bluuebunny/crossref_metadata_2025 huggingface dataset:
Rooming in and Breast Feeding Practices and Rate of Horizontal Transmission of SARS-CoV-2 Virus in 5 UAE Hospitals—An Observational Study
Authors: Kaushal Monika , Tulasi Venkata Subba Yamuna , Kaushal Ayush , Rakhecha Aditya , Memon Rafiq , Ramasamy Karvendhan , Khan Shoaib Shahzad
Published: November 2021

Objectives:

To assess risks of mother to child horizontal transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus during rooming in and breastfeeding in infants born to mothers with the coronavirus (COVID-19) disease.

Design:

Retrospective observational study.

Participants:

Five tertiary care centers located in the United Arab Emirates. Infants born to mothers positive for SARS-CoV-2 polymerase chain reaction (PCR) at the time of delivery, born between April 1 and October 30, 2020.

Methods:

In this retrospective observational study, we analyzed the newborn care practices in various tertiary care hospitals and the rate of horizontal transmission of SARS-CoV-2 from mother to infant (horizontal) while rooming in, breastfeeding, and post-discharge.

Results:

There were total of 2,405 deliveries in the 5 stated hospitals of which 40 infants were born to mothers with positive SARS-CoV-2 PCR at the time of delivery. One infant tested positive for SARS-CoV-2 after birth at 24 h of life and had respiratory symptoms and fever. Twenty-three of the well infants were roomed in during their hospital stay and were breastfed. In 8 cases, the mother and baby were separated and isolated from the time of birth till discharge. 95% of the discharged infants were rooming in with mothers, 45% of the infants were exclusively breastfed, and 55% were on mixed feeding (breast milk and formula milk) at the follow-up. None of the infants developed significant health issues or symptoms attributable to SARS-CoV-2.

Conclusion:

The risk of mother to infant horizontal transmission of COVID-19 in the perinatal period is very low. Our study reaffirms the American Academy of Pediatrics guidelines that rooming in and breastfeeding of newborns born to SARS-CoV-2 positive mothers is safe without an increased risk of horizontal transmission by following mandated safety precautions.
Social Work Core Competencies in Disaster Management Practice: An Integrative Review
Authors: Sim Timothy , He Minying , Dominelli Lena
Published: November 2021

Purpose: Though social workers are increasingly engaged in the disaster management, there has been a lack of professional guidelines for social work practice and training in this emerging field. This study aims to develop a rudimentary social work competence framework to plug this gap. Method: We conducted an integrative review of 183 international empirical studies and practice reflections, comprising a systematic search, selection, review, and content analysis, guided by ecological systems theory. Results: This rudimentary framework consists of 73 competencies, including 33 micro-level competencies, 18 meso-level ones and 22 macro-level ones, covering knowledge, values and skills in four disaster management phases. Conclusion: Compared to other competence frameworks, this framework further elucidated and classified the salient knowledge, values, and skills in disaster management training and practice for social work.
Oral Anticoagulant and Antiplatelet Therapy for Cervical Artery Dissection: A Meta-Analysis of Clinical Trials
Authors: Ye Sheng-Lin , Wang Chuang , Wang Lu-Lu , Xu Tian-Ze , Li Xiao-Qiang , Tang Tao
Published: November 2021

Carotid and vertebral artery dissections are estimated to account for ∼20% of strokes in patients under 45-years-old. This meta-analysis compared the efficacy and safety of treatment with anticoagulants versus antiplatelet agents to determine the optimal therapy. We searched 4 electronic databases for clinical trials published from January 1, 1980 to August 25, 2021 that included patients who received anticoagulant or antiplatelet therapy for carotid and/or vertebral artery dissections. The curative effect was judged by recanalization evaluated by imaging. The primary outcomes were all cause death and ischemic stroke; secondary outcomes included hemorrhage and transient ischemic attack (TIA). Patients who received only a single drug treatment were divided into antiplatelet or anticoagulant groups; all received conservative treatment without surgical intervention. For this investigation, we pooled the available studies to conduct a meta-analysis, which included 7 articles with 1126 patients. The curative effect of vascular recanalization was not significantly different between the 2 treatment groups (odds ratio [OR] = 0.913, 95% confidence interval [CI]: 0.611-1.365, P = .657); similarly, no significant differences were found regarding the primary outcomes all cause death (OR = 1.747, 95%CI: 0.202-15.079, P = .612) and ischemic stroke (OR = 2.289, 95%CI: 0.997-5.254, P = .051). Patients treated with anticoagulants were more likely to experience TIA (OR = 0.517, 95%CI: 0.252-1.060, P = .072) and hemorrhage (OR = 0.468, 95%CI: 0.210-1.042, P = .063), but the differences were not statistically significant. Overall, there were no statistically significant differences between anticoagulant therapy and antiplatelet therapy for the treatment of carotid and vertebral artery dissections.
Assessment of molecular response to tyrosine kinase inhibitors in Tunisian Patients with Chronic Myeloid Leukemia
Authors: Frikha Rim , Kassar Olfa , Elloumi Moez , Kamoun Hassen
Published: November 2021

Aim

This study was carried out to assess the minimal residual disease in Tunisian patients with chronic myeloid leukemia (CML) treated with tyrosine kinase inhibitors in routine clinical practice, to recognize potentially eligible carrier for treatment discontinuation, based on a molecular response (MR).

