bluuebunny/crossref_metadata_2025 huggingface dataset:
The global economic burden of violent conflict
Authors: de Groot Olaf J , Bozzoli Carlos , Alamir Anousheh , Brück Tilman
Published: February 2022

Calculating the consequences of global public bads such as climate change or pandemics helps uncover the scale, distribution and structure of their economic burdens. As violent conflict affects billions of people worldwide, whether directly or indirectly, this article sets out to estimate its global macro-economic repercussions. Using a novel methodology that accounts for multiple dimensions of war, the article finds that, in the absence of violent conflict since 1970, the level of global GDP in 2014 would have been, on average, 12% higher. When disaggregating these results by conflict type, civil conflicts are estimated to have been the costliest by far. Income growth is found to be altered up to four years following the end of a conflict, although the direction of this relationship depends on the intensity and type of conflict. Countries also suffer significantly from fighting in neighbouring countries, thereby showing the importance of mitigating spillovers rapidly. The largest absolute losses associated with violence emanate from Asia, while many high-income economies are found to benefit economically from participating in conflicts on foreign soil. This analysis thus shows that, despite some evidence of a faster post-conflict growth and possible benefits for external participants, violent conflict leads to net global losses that linger long after peace is achieved, reducing the peace dividend. The article concludes by discussing public policy options to strengthen the benefits of peace as a global public good.
Military Responses to the COVID-19 Pandemic Crisis in Latin America: Military Presence, Autonomy, and Human Rights Violations
Authors: Acacio Igor , Passos Anaís M. , Pion-Berlin David
Published: February 2022

The military in Latin America has been extensively involved in pandemic relief operations. This paper analyses the impact of militarization of pandemic relief operations on human rights. It argues that not all militarization is equally harmful to individuals in the region. When troops assume responsibilities regarding medical care and logistical support, human rights violations do not follow. When involved in policing the stay-at-home orders, the extent of human rights violations is explained by the level of operational autonomy the military has in public security operations. The more autonomous the military, more likely abuses are to occur. Additionally, military exposure to judicial prosecution for human rights offenses contributes to the explanation. After gathering original empirical evidence from 14 Latin American democracies on military presence in pandemic relief, we draw our inferences from process tracing on four comparative case studies of Argentina, Brazil, Chile, and El Salvador.
BIM–LCCA Integration for Road Pavement Maintenance
Authors: Oreto Cristina , Biancardo Salvatore Antonio , Veropalumbo Rosa , Viscione Nunzio , Russo Francesca , Dell’Acqua Gianluca
Published: February 2022

The use of building information modeling (BIM) for infrastructures is on the rise but the use of the life cycle cost analysis (LCCA) integrated within the BIM environment itself to analyze multiple design alternatives and set up a proper maintenance plan has not yet been developed. It is possible to integrate evaluation of maintenance and waste recovery strategies, minimizing costs and the use of raw materials. A visual programming tool was exploited to set up an application that applies the LCCA methodology to a road pavement project in the early design phase, returning the total maintenance cost updated to the year of construction, the number of maintenance interventions, and the residual value of accumulated fatigue damage. The execution of the LCCA tool dynamically updates the properties of the BIM model with the resulting pavement management plan and returns multiple outputs, giving to the user the possibility of making further assessments and store the data as needed. The developed application shows that BIM is a promising tool to implement more complex and useful analyses that can reduce the maintenance planning time and allow the designer to choose between multiple alternative solutions already in the early design phase, bringing consistent cost savings through the possibility of finding the minimum cost solution based on the specific project needs in compliance with the quality and safety criteria to be guaranteed for the road category.
Evaluation of animal toxicity studies with diisocyanates regarding presence of thresholds for induction and elicitation of respiratory allergy by quantitative weight of evidence
Authors: Dekant Wolfgang , Colnot Thomas
Published: February 2022

Animal toxicity studies on diisocyanates were evaluated using quantitative weight of evidence (QWoE) to test the hypothesis that the dose-response curve shows a threshold for the induction and/or elicitation of respiratory sensitization. A literature search identified 59 references that included at least two concentration groups of the diisocyanate and a vehicle-exposed concurrent control in the study design. These studies were subjected to a QWoE-assessment applying scoring criteria for quality and relevance/strength of effects relevant to the selected endpoint of respiratory sensitization. Overall, the studies assessing dose/concentration-response for diisocyanates with the endpoint, respiratory sensitization, were heterogenous regarding study design, animal models used, endpoints assessed, and quality. Only a limited number of the studies subjected to the QWoE-assessment allowed drawing conclusions about possible thresholds for respiratory sensitization. Highest quality and relevance/strength of effects scores were obtained by a series of studies specifically designed to investigate a potential threshold for elicitation of respiratory sensitization in the Brown Norway (BN) rat. These studies applied an elaborate study design to optimize induction of respiratory sensitization and reduce interference by respiratory tract irritation. In summary, the available studies provided moderate to good support for the existence of a threshold for elicitation and limited to moderate support for a threshold regarding induction of respiratory allergy by diisocyanates in experimental animals. However, a quantitative extrapolation of threshold values established in rodents to humans remains complex.
Shape recovery of polymers with inclusions under multi-axial stress
Authors: Liu Wenbo , Pochiraju Kishore
Published: February 2022

