bluuebunny/crossref_metadata_2025 huggingface dataset:
Severe sequelae in bilateral acute iris transillumination syndrome secondary to the use of oral moxifloxacin: a case report
Authors: Rivera-Valdivia Nicolás , Arteaga-Rivera Karla , Reyes-Guanes Juliana , Neira-Segura Natalia , de-la-Torre Alejandra
Published: September 2021

Background

Moxifloxacin is a fourth-generation fluoroquinolone used as a second-line treatment for multiple bacterial infections. Uveitis has been described as an adverse effect related to this medication. Although several case reports have been published describing uveitis and bilateral acute iris transillumination syndrome related to moxifloxacin, we present a unique case of a patient with severe sequelae associated with bilateral acute iris transillumination syndrome secondary to the use of oral moxifloxacin.

Case presentation

A 45-year-old Colombian hispanic female presented bilateral conjunctival hyperemia, decreased visual acuity, blurred vision, photophobia, and ocular pain after 15 days of treatment with systemic moxifloxacin for an upper tract respiratory infection. The patient presented unilateral anterior chamber pigment dispersion, mydriatic and nonreactive pupils, extensive iris transillumination defects, and secondary glaucoma. Blood and aqueous humor tests were negative for infectious and autoimmune diseases. Moxifloxacin-induced bilateral acute iris transillumination syndrome was diagnosed. Permanent sequelae such as ocular pain, photophobia, and focus difficulty secondary to severe bilateral iridian atrophy and inability of synkinetic reflex were left. Additionally, glaucoma was diagnosed, and Ahmed valve implantation was required.

Conclusions

We should be aware of the possible association between moxifloxacin and bilateral acute iris transillumination syndrome. A detailed anamnesis, adequate examination, and laboratory tests are necessary to reach an early diagnosis and treatment to avoid unnecessary therapies. Larger studies should be carried out to understand the pathophysiology, diagnosis, management, and sequelae of the disease.
Which factors increase informal care hours and societal costs among caregivers of people with dementia? A systematic review of Resource Utilization in Dementia (RUD)
Authors: Angeles Renira C. , Berge Line I. , Gedde Marie H. , Kjerstad Egil , Vislapuu Maarja , Puaschitz Nathalie G. , Husebo Bettina S.
Published: September 2021

Background

Nearly 19 million people across OECD countries are living with dementia, and millions of family caregivers are affected by the disease. The costs of informal care are estimated to represent 40–75% of the total dementia cost exceeding formal care time and medical costs.

Objective

To conduct a systematic review to evaluate the methodological quality and factors associated with high informal care hours per month that increase societal costs, and to identify what type of interventions may alleviate the entire burden of informal and formal caregiving.

Methods

The systematic review was registered at PROSPERO (15.12.2020). A search in Medline, Embase, PsycINFO, and web of science for observational studies, cost-effectiveness, and cost of illness (COI) analyses on resource utilization in dementia (RUD) was conducted on 1 December 2020. Our inclusion criteria included a requirement that studies had to use the original RUD, RUD-FOCA or RUD lite in terms of hours or days per month, and costs as primary or secondary outcome, OECD countries, within the last 20 years and a sample population comprising persons with dementia (PwD) ≥65 years and their caregivers. We followed the PRISMA, GRADE, PICO guidelines and Drummond criteria to assess the methodology and quality of the studies.

Results

Of 307 studies, 26 cross-sectional and 3 longitudinal cohort studies were included in the analyses. Two studies had a randomized controlled trial (RCT) design. The methods and cost categories in each study varied widely. Disease severity, caregiver factors, and behavioural and psychological symptoms of dementia (BPSD) were associated with high informal care hours and societal cost. One RCT found no effect of a non-pharmacological intervention on informal care hours, yet another RCT found a cost-effective impact of an in-home respite care programme reducing informal care burden and costs.

Conclusion

The divergent use of the RUD components within included studies encourage more harmonized analyses. There are only two RCTs on RUD, one of which shows a significant treatment effect. Larger sample sizes and longer follow-up periods are required in future RCTs with dedicated focus on cost-enhancing and resource intensive factors such as disease severity and BPSD. Novel interventions must diversify between caregiver and PwD groups.

PROSPERO registration

CRD42021226388.
A first case report of nasopharyngeal Mycobacterium abscessus subspecies massiliense infection
Authors: Oki Yamato , Hatakeyama Hiromitsu , Komatsu Masanori , Isono Yasuhiro , Ikemiyagi Hidetaka , Tsukiji Jun , Higa Ryoko , Oridate Nobuhiko
Published: September 2021

Background

Mycobacterium abscessus subspecies massiliense is a non-tuberculous mycobacteriosis and was subdivided from Mycobacterium abscessus in 2006. This article is the first report on nasopharyngitis caused by Mycobacterium abscessus subspecies massiliense.

Case presentation

A 45-year-old woman had an 18-month history of recurrent nasopharyngitis and presented with pain in the throat. Mycobacterial tissue culture and polymerase chain reaction testing revealed the presence of Mycobacterium abscessus subspecies massiliense in the nasopharyngeal tissue. This patient underwent surgery, followed by multiple rounds of chemotherapy with oral and intravenous antibiotic agents for 16 weeks. She has had no recurrence during the 56 weeks since treatment.