Patients and Methods

A retrospective study was carried out in the Hospital University of Sfax, south of Tunisia from January 2016 to October 2020, including all CML patients in the chronic phase at diagnosis, treated with TKI (tyrosine kinase inhibitors) for a minimum duration of 6 months. Quantitative assessment of the BCR-ABL transcript was performed using the Cepheid Xpert BCR-ABL ultra-assay. Molecular response and outcome were evaluated, according to the European Leukemia Net guidelines.

Results

A total of 162 CML patients were carried out. The median age was 50 years, the sex ratio M/F was 1.62. The rate of cumulative EMR; MMR and DMR was 80.8%; 73.8% and 55.9% respectively. According to the ELN criteria, 141 CML patients were evaluable. Optimal, suboptimal response and failure were noted in 81 (57.4%), 33(23.4%), and 27(19.1%) patients, respectively. Overall survival (OS) and progression-free survival (PFS) were 96.3% and 85%. Risk factors for an event (death/progression) were lack of EMR, MMR, and DMR (P < 0.05). Among 149 patients with sustained DMR; 14 (8.6%) CML patients have discontinued TKI therapy.

Conclusion

Despite the limit of our study (duration and size), the available real-life molecular responses with TKI therapy should be considered to identify potentially CML patients eligible for discontinuation of TKI therapy.
Evaluation and clinical impact of a pharmacist-led, interdisciplinary service focusing on education, monitoring and toxicity management of immune checkpoint inhibitors
Authors: Myers Glenn , Stevens Jonathan , Flewelling Andrew , Richard Jacqueline , London Meagan
Published: November 2021

Introduction

Immune-related adverse events are complications of immune checkpoint inhibitors which require robust patient education and proactive follow-up to ensure timely identification and management. Oncology pharmacist practice models with other anticancer modalities have been well documented, but there is limited evidence assessing the spectrum of pharmacist interventions in patients receiving immune checkpoint inhibitor(s) and the impact of these interventions on patient outcomes.

Methods

Patients initiated on immune checkpoint inhibitor(s) from 1 January 2016 to 31 August 2019 were included for data collection and analysis. Part 1 featured an intensive pharmacist follow-up cohort (study cohort) and summarized pharmacist interventions. Part 2 compared patient outcomes between the study cohort and a standard of care cohort (control cohort) from a different oncology centre. Patient outcomes included emergency department visits not resulting in admission, hospitalizations due to immune-related adverse event(s), immune checkpoint inhibitor cycles received, treatment discontinuation due to immune-related adverse event(s), completion of finite programmed death-1/death-1 ligand treatment course and completion of ipilimumab. Clinical outcomes were compared using a retrospective, matched cohort design based on age, cancer diagnosis and immune checkpoint inhibitor(s).

Results

A total of 143 patients were included in Part 1 encompassing 1664 pharmacist recommendations across 11 categories. The matched cohort yielded 92 matches (n = 184) with a higher odds of immune checkpoint inhibitor discontinuation due to immune-related adverse event(s) in the control cohort (odds ratio (OR) (95% confidence interval (CI)) = 5.5 (1.2−24.8); p = 0.022).

Conclusion

Intensive immune-related adverse event education, proactive follow-up and immune-related adverse event management by pharmacists result in clinically meaningful interventions which correlate to improved patient outcomes, namely lower odds of treatment discontinuation due to immune-related adverse event(s).
Duncan Dowson: Pioneer of elastohydrodynamic lubrication of gears
Authors: Evans HP , Snidle RW
Published: November 2021

The paper briefly reviews Duncan Dowson's ground-breaking contribution to the theory of elastohydrodynamic lubrication in relation to the understanding of lubrication of gear tooth contacts. His early work with Higginson on numerical modelling of elastohydrodynamic lubrication finally explained how gears can operate successfully, and avoid wear, due to the generation of a stiff, protective oil film. The resulting minimum film thickness equation stands as a reliable reference formula for calculations in gear design standards. The paper includes examples of how elastohydrodynamic lubrication theory has been developed by the present authors and their co-workers, and applied to aid the design of engineering components such as worm gears, thrust rims and profile-modified helical gears. Also included is its extension to include the important effects of surface roughness at the asperity level (micro-elastohydrodynamic lubrication) and its relevance to the current, troublesome problem of micropitting.
Whither Transformative Education? Taking Stock Well into the Twenty-First Century
Authors: Washburn Allyson
Published: November 2021

This article develops a framework for this special issue of JTE, and assesses the assessment of transformative learning. What and whom are the contributors assessing? For what ends? And how effectively? The call for manuscripts cited two “megatrends” in the transformative learning literature: 1. The importance of deep and transformative learning experiences that profoundly affect adult learners’ sense of self and their relationships and behavior in their community and broader world; 2. The need to clearly document these learning experiences and interventions and rigorously assess their outcomes, both proximal and distal. In what follows, I pose questions that these trends suggested to me and use them to take stock of transformative learning theory and education in the 21st century. At the end of each section, I synthesize what I found to be relevant from my review of the articles in this issue, highlighting what I see to be major contributions.
Quality-related fault diagnosis based onk-nearest neighbor rule for non-linear industrial processes
Authors: Ren Zelin , Tang Yongqiang , Zhang Wensheng
Published: November 2021

