bluuebunny/crossref_metadata_2025 huggingface dataset:
Assent for Orthognathic Surgery: Features, Challenges, and Benefits
Authors: Daws Steven
Published: August 2020

The ideal age to undergo orthognathic surgery approximates the age of majority, and as a result a considerable portion of the patient population undergoing orthognathic surgery are legal minors. When a patient cannot legally provide consent, assent is often sought. Assent for surgical orthodontics is complicated by particular changes in cognitive variables during adolescence, the multiphased and multi-provider treatment course, and the intervention’s elective nature. Ultimately, inclusion of a high-quality assent process can help identify patients most likely to benefit from orthognathic surgery and increase patient satisfaction.
Impact of Telehealth Interventions on Medication Adherence for Patients With Type 2 Diabetes, Hypertension, and/or Dyslipidemia: A Systematic Review
Authors: Bingham Jennifer M. , Black Melissa , Anderson Elizabeth J. , Li Yawen , Toselli Natalie , Fox Shawna , Martin Jennifer R. , Axon David R. , Silva-Almodóvar Armando
Published: August 2020

Objective:

To describe telehealth interventions and determine their effect on medication adherence for patients with type 2 diabetes, hypertension, and/or dyslipidemia.

Data Sources:

PubMed/MEDLINE, EMBASE, Cochrane, CINAHL Plus, PsycINFO, Academic Search Ultimate, International Pharmaceutical Abstracts, Scopus, Web of Science, WHO Global Index Medicus, association websites, and gray literature were searched from January 1, 1998, to December 31, 2019.

Study Selection and Data Extraction:

Eligible studies reported eHealth, mobile health, and telehealth interventions for adult patients prescribed medications for chronic condition management (eg, type 2 diabetes, hypertension, and/or dyslipidemia). Studies were required to evaluate medication adherence outcomes (eg, medication possession ratio [MPR], proportion of days covered (PDC)]. Randomized controlled trials, cohort studies, and controlled before-and-after studies were included. Multiple reviewers independently extracted data and evaluated risk of bias.

Data Synthesis:

Of 8693 studies identified, 13 reported either an MPR or PDC and were included in the systematic review. The systematic review demonstrated that electronic health (eHealth) and telehealth interventions were successful at improving medication adherence, whereas mobile health interventions did not improve medication adherence.

Relevance to Patient Care and Clinical Practice:

This systematic review highlighted the available research and findings of studies assessing interventions to improve medication nonadherence among patients with type 2 diabetes, hypertension, and/or dyslipidemia. The evaluated findings lend support to the need for targeted medication adherence interventions based on patient population and practice settings.

Conclusions:

Telehealth modalities include telephonic outreach and specialized tools designed to increase health literacy. eHealth and telehealth medication adherence interventions were associated with improved MPR and/or PDC rates.
Emotional Responses Shape the Substance of Information Seeking under Conditions of Threat
Authors: Coan Travis G. , Merolla Jennifer L. , Zechmeister Elizabeth J. , Zizumbo-Colunga Daniel
Published: August 2020

Menacing news inclines individuals to acquire information, and research has explored how emotional reactions such as fear or anger condition this process. While scholars have debated the relevance of fear and anger for levels of attentiveness and learning in politics, fewer studies consider how variation in emotional responses can shape the substance of information searches in times of threat. We posit that heightened fear motivates interest in defense-oriented information among threatened individuals, while heightened anger motivates interest in aggression-oriented information. To test these hypotheses, we focus on international terrorist threat because of its known tendency to elevate both anger and fear. We use data that permit a behavioral measure of information seeking, via an experiment embedded within a Dynamic Process Tracing Environment (DPTE) platform. Within this information-rich context, exposure to terrorist threat motivates a search for relevant information. Furthermore, we find that while an induction to elevate anger prompts more immediate attention to aggression-oriented information, an induction to elevate fear is more effective in steering attention toward defense-oriented information.
Factor Structure and Construct Validity of the Proposed Specifiers for Conduct Disorder (PSCD) Scale in Chinese Adolescents
Authors: Luo Jie , Wang Meng-Cheng , Neumann Craig S. , Hare Robert D. , Salekin Randall T.
Published: August 2020

The Proposed Specifiers for Conduct Disorder (PSCD) Scale is a new measure to assess psychopathic traits and symptoms of conduct disorder (CD) in children and adolescents. The current study examined the psychometric properties of the self-report version of the PSCD in a sample of community adolescents in mainland China ( N = 1,683; mean age = 13.60, SD = 1.14; 54.1% boys). The new instrument showed good internal consistency (alpha) for the 24-item total scale and good mean interitem correlations for each of the six-item subscales. Confirmatory factor analyses (CFAs) were conducted on all 24 items, and also a subset of 13 items that demonstrated strong item-level reliabilities. Using all 24 items, CFA results supported a four-factor bifactor model indicating the total score reflects a broad syndrome with four factors. The four factors included grandiose–manipulative traits (GM traits), callous–unemotional traits (CU traits), daring–impulsive traits (DI traits), and CD traits. The 13-item CFA results provided further support for a four-factor conceptualization of the PSCD and evidence of strong measurement invariance across gender. Finally, the PSCD exhibited the expected relations with other psychopathy measures, anxiety and depression, and aggression, supporting the PSCD scores convergent, discriminant, and criterion related validity. The findings provide preliminary evidence for the four-factor structure of the PSCD and support for the utility of the self-report PSCD for measuring psychopathic traits and CD in Chinese adolescents.
Clinical Validation of the Chinese Version of Patient Completed Caprini Risk Assessment Form
Authors: Chen Xiaolan , Deng Hui , Tong Xinjie , Gu Bei , Liu Jingxuan , Huang He , Ye Liwei , Pan Lei , Caprini Joseph A. , Wang Yong
Published: August 2020