This paper presents a two-phase composite model for predicting the shape memory and recovery behaviors of polymeric and particle-loaded polymeric composite parts. The shape recovery behavior is simulated using a homogenized material model with the matrix exhibiting the strain storage behavior and the inclusions adding to the stiffness and conductivity of the material. An electrically conductive reinforcement in the matrix enabled the activation of shape recovery with Joule heating. The shape recovery model for the matrix is adapted from literature and extended to include a three-dimensional stress state. Inclusions are assumed linearly elastic, and the matrix is elastic at the low-temperature glassy phase and elastic-incompressible at the high-temperature rubbery phase. The incompressibility is modeled using a temperature-dependent Poisson’s ratio that approaches close to 0.5 for the rubbery phase. A methodology for characterizing model parameters from experimental observations of shape recovery is also discussed. Correlations with experimental observations calibrate the model as well as validate it. The formulated two-phase shape recovery model was implemented into the 3D nonlinear finite element analysis. Simulations of shape recovery arbitrarily shaped 3D parts under multi-axial stress states and thermo-mechanical loading cycles are described.
Disciplined Into Hiding: Milk Banking and the “Obscured Organization”
Authors: Jones Sarah E. , Tracy Sarah J.
Published: February 2022

Amid recent attention to nonprofit and voluntary organizing, empirical studies have largely focused on social capital functions, decision-making, and volunteer relationships, in contrast to missions or practices that are contested, controversial, or concealed. This study examines how nonprofit milk banks and online milksharing networks experience concealment in unique, unintentional ways. Using ethnographic fieldwork and discursive interviews, we analyze how Discourses of Filth, Suspicion, and (In)adequacy discipline members’ corporeality and participation in the milk banking/sharing industry such that concealment is enacted and enforced. The findings provide evidence for obscured organizations as a useful complement to hidden organizations by highlighting how organizations involved in body product exchange encounter unique symbolic, structural, and technical communication problems that bear community consequence. The results have implications not only for studying contemporary organizations, but also for theorizing hidden organizing and stigmatized membership.
Stingless bees (Hymenoptera: Apidae) in Holocene copal and Defaunation resin from Eastern Africa indicate Recent biodiversity change
Authors: Solórzano-Kraemer Mónica M , Kunz Robin , Hammel Jörg U , Peñalver Enrique , Delclòs Xavier , Engel Michael S
Published: February 2022

Although specimens in fossil to Recent resins are remarkable for their fidelity of preservation, amber is well known and studied, unlike the younger resins as Pleistocene copal (2.58–0.0117 Ma) and Holocene copal (0.0117 Ma–1760 AD), or Defaunation resin, which is resin produced after 1760 AD. However, the scientific relevance of these younger resins preserving arthropods that lived in pre-Anthropocene time is often underestimated. Here, we present specimens of workers of stingless bees included in copal and Defaunation resin, from the coastal vichaka forests in Tanzania, and from northwest Madagascar, ranging in age from almost 3000 BP years to only 80 ± 30 BP years and from 2015, respectively. Three known species Hypotrigona gribodoi, Liotrigona bouyssoui, and Liotrigona nilssoni and two new species Axestotrigona kitingae sp. nov. and Hypotrigona kleineri sp. nov. have been discovered from 36 studied specimens. We also noted that the holotype of Trigona richardsi is a junior subjective synonym of Axestotrigona ferruginea ferruginea. The coastal forests in the East Africa region and in East Madagascar are now highly fragmented so that we can expect that the new species are already extinct. Here we demonstrate that the study of inclusions in copal and Defaunation resin can document losses of local biodiversity resulting, for example, from deforestation and they also bring proof of this potential anthropic defaunation.
Adoption of Technology Applications in Organized Retail Outlets in India:A TOE Model
Authors: Kumar Anil , Singh Rohit Kumar , Swain Swapnarag
Published: February 2022

Purpose:

The major intent of this study is to empirically explore the technology–organization–environment (TOE) factors that influence retail outlets’ adoption of technology applications in India.

Methodology:

In line with the objectives of the study, a conceptual model based on the TOE framework was proposed. A quantitative survey was conducted with organized retail outlets in Madhya Pradesh, India to validate the proposed model. The survey generated 134 valid responses. Partial least squares-structural equation modeling (PLS-SEM) was used to assess the research model.

Findings:

The findings elucidated that factors of the TOE framework significantly influence the technology adoption intention in the organized retail sector. It could be recommended that this framework is a robust instrument to envisage the adoption of technology applications in the retail sector.

Research implications:

The conceptual framework can be used by the retail sector in framing strategies for marketing that can enhance their potential customer base. It can also help to formulate policies which can act as a catalyst in adopting the technology applications.

Practical implications:

Retail vendors can use this model to increase their prospective customer base.

