bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of B4C reinforcement and hot rolling on microstructure and mechanical properties of WE43 magnesium matrix composite
Authors: Banijamali Seyed Masih , Palizdar Yahya , Nekouee Khan Ali , Najafi Soroush , Shariat Razavi Mahta
Published: March 2022

In this study, WE43 alloy matrix composites, reinforced with 2.5, 5, 7.5, and 10 wt% B4C particles have been produced by the stir casting technique at 750 °C. Cast ingots of the matrix alloy and the composites were then subjected to hot rolling at 480 °C. After that, the effect of B4C additions (0–10 wt%) as well as hot rolling on the microstructure and mechanical properties of WE43 alloy were investigated. Microstructural characterization following hot rolling revealed a relatively uniform distribution of B4C particles, well-bonded B4C particles to the matrix, and a minimal porosity level. Further, both as-cast and hot-rolled composites have shown considerable grain refinement and hence improved mechanical properties compared to unreinforced alloy. Twinning was the dominant deformation mechanism in the hot-rolled WE43 alloy, whereas dynamic recrystallization occurred extensively in hot-rolled composites. It was observed that tensile strength and hardness values were improved not only as B4C content increased but more due to the rolling effect; however, elongation to fracture was reduced. Maximum ultimate tensile strength of ∼284 MPa and yield strength of ∼259 MPa with an improved hardness to ∼97 HB were obtained for the hot-rolled WE43-10%B4C composite.
Montessori mealtimes for dementia: A pathway to person-centred care
Authors: Cartwright Jade , Roberts Karen , Oliver Elizabeth , Bennett Michelle , Whitworth Anne
Published: March 2022

Purpose

This study examined the impact of a Montessori mealtime intervention for people living with dementia to support the mealtime experience of residents and mealtime care practices of staff in a memory support unit. The mealtime intervention was part of a broader culture change project.

Method

An observational research design was used to evaluate changes in the mealtime experience and care practices across three time points (baseline, post-implementation, maintenance), spanning 30 months. Five video recordings of the lunch time service (range: 19–32 min) were analysed. The coding protocol comprised pre-determined indicators related to accepted dimensions of person-centred care. Resident and staff behaviours were quantified across four categories: providing choice and preferences, promoting the social side of eating, supporting independence and showing respect towards residents. Staff behaviours that reflected personal enhancing actions and personal detractors were also coded during each mealtime service.

Results

A significant increase in staff providing residents with the opportunity for choice and a subsequent significant increase in residents demonstrating choice behaviours was evident. Staff and residents both significantly increased their interactional behaviours, with greater social interaction between staff and residents. Staff further demonstrated greater support for mealtime independence that reached and maintained significance during the final two sampling points. Significant gains observed post implementation were largely maintained and, on specific measures, further increased over time. A significant increase in staff use of personal enhancing actions during mealtime care was also evident. Variability in individual staff and resident behaviour highlighted the complexity of mealtime care and culture change processes.

Implications

The study provides novel evidence to support the use of a Montessori mealtime intervention to achieve more person-centred mealtime care, and which resulted in a more respectful, enabling and social dining experience. Clinical implications and direction for future research are presented to build on these findings.
The promises and perils of predictive politics
Authors: Pamuk Zeynep
Published: March 2022

Rachel Friedman’s Probable Justice and Jeffrey Friedman’s Power without Knowledge explore the promises and pitfalls of the application of predictive tools to the solution of social and political problems. Rachel Friedman argues that a fundamental duality in philosophical interpretations of probability allowed social insurance schemes to successfully accommodate two rival visions of liberal justice over the centuries. But in focusing on ideas around probability, she misses the limitations of the experts who put these ideas into practice and threatened to undermine them in the process. Jeffrey Friedman, by contrast, is centrally concerned with the limitations of experts. While he shows how these undermine one rather narrow conception of technocratic legitimacy, he avoids examining their implications for democratic legitimacy understood more broadly.
Are schools in Oman planning to produce global citizens? A critical analysis of schools’ visions and missions
Authors: Al’Abri Khalaf Marhoun , Al-Naabi Ishaq Salim , Ambusaidi Abdullah Khamis
Published: March 2022

This paper investigates the existence of GCED principles in Omani Basic Education schools’ visions and missions. A qualitative exploratory collective case study research design was used by analysing 50 schools’ vision and mission statements for the existence of five GCED principles: peace and conflict, human rights, identity and diversity, environment concerns, commitment to social justice, democracy and equity. The results revealed the varying existence of GCED principles, with commitment to social justice, democracy and equity principle being the most evident principles and the environment concerns principle the least evident in the dataset. For enabling schools to produce global citizens, schools need a revision of their visions and missions for better inclusion of GCED principles.
Generating synthesized computed tomography from CBCT using a conditional generative adversarial network for head and neck cancer patients
Authors: Zhang Yun , Ding Sheng-gou , Gong Xiao-chang , Yuan Xing-xing , Lin Jia-fan , Chen Qi , Li Jin-gao
Published: March 2022