To create and validate patient-completed Caprini risk score (CRS) tools for Chinese people. We revised Chinese patient-completed CRS form according to previously published studies. We prospectively recruited 70 internal medical patients and 70 surgical patients. The average age of these patients was 54.26 ± 15.29 years, 54.29% of them were male and 80% of them had education beyond high school. The study compared: (1) patient-completed CRS and physician-completed CRS; (2) the final value of physician-completed CRS (physician-completed CRS + body mass index) and CRS in the electronic medical record (EMR) system. Patient-completed CRS was 3.71 ± 3.63, patients spent 3.60 ± 1.24 minutes, 57.14% patients were at high-highest risk; physician-completed CRS was 3.84 ± 3.63, physicians spent 2.11 ± 1.13 minutes, 59.28% patients were at high-highest risk; the final value of physician-completed CRS was 4.12 ± 3.62, 63.58% patients were at high-highest risk; CRS value in the EMR system was 4.07 ± 3.58, 65% patients were at high-highest risk. There were strong positive correlations ( P < .0001) between patient-completed CRS and physician-completed CRS ( r = 0.978, κ = 0.76) and between the final value of physician-completed CRS and CRS in EMR ( r = 0.994, κ = 0.97). This study successfully developed and validated a Chinese patient-completed CRS that we found can replace physician-completed CRS. This results in considerable time saving for physicians and this process should increase the percentage of patients having complete risk assessment when they are admitted to the hospital.
The Social Network of Victims of Domestic Violence: A Network-Based Intervention Model to Improve Relational Autonomy
Authors: Nolet Anne-Marie , Morselli Carlo , Cousineau Marie-Marthe
Published: August 2020

This study aims to understand when and how domestic violence victims’ relational autonomy changes and to propose an intervention model stemming from the findings. Using qualitative and social network analysis, we study the actions of network members, as well as changing features of victims’ networks. Results show that victims base their decisions on their expectations toward others, and on a desire to preserve their autonomy. Their relational autonomy tends to increase when they leave abusive partners and stay in shelters, but maintaining relational diversity proves challenging once they exit shelters. A network-based model of intervention that aims to improve the victims’ relational autonomy is proposed.
A Longitudinal Network Analysis of Intergovernmental Collaboration for Local Economic Development
Authors: Lee Youngmi , Lee In Won
Published: August 2020

Fragmented jurisdictions in a metropolitan area have found collaborating with others to be not only normatively appealing but also practically beneficial for reducing negative externalities from intense development competition. However, collaboration among communities could involve collective action dilemmas. As an alternative governance mechanism, jurisdictions strategically establish informal networks with others, depending on the conditions where jurisdictions are involved. This study focuses on the strategic behavior of individual jurisdictions for their economic growth: how autonomous jurisdictions have selected collaborative partners and how the collaboration has evolved over time. We apply an institutional collective action framework and a longitudinal network analysis using Simulation Investigation for Empirical Network Analysis (SIENA). The results indicate that, although there is strong evidence that jurisdictions create mutual and clustered relations with others in collaborative networks, there is relatively less for making ties to a popular actor. In addition, jurisdictions are more likely to collaborate with others who share similar political and socio-economic characteristics.
A Method for Developing Trustworthiness and Preserving Richness of Qualitative Data During Team-Based Analysis of Large Data Sets
Authors: Abraham Traci H. , Finley Erin P. , Drummond Karen L. , Haro Elizabeth K. , Hamilton Alison B. , Townsend James C. , Littman Alyson J. , Hudson Teresa
Published: August 2020

This article outlines a three-phase, team-based approach used to analyze qualitative data from a nation-wide needs assessment of access to Veteran Health Administration services for rural-dwelling veterans. The method described here was used to develop the trustworthiness of findings from analysis of a large qualitative data set, without the use of analytic software. In Phase 1, we used templates to summarize content from 205 individual semistructured interviews. During Phase 2, a matrix display was constructed for each of 10 project sites to synthesize and display template content by participant, domain, and category. In the final phase, the summary tabulation technique was developed by a member of our team to facilitate trustworthy observations regarding patterns and variation in the large volume of qualitative data produced by the interviews. This accessible and efficient team-based strategy was feasible within the constraints of our project while preserving the richness of qualitative data.
Perturbations in Endocytotic and Apoptotic Pathways Are Associated With Chemotherapy-Induced Nausea
Authors: Singh Komal , Cao Huangshen , Miaskowski Christine , Conley Yvette P. , Hammer Marilyn , Wright Fay , Levine Jon D. , Kober Kord M.
Published: August 2020

Background:

While vomiting is well controlled with current antiemetic regimens, unrelieved chemotherapy-induced nausea (CIN) is a significant clinical problem. Perturbations in endocytotic and apoptotic pathways in the gut can influence the functioning of the microbiome-gut-brain-axis and the occurrence of gastrointestinal (GI) symptoms. However, limited information is available on the mechanisms that underlie unrelieved CIN.