Originality:

The research contributes to the diversifying academic literature on technology application adoption by using factors within the TOE framework to explain organized retail outlets’ intention to adopt such technologies.
The Online Strength-Informed Acceptance and Commitment Therapy Among COVID-19-Affected Adolescents
Authors: Duan Wenjie , Kong Yansi , Bu He , Guan Qiujie , Chen Zheng , Luo Qiansheng , Zhang Jing
Published: February 2022

Purpose: This study develops and investigates the changes in anxiety symptoms and quality of life (QoL) among participants of the online Strength-informed Acceptance and Commitment Therapy (SACT) across three tests. Methods: A small-scale, quasi-experiment with no control group was conducted. Repeated-measures analysis was employed to assess the changes of the three tests, which were the pre-experimental, post-test, and 3-month follow-up test. A total of 47 adolescents (ages 10–12) completed the 45-min intervention that lasted 10 weeks. Results: Compared with the pre-experimental, the post-test indicated significant anxiety symptoms reduction but not a statistically significant increase in QoL. The 3-month follow-up test indicated reduced anxiety symptoms and improved QoL compared with the pre-experimental. The with-in subject changes were substantial. Conclusions: The online SACT is a promising model to reduce anxiety symptoms and promote QoL among adolescents during the current COVID-19 pandemic, which show both short- and long-term benefit to the participants.
Evaluating Interdependence in Workgroups: A Network-Based Method
Authors: Griffin Daniel J. , Somaraju Ajay V. , Dishop Christopher , DeShon Richard P.
Published: February 2022

Interdependence is a defining characteristic of groups and teams. However, a vast range of constructs and conceptualizations for interdependence has left researchers with a dizzying array of frameworks, metrics, and perspectives with which to evaluate interdependence. This situation leaves researchers with little guidance on how to theorize about or measure interdependence. As a solution, we propose a network-based perspective of interdependence. This network-based framework moves beyond network approaches to understanding interdependence that have been proposed in the past in three ways. First, this framework is applied generally to interdependence and not to an isolated form of interdependence. Second, building on previous network-based perspectives of interdependence, we present a procedure to conceptualize a team's interdependent relationships in terms of networks. Third, we utilize the network perspective to present a standardized index of interdependence. Using illustrative examples, we demonstrate the utility of this network-based approach and present various recommendations discussing how these approaches advance the study of interdependence.
Reformingsuo tempore: Exploring the unintended consequences of the European Union’s ‘reform actorness’
Authors: Blavoukos Spyros , Oikonomou Giorgio
Published: February 2022

The European Union is broadly considered a benign reform actor, encouraging and supporting reforms in member states and beyond. However, European Union-induced reforms do not only generate the intended effects; they can also trigger unintended consequences for other reforms. These unintended consequences occur primarily through the impact of European Union-induced reforms on the resources available. The scope and size of the unintended effects will be conditioned by the domestic cycles in economic and public policy-making. Here, we apply our analytical framework to study the resilience of governance reforms in Greece during the period of fiscal consolidation (2010–2015), highlighting the unintended consequences of the European Union’s ‘reform actorness’. We find that the distinction between financial and non-financial resources is critical in unpacking the unintended consequences of any exogenously driven reform. Depending on the current stage in the cycles, the impact on non-financial resources can generate positive side-effects that help prevent other ongoing domestic reforms being derailed.
Rectal avulsion associated with complex open pelvic fracture following rollover injury
Authors: Ping Jen Jian , Addison Sarah , Amerasekera Steve
Published: February 2022

Background: We present a rare case of complete rectal avulsion from the external anal sphincter complex associated with unstable pelvic ring disruption, including spinopelvic dissociation, following rollover by tractor. In the context of major pelvic trauma, evaluating for unstable bony, acute vascular, urethral and bladder injuries is essential. However, a detailed search for anorectal injury is also required by the reporting radiologist. Case Report: In this case report we highlight specific pelvic floor anatomy on CT, with a focus on gross morphology and the presence of peri-rectal free gas as primary evidence for injury. Secondary radiological evidence which should trigger the search for anorectal injury includes bony posterior pelvic ring disruption (sacrum or coccyx fractures) or associated Morel-Lavallee lesions. Conclusion: The presence of radiological abnormality should prompt direct clinical inspection for corroboration. Early recognition is crucial for joint colorectal and orthopaedic management and the avoidance of delayed pelvic sepsis, which may become intractable.
Social access: role of digital media in social relations of young people with disabilities
Authors: Kaur Herminder , Saukko Paula
Published: February 2022

Digital media have enabled people with disabilities (PWDs) to connect with each other, but online relations and gaming have been found escapist. We propose the analytical lens of social access to examine how the role of digital media in PWDs’ social relations is shaped by (1) affordances of digital media, (2) mixedness of relations and (3) interaction of online and offline worlds. This article presents an ethnographic study in a school for young PWDs and highlights two observations. First, visual profiles on social media platforms could aggravate the social exclusion of young PWDs online and offline, marked by intra-disability and intersectional differences. Second, the co-presence afforded by digital media enabled young PWDs to resort to digital interactions in unwelcoming offline environments without changing the latter. Social access underlines the importance of studying how digital media interweave with offline social relations and inequalities, rarely altering but sometimes augmenting and ameliorating them.
“Authentic” digital inclusion? Dis/ability performances on social media by users with concealable communicative disabilities
Authors: Bitman Nomy
Published: February 2022