Purpose: To overcome the imaging artifacts and Hounsfield unit inaccuracy limitations of cone-beam computed tomography, a conditional generative adversarial network is proposed to synthesize high-quality computed tomography-like images from cone-beam computed tomography images. Methods: A total of 120 paired cone-beam computed tomography and computed tomography scans of patients with head and neck cancer who were treated during January 2019 and December 2020 retrospectively collected; the scans of 90 patients were assembled into training and validation datasets, and the scans of 30 patients were used in testing datasets. The proposed method integrates a U-Net backbone architecture with residual blocks into a conditional generative adversarial network framework to learn a mapping from cone-beam computed tomography images to pair planning computed tomography images. The mean absolute error, root-mean-square error, structural similarity index, and peak signal-to-noise ratio were used to assess the performance of this method compared with U-Net and CycleGAN. Results: The synthesized computed tomography images produced by the conditional generative adversarial network were visually similar to planning computed tomography images. The mean absolute error, root-mean-square error, structural similarity index, and peak signal-to-noise ratio calculated from test images generated by conditional generative adversarial network were all significantly different than CycleGAN and U-Net. The mean absolute error, root-mean-square error, structural similarity index, and peak signal-to-noise ratio values between the synthesized computed tomography and the reference computed tomography were 16.75 ± 11.07 Hounsfield unit, 58.15 ± 28.64 Hounsfield unit, 0.92 ± 0.04, and 30.58 ± 3.86 dB in conditional generative adversarial network, 20.66 ± 12.15 Hounsfield unit, 66.53 ± 29.73 Hounsfield unit, 0.90 ± 0.05, and 29.29 ± 3.49 dB in CycleGAN, and 16.82 ± 10.99 Hounsfield unit, 58.68 ± 28.34 Hounsfield unit, 0.92 ± 0.04, and 30.48 ± 3.83 dB in U-Net, respectively. Conclusions: The synthesized computed tomography generated from the cone-beam computed tomography-based conditional generative adversarial network method has accurate computed tomography numbers while keeping the same anatomical structure as cone-beam computed tomography. It can be used effectively for quantitative applications in radiotherapy.
As clear as glass: How figurativeness and familiarity impact simile processing in readers with and without dyslexia
Authors: Egan Ciara , Siyanova-Chanturia Anna , Warren Paul , Jones Manon W
Published: March 2022

For skilled readers, idiomatic language confers faster access to overall meaning compared with non-idiomatic language, with a processing advantage for figurative over literal interpretation. However, currently very little research exists to elucidate whether atypical readers—such as those with developmental dyslexia—show such a processing advantage for figurative interpretations of idioms, or whether their reading impairment implicates subtle differences in semantic access. We wanted to know whether an initial figurative interpretation of similes, for both typical and dyslexic readers, is dependent on familiarity. Here, we tracked typical and dyslexic readers’ eye movements as they read sentences containing similes (e.g., as cold as ice), orthogonally manipulated for novelty (e.g., familiar: as cold as ice, novel: as cold as snow) and figurativeness (e.g., literal: as cold as ice [low temperature], figurative: as cold as ice [emotionally distant]), with figurativeness being defined by the sentence context. Both participant groups exhibited a processing advantage for familiar and figurative similes over novel and literal similes. However, compared with typical readers, participants with dyslexia had greater difficulty processing similes both when they were unfamiliar and when the context biased the simile meaning towards a literal rather than a figurative interpretation. Our findings suggest a semantic processing anomaly in dyslexic readers, which we discuss in light of recent literature on sentence-level semantic processing.
A Phase III, prospective, double-blind, randomized, placebo-controlled trial of thrombolysis in imaging-eligible, late-window patients to assess the efficacy and safety of tenecteplase (TIMELESS): Rationale and design
Authors: Albers Gregory W , Campbell Bruce CV , Lansberg Maarten G , Broderick Joseph , Butcher Ken , Froehler Michael T , Schwamm Lee H , Nouh Amre M , Liebeskind David S , Toy Florence , Yang Ming , Massaro Lori , Schoeffler Megan , Purdon Barbara
Published: March 2022

Rationale:

While thrombolysis is standard of care for patients with acute ischemic stroke (AIS) within 4.5 h of symptom onset, the benefit of tenecteplase beyond this time window is less certain.

Aim:

The TIMELESS trial (NCT03785678) aims to determine if treatment with tenecteplase increases the proportion of good clinical outcomes among patients with stroke due to a large vessel occlusion who present beyond 4.5 h after symptom onset.

Sample size estimates:

A total of 456 patients will provide ⩾90% power to detect differences in the distribution of modified Rankin Scale scores at Day 90 at the two-sided 0.049 significance level.

Methods and design:

TIMELESS is a Phase III, double-blind, randomized, placebo-controlled trial of tenecteplase with or without endovascular thrombectomy in patients with AIS and evidence of salvageable tissue via imaging who present within the 4.5- to 24-h time window with an internal carotid artery (ICA) or middle cerebral artery (MCA) (M1/M2) occlusion.

Study outcomes:

The primary efficacy objective of tenecteplase compared with placebo will be evaluated with ordinal modified Rankin Scale scores at Day 90. Safety will be evaluated via incidence of symptomatic intracranial hemorrhage, incidence and severity of adverse events, and mortality rate.