Conclusion

It is difficult to detect the presence of Mycobacterium abscessus subspecies massiliense in a culture from the swabbing sample. The tissue culture from a biopsy specimen is mandatory for the identification of the species. Currently, no definite treatment policy is available and only empirical treatment is applied. This case is an important for the diagnosis and treatment of this bacterial infection on nasopharynx.
Methodology of optimisation for a nanostructured two-photon absorption photodetector
Authors: Dauphin Maxence , Fix Baptiste , Jaeck Julien , Haïdar Riad
Published: September 2021

We introduce a 3-step method to optimise a nanostructured photodetector for infrared sensing through non degenerated two-photon absorption (NDTPA). First, the nanostructure is designed to tailor the distribution and concentration of both pump and signal intensities within the absorbing layer, thus leading to a gain in two-photon absorption. Second, the issue of the competition between NDTPA and other sub-bandgap transitions is tackled with a new figure of merit to favor as much as possible NDTPA while minimising other absorption processes. Third, a refined computation of the gain and the figure of merit is done to consider focused beams. Finally, two scenarios based on low power infrared photodetection are investigated to illustrate the flexibility and adaptibility of the method. It is shown that the gain is up to 7 times higher and the figure of merit is up to 20 times higher compared to the literature.
Three highly sensitive monoclonal antibody-based serological assays for the detection of tomato mottle mosaic virus
Authors: Li Xue , Guo Liqian , Guo Mengmeng , Qi Duo , Zhou Xueping , Li Fan , Wu Jianxiang
Published: September 2021

In recent years, tomato mottle mosaic virus (ToMMV) has become one of the most important viral pathogens affecting solanaceous crop production in Yunnan, Hainan, and Shandong provinces of China, often causing huge yield reductions. To provide farmers and vegetable industry with reliable and easy-to-use ToMMV detection methods, we immunized BALB/c mice with purified ToMMV and obtained six hybridoma cell lines (i.e., 2D6, 9C12, 26A10, 3A4, 23A4 and 17B11) that secrete anti-ToMMV monoclonal antibodies (MAbs) through the hybridoma technology. Using these MAbs as the detection antibody, we developed three serological assays: antigen-coated-plate enzyme-linked immunosorbent assay (ACP-ELISA), dot enzyme-linked immunosorbent assay (dot-ELISA) and tissue print enzyme-linked immunosorbent assay (tissue print-ELISA) for ToMMV detection. Our test results showed that these three newly developed serological methods can be used to specifically detect ToMMV infection in plant samples, but not tobacco mosaic virus, tomato mosaic virus, cucumber green mottle mosaic virus and cucumber mosaic virus. Sensitivity analyses further showed that ACP-ELISA and dot-ELISA can be used to detect ToMMV infection in plant crude extracts diluted at 1:81,920 and 1:40,960 (weight/volume, g/mL), respectively. Surprisingly, the detection limit of the developed dot-ELISA was 26 times higher than that of traditional RT-PCR. Using field-collected plant samples, we have demonstrated that these three new serological methods are accurate and easy-to-use for large-scale detection of ToMMV in fields.
Correlation between adiponectin level and the degree of fibrosis in patients with non-alcoholic fatty liver disease
Authors: Mohamed Manal Sabry , Youssef Tarek Mohammed , Abdullah Esraa Ebrahim , Ahmed Ahmed Elmetwally
Published: September 2021

Background

Non-alcoholic fatty liver disease (NAFLD) is one of the most prevalent chronic liver diseases, particularly in Egypt. It is defined as the accumulation of lipids inside the hepatocytes, in the absence of other etiologies of hepatic damage. It is frequently associated with obesity, diabetes mellitus, and metabolic syndrome. Adiponectin is an abundant adipocyte-derived protein with well-established anti-atherogenic, insulin-sensitizing, and anti-inflammatory properties. The liver is a major target organ for adiponectin especially in fatty liver diseases, and this adipocytokine has the ability to control many liver functions including metabolism, inflammation, and fibrosis. In this study, we aimed to find out the correlation between the degree of liver fibrosis in NAFLD patients and their serum adiponectin level as a future non-invasive method for the assessment of liver fibrosis to substitute liver biopsy to avoid its hazardous complication and also to study the correlation between diabetes mellitus as well as obesity and serum adiponectin level.

Results

Fifty patients were selected to participate in our study based on our inclusion criteria. They were recruited from the Internal Medicine Department, Gastroenterology Clinic in Al-Demerdash Hospital using a convenient sampling method. Diagnosis of NAFLD was confirmed by laboratory markers: aspartate aminotransferase (AST), alanine aminotransferase (ALT), lipid profile, ultrasound, and FibroScan examination. Analyzing the adiponectin levels showed that besides its significant correlation with body mass index (BMI), hypertension, diabetes mellitus, and dyslipidemia, it was significantly lower in the high-grade fibrosis group compared to the low-grade fibrosis group with a P-value of (0.000) and a cutoff value for stage 3/4 fibrosis of about 2.31 μg/ml which marked a promising hope of adiponectin being of protective value against liver fibrosis.