Objectives:

The purpose of this study was to evaluate for perturbed biological pathways associated with endocytosis and apoptosis in oncology patients who did (n = 353) and did not (n = 275) report CIN prior to their second or third cycle of chemotherapy (CTX).

Methods:

Oncology patients (n = 735) completed study questionnaires in the week prior to their second or third cycle of CTX. CIN occurrence was evaluated using the Memorial Symptom Assessment Scale. Pathway impact analyses (PIA) were performed in 2 independent samples using RNA-sequencing (sample 1, n = 334) and microarray (sample 2, n = 294) methodologies. Fisher’s combined probability method was used to identify signaling pathways related to endocytotic and apoptotic mechanisms that were significantly perturbed between the 2 nausea groups across both samples.

Results:

CIN was reported by 63.6% of the patients in sample 1 and 48.9% of the patients in sample 2. Across the 2 samples, PIA identified 4 perturbed pathways that are involved in endocytosis (i.e., endocytosis, regulation of actin cytoskeleton) and apoptosis (i.e., apoptosis, PI3K/Akt signaling).

Conclusions:

Our findings suggest that CTX-induced inflammation of the GI mucosa, that results in the initiation of endocytotic and apoptotic processes in the gut, is associated with the occurrence of CIN.
Microstructural characterization and tribological behavior of surface composites fabricated on AA7050-T7451 alloy via friction stir processing
Authors: Gangil Namrata , Maheshwari Sachin , Siddiquee Arshad Noor , Khan Noor Zaman , Chen Xizhang , Konovalov Sergey
Published: August 2020

The Alumimum alloy AA7050-T7451 is largely used in high strength aircraft applications, Usually in T-7451 temper conditions it possesses optimized strength. Any enhancement in the strength beyond optimized value can achieve great weight saving and energy efficient. Often, relative motion in mutual contact also causes friction and wear. Thus, wear characteristics of such materials is also very important. In the present work the wear characteristic of surface composites made from AA7050-T7451 has been investigated. The wear test were performed on surface composites with best and lowest strength, coefficient of friction and wear surface morphology was analyzed and is discussed in light of microstructural and microhardness profiles. The wear performance, microstructural features and strengthening related and mutually discussed. The overall finding of this work may be of great use to professionals and researchers as the strength, microstructure and wear are all discussed in the single text. The results indicate that poor bonding between the reinforcement-matrix significantly reduces strength and wear behaviors. The effective dispersion of reinforcement results in net enhancement in strength and wear performance both when the processing done within a specific range of processing time-temperature.
White parents’ racial socialization and young adults’ racial attitudes: Moral reasoning and motivation to respond without prejudice as mediators
Authors: Pahlke Erin , Patterson Meagan M. , Hughes Julie Milligan
Published: August 2020

This study examined relations between parental racial socialization messages (i.e., egalitarianism, racemute, and preparation for bias) and racial attitudes in a sample of 282 White young adults (ages 18–22) in the United States. Egalitarianism messages were positively related to warmth toward racial outgroup members, whereas preparation for bias was negatively related to warmth toward racial outgroup members. In both cases the relation between racial socialization and racial attitudes was mediated by internal motivation to respond without prejudice and fairness/reciprocity moral orientation. Contrary to our expectations, racemute socialization messages were not directly related to participants’ warmth toward racial outgroup members. However, racemute socialization predicted internal motivation to respond without prejudice and fairness/reciprocity moral orientation, which in turn predicted outgroup warmth. These findings suggest possible mechanisms by which parents’ messages about race and racism may shape youths’ racial attitudes.
Does classroom diversity improve intergroup relations? Short- and long-term effects of classroom diversity for cross-ethnic friendships and anti-immigrant attitudes in adolescence
Authors: Bohman Andrea , Miklikowska Marta
Published: August 2020

This study examined short- and long-term effects of ethnic classroom diversity for intergroup relations in adolescence. Using a five-year panel of Swedish majority youth ( MageT1 = 13.40, MageT5 = 17.30), we found only limited direct effects of classroom diversity on anti-immigrant attitudes. However, classroom diversity increased the likelihood of cross-ethnic friendships, which in turn was associated with lower levels of anti-immigrant attitudes. Moreover, we found that the effect of classroom diversity on friendships remained also after adolescents transitioned to new schools. The findings highlight the importance of longitudinal analyses and contribute to a deeper understanding of how intergroup relations develop during adolescence. It brings new insights related to the longevity of classroom effects and to cross-ethnic friendships’ ability to mediate the diversity–attitudes relationship.
Backlash politics against European integration
Authors: Kriesi Hanspeter
Published: August 2020