Discussion:

Results from TIMELESS will contribute to understanding of the safety and efficacy of tenecteplase administered 4.5–24 h following symptom onset for patients with an ICA or MCA occlusion.
Revisiting the May 1998 Riots in Indonesia: Civilians and Their Untold Memories
Authors: Himawan Eunike Mutiara , Pohlman Annie , Louis Winnifred
Published: March 2022

This paper examines the recollections of civilians about the May 1998 riots in Indonesia, as told in an anonymous online survey. These riots caused the deaths of an estimated 1000 people and saw targeted attacks on Indonesia's ethnic Chinese community, including state-led mass sexual violence against Chinese-Indonesian women and girls. Despite their scale, there has never been any official redress for these riots and they remain a taboo topic in Indonesia, rarely discussed publicly. Little is known about how Indonesians remember these events, with research into the personal or collective memories about the riots challenging, given the public silencing by the government. Here, we present findings from an anonymous survey completed by 235 Indonesians in which they revealed sometimes deeply personal memories about the riots. Examined thematically, these memories both confirm general understandings of the riots and reveal novel information about how communities coped during the violence.
Knowledge and awareness of COVID-19 epidemic preparedness and response among health care workers in Makkah city
Authors: Alrajhi Asrar Mansoor , Hussain Waleed Abdul-Halim , Rafie Basmah Amin , Taj Mehar , Elgarf Abdelaziz Moustafa
Published: March 2022

Objective:

This study determined and examined the knowledge and awareness of COVID-19 pandemic preparedness and response measures by health care workers (HCWs) in Makkah city.

Methods:

This descriptive study used a quantitative method with a cross-sectional design. A survey (questionnaire) collected data from 251 HCWs working in 10 hospitals and 80 health care centers.

Results:

The total score for the knowledge level was high (range: 50–76, mean ± SD = 65.370 ± 4.805). There was a relationship between the participants’ workplace and education levels to the nature of the disease ( p = 0.009*, 0.037*, respectively). Job descriptions were related to the transmission of the disease ( p = 0.003*). The participants’ age groups and years of experience were also associated with their actions in suspected, probable, and confirmed cases ( p = 0.015*, 0.03*, respectively). The HCWs’ knowledge of precautionary measures was not related to their demographic data, except for the education level shown ( p = 0.037*).

Discussion:

A similar level of knowledge and awareness was detected in Saudi Arabia in Riyadh and Al-Jouf, the UAE, Vietnam, and Uganda. Further study is recommended to measure the factors affecting HCWs’ knowledge and awareness during an epidemic situation.
Real-world effectiveness and safety profile of teriflunomide in the management of multiple sclerosis in the Gulf Cooperation Council countries: An expert consensus narrative review
Authors: Alroughani Raed , Inshasi Jihad , Al Khawajah Mona , Ahmed Samar Farouk , Al Malik Yaser , Alkhabouri Jaber , Shatila Ahmed , Aljarallah Salman , Cupler Edward J , Qureshi Shireen Al , Thakre Mona , Elhasin Heba , Ezzat Aly , Roushdy Sherif
Published: March 2022

Background

The prevalence of multiple sclerosis (MS) is increasing in Gulf Cooperation Council (GCC) countries. Multiple sclerosis contributes to significant burden on patients and caregivers. The pharmacological treatment in MS involves treating acute exacerbations and preventing relapses and disability progression using disease-modifying therapies. Clinical evidence suggests that teriflunomide is one of the therapeutic choices for patients with relapsing–remitting MS (RRMS). However, genetic and cultural differences across different regions may contribute to variations in drug use. Therefore, it is necessary to consider real-world evidence for teriflunomide usage in GCC countries.

Methods

An expert group for MS gathered from GCC countries in December 2020. The consensus highlighting role of teriflunomide in MS management has been developed using clinical experiences and evidence-based approach.

Results

The expert-recommended patient profile for teriflunomide usage includes individuals aged 18 years and above, both men and women (on effective contraceptives) with clinically isolated syndrome or RRMS. The factors considered were cost-effectiveness of the drug, patient preference, adherence, monitoring, established safety profile, and coronavirus disease 2019 status.

Conclusion

Expert recommendations based on their clinical experience will be more helpful to clinicians in clinical settings regarding the usage of teriflunomide and provide valuable insights applicable in day-to-day practice.
Patient-Reported Outcomes of Primary Total Ankle Arthroplasty in Patients Aged <50 Years
Authors: Pierce Ebaugh M. , Alford Travis , Kutzarov Kamen , Davis Elizabeth , Greaser Michael , McGarvey William C.
Published: March 2022

Background:

Compared to more prevalent arthritic conditions, ankle arthritis is complicated by an earlier age of onset. Recently published data demonstrates excellent survivorship and complication rates in short-/midterm follow-up of younger patients who received a primary total ankle arthroplasty (TAA). Additionally, older TAA patients display comparable reported outcomes relative to hip/knee arthroplasty. However, there remains a paucity of literature surrounding the reported outcomes of younger patients undergoing TAA. Thus, our aim was to assess the reported outcomes of individuals aged <50 years receiving a primary TAA.