Conclusion

Both serum levels and hepatic adiponectin receptor expression are decreased in NAFLD. Therefore, either adiponectin itself or adiponectin-inducing agents might be of key therapeutic interest in the near future in the treatment of NAFLD.
Interdisciplinary design education: development of an elective course in architecture and engineering departments
Authors: Badawi A. M. , Abdullah M. R.
Published: September 2021

Collaboration among disciplines is becoming a standard practice in Architecture, Engineering, and Construction (AEC) industry. However, limited studies have addressed the involvement of interdisciplinarity into architectural undergraduate curricula. The study seeks to expand the literature on this topic, namely by offering an alternative model for teaching an Interdisciplinary Design Course (IDC), mainly in architectural engineering departments, with the participation of engineering departments. The authors hypothesize that by the adoption of the IDC, architecture students would have a better understanding of the nature of AEC interdisciplinary design knowledge. The study aims to highlight the value of the IDC and to test the hypothesis. A qualitative research methodology has been adopted, including the design of an experiment and then the application of a case study comprising four instructors and 24 students from four departments in the Faculty of Engineering, Cairo University. Students’ design process, teamwork attitude, and own experiences on the IDC have been recorded using direct observation, interviews, and surveys. Data have been analyzed using descriptive statistics to identify the effectiveness and challenges of the experiment, in addition to the comparison with the traditional design studio. The results have shown the students’ satisfaction with collaboration with their peers from other disciplines, as it boosted their understanding of the integrated design process and increased their knowledge about each other’s discipline. In addition, architecture students commended the IDC much more than the traditional design studio.
Punnett Squares or Protein Production? The Expert–Novice Divide for Conceptions of Genes and Gene Expression
Authors: Newman Dina L. , Coakley Aeowynn , Link Aidan , Mills Korinne , Wright L. Kate
Published: September 2021

Through the lens of model-based reasoning, this work explores and uncovers important differences in how experts and novices conceptualize and reason about genes and gene expression. Findings from this work will help inform future research into the development and refinement of mental models.
Connecting the Dots from Professional Development to Student Learning
Authors: Ellingson Charlene L. , Edwards Katherine , Roehrig Gillian H. , Hoelscher M. Clark , Haroldson Rachelle A. , Dubinsky Janet M.
Published: September 2021

Teacher participation in professional development (PD) improved student learning compared with control teachers. Delivering neuroscience as a unit produced more student learning than when the content was sprinkled throughout the course. Despite commitment to enacting PD strategies, teacher decisions and implementation strategies influenced student outcomes.
Using objective clinical metrics to understand the relationship between the electronic health record and physician well-being: observational pilot study
Authors: Mosquera Matthew J. , Ward Heather Burrell , Holland Christopher , Boland Robert , Torous John
Published: September 2021

Background

Electronic health records (EHRs) are a significant contributor to physicians’ low satisfaction, reduced engagement and increased burnout. Yet the majority of evidence around EHR and physician harms is based on self-reported screen time, which may both over- and underreport actual exposure.

Aims

The purpose of this study was to examine how objective EHR use correlates with physician well-being and to develop preliminary recommendations for well-being-based EHR interventions.

Method

Prior to the onset of COVID-19, psychiatry residents and attending physicians working in an out-patient clinic at an academic medical centre provided consent for access to EHR-usage logs and completed a well-being assessment made up of three scales: the Maslach Burnout Inventory, the Urecht Work Engagement Scale and the Professional Quality of Life Measure. Survey responses and objective EHR data were analysed with descriptive statistics.

Results

Responses were obtained from 20 psychiatry residents (total eligible residents n = 27; 74% participation) and 16 clinical faculty members (total eligible faculty n = 24; 67% participation) with an overall response rate of 71% (total eligible residents and faculty n = 51 and total residents and faculty who completed survey n = 36). Moderate correlations for multiple well-being domains emerged in analysis for all participants, especially around the time spent per note and patient visits closed the same day.

Conclusions

EHR-usage logs represent an objective tool in the evaluation and enhancement of physician well-being. Results from our pilot study suggest that metrics for note writing efficiency and closing patient visits the same day are associated with physician well-being. These metrics will be important to study in ongoing efforts involving well-being-based EHR interventions.
Comparing U.S. Preventive Services Task Force 2013 versus 2021 lung cancer screening eligibility.
Authors: Smeltzer Matthew , Liao Wei , Taylor Meghan Brooke , Fehnel Carrie , Faris Nicholas , Lane Jordan Goss , Williams Sara Cat , Akinbobola Olawale , Pacheco Alicia , Epperson Amanda , Luttrell Joy , McCoy Denise , Smith Elizabeth , Adams Kim , Ray Meredith , Robbins Todd , Wright Jeffrey , Osarogiagbon Raymond U.
Published: September 2021