The answer to the question whether opposition to the European integration process is an example of backlash politics is an ambiguous one. While the Euroscepticism from the radical right qualifies for backlash politics, the Euroscepticism from the radical left does not at first sight, although it also shows some traces of this kind of politics. Both the radical left and the radical right mobilise political discontent and are part of a ‘populist backlash’, but it is only the ‘nationalistic backlash’ against European integration of the radical right which qualifies as a politics with a retrograde objective. The argument is illustrated by the case of Brexit, the British version of the ‘nationalistic backlash’.
Experimental and numerical studies on Seismic Performance of The SCFST Column Eccentrically Braced Frames
Authors: Wu Ya-Peng , Chen Zhi-Hua , Zhou Ting , Chen Xian-Dong , Wang Xiao-Dun
Published: August 2020

The quasi-static experiments and finite element analysis of three groups of special-shaped concrete-filled steel tube (SCFST) column chevron braced frames (two groups of eccentrically braced frames and one group of concentrically braced frame) were carried out. The differences of quasi-static mechanical properties between the three groups frame were compared. The damage mechanism of the concentrically and eccentrically braced frames was significantly different, and the eccentrically braced frame could significantly improve the energy-dissipation ability and ductility. When the single limb of columns was connected by double-steel-plate, the stiffness of eccentrically braced structure could be improved around 10.4% and showed better energy-dissipation capacity. The finite element simulation was built on the basis of experiments, and parametric analysis was examined. The analysis results showed that section forms of the SCFST column and the thickness of brace have significant impacts on the quasi-static properties of such type of structure.
Computational modeling of degradation process on the mechanical performance of Poly-lactic acid /Magnesium composite
Authors: Shahmohmmadi Armin , Baghani Mostafa , Shariat Panahi Masoud , Wang Kui , Hasanpur Ehsan , Baniassadi Majid
Published: August 2020

In this study, the corrosion behavior of biodegradable composites is modeled. These composites are made of Poly-Lactic acid and Magnesium with different volume fractions. The scanning electron microscopy images of these composites were taken, and statistical reconstruction of the composite based on scanning electron microscopy images was done by the phase recovery algorithm, the three-dimensional structure of this composite was extracted with this reconstruction, then a three-dimensional cellular automata model was developed to predict the corrosion of this composite. Results of experiments for the composite with 10% of Magnesium volume fraction were used to calibrate the parameters of the cellular automata model, and with these parameters, the results for the composite with 5% of Magnesium volume fraction was obtained, and with comparing these data with the results of the experiment, our model was validated. In the end, we estimated the mechanical properties of these composites and analyzed the results.
Influence of multiple scan fields on the processing of 316L stainless steel using laser powder bed fusion
Authors: Leça TC , Silva TEF , Jesus AMP de , Neto Rui L , Alves Jorge L , Pereira JP
Published: August 2020

The sharp growth that additive manufacturing has been showing recently has broadened its application field and resulted in more varied demand of high-volume parts as well as a general increase in part series. The current focus on productivity enhancement of additive manufacturing has imposed the implementation of multiple-laser systems with larger scan fields. Its usage, combined with adequate layer thickness and laser power selection, makes high-volume parts less challenging to obtain. This paper focuses on understanding the influence of using multiple-scan fields for the fabrication of large components, especially on the parts region corresponding to scan field interface. The microstructure as well as mechanical behaviour of the multi-field manufactured samples are compared with parts fabricated using a single-field, for distinct processing parameters. Moreover, given the unreliability of additive manufacturing regarding dimensional and geometrical tolerances with increasing build rates, post-processing metal-cutting operations were studied towards additive manufacturing process hybridization. Despite the typical additive manufacturing process variability, a set of parameters, within testing conditions, could be identified as the most appropriate solution towards mechanical strength enhancement. Nonetheless, porosity levels can significantly impact the ductility of parts, which may be additionally compromised by its occurrence in the scan-field interface region.
Learning to see with Deleuze: understanding affective responses in image-viewer research assemblages
Authors: Wilson A N
Published: August 2020

I describe an approach to analysing the affective flows produced in sociomaterial assemblages of visual images and humans in research processes. The approach combines Deleuzian understandings of repetition and difference, and of lines of articulation and flight, with interpretative techniques drawn from visual social semiotics. I use examples from my research into images shared by professionals on Twitter to illustrate how this approach can reveal not only the forces, intensities and hidden logics that lead to particular responses, but also the ways in which these responses impact on research decisions and interpretations.
A Human Reliability Analysis to Crankshaft Overhauling in Dry-Docking of a General Cargo Ship
Authors: Bicen Samet , Kandemir Cagatay , Celik Metin
Published: August 2020