The fault diagnosis approaches based on k-nearest neighbor rule have been widely researched for industrial processes and achieve excellent performance. However, for quality-related fault diagnosis, the approaches using k-nearest neighbor rule have been still not sufficiently studied. To tackle this problem, in this article, we propose a novel quality-related fault diagnosis framework, which is made up of two parts: fault detection and fault isolation. In the fault detection stage, we innovatively propose a novel non-linear quality-related fault detection method called kernel partial least squares- k-nearest neighbor rule, which organically incorporates k-nearest neighbor rule with kernel partial least squares. Specifically, we first employ kernel partial least squares to establish a non-linear regression model between quality variables and process variables. After that, the statistics and thresholds corresponding to process space and predicted quality space are appropriately designed by adopting k-nearest neighbor rule. In the fault isolation stage, in order to match our proposed non-linear quality-related fault detection method kernel partial least squares- k-nearest neighbor seamlessly, we propose a modified variable contributions by k-nearest neighbor (VCkNN) fault isolation method called modified variable contributions by k-nearest neighbor (MVCkNN), which elaborately introduces the idea of the accumulative relative contribution rate into VC k-nearest neighbor, such that the smearing effect caused by the normal distribution hypothesis of VC k-nearest neighbor can be mitigated effectively. Finally, a widely used numerical example and the Tennessee Eastman process are employed to verify the effectiveness of our proposed approach.
Leveraging an Integrated Visual Display for Case-Based Analysis in Mixed Method Research
Authors: Creamer Elizabeth G.
Published: November 2021

A case-based visual display can serve as method for analysis in mixed method research. This methodological article builds an argument for the role that a matrix, diagram, table, or figure can play when used interactively to generate, elaborate, or confirm analytical insight in a case-based analysis in mixed methods research. The article provides an in-depth exploration of two visual methods: timelining and mapping. Timelining adds dimensionality through investigating a temporal sequence, while a mapping activity can do the same with the understanding of physical locations. Both types of visual displays can enhance validity by providing a way to engage qualitative and quantitative data iteratively and dialectically during analysis. The necessity to pursue dissonance that often arises from integrating qualitative and quantitative results is one signal of the complexity of the examples reviewed. The examples support the argument that a visual display that integrates data from different sources iteratively and dialectically is an analytical strategy unique to mixed methods.
Non-isothermal rarefied gas flow in microtube with constant wall temperature
Authors: Guranov Iva , Milićev Snežana , Stevanović Nevena
Published: November 2021

In this paper, pressure-driven gas flow through a microtube with constant wall temperature is considered. The ratio of the molecular mean free path and the diameter of the microtube cannot be negligible. Therefore, the gas rarefaction is taken into account. A solution is obtained for subsonic as well as slip and continuum gas flow. Velocity, pressure, and temperature fields are analytically attained by macroscopic approach, using continuity, Navier-Stokes, and energy equations, with the first order boundary conditions for velocity and temperature. Characteristic variables are expressed in the form of perturbation series. The first approximation stands for solution to the continuum flow. The second one reveals the effects of gas rarefaction, inertia, and dissipation. Solutions for compressible and incompressible gas flow are presented and compared with the available results from the literature. A good matching has been achieved. This enables using proposed method for solving other microtube gas flows, which are common in various fields of engineering, biomedicine, pharmacy, etc. The main contribution of this paper is the integral treatment of several important effects such as rarefaction, compressibility, temperature field variability, inertia, and viscous dissipation in the presented solutions. Since the solutions are analytical, they are useful and easily applicable.
Disclosure of HIV seropositivity to sexual partner in Ethiopia: A systematic review
Authors: Endalamaw Aklilu , Assefa Yibeltal , Geremew Demeke , Belete Habte , Dachew Berihun Assefa , Belachew Amare , Animaw Worku , Habtewold Tesfa Dejenie , Wilson Rhonda
Published: November 2021

Introduction:

In Ethiopia, the burden of HIV/AIDS is a public health issue that requires significant control of transmission. Once an infection has been established, determinants influence people living with HIV to disclose or not their HIV-positive status to sexual partners. This study assessed the proportion and associated factors of people living with HIV’s disclosure status to sexual partners.

Methods:

CRD42020149092 is the protocol’s registration number in the PROSPERO database. We searched PubMed, Scopus, African Journals Online, and Google Scholar databases. For the subjective and objective assessment of publication bias, we used a funnel plot and Egger’s regression test, respectively. The I2 statistic was used to assess variation across studies. Meta-analysis of weighted inverse variance random-effects model was used to estimate the pooled proportion. We conducted subgroup and sensitivity analyses to investigate the cause of heterogeneity and the impact of outliers on the overall estimation, respectively. A trend analysis was also performed to show the presence of time variation.