Despite the increased technical accessibility of social media, disabled users’ attempts to be socially included are still understudied. These users’ agency-based choices are impacted by constant able-bodied surveillance and disciplining, especially when it comes to dis/ability visibility and potential context collapse. This paper develops the concept of disability performance within social media studies, presenting a qualitative study of social media users with concealable communicative disabilities: autistics, hard-of-hearing and people who stutter. Four factors were found to shape users’ dis/ability performances: the use of social media interfaces for the compartmentalization of disabled identity; users’ continuous efforts to make their social environment inclusionary; the centrality of users’ disabled identity and intersectionality; and the design of the performance’s message. Together, these show disability performances to be deliberate expressions of agency on the part of vulnerable social media users, who perform dis/ability according to their own evaluation of authenticity to increase their social inclusion.
Tracking changes in tourism demand with point-of-sale data: The case of Portugal
Authors: Marques Carlos P , Guedes Alexandre S , Bento Ricardo
Published: February 2022

This study extends the literature on big data applied to tourism by validating the significance of point-of-sale (POS) electronic transactions, which have received little attention within tourism literature, as a reliable and effective alternative to surveys on guests stays at tourist accommodation establishments. Compared with official statistics on occupancy of tourist accommodation establishments, data on POS transactions tend to exhibit greater volatility and a less adverse year-on-year variation during the COVID-19 pandemic in Portugal. Still, both data sources reveal the same underlying trend. POS electronic payments, namely, at lodging establishments, deliver timely data for most municipalities in Portugal, filling in significant data gaps in many low-density areas, where statistical confidentiality is imposed in tourism indicators. This supports POS data’s effectiveness to analyse regional inequalities at the municipal level, allowing to gain a clearer understanding of the impacts of COVID-19 in domestic tourism.
Development of a clinician guide for electronic medication adherence products in older adults
Authors: Patel Tejal , Ivo Jessica , McDougall Aidan , Lee Catherine , Chang Feng , Bauer Jillian , Pritchard Sarah
Published: February 2022

Background/objectives:

The ability to manage medications independently may be affected in older adults due to physical and cognitive limitations. Numerous electronic medication adherence products (eMAPs) are available to aid medication management. Unfortunately, there are no available guidelines to support clinicians in recommending eMAPs. The objective of this study was to create and validate a clinician tool to guide use of eMAPs.

Methods:

Pharmacists who previously tested the usability of the eMAPs participated in a focus group to provide feedback on 5 metrics of the clinician guide: unassisted task completion, efficiency, usability, workload and an overall eMAP score. Participants were asked semistructured questions on how they would use the tool to inform recommendations of medication aids to patients. The discussions were audio-recorded and transcribed verbatim and qualitatively analyzed. The clinician guide was modified to reflect feedback.

Results:

Five pharmacists (80% female, mean years of practice: 15.8) participated in the focus group. The clinician guide was modified by removing 2 metrics and adding an additional 8 metrics: maximum number of alarms, number of days the product can accommodate for based on a daily dosing regimen, price, monthly subscription, portability, locking feature, average time to set the device and number of steps required to set the device. The definition and calculation for unassisted task completion were modified. Additional instructions and specific patient case examples were also included in the final clinician guide.

Conclusion:

Since significant variability exists between eMAPs, it is imperative to have a tool for frontline clinicians to use when appropriately recommending the use of these products for medication management in older adults.
Osteochondral Allograft for Unsalvageable Osteochondritis Dissecans in the Skeletally Immature Knee
Authors: Tisano Breann , Ellis Henry B. , Wyatt Chuck , Wilson Philip L.
Published: February 2022

Background:

While an excellent option for osteochondral defects in the adult knee, fresh osteochondral allograft (FOCA) in the skeletally immature adolescent knee has been infrequently studied.

Purpose:

To compare radiographic and patient-reported outcomes (PROs) in skeletally mature and immature adolescents after FOCA in the knee for treatment of unsalvageable osteochondritis dissecans (OCD).

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Included were 34 patients (37 knees) who underwent size-matched FOCA of the knee for unsalvageable OCD lesions. All patients were aged ≤19 years and had a minimum of 12 months of follow-up. Patient characteristics, lesion characteristics, reoperations, and PROs were evaluated and compared between patients with open physes (skeletally immature; n = 20) and those with closed physes (skeletally mature; n = 17). Graft failure was defined as the need for revision osteochondral grafting. Postoperative radiographs were analyzed at 1 year and the final follow-up for graft incorporation and classified as A (complete), B (≥50% healed), or C (<50% healed).

Results:

The mean patient age was 15.4 years (range, 9.6-17.6 years), and the mean follow-up was 2.1 years (range, 1-5.3 years). The mean graft size was 5.0 cm2 and did not differ significantly between the study groups. Patients with open physes were younger (14.7 vs 16.2 years; P = .002) and more commonly male (80% vs 35%; P = .008). At the 1-year follow-up, 85% of immature patients and 82% of mature patients had radiographic healing grades of A or B. Patients with open physes were more likely to achieve complete radiographic union at 1 year (65% vs 15%; P = .007) and demonstrated better Knee injury and Osteoarthritis Outcome Score (KOOS) Daily Living (96.8 vs 88.5; P = .04) and KOOS Quality of Life (87.0 vs 56.8; P = .01) at the final follow-up. Complications were no different in either group, and graft failure occurred in only 1 skeletally mature patient with a trochlear lesion.