This study conducts a practical application of shipboard operation human reliability analysis (SOHRA) to a crankshaft overhauling operation of a general cargo ship at dry-docking period. The SOHRA approach includes error producing condition (EPC) and general task type (GTT) parameters to consistently calculate the human error probability (HEP) values of operation steps. In this case, a comprehensive overhauling of main engine was planned at shipyard since the ship has experienced a catastrophic failure. An onboard survey to ship engine room is conducted to monitor the operational conditions. The targeted operation, involves disassembly, maintenance, and reassembly stages, is monitored based on 39 sub-tasks. According to the initial findings, immediate recovery actions are suggested to eliminate critical safety issues in a timely manner. Moreover, an extended discussion through long-term safety recommendations are also provided. The results revealed from case study illustrates that HEP values in maintenance operations are sensitive to ship operating conditions. The proposed approach is found very useful by company executives to support ship technical superintendents in critical operation monitoring. The further study is considered to develop mobile application of SOHRA specific to maintenance operations onboard ships.
Race-Conscious Career Development: Exploring Self-Preservation and Coping Strategies of Black Professionals in Corporate America
Authors: Sisco Stephanie
Published: August 2020

The Problem

Corporations have maintained a history of operating as racialized social systems that contribute to racial divisions and inequities in the workplace. Despite this reality, there have been high-achieving Black men and women who have overcome limitations and unfavorable circumstances. In this study, resilience to racial bias in corporate America is explored through the lived experience of Black professionals by using a phenomenological research method.

The Solution

Race, racism, and workplace incivility are discussed in a conceptual framework to examine how racial bias still exists in the workplace and to contextualize the participants’ experiences. As a result of the findings, self-preservation and coping strategies are identified to provide insight into how the participants overcame social and racial barriers that influence their professional identities and career development in corporate America.

The Stakeholders

This research is intended to inform organizational leaders and career development researchers and specialists who are invested in the advancement of Black professionals and the communities they represent. This study also has implications for human resource developers and researchers who seek to minimize racial bias against Black professionals through racial discourse and race-conscious research.
Suppressed “Warburg Effect” in Nasopharyngeal Carcinoma Via the Inhibition of Pyruvate Kinase Type M2-Mediated Energy Generation Pathway
Authors: Zhao Penglong , Zhou Mengyan , Chen Ruixiang , Su Renjie
Published: August 2020

Warburg effect describes the abnormal energy metabolism in cancer cells and pyruvate kinase type M2 is involved in the regulation of this effect. In the current study, the role of pyruvate kinase type M2 in the initiation of Warburg effect in nasopharyngeal carcinoma cells was explored. The expression status of pyruvate kinase type M2 was detected in nasopharyngeal carcinoma samples and analyzed by different clinicopathological characteristics. Then the level of pyruvate kinase type M2 was suppressed in 2 nasopharyngeal carcinoma cell lines. The effects of pyruvate kinase type M2 inhibition on cell viability, apoptosis, invasion, glucose uptake, ATP generation, and glycolysis metabolism were determined. The data showed that the high expression of pyruvate kinase type M2 in nasopharyngeal carcinoma tissues was associated with the larger tumor size and advanced metastasis in the patients. The inhibition of pyruvate kinase type M2 resulted in the repressed proliferation and invasion in nasopharyngeal carcinoma cells, along with the increased apoptotic rate. The lack of pyruvate kinase type M2 function inhibited glucose uptake, while increased ATP generation in nasopharyngeal carcinoma cells. Moreover, the production of glycolysis metabolites, including pyruvic acid, lactate, citrate, and malate, was also suppressed by pyruvate kinase type M2 inhibition. At molecular level, the expressions of glucose transporter and hexokinase 2 were downregulated by pyruvate kinase type M2 inhibition, confirming the changes in glucose metabolism. Collectively, the current study demonstrated that the function of pyruvate kinase type M2 was important to maintain the proliferation and invasion of nasopharyngeal carcinoma cells, and the inhibition of the factor would antagonize nasopharyngeal carcinoma by blocking Warburg effect.
High School Students’ Knowledge, Attitude and Preventive Practice of Dementia Care in Macao
Authors: Lo Iek Long , Zeng Wen , Lei Chin Ion , Lam Chong , Lou Hong Lei
Published: August 2020

Objective:

To investigate knowledge, attitude and preventive practice of dementia care among high school students in Macao.

Methods:

Questionnaires was developed and distributed to 10 randomly selected high schools in Macao and 586 valid questionnaires were returned.

Results:

Knowledge, attitude and preventive practice of dementia care were 56.27 ± 24.90, 73.97 ± 7.72 and 68.34 ± 14.05. There were positive relationships between preventive practice and attitude, and knowledge. The students of 2 high schools had participated or organized lectures or events related to dementia scored higher knowledge, attitude and preventive practice than those hadn’t. Knowledge and attitude of female students were significantly higher than male students. Knowledge and preventive practice of the high school students were significantly lower than primary health professionals in Macao.