Results:

The percentage of people living with HIV who disclosed their HIV-positive status to sexual partners was 76.03% (95% confidence interval: 68.78, 83.27). Being on antiretroviral therapy (adjusted odds ratio = 6.19; 95% confidence interval: 2.92, 9.49), cohabiting with partner (adjusted odds ratio = 4.48; 95% confidence interval: 1.24, 7.72), receiving HIV counseling (adjusted odds ratio = 3.94; 95% confidence interval: 2.08, 5.80), having discussion prior to HIV testing (adjusted odds ratio = 4.40; 95% confidence interval: 2.11, 6.69), being aware of partner’s HIV status (adjusted odds ratio = 6.08; 95% confidence interval: 3.05, 9.10), positive relationship with partner (adjusted odds ratio = 4.44; 95% confidence interval:1.28, 7.61), and being member of HIV association (adjusted odds ratio = 3.70; 95% confidence interval: 2.20, 5.20) had positive association with HIV status disclosure.

Conclusion:

In Ethiopia, more than one-fourth of adults living with HIV did not disclose their HIV-positive status to sexual partners. HIV-positive status disclosure was influenced by psychosocial factors. A multidimensional approach is required to increase seropositive disclosure in Ethiopia.
A palladium-catalyzed cascade approach for the synthesis of 3,3a,4,6,7,8,9,9a-octahydro-1H-benzo[f]isoindole-1,5(2H)-diones
Authors: Cheng Dong , Meng Xiangzhen , Wang Dan , Zhao Xuan , Wang Yusheng , Ji Zhiyu
Published: November 2021

A synthetic method for the preparation of 3,3a,4,6,7,8,9,9a-octahydro-1 H-benzo[ f]isoindole-1,5(2 H)-diones from 1,6-dienes and vinyl iodides is developed using PdCl2(PPh3)2 as the catalyst. The presented approach exhibits a good functional group tolerance and affords moderate yields of the products. A mechanism is also proposed.
Firsthand Experience in Graduating Three Cohorts of Forensic Pathologists Trained With Competency by Design (CBD) Curriculum
Authors: Herath Jayantha C.
Published: November 2021

Introduction:

The University of Toronto experienced graduating three cohorts of forensic pathologists trained with Competency by Design (CBD) curriculum. We achieved this as a result of multiyear development of Entrustable Professional Activities (EPAs), Required Training Experience (RTEs), and Specialty Competency Requirements (SCRs) by the Royal College of Physicians and Surgeons of Canada’s Forensic Pathology Speciality Committee, the Ontario Forensic Pathology Service, and the University of Toronto.

Method:

Our academic year is comprised of 13 blocks. We divided the 13-block period into 4 stages to map all the EPAs and RTEs. The first stage, Transition to Discipline, is 1 block, the second stage, Foundation of Discipline, consists of 3 blocks; the third stage, Core of Discipline, consists of 6 blocks, and the final fourth stage, Transition to Practice, consists of 3 blocks. Board-certified faculty members in Forensic Pathology with more than five years of experience supervised the trainees. We graduated 5 Canadian and 4 international trainees at the end of the third cycle of CBD-based training program.

Conclusion:

Using the Royal College Speciality Committee blueprint, the University of Toronto started in 2016 planning the CBD curriculum in the forensic pathology training program. By the end of June 2021, we graduated nine trainees from our CBD-based Forensic Pathology training program. We are training the fourth cohort, and they will be graduating at the end of June 2022. This article aims to share our firsthand experiencing in CBD training in forensic pathology.
A preliminary report of the pattern of ear disease among students attending a school for people with disabilities in Samoa
Authors: Kaspar Annette , Pifeleti Sione , Lifeng An , Driscoll Carlie
Published: November 2021

Objectives:

The Ear, Nose, and Throat Department of Samoa is developing a school outreach service, and the aim of this study is to determine the pattern of ear disease among students attending a school for people with disabilities in Samoa.

Methods:

The study design is a prospective study of a 2-day outreach visit to a school for people with disabilities by the Samoan Ear, Nose, and Throat team who recorded their clinical findings (N = 28). Two Ear, Nose, and Throat Specialists performed ear examinations for each student and recorded their diagnosis and recommendations as per routine Ear, Nose, and Throat Clinic protocols on a purposefully designed form based on the World Health Organization Ear and Hearing Survey. This information was entered into an Excel spreadsheet for descriptive statistical analysis.

Results:

Results showed that 39% (n = 11) of students passed their initial ear examination, while 61% (n = 17) of students presented with at least one ear condition requiring Ear, Nose, and Throat intervention. The most common pathology was impacted wax (n = 15 ears). Following the Ear, Nose, and Throat Clinic outreach visit, 21 students (75%) no longer required Ear, Nose, and Throat or medical services, five students (18%) required a medical prescription for the treatment of ear disease, and two students (7%) were referred to the Ear, Nose, and Throat Department for further review.