13

Background: Early detection of lung cancer provides the best opportunity for long-term survival. In 2021 US Preventive Services Task Force (USPSTF) expanded the 2013 risk-based Low-dose CT (LDCT) screening criteria, in part to reduce unintended race and gender disparities in lung cancer detection. We evaluated the impact of the updated USPSTF criteria in a cohort of patients from an incidental lung nodule program (ILNP). Methods: We implemented an ILNP in a community healthcare system in the mid-south US. Patients with lung lesions on routinely-performed radiologic studies were triaged using evidence-based guidelines. We prospectively tracked patient demographics, clinical characteristics, procedures, complications, and health outcomes. We classified all patients in the ILNP cohort based on USPSTF 2013 and 2021 screening criteria. Statistical analysis used the chi-square test. Results: The ILNP cohort included 14,642 patients from 2015-2021. This cohort was 56% female, 65% White, 29% Black, with a median age of 64 years. Overall 1,581 (10.8%) met 2013 and 2,051 (14.0%) met 2021 USPSTF criteria. 1.9% of subjects eligible by 2013 criteria were diagnosed with lung cancer compared to 2.2% by 2021 criteria. 470 additional patients met screening criteria when we expanded from USPSTF 2013 to 2021. As expected, these patients were younger and less likely to have Medicare insurance. These additional eligible patients were significantly more likely to be female (58% v 49%, p = 0.0011) or Black (28% vs. 18%, p < 0.0001) compared to those eligible by 2013 criteria. 44 of the 470 (9%) were diagnosed with cancer: 36% adenocarcinoma, 18% squamous, and 11% small cell, 11% non-lung primary, 9% non-small cell lung cancer NOS, and 15% other or unknown histology. The median tumor size was 3 cm with an interquartile range from 1.7 to 4.2 cm. The clinical stage distribution was 34% I, 4.5% II, 15.9% III, and 31.8% IV. Conclusions: In this selective community-based cohort, USPSTF 2021 criteria identified a higher percentage of subjects with lung cancer and were more inclusive of women and minorities compared to USPSTF 2013 criteria.
Biomarker testing patterns and identification of barriers to testing for homologous recombination deficiencies across four advanced-stage solid tumors in a multicommunity practice setting.
Authors: Goldfarb Scott D. , McLaurin Kimmie K. , McAneny Barbara L. , Shetty Veena , Engstrom-Melnyk Julia , Black Christopher M.
Published: September 2021

16

Background: Opportunities have increased for diagnostic test results to affect treatment choice in tumor types with homologous recombination deficiencies. According to NCCN Guidelines, biomarker testing has the potential to identify patients eligible for targeted treatment such as PARP inhibitors. Methods: We conducted a noninterventional, mixed-methods cohort study to evaluate biomarker testing concordant with NCCN guidelines in 2018-19. Starting with an abstraction of structured and unstructured data from electronic health records, a cohort of 300 patients newly diagnosed with advanced ovarian cancer (aOC), HER2-negative metastatic breast cancer (MBC), metastatic pancreatic cancer (mPaC), and metastatic prostate cancer (mPC) was selected in reverse chronological order of diagnosis date, proportionately distributed from the NCCA (National Cancer Care Alliance, LLC) network. Outcomes included: proportion of patients who completed biomarker testing (defined as at least BRCA1/2 testing), time from diagnosis to test order, and time from test order to results. For patients that did not receive a biomarker test, the treating physicians were sent questionnaires to capture reasons for not ordering or for non-completion of biomarker testing. Results: Patients were identified at 10 practices from 8 states (CA, ME, NM, NY, OH, TX, UT, VT) in 2018 (N=86) and 2019 (N=214). The most commonly used tests were germline only (47%-66%), followed by tissue for multiple genes (18%-40%). Ovarian cancer had the highest completion of biomarker testing (Table). For HER2-negative MBC, the completion rate of BRCA testing was 85% for triple-negative disease and 55% for hormone receptor-positive disease. All questionnaires were completed (N=85); the most common reasons identified as barriers to testing were no perceived need or clinical benefit (42%), biomarker tests considered for a later date depending on patient’s response to treatment (14%), lack of a standard practice or guidance for biomarker testing at the practice (14%), and reimbursement for genetic counseling (12%). Conclusions: Biomarker workup was completed for the majority of patients. Given the first FDA approval of a PARP inhibitor was for aOC in 2014, biomarker testing rates and timing may naturally improve for more recent approvals such as mPC (2020). Evaluation of long-term trends for adherence to NCCN biomarker testing recommendations on the impact to patient outcomes is warranted. [Table: see text]
Leveraging social determinants of health to reduce hospital length of stay: A pilot quality improvement project to address inpatient cancer patients' barriers during the COVID 19 pandemic.
Authors: Kamaraju Sailaja , Atkinson Dave , Wetzel Thomas , Wright Tamiah , Charlson John A. , Cadman Jennifer , Campbell Grace , Power Steve
Published: September 2021

233

Background: Prior reports from our institution demonstrated high rates of racial segregation, unfavorable social determinants of health (SDoH) in Milwaukee, WI, and statewide reports of inferior outcomes for cancer patients from minority communities. At the Medical College of Wisconsin's Cancer Center (Milwaukee, WI), during the first through last quarters of 2018-2019, cancer patients from the low socioeconomic status (SES) communities who were hospitalized to inpatient oncology units had an average length of stay (LOS) of 7.2 days compared to 5.6 days for high SES group. Under the auspices of the American Society of Clinical Oncology's Quality Training Program (QTP) initiative, we aimed to reduce the hospital LOS by 10% or less by May 2021 for inpatient oncology teams. Methods: A multidisciplinary team collaboration between the inpatient and outpatient providers was developed during this QI initiative. We examined LOS index data, payer types, and other diagnostic criteria for the oncology inpatient solid tumor service and two comparator services (bone marrow transplant, BMT; internal medicine). We generated workflow, a cause-and-effect diagram, and a Pareto diagram to determine the relevant factors associated with longer hospital LOS. Institution-wide implementation of the SDH screen project was launched to evaluate and address specific barriers to SDoH to expedite a safe discharge process during the pandemic. Results: Through one test of change (Plan-Do-Study-Act cycles 1, 2 &3), we identified the problem of extended LOS and patient-related barriers to discharge during this QI initiative. Compared to the baseline LOS, after the launch of the SDoH screen project, there was a 6.5% decrease in the inpatient average LOS for oncology patients (7.89 to 7.40days, p = 0.004),10.7% for BMT (15.96 days to14.26, p = 0.166), and 2.4% for Internal Medicine (4.61 to 4.50 to days, p = 0.131). There was a 10.0% decrease in LOS (8.07 to 7.26 days, p = < 0.001) for the three specialties combined. With collaboration from inpatient and outpatient providers, appropriate referrals were generated to address patient-specific SDH before discharge (i.e., transportation coordination, nutritional and physical therapy referrals, social worker assistance with food, and housing insecurities). Conclusions: In this pilot project, implementing SDoH screening-based-care delivery at the time of inpatient admission demonstrated a slight improvement in LOS for solid tumor oncology patients and provided timely referrals, opportunities to engage and explore the discharge facilities early on during the COVID 19 pandemic. With this preliminary data, we plan to continue to expand our efforts through a systemwide implementation of this SDoH survey both in the inpatient and outpatient settings to address cancer inequities.
Adoption of immune checkpoint inhibitors (ICI) for unresectable locally advanced or metastatic urothelial carcinoma (u/mUC): A retrospective assessment of community oncology practices.
Authors: Aguilar Kathleen M. , Grivas Petros , Seal Brian S. , Robert Nicholas J. , Davies Kalatu , Fleming Mark T.
Published: September 2021