Methods:

A retrospective cohort analysis of adult patients <50 years who received a primary total ankle replacement was conducted. Patient demographics, diagnosis, treatment, and outcome characteristics were recorded from a chart review of 41 patients with at least 1 year of postoperative clinical follow-up. Postoperative reported outcomes were obtained via telephone interviews. Primary outcomes that were measured included emotional and physical health, activity limitation, ambulation, and global health. Measures used included the 36-Item Short Form Health Survey (SF-36), Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health, and Sickness Impact Profile Ambulation. The functional outcomes in our study sample were compared with age- and gender-matched norms from a general US population, and 95% CIs were calculated for each functional outcome mean. Student t test was used for continuous variables, and χ2 analysis was used for categorical variables.

Results:

Thirty-one of 41 eligible patients were reached for interview. The average age at surgery was 39.7 years. Clinical and radiographic follow-up was a mean of 51.6 months and 31.2 months following TAA, respectively. General health as measured with the SF-36 was not significantly different from age-/gender-matched norms. Eighty-seven percent of patients would choose to have a TAA again. Although 58% reported being limited in vigorous activities, 61% were able to ambulate frequently for long periods of time. On average, the patients did not report ongoing pain, and only 16% reported fatigue that hindered activities. Eighty-one percent reported returning to full employment and performing their duties without difficulty, and 84% reported they resumed all normal social activities. Primary implant survivorship was 93%.

Conclusion:

Despite a younger age and potentially increased demands, patients aged <50 years undergoing primary TAA are generally satisfied with their index procedure at a mean follow-up of nearly 5 years. Our findings of positive outcomes on their health and well-being may improve surgeon insight for TAA as an alternative treatment for younger individuals with end-stage ankle arthritis. Level of Evidence: Level IV, case series.
Natural history of PF4 antibodies in vaccine-induced immune thrombocytopenia and thrombosis
Authors: Craven Brian , Lester William , Boyce Sara , Thomas Will , Kanny Angela , Davies Claire , Pavord Sue , Hermans Joannes , Makris Michael , Bart-Smith Emily , Arnott Sarah , Hunt Beverley J. , Chudakou Pavel , Calvert Anthony , Singh Deepak , Scully Marie
Published: March 2022

The COVID-19 pandemic has resulted in the rapid development of a range of vaccines against SARS-CoV-2. Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is a rare but life-threatening complication of primarily adenoviral-based vaccines associated with the presence of antibodies to a PF4/polyanion neoepitope and measured by using enzyme-linked immunosorbent assays. Presented are serial anti–PF4/polyanion antibody, platelet, and D-dimer measurements in a large cohort of patients and their relation to relapse. Overall, 51% of patients using the Stago assay had persistently positive anti–PF4/polyanion levels 100 days’ postdiagnosis, whereas 94% of patients monitored by using the Immucor assay remain positive. The median duration of positivity of the PF4 assay is 87 days, with 72% of patients remaining positive after a median follow-up of 105 days. The use of plasma exchange seemed to reduce anti–PF4/polyanion levels and increase platelet counts in the acute setting more rapidly than other therapies. The rate of relapse in this study was 12.6%, with all relapsed cases exhibiting persistently positive PF4 antibodies and falling platelet counts. Only one patient had extension of their thrombosis. Overall, despite the persistence of PF4 antibodies in 72% of patients, the rate of relapse was low and did not seem to result in recrudescence of the aggressive clinical picture seen at index presentation. Monitoring of these patients in the UK cohort is ongoing and will aid in definition of the natural history of this novel condition.
Post-acute COVID-19 syndrome
Authors: Montani David , Savale Laurent , Noel Nicolas , Meyrignac Olivier , Colle Romain , Gasnier Matthieu , Corruble Emmanuelle , Beurnier Antoine , Jutant Etienne-Marie , Pham Tài , Lecoq Anne-Lise , Papon Jean-François , Figueiredo Samy , Harrois Anatole , Humbert Marc , Monnet Xavier
Published: March 2022

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic that has resulted in millions of deaths and a major strain on health systems worldwide. Medical treatments for COVID-19 (anticoagulants, corticosteroids, anti-inflammatory drugs, oxygenation therapy and ventilation) and vaccination have improved patient outcomes. The majority of patients will recover spontaneously or after acute-phase management, but clinicians are now faced with long-term complications of COVID-19 including a large variety of symptoms, defined as “post-acute COVID-19 syndrome”. Most studies have focused on patients hospitalised for severe COVID-19, but acute COVID-19 syndrome is not restricted to these patients and exists in outpatients. Given the diversity of symptoms and the high prevalence of persistent symptoms, the management of these patients requires a multidisciplinary team approach, which will result in the consumption of large amounts of health resources in the coming months. In this review, we discuss the presentation, prevalence, pathophysiology and evolution of respiratory complications and other organ-related injuries associated with post-acute COVID-19 syndrome.
Chronic lung diseases: entangled in extracellular matrix
Authors: Burgess Janette K. , Harmsen Martin C.
Published: March 2022