Conclusion:

FOCA treatment for unsalvageable OCD in the young knee may be expected to yield excellent early results. Despite the presence of open physes and immature epiphyseal osteochondral anatomy, equivalent or improved healing and PRO scores compared with those of skeletally mature patients may be expected.
Oral anticoagulation versus antiplatelet therapy for secondary stroke prevention in patients with embolic stroke of undetermined source: A systematic review and meta-analysis
Authors: Hariharan Nikhil Nair , Patel Kashyap , Sikder Omaike , Perera Kanjana S , Diener Hans-Christoph , Hart Robert G , Eikelboom John W
Published: February 2022

Purpose

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of direct oral anticoagulation (DOAC) compared with antiplatelet therapy for secondary stroke prevention in adult patients with embolic stroke of undetermined source (ESUS).

Method

We searched major databases (Embase, MEDLINE, CINAHL, CENTRAL, and Web of Science) for RCTs published until March 2021. The primary outcome was recurrent stroke, and the main safety outcomes were major bleeding and clinically relevant non-major bleeding (CRNB). We assessed risk of bias using the Cochrane Risk of Bias tool. We used a random-effects model to determine pooled risk ratios and 95% confidence intervals in the datasets and key subgroups.

Findings

Our search identified two RCTs, involving a total of 12,603 patients with ESUS. Anticoagulation with dabigatran or rivaroxaban compared with aspirin did not reduce the risk of recurrent stroke (RR, 0.96 [0.76–1.20]) or increase major bleeding (RR, 1.77 [0.80–3.89]) but significantly increased the composite of major or clinically relevant non-major bleeding (RR, 1.57 [1.26–1.97]). Prespecified subgroup analysis demonstrated consistent results according to age and sex. Additional post-hoc subgroup analyses demonstrated consistent results according to prior stroke and presence of a patent foramen ovale but suggested that DOACs reduced recurrent stroke in patients with an estimated glomerular filtration rate (eGFR) <50 and 50-80 ml/min but not in those with eGFR >80 ml/min (interaction P = 0.0234).

Discussion/conclusion

Direct oral anticoagulations are not more effective than aspirin in preventing stroke recurrence in patients with ESUS and increase bleeding.

Registration

PROSPERO ID: CRD42019138593
Cerebral vasculature exhibits dose-dependent sensitivity to thrombocytopenia that is limited to fetal/neonatal life
Authors: Farley Alison M. , Dayton Merle , Biben Christine , Stonehouse Olivia , Terreaux Antoine , Taoudi Samir
Published: February 2022

Whether increasing platelet counts in fetal and neonatal alloimmune thrombocytopenia (FNAIT) is effective at preventing intracerebral hemorrhage (ICH) has been a subject of debate. The crux of the matter has been whether thrombocytopenia is the major driver of ICH in diseases such as FNAIT. We recently demonstrated in mice that severe thrombocytopenia was sufficient to drive ICH in utero and in early neonatal life. It remains unclear what degree of thrombocytopenia is required to drive ICH and for how long after birth thrombocytopenia can cause ICH. By inducing a thrombocytopenic range, we demonstrate that there is a large buffer zone of mild thrombocytopenia that does not result in ICH, that ICH becomes probabilistic at 40% of the normal platelet number, and that ICH becomes fully penetrant below 10% of the normal platelet number. We also demonstrate that although the neonatal mouse is susceptible to thrombocytopenia-induced ICH, this sensitivity is rapidly lost between postnatal days 7 and 14. These findings provide important insights into the risk of in utero ICH with varying degrees of thrombocytopenia and into defining the developmental high-risk period for thrombocytopenia-driven ICH in a mouse model of FNAIT.
Mapping the prothrombin-binding site of pseutarin C by site-directed PEGylation
Authors: Üstok Fatma Işık , Huntington James A.
Published: February 2022

The prothrombinase complex processes prothrombin to thrombin through sequential cleavage at Arg320 followed by Arg271 when cofactor, factor (f) Va, protease, fXa, and substrate, prothrombin, are all bound to the same membrane surface. In the absence of the membrane or cofactor, cleavage occurs in the opposite order. For the less favorable cleavage site at Arg320 to be cleaved first, it is thought that prothrombin docks on fVa in a way that presents Arg320 and hides Arg271 from the active site of fXa. Based on the crystal structure of the prothrombinase complex from the venom of the Australian eastern brown snake, pseutarin C, we modeled an initial prothrombin docking mode, which involved an interaction with discrete portions of the A1 and A2 domains of fV and the loop connecting the 2 domains, known as the a1-loop. We interrogated the proposed interface by site-directed PEGylation and by swapping the a1-loop in pseutarin C with that of human fV and fVIII and measuring the effect on rate and pathway of thrombin generation. PEGylation of residues within our proposed binding site greatly reduced the rate of thrombin generation, without affecting the pathway, whereas those outside the proposed interface had no effect. PEGylation of residues within the a1-loop also reduced the rate of thrombin generation. The sequence of the a1-loop was found to play a critical role in prothrombin binding and in the presentation of Arg320 for initial cleavage.
Vidarabine, an anti-herpes agent, prevents occlusal-disharmony-induced cardiac dysfunction in mice
Authors: Hayakawa Yoshio , Suita Kenji , Ohnuki Yoshiki , Mototani Yasumasa , Ishikawa Misao , Ito Aiko , Nariyama Megumi , Morii Akinaka , Kiyomoto Kenichi , Tsunoda Michinori , Matsuo Ichiro , Kawahara Hiroshi , Okumura Satoshi
Published: February 2022