Conclusion:

Students attending schools for people with disabilities are a priority population for the Ear, Nose, and Throat Clinical service outreach programme.
A case of Turner’s syndrome with Graves’ disease and primary hyperparathyroidism
Authors: Nagaki Shigeru , Tachikawa Emiko , Kodama Hitomi , Obara Takao , Osawa Makiko , Nagata Satoru
Published: November 2021

We report a 21-year-old woman with Turner’s syndrome, Graves’ disease and primary hyperparathyroidism. At 12 years of age, she was of short stature, and was diagnosed with Turner’s syndrome and treated with growth hormone. At the age of 17 years, she was diagnosed with Graves’ disease. On treatment with methimazole, her laboratory findings normalized. At the age of 20 years, her serum calcium and intact parathyroid hormone levels were high. The upper left parathyroid gland showed swelling and was resected, and adenoma was diagnosed pathologically. Then, primary hyperparathyroidism induced by the adenoma was diagnosed. After the parathyroidectomy, the patient’s serum calcium and intact parathyroid hormone levels normalized. Is likely that Turner’s syndrome and Graves’ disease were not associated with primary hyperparathyroidism. Multiple endocrine neoplasia type 1 was unlikely considering the clinical, laboratory, ultrasonographic, and scintigraphic findings.
Magnetic resonance imaging-guided biopsies in children
Authors: Hirvonen Mika , Sinikumpu Juha-Jaakko , Tervonen Osmo , Sequeiros Roberto Blanco
Published: November 2021

Background

Magnetic resonance imaging (MRI) is used far less as an imaging-guided method for percutaneous biopsies than computed tomography (CT) and ultrasound (US), despite its imaging benefits, particularly in children.

Purpose

To evaluate the feasibility, accuracy and safety of MRI-guided biopsies in paediatric patient population.

Material and Methods

The retrospective study included 57 consecutive paediatric patients (<18 years old). A percutaneous core needle biopsy (PCNB) or trephine biopsy was performed in 53 cases, and an additional fine-needle aspiration biopsy (FNAB) in 26 cases. In 4 cases, a stand-alone FNAB was taken. Biopsies were performed with 0.23 T open and 1.5 T closed MRI scanners. Statistical methods used for confidence intervals and p-values were Wilson score method and chi-square test.

Results

The overall diagnostic accuracy of histologic biopsy was 0.94, with sensitivity 0.82, specificity 1.00, positive predictive value (PPV) 1.00 and negative predictive value (NPV) 0.92. In histological bone biopsies, diagnostic accuracy was 0.96, with sensitivity 0.86, specificity 1.00, PPV 1.00 and NPV 0.94. The FNAB sample diagnosis was associated with the histological diagnosis in 79% of cases. There were no major primary complications and only a few late complications. After biopsy, 83% of the children were ambulatory in 6 h. Anti-inflammatory drugs and paracetamol provided satisfactory pain relief in 96% of the patients after biopsy. Most outpatients (71%) were discharged from hospital either on the same day or 1 day later.

Conclusion

MRI is a technically feasible, accurate and safe guidance tool for performing percutaneous biopsies in children.
Left Pulmonary Artery Sling: Postoperative Outcomes for Patients at a Single Center
Authors: Carlson Laura , Haider Mahwish , Liu Hua , Baird Christopher , Mayer John E. , Nathan Meena
Published: November 2021

Background

Left pulmonary artery (LPA) sling is a rare anomaly characterized by the origin of the LPA from the right pulmonary artery with a course between the trachea and esophagus. It is often associated with airway and cardiac anomalies.

Methods

This is a retrospective case series of consecutive patients who underwent LPA sling repair (LPASR) at a tertiary care center over a 35-year period with a focus on tracheal and/or LPA reinterventions and survival.

Results

Between June 1983 and July 2018, 42 patients were identified: isolated LPASR was performed in 16 (38%), LPASR/intracardiac repair in 10 (24%), and LPASR/tracheal repair in 16 (38%). There were 5 (12%) in-hospital and 4 (10%) late deaths. Survival rates (15 years) were as follows: 100% (isolated LPASR), 65% (concomitant intracardiac repair), and 52% (concomitant tracheal surgery). Preoperative intensive care unit (ICU) hospitalization was associated with future intervention on the LPA/trachea (61%, 11/18). The median distribution of blood flow to the left lung post-index surgery was 38%. Freedom from isolated LPA intervention was 100% after isolated LPASR, 93% after LPASR/tracheal surgery, and 69% after LPASR/intracardiac repair. Freedom from isolated tracheal intervention was 92% after isolated LPASR, 73% after LPASR/tracheal surgery, and 78% after LPASR/intracardiac repair.

Conclusions

ICU hospitalization prior to index surgery may indicate the severity of associated cardiac/tracheal abnormalities as this is associated with increased morbidity and mortality. Patients who underwent LPASR/intracardiac surgery were more likely to undergo isolated LPA intervention and those who underwent LPASR/tracheal surgery were more likely to undergo isolated tracheal intervention.
The Failed Bidirectional Glenn Shunt: Risk Factors for Poor Outcomes and the Role of Early Reoperation
Authors: Greenberg Jason W. , Pribble Chase M. , Singareddy Aashray , Ta Ngoc-Anh , Sescleifer Anne M. , Fiore Andrew C. , Huddleston Charles B.
Published: November 2021