The extracellular matrix (ECM) is the scaffold that provides structure and support to all organs, including the lung; however, it is also much more than this. The ECM provides biochemical and biomechanical cues to cells that reside or transit through this micro-environment, instructing their responses. The ECM structure and composition changes in chronic lung diseases; how such changes impact disease pathogenesis is not as well understood. Cells bind to the ECM through surface receptors, of which the integrin family is one of the most widely recognised. The signals that cells receive from the ECM regulate their attachment, proliferation, differentiation, inflammatory secretory profile and survival. There is extensive evidence documenting changes in the composition and amount of ECM in diseased lung tissues. However, changes in the topographical arrangement, organisation of the structural fibres and stiffness (or viscoelasticity) of the matrix in which cells are embedded have an undervalued but strong impact on cell phenotype. The ECM in diseased lungs also changes in physical and biomechanical ways that drive cellular responses. The characteristics of these environments alter cell behaviour and potentially orchestrate perpetuation of lung diseases. Future therapies should target ECM remodelling as much as the underlying culprit cells.
Metabolomics and microbiome reveal potential root microbiota affecting the alkaloidal metabolome in Aconitum vilmorinianum Kom.
Authors: Li Hongrui , Shi Hongdi , Xu Peng , Yu Diqiu
Published: March 2022

Background

The plant microbiome is vital for plant health, fitness, and productivity. Interestingly, plant metabolites and the plant microbiome can influence each other. The combination of metabolomics and microbiome may reveal the critical links between the plant and its microbiome. It is of great significance to agricultural production and human health, especially for Chinese medicine research. Aconitum vilmorinianum Kom. is a herb with alkaloid activities, and its roots are the raw material for some Chinese medicines. Former studies have investigated alkaloidal metabolites and antibacterial activities of endophytes in A. vilmorinianum roots. However, there are limited reports on the root microbiota that can influence the alkaloidal metabolome of A. vilmorinianum.

Results

This research used ultra performance liquid chromatography-tandem mass spectrometry technology and high-throughput sequencing to examine the alkaloidal metabolome, bacterial microbiota, and fungal microbiota in A. vilmorinianum roots at two different sites in China. The results revealed that the samples from the two sites were rich in distinct alkaloidal metabolites and recruited significantly different root microbiota. Based on bioinformatics analysis, we found the potential bacterial and fungal microbiota impacting the alkaloidal metabolome in A. vilmorinianum.

Conclusion

Our findings reveal the composition of the alkaloidal metabolome, bacterial root microbiota, and fungal root microbiota in A. vilmorinianum roots at two different sites. Potential root microbiota that can influence the alkaloidal metabolome of A. vilmorinianum are indicated. This study provides a strategy for the cultivation and research of A. vilmorinianum and other Chinese herbs.
Propofol suppresses adipose-derived stem cell progression via PI3K/AKT-Wnt signaling pathway
Authors: Yin Guoping , Wang Jia , Zhong Yanling , Wu Weidong
Published: March 2022

Adipose-derived stem cell (ADSC) transplantation has become a prospective way to treat cardiovascular diseases and skin traumas. Propofol, a short-acting intravenous anesthetic agent, plays an important role in the induction and maintenance of general anesthesia. In this study, we investigated the effects of propofol on ADSCs. The flow cytometry results showed that ADSCs were positive for CD29, CD44, and CD90 and negative for CD31, CD34, and CD45. The results of MTT and BrdU assays demonstrated that propofol impeded the proliferation of ADSCs. The cell scratch test showed that propofol had an inhibitory effect on the migration of ADSCs. Transwell assay showed that invasive ASDC counts decreased significantly after propofol treatment. Propofol also promoted ADSC apoptosis and arrested ADSCs in the G0/G1 phase. All these effects showed in a dose-dependent manner that the higher the concentration, the stronger the effect. Western blot analysis revealed decreased levels of FAK, PI3K, AKT, and GSK3β phosphorylation, while the phosphorylation of β-catenin increased after 48 h of treatment with propofol. The findings above indicated that the PI3K/AKT-Wnt pathways mediated propofol-inhibited ADSC proliferation, providing new insights into the propofol application in ADSCs.
Predictors and outcomes of postoperative tracheostomy in patients undergoing acute type A aortic dissection surgery
Authors: Wang Dashuai , Wang Su , Song Yu , Wang Hongfei , Zhang Anchen , Wu Long , Huang Xiaofan , Ye Ping , Du Xinling
Published: March 2022

Background

Despite surgical advances, acute type A aortic dissection remains a life-threatening disease with high mortality and morbidity. Tracheostomy is usually used for patients who need prolonged mechanical ventilation in the intensive care unit (ICU). However, data on the risk factors for requiring tracheostomy and the impact of tracheostomy on outcomes in patients after Stanford type A acute aortic dissection surgery (AADS) are limited.

Methods

A retrospective single-institutional study including consecutive patients who underwent AADS between January 2016 and December 2019 was conducted. Patients who died intraoperatively were excluded. Univariate analysis and multivariate logistic regression analysis were used to identify independent risk factors for postoperative tracheostomy (POT). A nomogram to predict the probability of POT was constructed based on independent predictors and their beta-coefficients. The area under the receiver operating characteristic curve (AUC) was performed to assess the discrimination of the model. Calibration plots and the Hosmer–Lemeshow test were used to evaluate calibration. Clinical usefulness of the nomogram was assessed by decision curve analysis. Propensity score matching analysis was used to analyze the correlation between requiring tracheostomy and clinical prognosis.