We recently reported a positive relationship between occlusal disharmony and cardiovascular disease via activation of β-adrenergic signaling in mice. Furthermore, inhibition of type 5 adenylyl cyclase (AC5), a major cardiac subtype in adults, protects the heart against oxidative stress. Here, we examined the role of AC5 in the development of occlusal-disharmony-induced cardiovascular disease in bite-opening (BO) mice, prepared by cementing a suitable appliance onto the mandibular incisor. We first examined the effects of BO treatment on cardiac function in mice treated or not treated for 2 weeks with vidarabine, which we previously identified as an inhibitor of cardiac AC. Cardiac function was significantly decreased in the BO group compared to the control group, but vidarabine ameliorated the dysfunction. Cardiac fibrosis, myocyte apoptosis and myocyte oxidative DNA damage were significantly increased in the BO group, but vidarabine blocked these changes. The BO-induced cardiac dysfunction was associated with increased phospholamban phosphorylation at threonine-17 and serine-16, as well as increased activation of the Ca2+-calmodulin-dependent protein kinase II/receptor-interacting protein 3 signaling pathway. These data suggest that AC5 inhibition with vidarabine might be a new therapeutic approach for the treatment of cardiovascular disease associated with occlusal disharmony.
Examination of blood samples using deep learning and mobile microscopy
Authors: Pfeil Juliane , Nechyporenko Alina , Frohme Marcus , Hufert Frank T. , Schulze Katja
Published: February 2022

Background

Microscopic examination of human blood samples is an excellent opportunity to assess general health status and diagnose diseases. Conventional blood tests are performed in medical laboratories by specialized professionals and are time and labor intensive. The development of a point-of-care system based on a mobile microscope and powerful algorithms would be beneficial for providing care directly at the patient's bedside. For this purpose human blood samples were visualized using a low-cost mobile microscope, an ocular camera and a smartphone. Training and optimisation of different deep learning methods for instance segmentation are used to detect and count the different blood cells. The accuracy of the results is assessed using quantitative and qualitative evaluation standards.

Results

Instance segmentation models such as Mask R-CNN, Mask Scoring R-CNN, D2Det and YOLACT were trained and optimised for the detection and classification of all blood cell types. These networks were not designed to detect very small objects in large numbers, so extensive modifications were necessary. Thus, segmentation of all blood cell types and their classification was feasible with great accuracy: qualitatively evaluated, mean average precision of 0.57 and mean average recall of 0.61 are achieved for all blood cell types. Quantitatively, 93% of ground truth blood cells can be detected.

Conclusions

Mobile blood testing as a point-of-care system can be performed with diagnostic accuracy using deep learning methods. In the future, this application could enable very fast, cheap, location- and knowledge-independent patient care.
Whole-exome sequencing reveals a rare missense variant in DTNA in an Iranian pedigree with early-onset atrial fibrillation
Authors: Malakootian Mahshid , Jalilian Masoumeh , Kalayinia Samira , Hosseini Moghadam Maryam , Heidarali Mona , Haghjoo Majid
Published: February 2022

Atrial fibrillation (AF) is a morbid and heritable irregular cardiac rhythm that affects about 2%–3% of the population. Patients with early-onset AF have a strong genetic association with the disease; nonetheless, the exact underlying mechanisms need clarification. We herein present our evaluation of a 2-generation Iranian pedigree with early-onset AF. Whole-exome sequencing was applied to elucidate the genetic predisposition. Direct DNA sequencing was utilized to confirm and screen the variants in the proband and his available family members. The pathogenicity of the identified nucleotide variations was scrutinized via either segregation analysis in the family or in silico predictive software. The comprehensive variant analysis revealed a missense variant (c.G681C, p.E227D, rs1477078144) in the human α-dystrobrevin gene (DTNA), which is rare in genetic databases. Most in silico analyses have predicted this variant as a disease-causing variant, and the variant is co-segregated with the disease phenotype in the family. Previous studies have demonstrated the association between the DTNA gene and left ventricular noncompaction cardiomyopathy. Taken together, we provide the first evidence of an association between a nucleotide variation in the DTNA gene and early-onset AF in an Iranian family. However, the genetic testing of AF in the Iranian population is still limited. This finding not only further confirms the significant role of genetics in the incidence of early-onset AF but also expands the spectrum of the gene variations that lead to AF. Additionally, it may have further implications for the treatment and prevention of AF.
Safety and efficacy of non-fluoroscopic endoscopic dilatation of gastrointestinal tuberculosis related strictures
Authors: Kumar Pankaj , Jena Anuraag , Birda Chhagan Lal , Singh Harjeet , Gupta Pankaj , Prasad Kaushal Kishor , Dutta Usha , Sharma Vishal
Published: February 2022

Introduction

Stricturing gastrointestinal tuberculosis (GITB) may result in persistent symptoms even after antitubercular therapy (ATT) and may require surgical intervention. Data on efficacy and safety of endoscopic dilatation for management GITB related strictures is scarce.

Methods

A retrospective analysis of database of patients who underwent endoscopic balloon dilatation for suspected or proven gastrointestinal tuberculosis was performed. The analysis included the site of involvement, technical success, clinical success (response), relapse and requirement of surgery in these patients.