Background: Bidirectional Glenn shunt (BDG) failure carries high morbidity and mortality but the clinical factors associated with failure and the optimal management strategy are understudied. Methods: A total of 217 patients undergoing BDG at our institution between 1989 and 2020 were retrospectively reviewed and categorized as success or failure. Failure was defined as the need for reoperation (BDG takedown, reoperation for correction of cardiac defect, and/or transplantation) at any time postoperatively; operative mortality (death attributable to BDG malfunction occurring during the index hospitalization for BDG or within 30 days of discharge); or late mortality (death directly attributable to BDG malfunction occurring prior to Fontan or next-stage palliation). Univariate and binary logistic regression analyses were performed. Results: BDG failure occurred in 14 (6.5%) patients. Univariate predictors were: hypoplastic left heart syndrome ( P = .037), right ventricular (RV) dominance ( P = .010), greater pre-BDG pulmonary vascular resistance (PVR) ( P = .012), concomitant atrioventricular valve repair ( P = .020), prolonged pleural drainage ( P = .001), intensive care unit ( P<.001) and hospital ( P = .002) stays, and extracorporeal membrane oxygenation (ECMO) requirement ( P<.001). Multivariate predictors were: RV dominance ( P = .002), greater PVR ( P = .041), ICU ( P<.001) and hospital ( P = .020) stays, and need for ECMO ( P<.001). As many as 10 of 14 (71%) patients with BDG failure died. Reoperation was performed for 10 patients with BDG failure. Five reoperation patients survived until discharge, with four patients alive at last follow-up (mean 7.9 years). Survivors underwent reoperation earlier than nonsurvivors (36 vs. 94 days). Conclusions: BDG failure carries high mortality, but preoperative predictors and postoperative indicators of failure exist. Early BDG takedown and insertion of aorta-pulmonary shunt may allow survival.
Strategic Learning and Knowledge Management of Technological Innovation in Safety Evaluation Planning of Construction Projects
Authors: Xiaoping Bai , Tao Pu
Published: November 2021

The safety evaluation of construction projects is a very important problem. In the current study, the new smart methods especially for the complexity and variability of construction safety evaluation are absent. Combined with the engineering examples, this paper analyzes the sensitive factors that affect the construction project safety and makes discretizating of influencing factors based on expert and BIM technique. Based on BIM and Bayesian network, this paper established a new construction project safety evaluation model and presented the hybrid methods of strategic learning and knowledge management of technological innovation in construction project safety evaluation. Combined with the example of underground traffic engineering of Zhengzhou city comprehensive transportation hub, the Bayesian network was used to predict its security level. The probability of the safety level of the project in grade 3 is 0.614. Compared to other evaluation methods, presented hybrid method is more intelligent in strategic learning and knowledge management of technological innovation. Through the Bayesian network sensitivity analysis, we can know that the sensitivity factor of the construction project safety in the project is the construction risk, the continuous operation time, the protective measures, the material risk, and the number of maintenance. Presented detailed computational methods and steps in this paper can be used to improve the level of construction project safety effectively and help construction managers to take more effective control measures to prevent or reduce the occurrence of security incidents.
The Relationship of Work-Related ICT Use With Well-being, Incorporating the Role of Resources and Demands: A Meta-Analysis
Authors: Baumeister Viktoria Maria , Kuen Leonie Petra , Bruckes Maike , Schewe Gerhard
Published: November 2021

An understanding of the overall relationship between the work-related use of information and communication technology (ICT) and employees’ well-being is lacking as the rising number of studies has produced mixed results. We meta-analytically synthesize and integrate existing literature on the consequences of ICT use based on the job demands-resources model. By using meta-analytical structural equation modeling based on 63 independent studies ( N = 26,295), we shed light on the relationship between ICT use and employees’ well-being (operationalized as burnout and engagement) in a model that incorporates the mediating role of ICT-related resources and demands. Results show that ICT use is opposingly related to burnout and engagement through autonomy, availability, and work-life conflict. Our study brings clarity into the contradictory results and highlights the importance of a simultaneous consideration of both positive and negative effects for a comprehensive understanding of the relationship. We further show that the time of use and managerial position, and methodological moderators can clarify heterogeneity in previous results.
Two Cases of Severe Autoimmune Thyrotoxicosis Following SARS-CoV-2 Infection
Authors: Edwards Khary , Hussain Iram
Published: November 2021

Since the start of the COVID-19 pandemic, there have been multiple reports of related thyroid dysfunction, most commonly, thyroiditis. The exact mechanism for this has not been elucidated, but it is known that thyroid gland cells have both angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) receptors, which the SARS-CoV-2 virus uses to enter cells. While SARS-CoV-2 has also been shown to precipitate other autoimmune diseases, there are only a few reported cases of new onset Graves’ disease in the setting of SARS-CoV-2 infection. We report 2 patients who presented with severe thyrotoxicosis (thyroid storm and impending storm) that was likely precipitated by SARS-CoV-2 infection. Both patients had no previous history of hyperthyroidism, and potentially also developed Graves’ disease after getting COVID-19. The addition of these cases to the medical literature will further highlight the fact that SARS-CoV-2 infection should be considered a causative agent for thyrotoxicosis when no other cause can be found, and that SARS-CoV-2 may be a potential trigger for autoimmune thyroid disease. It is important to know the SARS-CoV-2 status of such patients for infection control purposes, and to identify patients who may have their hospital course complicated by this disease. These cases may also help further our understanding of the etiology of autoimmune thyroid disease following a viral infection.
Prolonged Postoperative Opioid Use After Arthroscopic Femoroacetabular Impingement Syndrome Surgery: Predictors and Outcomes at Minimum 2-Year Follow-up
Authors: Beck Edward C. , Nwachukwu Benedict U. , Drager Justin , Jan Kyleen , Rasio Jonathan , Krishnamoorthy Vignesh P. , Nho Shane J.
Published: November 2021

Background:

The association between prolonged postoperative opioid use on outcomes after hip preservation surgery is not known.