Results

There were 492 patients included in this study for analysis, including 55 patients (11.2%) requiring tracheostomy after AADS. Compared with patients without POT, patients with POT experienced longer ICU and hospital stay and higher mortality. Age, cerebrovascular disease history, preoperative white blood cell (WBC) count and renal insufficiency, intraoperative amount of red blood cell (RBC) transfusion and platelet transfusion were identified as independent risk factors for POT. Our constructed nomogram had good discrimination with an AUC = 0.793 (0.729–0.856). Good calibration and clinical utility were observed through the calibration and decision curves, respectively. For better clinical application, we defined four intervals that stratified patients from very low to high risk for occurrence of POT.

Conclusions

Our study identified preoperative and intraoperative risk factors for POT and found that requiring tracheostomy was related to the poor outcomes in patients undergoing AADS. The established prediction model was validated with well predictive performance and clinical utility, and it may be useful for individual risk assessment and early clinical decision-making to reduce the incidence of tracheostomy.
Early changes in laboratory tests predict liver function damage in patients with moderate coronavirus disease 2019: a retrospective multicenter study
Authors: Wang Yiting , Gao Dandan , Li Xuewen , Xu Panyang , Zhou Qi , Yin Junguo , Xu Jiancheng
Published: March 2022

Background

Most patients with coronavirus disease 2019 demonstrate liver function damage. In this study, the laboratory test data of patients with moderate coronavirus disease 2019 were used to establish and evaluate an early prediction model to assess the risk of liver function damage.

Methods

Clinical data and the first laboratory examination results of 101 patients with moderate coronavirus disease 2019 were collected from four hospitals’ electronic medical record systems in Jilin Province, China. Data were randomly divided into training and validation sets. A logistic regression analysis was used to determine the independent factors related to liver function damage in patients in the training set to establish a prediction model. Model discrimination, calibration, and clinical usefulness were evaluated in the training and validation sets.

Results

The logistic regression analysis showed that plateletcrit, retinol-binding protein, and carbon dioxide combining power could predict liver function damage (P < 0.05 for all). The receiver operating characteristic curve showed high model discrimination (training set area under the curve: 0.899, validation set area under the curve: 0.800;P < 0.05). The calibration curve showed a good fit (training set:P = 0.59, validation set:P = 0.19;P > 0.05). A decision curve analysis confirmed the clinical usefulness of this model.

Conclusions

In this study, the combined model assesses liver function damage in patients with moderate coronavirus disease 2019 performed well. Thus, it may be helpful as a reference for clinical differentiation of liver function damage.

Trial registrationretrospectively registered.
Intrasellar pressure in patients with pituitary adenoma – relation to tumour size and growth pattern
Authors: Simander Gabriel , Eriksson Per Olof , Lindvall Peter , Koskinen Lars-Owe D.
Published: March 2022

Background

Only a few earlier publications on intrasellar pressure (ISP) have not been able to fully clarify any association between ISP and pituitary adenoma size and growth pattern. The aim of the study was to determine if intrasellar pressure (ISP) is elevated in patients with pituitary adenoma, and if the pressure is associated with tumour size and growth pattern.

Methods

The study included 100 patients operated for suspected pituitary adenoma, who have had their ISP measured intraoperatively. All adenomas were classified on the basis of Knosp and SIPAP, from which further classification of invasiveness was performed. MRT examinations were used to calculate the tumour volume and diameter in three axes.

Results

After exclusions, 93 cases were analysed. The mean ISP was 23.0 ± 8.4 mmHg. There were positive correlations between ISP and tumour volume and tumour diameters along all three axes. Coronal tumour diameter showed the strongest correlation with ISP elevation in a multivariate effect test. Adenomas classified as parasellar invasive (Knosp grade 3–4) showed higher mean ISP than adenomas considered as non-invasive (Knosp 0–2).

Conclusions

ISP is affected by tumour anatomy and correlates positively with tumour volume. Tumour width, i.e. diameter in the coronal plane, appears to be the measure that most strongly affects the ISP. This is confirmed by the association between ISP elevation and parasellar growth.
Clinical consequences of gestational diabetes mellitus and maternal obesity as defined by asian BMI thresholds in Viet Nam: a prospective, hospital-based, cohort study
Authors: Yue Serena , Thi Vu Thai Kim , Dung Le Phuong , Nhu Bui Thi Hong , Kestelyn Evelyne , Thuan Dang Trong , Thanh Le Quang , Hirst Jane E
Published: March 2022

Background

Gestational Diabetes Mellitus (GDM) is common in South East Asia, occurring at relatively lean Body Mass Index (BMI). Outside pregnancy, cardiometabolic risks increase at lower BMI in Asian populations, justifying Asian-specific thresholds for overweight and obesity. We aimed to explore the effects of GDM and obesity on perinatal outcomes using a WHO expert consultation-recommended Asian-specific definition of obesity.