Conclusion:

Most high school students in Macao had insufficient knowledge and inappropriate preventive practice of dementia care. Enhanced dementia education should be a strong agenda for high school students in Macao.
Macrophage Activation and M2 Polarization in Wound Bed of Diabetic Patients Treated by Dermal/Epidermal Substitute Nevelia
Authors: Montanaro Manuela , Meloni Marco , Anemona Lucia , Giurato Laura , Scimeca Manuel , Izzo Valentina , Servadei Francesca , Smirnov Artem , Candi Eleonora , Mauriello Alessandro , Uccioli Luigi
Published: August 2020

Clinical evidences have shown good results using dermal/epidermal substitutes (DESs) to treat diabetic foot ulcers. Recent studies suggest that, in addition to their scaffold action, DESs may favor wound healing by influencing wound bed inflammatory cells. This study aims to investigate whether DES may influence the inflammatory infiltrate and macrophages polarization toward a reparative phenotype. Fifteen diabetic patients with chronic foot ulcers have been randomly enrolled: 5 treated only by standard of care, served as control group (CG), and 10 treated with DES composed of type 1 bovin collagen (Nevelia, SYMATESE) considered as test group (TG). A biopsy was taken at baseline (T0) and after 30 days (T1). From bioptic paraffin specimen histological, immunohistochemical, and immunofluorescence analysis was performed. Immunohistochemistry reactions evaluated the number of M1 macrophage (CD38+) and M2 macrophage (CD163+). TG patients displayed general macrophage activation and their greater polarization toward M2 subpopulation 30 days after DES implant, compared with CG. From T0 to T1 there was a significant decrease of CD38+ (230 ± 42 and 135 ± 48 mm2, respectively; P < .001) and significant increase of CD163+ (102 ± 21 positive cells/mm2 and 366 ± 42 positive cells/mm2, respectively; P < .001). Confocal microscopy confirmed an increase of M2 cells as expressed by the reduced CD68+/CD163+ ratio. After 6 months of observation 6 patients (60%) of the TG completely healed, while only 1 patient (20%) healed in the CG ( P < .01). The tested DES makes possible to treat diabetic foot ulcers inducing tissue reparative processes through macrophage activation and M2 reparative polarization.
Hirudotherapy in Wound Healing
Authors: Nair Harikrishna K. R. , Ahmad Nazni Wasi , Lee Han Lim , Ahmad Norazah , Othamn Suhana , Mokhtar Noor Shazleen Husnie Mohd , Chong Sylvia Syin Ying
Published: August 2020

Leeches are hermaphrodite, bloodsucking parasitic worms usually found in places with fresh water. Leech therapy existed 3000 years, and it is being used at a different scope. Several species of leeches have been used in medicine, and the most common species used is Hirudo medicinalis. Leeches suck the excess blood, reduce the swelling in the tissues, and promote healing by allowing fresh oxygenated blood to reach the area until normal circulation can be restored. Pain relief from leech therapy is rapid, effective, and long-lasting in many conditions. The aim of this study was to evaluate the efficacy and duration of healing utilizing sterile medicinal leeches, Hirudinaria manillensis, in the management of pain and wound healing. Leech was taken out from its sterile tube by using a pair of non-tooth sterile plastic forceps and gloved hands. Each leech was left in place for as long as it was feeding. Leeches were removed only after they became detached from the patient. The specimen jars containing the used leeches were sealed in either a biohazard bag or in a small yellow clinical waste bin liner securely fastened with a cable tie. The leech was killed by using 70% alcohol prior to disposal into a yellow hazard bin, which undergoes incineration. All 3 patients had improvements in their condition, especially in terms of reduction in the pain and improvement in their sense of balance. All the wounds healed well. Therefore, leech therapy is effective in reducing pain and increasing perfusion to allow the wounds to heal quickly. However, a more robust trial is needed to show significance as the sample size is small.
A Systematic Literature Review of Animal-Assisted Interventions in Oncology (Part I): Methods and Results
Authors: Holder Timothy R. N. , Gruen Margaret E. , Roberts David L. , Somers Tamara , Bozkurt Alper
Published: August 2020

Animal-assisted interventions (AAIs) use human-animal interactions to positive effect in various contexts including cancer care. As the first installment of a 2-part series, this systematic literature review focuses on the research methods and quantitative results of AAI studies in oncology. We find methodological consistency in the use of canines as therapy animals, in the types of high-risk patients excluded from studies, and in the infection precautions taken with therapy animals throughout cancer wards. The investigated patient endpoints are not significantly affected by AAI, with the exceptions of improvements in oxygen consumption, quality of life, depression, mood, and satisfaction with therapy. The AAI field in oncology has progressed significantly since its inception and has great potential to positively affect future patient outcomes. To advance the field, future research should consistently improve the methodological design of studies, report data more completely, and focus more on the therapy animal’s well-being.
African Immigrant Health: Prostate Cancer Attitudes, Perceptions, and Barriers
Authors: Malika Nipher , Ogundimu Oyinkansola , Roberts Lisa , Alemi Qais , Casiano Carlos , Montgomery Susanne
Published: August 2020