Purpose:

To compare minimum 2-year patient-reported outcomes (PROs) between patients who required ≥1 postoperative opioid refill after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) versus patients who did not require a refill and to identify preoperative predictors for patients requiring ≥1 postoperative opioid refill.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Data from consecutive patients who underwent arthroscopic surgery for FAIS between January 2012 and January 2017 were analyzed. Multivariate regression analysis was performed to classify patient and radiographic variables as predictive of requiring ≥1 opioid prescription refill after surgery. Patients completed the following PROs preoperatively and at 2-year follow-up: Hip Outcome Score— Activities of Daily Living subscale (HOS-ADL), HOS–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), International Hip Outcome Tool (iHOT-12), and 100-point visual analog scale (VAS) for pain and satisfaction. Scores were compared between patients needing additional prescription opioids and those who did not.

Results:

A total of 775 patients, of whom 141 (18.2%) required ≥1 opioid prescription refill, were included in the analysis. Patients requiring opioid refills had significantly lower 2-year postoperative PRO scores compared with patients not requiring refills: HOS-ADL (79.9 ± 20.3 vs 88.7 ± 14.9), HOS-SS (64.6 ± 29.5 vs 78.2 ± 23.7), mHHS (74.2 ± 21.1 vs 83.6 ± 15.9), iHOT-12 (63.6 ± 27.9 vs 74.9 ± 24.8), and VAS satisfaction (73.4 ± 30.3 vs 82.2 ± 24.9), as well as significantly more pain (26.8 ± 23.4 vs 17.9 ± 21.8) ( P ≤ .001 for all). Predictors of requiring a postoperative opioid refill included patients with active preoperative opioid use (odds ratio, 3.12 [95% confidence interval, 1.06-9.21]; P = .039) and larger preoperative alpha angles (odds ratio, 1.04 [95% confidence interval, 1.01-1.07]; P = .03).

Conclusion:

Patients requiring ≥1 opioid prescription refill after hip arthroscopy for FAIS had lower preoperative and 2-year PRO scores when compared with patients not requiring refills. Additionally, active opioid use at the time of surgery was found to be predictive of requiring additional opioids for pain management.
Case Study Analysis as an Effective Teaching Strategy: Perceptions of Undergraduate Nursing Students From a Middle Eastern Country
Authors: Seshan Vidya , Matua Gerald Amandu , Raghavan Divya , Arulappan Judie , Al Hashmi Iman , Roach Erna Judith , Sunderraj Sheeba Elizebath , Prince Emi John
Published: November 2021

Background: Case study analysis is an active, problem-based, student-centered, teacher-facilitated teaching strategy preferred in undergraduate programs as they help the students in developing critical thinking skills. Objective: It determined the effectiveness of case study analysis as an effective teacher-facilitated strategy in an undergraduate nursing program. Methodology: A descriptive qualitative research design using focus group discussion method guided the study. The sample included undergraduate nursing students enrolled in the Maternal Health Nursing Course during the Academic Years 2017 and 2018. The researcher used a purposive sampling technique and a total of 22 students participated in the study, through five (5) focus groups, with each focus group comprising between four to six nursing students. Results: In total, nine subthemes emerged from the three themes. The themes were “Knowledge development”, “Critical thinking and Problem solving”, and “Communication and Collaboration”. Regarding “Knowledge development”, the students perceived case study analysis method as contributing toward deeper understanding of the course content thereby helping to reduce the gap between theory and practice especially during clinical placement. The “Enhanced critical thinking ability” on the other hand implies that case study analysis increased student's ability to think critically and aroused problem-solving interest in the learners. The “Communication and Collaboration” theme implies that case study analysis allowed students to share their views, opinions, and experiences with others and this enabled them to communicate better with others and to respect other's ideas which further enhanced their team building capacities. Conclusion: This method is effective for imparting professional knowledge and skills in undergraduate nursing education and it results in deeper level of learning and helps in the application of theoretical knowledge into clinical practice. It also broadened students’ perspectives, improved their cooperation capacity and their communication with each other. Finally, it enhanced student's judgment and critical thinking skills which is key for their success.
177Lu-dotatate use in chronic kidney disease patients: A single center experience
Authors: Manohar Sandhya , Kompotiatis Panagiotis , Halfdanarson Thorvardur R , Hobday Timothy J , Thorpe Matthew , Johnson Geoffrey B , Kendi Ayse Tuba , Leung Nelson
Published: November 2021

Background:

Peptide receptor radionuclide therapy with 177Lu-dotatate is a novel therapy for metastatic neuroendocrine cancers. It undergoes reabsorption at the proximal tubule; after the breakdown of the peptide fragment, 177Lu is retained and continues its decay process exposing the nephron to continuous low dose radiation. Pivotal NETTER-1 trial did not include patients with eGFR <50 and so its effects in CKD patients is not known.

