out to be important factors that ostensibly account for the deterioration of wellbeing outcomes in Swabi district over the course of a decade of implementation of the local government system. The findings suggest that political factors have overshadowed technical considerations in terms of explaining the discrepant outcomes of decentralized service delivery across the two localities.
Early clinical outcomes of one-stage total hip arthroplasty for the treatment of advanced hip tuberculosis
Authors: Chen Chang , Yin Yiran , Xu Huan , Chen Ge
Published: March 2021

Objective:

To investigate the clinical efficacy of one-stage total hip arthroplasty (THA) for treating the advanced hip tuberculosis.

Methods:

A retrospective study was conducted from July 2013 to June 2018, including 19 patients with advanced hip tuberculosis. All patients underwent total hip arthroplasty through posterior approach, and the surgical efficacy was evaluated.

Results:

Nineteen patients were followed up from 24 months to 48 months, the mean follow-up were 32.1 months. All the incisions healed in grade A. There were no aseptic loosening, dislocation or recurrence of hip tuberculosis after operation. At the last follow-up, the Harris score of the patients was (89.3 ± 6.7), which was significantly higher than (38.2 ± 10.5) of the patients before operation (P < 0.05); the flexion-extension range of motion was (93.6° ± 12.1°), which was significantly larger than (38.2° ± 10.5°) of the patients before operation (P < 0.05).

Conclusion:

The one-stage total hip arthroplasty with regular antituberculosis treatment can attain satisfactory clinical efficacy in the treatment of advanced hip tuberculosis, which can relieve the joint pain and improve the joint function, without recurrence of hip tuberculosis.
Clinically Reliable Knee Flexion Angle Measured on Stress Radiography for Quantifying Posterior Instability in Posterior Cruciate Ligament Injury
Authors: Ryu Dong Jin , Kwon Kyeu Baek , Jung Eui Yub , Lee Sung-Sahn , Kim Joo Hwan , Jang Min Chang , Wang Joon Ho
Published: March 2021

Background:

After posterior cruciate ligament injury, stress radiography is a common method of quantifying posterior instability, defined as the side-to-side difference in posterior tibial displacement (PTD) between the injured knee and contralateral noninjured knee. However, no study has evaluated the reliability of PTD according to knee flexion angle (KFA) measurements on stress radiographs.

Purpose:

To evaluate the test-retest reliability of stress radiographic measurements of the KFA in the noninjured knee. In addition, we established a reliable range of KFAs to indicate posterior instability by comparing results with the instability measured at 90° KFA, which is considered the gold standard.

Study Design:

Cohort study (diagnosis); Level of evidence, 3.

Methods:

We evaluated patients who had undergone bilateral stress radiographic examinations at least 5 times for ligament injuries between January 2013 and November 2019. All examinations were performed on a Telos device with a 150-N posterior load. A total of 120 knees and 644 stress radiographs were enrolled. We measured the KFA and PTD on stress radiographs and evaluated the reliability of repeated PTD measurement and the correlation between KFA and PTD.

Results:

The distribution of the actual noninjured knee KFA ranged from 56.9° to 106.7°. Among the 644 radiographs, 155 (24.1%) showed KFAs between 85° and 95°, and 287 (44.6%) showed KFAs between 80° and 85°. A significant correlation was found between KFA and PTD ( P < .001), and the intrapatient intraclass correlation coefficient (ICC) was 0.788. A KFA range of 85° to 92° satisfied the criteria of high ICC (0.885) and nonsignificant correlation between KFA and PTD ( P = .055) and thus was considered a reliable range of KFAs for quantifying posterior instability. We found no significant risk factors for measurement error, including age ( P = .674), sex ( P = .328), height ( P = .957), weight ( P = .248), or body mass index ( P = .257).

Conclusion:

We found high reproducibility of posterior displacement measurements on Telos stress radiography at a KFA of 85° to 92° in noninjured knees.
Outcomes of older patients with follicular lymphoma using individual data from 5922 patients in 18 randomized controlled trials
Authors: Casulo Carla , Dixon Jesse G. , Ou Fang-Shu , Hoster Eva , Peterson Bruce A. , Hochster Howard S. , Brice Pauline , Ladetto Marco , Hiddemann Wolfgang , Marcus Robert , Kimby Eva , Herold Michael , Nielsen Tina , Morschhauser Franck , Rummel Mathias , Hagenbeek Anton , Vitolo Umberto , Salles Gilles A. , Shi Qian , Flowers Christopher R.
Published: March 2021