Prostate cancer (PCa) is the second leading cause of cancer-related death among Black men who present with higher incidence, mortality, and survival compared to other racial groups. African immigrant men, however, are underrepresented in PCa research and thus this research sought to address that gap. This study applied a social determinants of health framework to understand the knowledge, perceptions, and behavioral tendencies regarding PCa in African immigrants. African immigrant men and women residing in different parts of the country (California, Texas, Colorado, Oklahoma, and Florida) from various faith-based organizations, African community groups, and social groups were recruited to participate in key informant interviews ( n = 10) and two focus groups ( n = 23). Four themes were identified in this study: (a) PCa knowledge and attitudes—while knowledge is very limited, perceptions about prostate health are very strong; (b) culture and gender identity strongly influence African health beliefs; (c) preservation of manhood; and (d) psychosocial stressors (e.g., financial, racial, immigration, lack of community, and negative perceptions of invasiveness of screening) are factors that play a major role in the overall health of African immigrant men. The results of this qualitative study unveiled perceptions, attitudes, beliefs, and knowledge of PCa among African immigrants that should inform the planning, development, and implementation of preventive programs to promote men’s health and PCa awareness.
The Double Threshold: Consequences for Identifying Low-Dose Radiation Effects
Authors: Waltar Alan , Feinendegen Ludwig
Published: August 2020

Prior to observing low-dose-induced cell signaling and adaptive protection, radiogenic stochastic effects were assumed to be linearly related to absorbed dose. Now, abundant data prove the occurrence of radiogenic adaptive protection specifically at doses below ∼ 200 mGy (with some data suggesting such protection at a dose even higher than 200 mGy). Moreover, cells do not thrive properly when deprived of radiation below background dose.

Two threshold doses need be considered in constructing a valid dose-response relationship. With doses beginning to rise from zero, cells increasingly escape radiation deprivation. The dose at which radiation-deprived cells begin to function homeostatically provides dose Threshold A. With further dose increase, adaptive protection becomes prominent and then largely disappears at acute doses above ∼ 200 mGy. The dose at which damage begins to override protection defines Threshold B.

Thresholds A and B should be terms in modeling dose-response functions. Regarding whole-body responses, current data suggest for low-LET acute, non-chronic, irradiation a Threshold B of about 100 mGy prevails, except for leukemia and probably some other malignancies, and for chronic, low dose-rate irradiation where the Threshold B may well reach 1 Gy per year. A new Research and Development Program should determine individual Thresholds A and B for various radiogenic cell responses depending on radiation quality and target.
Anti-Thrombotic Therapy to Ameliorate Complications of COVID-19 (ATTACC): Study design and methodology for an international, adaptive Bayesian randomized controlled trial
Authors: Houston Brett L , Lawler Patrick R , Goligher Ewan C , Farkouh Michael E , Bradbury Charlotte , Carrier Marc , Dzavik Vlad , Fergusson Dean A , Fowler Robert A , Galanaud Jean-Phillippe , Gross Peter L , McDonald Emily G , Husain Mansoor , Kahn Susan R , Kumar Anand , Marshall John , Murthy Srinivas , Slutsky Arthur S , Turgeon Alexis F , Berry Scott M , Rosenson Robert S , Escobedo Jorge , Nicolau Jose C , Bond Lindsay , Kirwan Bridget-Anne , de Brouwer Sophie , Zarychanski Ryan
Published: August 2020

Background:

Mortality from COVID-19 is high among hospitalized patients and effective therapeutics are lacking. Hypercoagulability, thrombosis and hyperinflammation occur in COVID-19 and may contribute to severe complications. Therapeutic anticoagulation may improve clinical outcomes through anti-thrombotic, anti-inflammatory and anti-viral mechanisms. Our primary objective is to evaluate whether therapeutic-dose anticoagulation with low-molecular-weight heparin or unfractionated heparin prevents mechanical ventilation and/or death in patients hospitalized with COVID-19 compared to usual care.

Methods:

An international, open-label, adaptive randomized controlled trial. Using a Bayesian framework, the trial will declare results as soon as pre-specified posterior probabilities for superiority, futility, or harm are reached. The trial uses response-adaptive randomization to maximize the probability that patients will receive the more beneficial treatment approach, as treatment effect information accumulates within the trial. By leveraging a common data safety monitoring board and pooling data with a second similar international Bayesian adaptive trial (REMAP-COVID anticoagulation domain), treatment efficacy and safety will be evaluated as efficiently as possible. The primary outcome is an ordinal endpoint with three possible outcomes based on the worst status of each patient through day 30: no requirement for invasive mechanical ventilation, invasive mechanical ventilation or death.