Methods

This is a secondary analysis of a prospective, hospital-based, cohort study in Ho Chi Minh City. Participants were recruited from antenatal clinics between 19+ 0-22+ 6 weeks gestation and followed until delivery. GDM screening occurred between 24 and 28 weeks using WHO criteria. Obesity was defined as BMI ≥ 27.5 kg/m2, based on weight and height at recruitment. We assessed associations between GDM (singly, and in combination with obesity) and perinatal outcomes. Participants were categorised into four groups: no GDM/non-obese (reference group), GDM/non-obese, no GDM/obese and GDM/obese. Outcomes included primary caesarean section, hypertensive disorders of pregnancy (HDP), large-for-gestational-age (LGA), birth weight, preterm birth, and composite adverse neonatal outcome. Logistic and linear regressions were performed with adjustment for differences in baseline characteristics.

Results

Among 4,970 participants, 908 (18%) developed GDM. Compared to women without GDM, GDM increased risks for preterm birth (OR: 1.40, 95% CI: 1.09–1.78), higher birthweight (birthweight z-score 0.16 versus 0.09, p = 0.027), and LGA (OR 1.14, 0.89–1.46). GDM without obesity was associated with an increased risk of preterm birth (OR 1.35, 1.04–1.74). Obese women without GDM were more likely to deliver by caesarean section and have an LGA baby (1.80, 1.33–2.44 and 2.75, 1.88–4.03). The highest risks were observed amongst women with both GDM and obesity: caesarean Sect. (2.43, 1.49–3.96), LGA (3.36, 1.94–5.80) and preterm birth (2.42, 1.32–4.44).

Conclusions

GDM was associated with an increased risk of preterm birth and larger newborn size. Using an Asian-specific definition of obesity, we demonstrate obese women with GDM are at the highest risk of adverse outcomes. Using a BMI threshold in pregnancy of 27.5 kg/m2 (between 19 and 22 weeks gestation) for Asian women can identify women who will benefit from intensified diabetes, nutritional, and obstetric care. This has relevance for obstetric service delivery within Asia, and other health systems providing pregnancy care for Asian expatriate women.
Social responsibility perspective in public response to the COVID-19 pandemic: a grounded theory approach
Authors: Low Lee Lan , Tong Seng Fah , Ang Ju Ying , Abdullah Zalilah , Hamid Maimunah A , Risman Mikha Saragi , Wong Yun Teng , Jamalul-lail Nurul Iman , Chelladorai Kalvina , Tan Yui Ping , Tay Yea Lu , Nordin Awatef Amer , HSS Amar-Singh
Published: March 2022

Background

Combating viral outbreaks extends beyond biomedical and clinical approaches; thus, public health prevention measures are equally important. Public engagement in preventive efforts can be viewed as the social responsibility of individuals in controlling an infectious disease and are subjected to change due to human behaviour. Understanding individuals’ perception of social responsibility is crucial and is not yet explored extensively in the academic literature. We adopted the grounded theory method to develop an explanatory substantive theory to illustrate the process of how individual responded to the outbreak from a social responsibility perspective.

Methods

In-depth interviews were conducted among 23 Malaysians either through telephone or face-to-face depending on the participant’s preference. Both purposive and theoretical sampling were used. Participants were invited to share their understanding, perceptions and activities during the COVID-19 pandemic. They were further probed about their perceptions on complying with the public health interventions imposed by the authorities. The interviews were audio-recorded and transcribed verbatim. Data was analysed via open coding, focus coding and theoretical coding, facilitated by memoing, sketching and modelling.

Results

Study findings showed that, social responsibility is perceived within its role, the perceived societal role responsibility. In a particular context, an individual assumed only one of the many expected social roles with their perceived circle of responsibility. Individuals negotiated their actions from this perspective, after considering the perceived risk during the outbreak. The four types of behaviour depicted in the matrix diagram facilitate the understanding of the abstract concept of negotiation in the human decision-making process, and provide the spectrum of different behaviour in relation to public response to the COVID-19 pandemic.

Conclusions

Our study adopted the grounded theory approach to develop a theoretical model that illustrates how individual response to COVID-19 preventive measures is determined by the negotiation between perceived societal role responsibility and perceived infection risk. This substantive theoretical model is abstract, thus has relevance for adoption within similar context of an outbreak.
Pre and postoperative lactate levels and lactate clearance in predicting in-hospital mortality after surgery for gastrointestinal perforation
Authors: Kang Min Kyu , Oh Seung-Young , Lee Hannah , Ryu Ho Geol
Published: March 2022

Background

This study aimed to compare the prognostic significance of pre and postoperative lactate levels and postoperative lactate clearance in the prediction of in-hospital mortality after surgery for gastrointestinal (GI) perforation.

Methods

Among patients who underwent surgery for GI perforation between 2013 and 2017, only patients whose lactate were measured before and after surgery were included and divided into an in-hospital mortality group and a survival group. Data on demographics, comorbidities, pre and postoperative laboratory test results, and operative findings were collected. Risk factors for in-hospital mortality were identified, and receiver-operating characteristic (ROC) curve analysis was performed for pre and postoperative lactate levels and postoperative lactate clearance.