293

Background: ICI approval provided new treatment options for patients (pts) with u/mUC. We aimed to assess the adoption of ICI and describe 1L treatment patterns in the US community oncology setting. We hypothesized that most pts would receive ICI either as first- (1L) or second- line (2L) treatment given their FDA approval indications within the study period. Methods: This was a retrospective study of all study-eligible adult pts with u/mUC who initiated 1L treatment between 5/1/16 – 11/30/18 within The US Oncology Network. Data were sourced from structured and unstructured electronic health record data through 5/31/19 and assessed descriptively. Results: Among 750 eligible pts, 327 received 1L ICI (median age 74, 72.5% men, 77.1% white, 27.2% never smokers, 63.6% Eastern Cooperative Oncology Group performance status (ECOG PS] score of 0/1) and 423 1L non-ICI agents (median age 72, 74.0% men, 84.2% white, 26.0% never smokers, 60.5% ECOG PS score of 0/1). The most common treatment sequences were 1L ICI or 1L non-ICI without 2L treatment (n = 301 [40.1%] and n = 197 [26.3%], respectively), followed by 1L non-ICI and 2L ICI (n = 176, 23.5%). Platinum-based chemotherapy was the most common non-ICI therapy. Among a subset of patients randomly selected for chart review who received 1L ICI (n = 70), the most common reasons for 1L discontinuation were death (22.9%), transition to hospice (21.4%) and disease progression (11.4%). In contrast, the most common reason for 1L discontinuation among patients who received 1L non-ICI therapy selected for chart review (n = 133) were toxicity (27.8%), disease progression (22.6%) and completion of planned treatment (19.5%). Conclusions: As a retrospective observational study, limitations include lack of randomization, missing data, selection bias and unmeasured confounders. The high proportion of pts who received ICI during this period suggests enthusiasm for new therapies with less toxicity than chemotherapy. Nonetheless, the high attrition across treatment lines indicates an unmet need for tolerable and effective 1L u/mUC therapies, including switch maintenance ICI, which recently emerged as the new standard of care with level I evidence. Further investigation is needed to understand factors considered by pts and providers when determining treatment, as well as prognostic and predictive biomarkers.
Experienced quality of care and emotional functioning of patients with advanced cancer and their relatives: Results of a multicenter observational cohort study (eQuiPe).
Authors: van Roij Janneke , Raijmakers Natasja , Ham Laurien , van den Beuken-van Everdingen Marieke , van den Borne Ben , Creemers Geert-Jan , Hunting Jarno Cornelis , Kuip Evelien , van Leeuwen Lobke , Van Laarhoven Hanneke W.M. , Mandigers Caroline M. , Nieboer Peter , van der Velden Lilly-Ann , Van Zuijlen Cornelia , Gelissen John , Zijlstra Myrte , Brom Linda , Fransen Heidi , van de Poll-Franse Lonneke V ,   eQuipe Study Group
Published: September 2021