Conclusion:

Using an adaptive trial design, the Anti-Thrombotic Therapy To Ameliorate Complications of COVID-19 trial will establish whether therapeutic anticoagulation can reduce mortality and/or avoid the need for mechanical ventilation in patients hospitalized with COVID-19. Leveraging existing networks to recruit sites will increase enrollment and mitigate enrollment risk in sites with declining COVID-19 cases.
User-centered design principles in the development of clinical research tools
Authors: Walden Anita , Garvin Lynsi , Smerek Michelle , Johnson Constance
Published: August 2020

Background:

Increasing and sustaining the engagement of participants in clinical research studies is a goal for clinical investigators, especially for studies that require long-term or frequent involvement of participants. Technology can be used to reduce barriers to participation by providing multiple options for clinical data entry and form submission. However, electronic systems used in clinical research studies should be user-friendly while also ensuring data quality. Directly involving study participants in evaluating the effectiveness and usability of electronic tools may promote wider adoption, maintain involvement, and increase user satisfaction of the technology. While developers of healthcare applications have incorporated user-centered designs, these methods remain uncommon in the design of clinical study tools such as patient-reported outcome surveys or electronic data capture digital health tools.

Methods:

Our study evaluated whether the clinical research setting may benefit from implementing user-centered design principles. Study participants were recruited to test the web-based form for the Measurement to Understand the Reclassification of Disease of Cabarrus/Kannapolis (MURDOCK) Study Community Translational Population Health Registry and Biorepository that would enable them to complete their study forms electronically. The study enrollment form collects disease history, conditions, smoking status, medications, and other information. The system was initially evaluated by the data management team through traditional user-acceptance testing methods. During the tool evaluation phase, a decision was made to incorporate a small-scale usability study to directly test the system.

Results:

Results showed that a majority of participants found the system easy to use. Of the eight required tasks, 75% were completed successfully. Of the 72 heuristics violated, language was the most frequent violation.

Conclusion:

Our study showed that user-centered usability methods can identify important issues and capture information that can enhance the participant’s experience and may improve the quality of study tools.
Exploring mechanisms of action in clinical trials of complex surgical interventions using mediation analysis
Authors: Sharples Linda , Papachristofi Olympia , Rex Saleema , Landau Sabine
Published: August 2020

Background:

Surgical interventions allow for tailoring of treatment to individual patients and implementation may vary with surgeon and healthcare provider. In addition, in clinical trials assessing two competing surgical interventions, the treatments may be accompanied by co-interventions.

Aims:

This study explores the use of causal mediation analysis to (1) delineate the treatment effect that results directly from the surgical intervention under study and the indirect effect acting through a co-intervention and (2) to evaluate the benefit of the surgical intervention if either everybody in the trial population received the co-intervention or nobody received it.

Methods:

Within a counterfactual framework, relevant direct and indirect effects of a surgical intervention are estimated and adjusted for confounding via parametric regression models, for the situation where both mediator and outcome are binary, with baseline stratification factors included as fixed effects and surgeons as random intercepts. The causal difference in probability of a successful outcome (estimand of interest) is calculated using Monte Carlo simulation with bootstrapping for confidence intervals. Packages for estimation within standard statistical software are reviewed briefly. A step by step application of methods is illustrated using the Amaze randomised trial of ablation as an adjunct to cardiac surgery in patients with irregular heart rhythm, with a co-intervention (removal of the left atrial appendage) administered to a subset of participants at the surgeon’s discretion. The primary outcome was return to normal heart rhythm at one year post surgery.

Results:

In Amaze, 17% (95% confidence interval: 6%, 28%) more patients in the active arm had a successful outcome, but there was a large difference between active and control arms in the proportion of patients who received the co-intervention (55% and 30%, respectively). Causal mediation analysis suggested that around 1% of the treatment effect was attributable to the co-intervention (16% natural direct effect). The controlled direct effect ranged from 18% (6%, 30%) if the co-intervention were mandated, to 14% (2%, 25%) if it were prohibited. Including age as a moderator of the mediation effects showed that the natural direct effect of ablation appeared to decrease with age.

Conclusions:

Causal mediation analysis is a useful quantitative tool to explore mediating effects of co-interventions in surgical trials. In Amaze, investigators could be reassured that the effect of the active treatment, not explainable by differential use of the co-intervention, was significant across analyses.
When Beliefs Face Reality: An Integrative Review of Belief Updating in Mental Health and Illness
Authors: Kube Tobias , Rozenkrantz Liron
Published: August 2020

Belief updating is a relatively nascent field of research that examines how people adjust their beliefs in light of new evidence. So far, belief updating has been investigated in partly unrelated lines of research from different psychological disciplines. In this article, we aim to integrate these disparate lines of research. After presenting some prominent theoretical frameworks and experimental designs that have been used for the study of belief updating, we review how healthy people and people with mental disorders update their beliefs after receiving new information that supports or challenges their views. Available evidence suggests that both healthy people and people with particular mental disorders are prone to certain biases when updating their beliefs, although the nature of the respective biases varies considerably and depends on several factors. Anomalies in belief updating are discussed in terms of both new insights into the psychopathology of various mental disorders and societal implications, such as irreconcilable political and societal controversies due to the failure to take information into account that disconfirms one’s own view. We conclude by proposing a novel integrative model of belief updating and derive directions for future research.