Results

Out of 34 patients (47.1% males, mean age 31.9 ± 12.9 years), eventually four patients were diagnosed to have Crohn’s disease while the rest had GITB. Initial technical success was achieved in 30 (88.2%) patients. Initial clinical success was achieved in 28 (82.3%) patients. Median number of dilatation sessions required to obtain symptomatic relief were 2.5 (1–5) per patient. Two patients with initial clinical success had recurrence of symptoms over follow up of 1 year, out of which one patient was managed with repeat endoscopic balloon dilatation successfully. Of 30 patients with technical success, 16 (53.4%) were on ATT when they underwent dilatation while two were in intestinal obstruction. Eventually 7 patients required surgical intervention for various reasons.

Conclusion

Non-fluoroscopic endoscopic balloon dilatation is an acceptable and fairly safe modality for symptomatic tuberculous strictures of gastrointestinal tract.
The Hyperdense middle cerebral artery sign is associated with poor leptomeningeal collaterals in acute ischemic stroke: a retrospective study
Authors: Hong Ye , Fang Jinghuan , Ma Mengmeng , Su Wei , Zhou Muke , Tang Li , Tang Huairong , He Li
Published: February 2022

Background

The hyperdense middle cerebral artery sign (HMCAS) is an early radiological marker to provide an early diagnosis and to identify ischemia. As reported, HMCAS is associated with heavy clot burden. Moreover, a heavy clot burden may cause obstruction of the orifices of arteries for leptomeningeal collateral flows and can lead to severe clinical conditions. However, the direct relationship between HMCAS and collateral flows remains unclear. Therefore, we explored the association between HMCAS and leptomeningeal collaterals in patients with acute ischemic stroke.

Methods

Consecutive ischemic stroke patients were enrolled from January 2015 to April 2021. HMCAS appearance and collateral status were detected by multimodal computed tomography at admission. Logistic regression analyses helped to identify the association between HMCAS, collateral flows and stroke severity.

Results

In 494 included patients, 180 (36.4%) presented with HMCAS. Ipsilateral collaterals were not seen or less prominent in patients with HMCAS (P < 0.001). The HMCAS appearance was significantly associated with less collaterals (odds ratio 5.17, 95% confidence interval 3.27-8.18,P < 0.001), internal carotid artery + M1/M1 occlusion, the initial stroke severity and follow-up outcomes. Subgroup analyses further confirmed HMCAS as an indicator of poor collaterals in ischemic stroke (allPvalues < 0.05).

Conclusions

HMCAS is associated with poor leptomeningeal collaterals, the stroke severity and a poor neurological outcome. Therefore, the HMCAS appearance can act as an early warning sign for healthcare professionals to be alert for poor collateral flows and poor neurological outcomes in ischemic stroke patients with middle cerebral artery occlusion.
Epidemiology of pre-existing multimorbidity in pregnant women in the UK in 2018: a population-based cross-sectional study
Authors: Lee Siang Ing , Azcoaga-Lorenzo Amaya , Agrawal Utkarsh , Kennedy Jonathan I. , Fagbamigbe Adeniyi Francis , Hope Holly , Subramanian Anuradhaa , Anand Astha , Taylor Beck , Nelson-Piercy Catherine , Damase-Michel Christine , Yau Christopher , Crowe Francesca , Santorelli Gillian , Eastwood Kelly-Ann , Vowles Zoe , Loane Maria , Moss Ngawai , Brocklehurst Peter , Plachcinski Rachel , Thangaratinam Shakila , Black Mairead , O’Reilly Dermot , Abel Kathryn M. , Brophy Sinead , Nirantharakumar Krishnarajah , McCowan Colin ,   on behalf of the MuM-PreDiCT Group
Published: February 2022

Background

Although maternal death is rare in the United Kingdom, 90% of these women had multiple health/social problems. This study aims to estimate the prevalence of pre-existing multimorbidity (two or more long-term physical or mental health conditions) in pregnant women in the United Kingdom (England, Northern Ireland, Wales and Scotland).

Study design

Pregnant women aged 15–49 years with a conception date 1/1/2018 to 31/12/2018 were included in this population-based cross-sectional study, using routine healthcare datasets from primary care: Clinical Practice Research Datalink (CPRD, United Kingdom, n = 37,641) and Secure Anonymized Information Linkage databank (SAIL, Wales, n = 27,782), and secondary care: Scottish Morbidity Records with linked community prescribing data (SMR, Tayside and Fife, n = 6099). Pre-existing multimorbidity preconception was defined from 79 long-term health conditions prioritised through a workshop with patient representatives and clinicians.

Results

The prevalence of multimorbidity was 44.2% (95% CI 43.7–44.7%), 46.2% (45.6–46.8%) and 19.8% (18.8–20.8%) in CPRD, SAIL and SMR respectively. When limited to health conditions that were active in the year before pregnancy, the prevalence of multimorbidity was still high (24.2% [23.8–24.6%], 23.5% [23.0–24.0%] and 17.0% [16.0 to 17.9%] in the respective datasets). Mental health conditions were highly prevalent and involved 70% of multimorbidity CPRD: multimorbidity with ≥one mental health condition/s 31.3% [30.8–31.8%]).

After adjusting for age, ethnicity, gravidity, index of multiple deprivation, body mass index and smoking, logistic regression showed that pregnant women with multimorbidity were more likely to be older (CPRD England, adjusted OR 1.81 [95% CI 1.04–3.17] 45–49 years vs 15–19 years), multigravid (1.68 [1.50–1.89] gravidity ≥ five vs one), have raised body mass index (1.59 [1.44–1.76], body mass index 30+ vs body mass index 18.5–24.9) and smoked preconception (1.61 [1.46–1.77) vs non-smoker).