3

Background: Previous studies on experienced quality of care and quality of life have not addressed the reciprocal relation between patients and their relatives. For the first time we were able to include almost 700 couples (patient – relative) in a palliative oncological care context. This study aims to assess the experienced quality of care and emotional functioning (EF) of patients with advanced cancer and their relatives, including their reciprocal relation by using a dyadic approach. Methods: A prospective multicentre observational study among patients with advanced cancer and their relatives, recruited from 40 hospitals in the Netherlands or self-enrolled between November 2017 and January 2020 (eQuiPe study). Patients with metastatic cancer and their relatives were eligible to participate. Respondents completed a questionnaire and clinical data of the patient were obtained by linking the information to the Netherlands Cancer Registry (NCR). Logistic regression analyses were performed on baseline data of 1,103 patients and 831 relatives to assess the association between experienced quality of care and EF of patients and relatives separately and across dyads. Results: In total, 1,103 (65%) patients and 831 (71%) relatives completed the baseline questionnaire, including 699 unique patient-relative couples. Patients experienced lower levels of quality of life, including EF, and more symptoms compared to the normative population ( p<.001). Relatives reported even clinically relevantly lower EF compared to patients (69 vs. 78, p<.001) and were less satisfied with care (59 vs. 74; p<.001). Being more satisfied with care in general ( p<.05) and clarity about who their central health care professional ( p<.05) were positively associated with high EF in patients. For relatives, perceived continuity of care ( p<.01) and continuity of information for the patient ( p<.05) were positively associated with high EF. Dyadic analyses showed that EF of patients ( p<.001) and relatives ( p<.001) was positively associated with EF of the other person and perceived continuity of care by relatives was positively associated with high EF in patients ( p<.01). Conclusions: Experienced integral organisation and satisfaction with care in patients and relatives are related to their EF. The additional reciprocal relation between patients’ and their relatives’ EF and the experienced continuity of care suggests the opportunity for a family‐centered approach to optimize advanced cancer care.
Descriptive analysis of MRI functional changes occurring during reduced dose radiotherapy for myxoid liposarcomas
Authors: Kousi Evanthia , Messiou Christina , Miah Aisha , Orton Matthew , Haas Rick , Thway Khin , Hopkinson Georgina , Zaidi Shane , Smith Myles , Barquin Elizabeth , Moskovic Eleanor , Fotiadis Nicos , Strauss Dirk , Hayes Andrew , Schmidt Maria A
Published: September 2021

Objectives:

Myxoid liposarcomas (MLS) show enhanced response to radiotherapy due to their distinctive vascular pattern and therefore could be effectively treated with lower radiation doses. This is a descriptive study to explore the use of functional MRI to identify response in a uniform cohort of MLS patients treated with reduced dose radiotherapy

Methods:

10 patients with MLS were imaged pre-, during, and post-radiotherapy receiving reduced dose radiotherapy and the response to treatment was histopathologically assessed post-radiotherapy. Apparent diffusion coefficient (ADC), T2* relaxation time, volume transfer constant (Ktrans), initial area under the gadolinium curve over 60 s (IAUGC60) and (Gd) were estimated for a central tumour volume.

Results:

All parameters showed large inter- and intrasubject variabilities. Pre-treatment (Gd), IAUGC60 and Ktrans were significantly different between responders and non-responders. Post-radiotherapy reductions from baseline were demonstrated for T2*, (Gd), IAUGC60 and Ktrans for responders. No statistically significant ADC differences were demonstrated between the two response groups. Significantly greater early tumour volume reductions were observed for responders.

Conclusions:

MLS are heterogenous lesions, characterised by a slow gradual contrast-agent uptake. Pre-treatment vascular parameters, early changes to tumour volume, vascular parameters and T2* have potential in identifying response to treatment. The delayed (Gd) is a suitable descriptive parameter, relying simply on T1 measurements. Volume changes precede changes in MLS functionality and could be used to identify early response.

Advances in knowledge:

MLS are are characterised by slow gradual contrast-agent uptake. Measurement of the delayed contrast-agent uptake (Gd) is simple to implement and able to discriminate response.
Flow cytometry of bone marrow aspirates from neuroblastoma patients is a highly sensitive technique for quantification of low-level neuroblastoma
Authors: Jain Neha , Sattar Shaista , Inglott Sarah , Burchill Susan , Fisher Jonathan , Serban Andreea-Madalina , Thomas Rebecca , Connor Chris , Ghara Niharendu , Chowdhury Tanzina , Duncan Catriona , Barone Giuseppe , Anderson John
Published: September 2021

Background: Bone marrow involvement is an important aspect of determining staging of disease and treatment for childhood neuroblastoma. Current standard of care relies on microscopic examination of bone marrow trephine biopsies and aspirates respectively, to define involvement. Flow cytometric analysis of disaggregated tumour cells, when using a panel of neuroblastoma specific markers, allows for potentially less subjective determination of the presence of tumour cells.

Methods: A retrospective review of sequential bone marrow trephine biopsies and aspirates, performed at Great Ormond Street Hospital, London, between the years 2015 and 2018, was performed to assess whether the addition of flow cytometric analysis to these standard of care methods provided concordant or additional information.

Results: There was good concurrence between all three methods for negative results 216/302 (72%). Positive results had a concordance of 52/86 (61%), comparing samples positive by flow cytometry and positive by either or both cytology and histology.  Of the remaining samples, 20/86 (23%) were positive by either or both cytology and histology, but negative by flow cytometry. Whereas 14/86 (16%) of samples were positive only by flow cytometry.

Conclusions: Our review highlights the ongoing importance of expert cytological and histological assessment of bone marrow results. Flow cytometry is an objective, quantitative method to assess the level of bone marrow disease in aspirates.  In this study, flow cytometry identified low-level residual disease that was not detected by cytology or histology. The clinical significance of this low-level disease warrants further investigation.
Case Report: Pseudomonas can take a toll on a patient
Authors: Buchbinder David K. , Singh Jasjit , Dao Tuan , Sassoon Aaron , Arrieta Antonio
Published: September 2021