Results

Of 104 included patients, 17 patients (16.3%) died before discharge. The in-hospital mortality group demonstrated higher preoperative lactate (6.3 ± 5.1 vs. 3.5 ± 3.2, P = 0.013), SOFA score (4.5 ± 1.7 vs. 3.4 ± 2.3, P = 0.004), proportions of patients with lymphoma (23.5% vs. 2.3%, P = 0.006), and rates of contaminated ascites (94.1% vs. 68.2%, P = 0.036) and lower preoperative hemoglobin (10.4 ± 1.6 vs. 11.8 ± 2.4, P = 0.018) compare to the survival group. Multivariate analysis revealed that postoperative lactate (HR 1.259, 95% CI 1.084–1.463, P = 0.003) and preoperative hemoglobin (HR 0.707, 95% CI 0.520–0.959, P = 0.026) affected in-hospital mortality. In the ROC curve analysis, the largest area under the curve (AUC) was shown in the postoperative lactate level (AUC = 0.771, 95% CI 0.678–0.848).

Conclusion

Of perioperative lactate levels in patients underwent surgery for GI perforation, postoperative lactate was the strongest predictor for in-hospital mortality.
Peers empowering peers-feasibility of a peer educator training program to prevent diabetes
Authors: Vivian Eva , Flanagan Constance
Published: March 2022

Background

This study assessed the feasibility and acceptability of the Healthy Outcomes through Peer Educators (HOPE) training program designed to train African American (AA) grandmothers to serve as peer educators for other AA grandmothers who are at risk for diabetes. The newly trained peer educators will provide the needed encouragement and positive reinforcement essential for successful sustainable health behaviors to grandmothers enrolled in a subsequent Diabetes Prevention Program.

Methods

Thirty AA women between the ages of 49–72 were enrolled in the pre-post single group study. The participants were required to attend a 2-h Diabetes Prevention Program session every week for 16 weeks. The sessions covered the role of the peer educator and encouraged participants to increase their physical activity and consume more servings of fruits and vegetables daily. We noted the number of participants who successfully completed the training and solicited their perspective regarding the strengths of the program and suggestions to improve the program. The Wilcoxon Signed Ranks Test was performed to evaluate changes in body weight, self-reported physical activity, and fruit and vegetable intake from baseline to week 16.

Results

Ninety three percent (n = 28) of enrollees completed the training program. All (n = 28) the peer educator trainees indicated that they would recommend the program to a friend and 93% (n = 26) reported that the program met their needs. The participants (n = 28) felt that the training prepared them to offer support to other grandmothers in their community. A Wilcoxon Signed Ranks Test revealed that participants body weights were significantly lower after completion of the 16 week training program (median = 156.5 lbs., n = 28) compared to baseline (median = 163.0, n = 28), Z = − 4.43, p < 0.05. Fruit and vegetable intake increased significantly (median = 5, n = 28) at week 16 compared to week one, (median = 2, n = 28) Z = 4.46, p < 0.05. Participants were more physically active at week 16 (median = 150 min per week, n = 28) compared to week 1, (median = 30 min per week, n = 28) Z = 4.62, p < 0.05.

Conclusions

The peer educator training component of HOPE was found to be feasible and acceptable as evidenced by our successful recruitment and retention of participants. Participation in the peer educator training program also resulted in improvement in health behaviors.
Social network-based ethical analysis of COVID-19 vaccine supply policy in three Central Asian countries
Authors: Aripov Timur , Wikler Daniel , Asadov Damin , Tulekov Zhangir , Murzabekova Totugul , Munir Kerim M.
Published: March 2022

Background

In the pandemic time, many low- and middle-income countries are experiencing restricted access to COVID-19 vaccines. Access to imported vaccines or ways to produce them locally became the principal source of hope for these countries. But developing a strategy for success in obtaining and allocating vaccines was not easy task. The governments in those countries have faced the difficult decision whether to accept or reject offers of vaccine diplomacy, weighing the price and availability of COVID-19 vaccines against the concerns over their efficacy and safety. We aimed to analyze public opinion regarding the governmental strategies to obtain COVID-19 vaccines in three Central Asian countries, focusing particularly on possible ethical issues.

Methods

We searched for opinions expressed either in Russian or in the respective national languages. We provided data on the debate within three countries, drawn from social media postings and other sources. The opinion data was not restricted by source and time. This allowed collecting a wide range of possible opinions that could be expressed regarding COVID-19 vaccine supply and human participation in the vaccine trial. We recognized ethical issues and possible questions concerning different ethical frameworks. We also considered scientific data and other information, in the process of reasoning.

Results

As a result, public views on their respective government policies on COVID-19 vaccine supply ranged from strongly negative to slightly positive. We extracted the most important issues from public debates, for our analysis. The first issue involved trade-offs between quantity, speed, price, freedom, efficacy, and safety in the vaccines. The second set of issues arose in connection with the request to site a randomized trial in one of the countries (Uzbekistan). After considering additional evidence, we weighed individual and public risks against the benefits to make specific judgements concerning every issue.

Conclusions

We believe that our analysis would be a helpful example of solving ethical issues that can arise concerning COVID-19 vaccine supply around the world. The public view can be highly critical, helping to spot such issues. An ignoring this view can lead to major problems, which in turn, can become a serious obstacle for the vaccine coverage and epidemics’ control in the countries and regions.