Conclusion

Multimorbidity is prevalent in pregnant women in the United Kingdom, they are more likely to be older, multigravid, have raised body mass index and smoked preconception. Secondary care and community prescribing dataset may only capture the severe spectrum of health conditions. Research is needed urgently to quantify the consequences of maternal multimorbidity for both mothers and children.
Magnitude and factors associated with intimate partner violence against pregnant women in Ethiopia: a multilevel analysis of 2016 Ethiopian demographic and health survey
Authors: Liyew Alemneh Mekuriaw , Alem Adugnaw Zeleke , Ayalew Hiwotie Getaneh
Published: February 2022

Background

Intimate partner violence (IPV) is defined as acts of physical aggression, sexual coercion, psychological/emotional abuse, or controlling behaviors by a current or former partner or spouse. IPV has a special concern for pregnant women since it leads to higher rates of miscarriage, several complications including adverse birth outcomes. So far, the effect of contextual factors on IPV was largely overlooked. Therefore, this study aimed to assess the magnitude and factors associated with IPV among pregnant women in Ethiopia.

Method

Data from the 2016 Ethiopian Demographic and Health Survey was used for this study. A total of 4167 (weighted sample) pregnant women were included in the analysis. The multi-level logistic regression model was fitted to identify factors associated with IPV. Finally, the adjusted odds ratio (AOR) with 95% CI and random effects for the multilevel logistic regression model was reported.

Results

In this study, the overall magnitude of IPV among pregnant women was 28.74 (95% CI 27.38, 30.13) with emotional violence being the most common (24.09%) type. In the multi-level analysis, women with no education (AOR = 2.07; 95%CI 1.23, 3.48), primary education (AOR = 2.04; 95%CI:1.24, 3.38), and secondary education (AOR = 1.53; 95%CI:1.29.2.62), women from households with poorest (AOR = 1.72; 95%CI: 1.16, 2.56), poorer (AOR = 1.62;95% CI:1.09, 2.41), middle (AOR = 1.74;95%CI:1.17, 2.56), and richer (AOR = 1.58;95%CI: 1.08, 2.33) wealth index, women aged 35–39 years (AOR = 1.28;95%CI:1.01, 1.63) and 40–49 years (AOR = 1.78;95%CI:1.28, 2.45) and those from pastoral (AOR = 1.47;95%CI:1.04, 1.93) and agrarian regions (AOR = 1.32;95%CI 1.02, 1.88) had a higher likelihood of having IPV. Of the partner-related factors, women with husbands who drink alcohol (AOR = 2.94; 95%CI: 2.36, 3.42) and secondary educational level (AOR = 1.47; 95%CI 1.02, 2.12) had higher odds of experiencing IPV during pregnancy.

Conclusion

Intimate partner violence during pregnancy is a public health problem in Ethiopia. Therefore, improving the educational status of women and their husbands, improving the economic capacity of women, and promoting the healthy behavior of husbands by reducing the alcohol consumption in those agrarian and pastoral regions of Ethiopia is vital to reduce the magnitude of IPV.
The impact of sarcopenia on low back pain and quality of life in patients with osteoporosis
Authors: Iwahashi Shoji , Hashida Ryuki , Matsuse Hiroo , Higashi Eriko , Bekki Masafumi , Iwanaga Sohei , Hara Koji , Higuchi Takahiko , Hirakawa Yohei , Kubota Asami , Imagawa Hiromi , Muta Yoko , Minamitani Kazuhito , Yoshida Tatsuhiro , Yokosuka Kimiaki , Yamada Kei , Sato Kimiaki , Shiba Naoto
Published: February 2022

Purpose

Osteoporosis combined with sarcopenia contributes to a high risk of falling, fracture, and even mortality. However, sarcopenia’s impact on low back pain and quality of life (QOL) in patients with osteoporosis is still unknown. The purpose of this study is to investigate low back pain and QOL in osteoporosis patients with sarcopenia.

Methods

We assessed 100 ambulatory patients who came to our hospital for osteoporosis treatment. Low back pain was evaluated using the Visual Analogue Scale (VAS) with 100 being an extreme amount of pain and 0 no pain. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) score was used to assess QOL after adjustment for age, history of vertebral fracture, and adult spinal deformity. Differences in low back pain intensity assessed by VAS between groups were evaluated by the Willcoxon rank-sum test. Covariance analysis was used to assess QOL. All data are expressed as either median, interquartile range, or average, standard error.

Results

Patients were classified into the sarcopenia group (n = 32) and the non-sarcopenia group (n = 68). Low back pain intensity assessed by VAS was significantly higher in the sarcopenia group than in the non-sarcopenia group (33.0 [0-46.6] vs. 8.5 [0-40.0]; p < 0.05). The subscales of the JOABPEQ for low back pain were significantly lower in the sarcopenia group than in the non-sarcopenia group (65.0 ± 4.63 vs. 84.0 ± 3.1; p < 0.05).

Conclusion

In this cross-sectional study, sarcopenia affected low back pain and QOL in ambulatory patients with osteoporosis. Sarcopenia may exacerbate low back pain and QOL.