Pseudomonas aeruginosa (P. aeruginosa) is an aerobic Gram-negative bacterium that is implicated in the development of severe systemic infections among pediatric patients.  It is identified in hospitalized chronically ill pediatric patients in association with genitourinary, respiratory tract, and skin or soft tissue infections as well as severe and life-threating infection including sepsis.  A variety of immunologic mechanisms play a vital role in the host defense mechanisms against invasive infections with P. aeruginosa. Rarely, specific inborn errors of immune function are implicated in deficiencies that predispose to invasive infections with P. aeruginosa.  Innate immune function including germ-line encoded pattern recognition receptors such as toll-like receptors (TLRs) and their downstream signaling is vital in the host defense against P. aeruginosa through the generation of antimicrobial peptides, cytokines/chemokines, and shaping of adaptive immune responses. Herein, we describe a previously healthy two-year-old female with an invasive skin, soft tissue, and central nervous system infection secondary to P. aeruginosa.  The invasive nature of this infection prompted a careful evaluation for an inborn error of immunity. Decreased cytokine response to agonists of TLRs was documented. Targeted sequencing of interleukin-1 receptor-associated kinase (IRAK)-4 documented a homozygous deletion of exons 8-13 consistent with IRAK-4 deficiency.  This report provides a vital educative message in the existing scientific literature by underscoring the importance of considering inborn errors of immunity in all patients with severe P. aeruginosa infections.  Functional assessments of immune function often in combination with sequencing can accurately assign a diagnosis in a timely fashion allowing for definitive treatment and the use of necessary supportive care.
Risk factors and hematological profile associated with colic in Delman horses in Gresik, Indonesia
Authors: Purnama Muhammad Thohawi Elziyad , Hendrawan Dodit , Wicaksono Arya Pradana , Fikri Faisal , Purnomo Agus , Chhetri Shekhar
Published: September 2021

Background: Horses are herd animals that have been domesticated in the last century. In several countries, an overview of risk factors and clinical evaluation in horses with colic has not been well‐described. This study aimed to evaluate risk factors and hematological profiles in horses associated with colic in Gresik, East Java, Indonesia.

Methods: A cross-sectional study was performed during April - October 2019. A total of 115 horses were diagnosed based on physical examination, clinical symptoms, and rectal examination. A questionnaire was asked to the horse-owners to analyze the risk factors while the clinical examination was performed and blood samples were collected for pre-treatment and 14 days post-treatment. Hematological profile was evaluated from a whole blood sample. Serum cortisol, plasma epinephrine, and norepinephrine concentrations were also evaluated after separating the aliquots. 

Results: Of the 115 horses, 96 were diagnosed with colic. The horses with colic showed a significant association between cases with gender (p<0.021), breed (p<0.000), wheat bran feeding (p<0.015), concentrate feeding (p<0.003), anthelmintics administration (p<0.000), gastrointestinal parasites (p<0.000), dental diseases (p<0.024), previous exposure to colic (p<0.000), body condition score (p<0.000), and access to water per day (p<0.000). Based on whole blood and serum evaluation, there were ameliorated significantly on the hematological profile (p<0.01), serum cortisol (p<0.05), and plasma epinephrine (p<0.01) at 14 days post-treatment.

Conclusion: This study has identified factors associated with colic in Delman horses. The study provides crucial information to investigate cases of colic and to contribute the development of healthcare strategies during treatment and clinical evaluation.
The Wessex Fit-4-Cancer Surgery Trial (WesFit): a protocol for a factorial-design, pragmatic randomised-controlled trial investigating the effects of a multi-modal prehabilitation programme in patients undergoing elective major intra–cavity cancer surgery
Authors: West Malcolm , Bates Andrew , Grimmett Chloe , Allen Cait , Green Richard , Hawkins Lesley , Moyses Helen , Leggett Samantha , Z H Levett Denny , Rickard Sally , Varkonyi-Sepp Judit , Williams Fran , Wootton Stephen , Hayes Matthew , P W Grocott Micheal , Jack Sandy
Published: September 2021

Background: Surgical resection remains the primary curative treatment for intra-cavity cancer. Low physical fitness and psychological factors such as depression are predictive of post–operative morbidity, mortality and length of hospital stay. Prolonged post-operative morbidity is associated with persistently elevated risk of premature death. We aim to investigate whether a structured, responsive exercise training programme, a psychological support programme or combined exercise and psychological support, delivered between treatment decision and major intra-cavity surgery for cancer, can reduce length of hospital stay, compared with standard care.

Methods: WesFit is a pragmatic, 2x2 factorial-design, multi-centre, randomised-controlled trial, with planned recruitment of N=1560. Participants will be randomised to one of four groups. Group 1 (control) will receive usual pre-operative care, Group 2 (exercise) patients will undergo 2/3 aerobic, high-intensity interval training sessions per week supervised by personal trainers. Group 3 (psychological support) patients are offered 1 session per week at a local cancer support centre. Group 4 will receive both exercise and psychological support. All patients undergo baseline and pre-operative cardiopulmonary exercise testing, complete self-report questionnaires and will be followed up at 30 days, 12 weeks and 12 months post-operatively. Primary outcome is post-operative length-of-stay. Secondary outcomes include disability-adjusted survival at 1-year postoperatively, post-operative morbidity, and health-related quality of life. Exploratory investigations include objectively measured changes in physical fitness assessed by cardiopulmonary exercise test, disease-free and overall mortality at 1-year postoperatively, longer-term physical activity behaviour change, pre-operative radiological tumour regression, pathological tumour regression, pre and post-operative body composition analysis, health economics analysis and nutritional characterisation and its relationship to post-operative outcome.

Conclusions: The WesFit trial will be the first randomised controlled study investigating whether an exercise training programme +/- psychological intervention results in improvements in clinical and patient reported outcomes in patients undergoing major inter-cavity resection of cancer.