Limited data exist to describe the clinical features and outcomes for elderly patients with follicular lymphoma (FL). The Follicular Lymphoma Analysis of Surrogacy Hypothesis (FLASH) group performed a prospectively planned pooled analysis of individual patient data from first-line randomized controlled trials (RCTs) and examined associations between age (≤70 vs >70 years), clinical characteristics, and FL outcomes. We identified 18 multicenter clinical RCTs in the FLASH database that enrolled elderly patients (>70 years). Primary end points were early disease outcomes, CR24 and CR30, and progression-free survival (PFS) at 24 months (PFS24). Secondary end points were PFS and overall survival (OS). We identified 5922 previously untreated FL patients from 18 RCTs. Patients age >70 years (vs ≤70 years) more commonly had elevated lactate dehydrogenase, hemoglobin <12 g/dL, ECOG PS ≥2, and elevated β2-microglobulin. Median follow-up was 5.6 years. Patients >70 years did not differ from patients ≤70 years in rates of CR24, CR30, or PFS24. With a median OS of 14.6 years for all patients, median OS was 7.4 and 15.7 years for patients >70 and ≤70 years of age, respectively (hazard ratio = 2.35; 95% confidence interval = 2.03-2.73; P < .001). Age >70 years was a significant predictor of OS and PFS due to higher rates of death without progression, but not PFS24, CR24, or CR30. FL patients >70 years treated on trials have similar early disease outcomes to younger patients. There is no disease-specific outcome difference between age groups. Age alone should not disqualify patients from standard treatments or RCTs.
Changes in health status, workload, and lifestyle after starting the COVID-19 pandemic: a web-based survey of Japanese men and women
Authors: Suka Machi , Yamauchi Takashi , Yanagisawa Hiroyuki
Published: March 2021

Background

This study aimed to examine the change in health status of the general public after starting the COVID-19 pandemic and its association with changes in workload and lifestyle.

Methods

A web-based survey was conducted in November 2020, about 9 months after starting the COVID-19 pandemic in Japan, among 8000 Japanese men and women aged 25–64 years. Participants asked for the changes after starting the COVID-19 pandemic in health status, workload, daily life, and health behavior. Ordinal logistic regression was performed to elucidate factors associated with deterioration in general health status.

Results

A deterioration in general health status was reported by 17.0% of male and 19.4% of female. There has been a clear shift to sedentary life with decreasing moderate activity and increasing screen time. The multivariate analysis revealed that deteriorated work style, increased burden of housework, decreased moderate activity, increased digital media exposure, and increased body weight were significantly associated with deteriorating health status.

Conclusion

Both men and women have experienced significant changes in workload and lifestyle since the COVID-19 pandemic started. People should be aware of the risks associated with their recent life changes and take self-care measures to prevent serious health consequences.
Phytotoxin sorption to clay minerals
Authors: Schönsee Carina D. , Wettstein Felix E. , Bucheli Thomas D.
Published: March 2021

Background

Phytotoxins of various classes and origin are often found in their cationic form in the soil environment and thus, their overall soil behavior may be strongly affected by all geosorbents presenting cation exchange capacity (CEC). In addition to soil organic carbon (SOC), clays may exhibit great potential as sorbents for cationic organic chemicals. Therefore, 52 compounds of the major phytotoxin classes alkaloids, terpenoids and steroids were investigated with regard to their sorption behavior to the clay minerals kaolinite (low CEC) and montmorillonite (high CEC) by means of continuous flow column sorption experiments as a high-throughput alternative to traditional batch sorption experiments.

Results

In total, sorption coefficients log Dclay [L kg−1] were quantifiable for 26 phytotoxins on kaolinite (log Dclay > 0.1) and 33 on montmorillonite (log Dclay > 0.5). They ranged from 0.14 ± 0.09 for the pyrrolizidine alkaloid senkirkine on kaolinite to 3.05 ± 0.03 for the indole alkaloid brucine on montmorillonite. Although maximum sorbed concentrations lay well below the CEC for both clay minerals, sorption non-linearity was observed in some cases where as little as 0.1% of all cation exchange sites were occupied. Contrary to the expectations, sorption non-linearity could not be wholly explained by saturation of available sorption sites; for protonated tertiary amines with aromatic moieties, cooperative sorption seemingly took place and the results indicated a significant increase in sorption affinities within a very limited concentration range. Comparing montmorillonite and SOC, notable differences in preferences of cationic sorbates were observed between phytotoxins with and without aromatic moieties (e.g., isoquinoline versus pyrrolizidine alkaloids) as well as between N-heterocycles and N-heteroaromatics in particular (e.g., strychnine versus gramine; both indole alkaloids).

Conclusions

Overall, clay sorption seems a result of the interplay of charge location on the sorbent and various structural features of the sorbates. To confirm observed tendencies towards cooperative sorption for certain cationic phytotoxins, further studies with higher concentrations are needed. Nevertheless, obtained sorption coefficients indicate that a high proportion of phytotoxin sorption in soils may be attributed to clay minerals. Thus, clay minerals possess the ability to decrease total cationic phytotoxin environmental mobility.