ClinicalTrials.gov registration: NCT03509428 (26/04/2018)
The accuracy of Infrared sensor detection in a smart toilet
Authors: Lokman Amar , Rajendran Kirenraj , Ramasamy R Kanesaraj
Published: September 2021

Background: Infrared (IR) sensors are useful tools for detecting distance and proximity. However, these sensors are not good at detecting edges of an area, therefore when used in a smart toilet it has difficulty in detecting the orientation and position of the user’s body. The aim of this study was to design an IR sensor for a smart toilet with a more accurate and consistent detection. 

Methods: A total of 12(six men and six women) participants with different body types were involved in this study. IR sensor detection was tested in the sitting and squatting toilets. For the best accuracy, the  IR sensor's angle was measured. Red, blue, and red-blue plastic covers were used, as these colors improve precision. The microcontroller was  set up to calculate the participant’s distance and presence in the cubicle.   

Results:  Toilet positioning varied greatly depending on whether one is sitting or squatting. For sitting

toilet, the red cover was close to the accurate distance at a 172˚ angle. IR detected a man but not a woman's body. The blue cover provided the same best angle of 172˚ with a higher sensor distance. When the red and blue cover combination was applied, the reading of 141cm detected both men and women, at 172˚ 

angle. The actual distance for squatting toilets  was 158cm. The optimal angle for both red and blue covers was 176˚, however the sensor distance was greater for the blue cover. Finally, the red and blue cover combination gave a more accurate distance of up to 163cm from the actual reading, when detecting both genders at a normal angle of 76˚. 

Conclusion: The combination of red and blue cover gave the most accurate detection for the squatting and sitting toilets. The best angle for sitting was 172˚, and for squatting was 176˚.
Theoretical foundations of commodity science
Authors: Nikolaeva Mariya
Published: September 2021

The textbook reveals the basic concepts of commodity science, objects, subjects and methods of commodity science activity; the factors that ensure the formation and preservation of commodity characteristics are considered. Special attention is paid to the means of information about the product: accompanying documents and labeling, including information signs. For students studying in the specialties "Commerce" and "Commodity Science and examination of goods", as well as for students of the system of advanced training of trade workers and practitioners whose activities are related to commodity science and examination of goods.
Justice and equity
Authors: Kleandrov Mihail
Published: September 2021

The monograph examines the fundamental problems of justice from the point of view of the need to ensure organizational and legal means of justice in judicial activity. The problems of philosophical, legal and other approaches to understanding justice and the mechanism of justice are studied; the problems of justice in the system of current legislation, including in the conditions of uncertainty of legal norms, within the framework of judicial discretion, in judicial law - making and rule — making; the problems of evidence in court proceedings; the problems of fair justice in extreme conditions of the coronavirus pandemic; as a vector of the future-the problems of justice carried out by artificial intelligence; the problem of justice of the death sentence. Proposals aimed at improving the mechanism of fair justice are being made.
For employees of legislative, judicial and law enforcement agencies, active judges and those who want to become them, scientists, teachers, graduate students and law students, as well as for practicing lawyers.
A three solutions theorem for Pucci's extremal operator and its application
Authors: Mallick Mohan , Verma Ram Baran
Published: September 2021

In this article we prove a three solution type theorem for the following boundary value problem: \begin{equation*} \label{abs} \begin{cases} -\mathcal{M}_{\lambda,\Lambda}^+(D^2u) =f(u)& \text{in }\Omega,\\ u =0& \text{on }\partial\Omega, \end{cases} \end{equation*} where $\Omega$ is a bounded smooth domain in $\mathbb{R}^N$ and $f\colon [0,\infty]\to[0,\infty]$ is a $C^{\alpha}$ function. This is motivated by the work of Amann \cite{aman} and Shivaji \cite{shivaji1987remark}, where a three solutions theorem has been established for the Laplace operator. Furthermore, using this result we show the existence of three positive solutions to above boundary value by explicitly constructing two ordered pairs of sub and supersolutions when $f$ has a sublinear growth and $f(0)=0.$
Noteworthy records of abnormal coloration in Mexican bats
Authors: Aguilar-López Melany , Aguilar-Rodríguez Pedro Adrián , Cruzado-Cortés Juan , MacSwiney G. M. Cristina , Ortega Jorge
Published: September 2021

La coloración atípica permanente en mamíferos puede ocurrir por una condición congénita o por causas ambientales, pero se expresa por defectos en el número o función de los melanocitos (células productoras de melanina). Alrededor del mundo, se han reportado murciélagos con coloración anormal en la piel, pero en México se conocen pocos casos. Aquí, presentamos registros de trastornos cromáticos en varias especies capturadas en diferentes lugares de México. Los murciélagos fueron capturados con redes de niebla afuera de los sitios de percha o en senderos con vegetación. Todos los individuos fueron liberados en el sitio de captura. Registramos 9 individuos de la familia Phyllostomidae y 3 de Molossidae con trastornos cromáticos: 11 individuos con manchas blancas y 1 con albinismo. El fenotipo de manchas blancas se reporta por primera vez en Mimon cozumelae y el primer registro para Leptonycteris yerbabuenae y Nyctinomops laticaudatus en México. Los registros de individuos con trastornos pigmentarios son raros en la naturaleza, e informar la ocurrencia de estos eventos en murciélagos aumenta el conocimiento de la historia natural de las especies.