Methods:

We performed a retrospective chart review of all consecutive adult patients that received 177Lu-dotatate over 1 year at Mayo Clinic, Rochester. We analyzed renal and hematological laboratory data obtained prior to each of four treatment cycles and at 3- and 6-month post completion of all treatment. We defined CKD as eGFR <60 ml/min and AKI as creatinine increase of ⩾0.3 from baseline by AKIN criteria.

Results:

Overall 86 patients were included in the study with 39 (45%) with known CKD. About three patients had CKD, four with eGFR of 20–30 ml/min. About 4 (4.6%) patients had AKI and the predominant cause being hypotension. Among the CKD patients the average eGFR improved after the first cycle of PRRT therapy from baseline of 49 (13) to 53.5 (17) ml/min ( p = 0.01) with no significant decline of renal function noted at 3- and 6-months post treatment follow up. Rate of thrombocytopenia and leukopenia were significantly more in the CKD patients starting even after single treatment. No drug dose correlation was noted.

Conclusion:

Patients with CKD are at a higher risk of hematological toxicity especially with thrombocytopenia and require close monitoring and ongoing dose adjustment. Ongoing safety studies to assess the long-term impact of 177Lu-dotatate on the kidney are needed.
Clinical Outcomes and Complications With Open vs Minimally Invasive Achilles Tendon Repair
Authors: Caolo Kristin C. , Eble Stephanie K. , Rider Carson , Elliott Andrew J. , Demetracopoulos Constantine A. , Deland Jonathan T. , Drakos Mark C. , Ellis Scott J.
Published: November 2021

Background:

There is no current consensus on whether to use an open or minimally invasive (MIS) approach for Achilles tendon repair after acute rupture. We hypothesized that patients in both open and MIS groups would have improved patient-reported outcome scores using the PROMIS system postoperatively, but that there would be minimal differences in these scores and complication rates between operative techniques.

Methods:

A total of 185 patients who underwent surgery for an acute, unilateral Achilles tendon rupture between January 2016 and June 2019, with minimum 1-year follow-up were included in the cohort studied. The minimally invasive group was defined by use of a commercially available minimally invasive device through a smaller surgical incision (n=118). The open repair group did not use the device, and suture repair was performed through larger surgical incisions (n=67). Postoperative protocols were similar between groups. Preoperative and postoperative PROMIS scores were collected prospectively through our institution’s registry. Demographics and complications were recorded.

Results:

PROMIS scores overall improved in both study groups after operative repair. No significant differences in postoperative PROMIS scores were observed between the open and MIS repair groups. There were also no significant differences in complication rates between groups. Overall, 19.5% of patients in the MIS group had at least 1 postoperative complication (8.5% deep vein thrombosis [DVT], 3.3% rerupture, 1.7% sural nerve injury, 2.5% infection), compared to 16.4% in the open group (9.0% DVT, 1.5% rerupture, 1.5% sural nerve injury, 0% infection).

Conclusion:

Patients undergoing either minimally invasive or open Achilles tendon repair after acute rupture have similar PROMIS outcomes and complication types and incidences.

Level of Evidence:

Level III, retrospective cohort study.
Seascape shadows: Life in the ruins of the edible bird's nest harvest in northern Palawan, the Philippines
Authors: Satizábal Paula , Dressler Wolfram H. , Guieb Eulalio R. , Varquez Jessie G. , Fabinyi Michael
Published: November 2021

The intensifying extraction, privatization, and conservation of maritime spaces are transforming seascapes globally. Amidst rapid coastal change and the ambiguous reconfiguration of oceans as frontiers are coastal dwellers who occupy the shadows of these seascapes. In contrast to the capture of high-profile marine species, the harvest of the edible nests of balinsasayaw (swiftlet, Aerodramus fuciphagus) remains largely concealed at the interstitial spaces between land, coast, and sea. In the Philippines, harvesters known as busyador negotiate social relations, political networks, and karst systems to extract these lucrative nests. Despite the nest industry growing in value in Southeast Asia, we show how the busyador struggle in precarious social relations and spaces peripheral to coastal governance in northern Palawan Island. Building on the concept of ‘seascape assemblages’, we emphasize the importance of the less visible human-nonhuman relations that shape the nest harvest and trade. We trace the marginal social histories of the balinsasayaw by highlighting the precarious nature of the harvest, revealing how the busyador are subject to unfair working conditions, dispossession, and violence. We argue that as state actors and local elites reconfigure oceans as frontiers for development and conservation, struggles over labour and tenure rights, livelihood opportunities, and justice at sea are disregarded.
Safety and reactogenicity of the adjuvanted recombinant zoster vaccine: experience from clinical trials and post-marketing surveillance
Authors: Fiore Joseph , Co-van der Mee Maribel Miranda , Maldonado Andrés , Glasser Lisa , Watson Phil
Published: November 2021

An adjuvanted recombinant zoster vaccine (RZV) is licensed for the prevention of herpes zoster. This paper reviews its safety and reactogenicity. A pooled analysis of two pivotal randomized Phase-3 trials (NCT01165177, NCT01165229) in adults ⩾50 years found that more solicited adverse events (AEs) were reported with RZV than placebo. Injection site pain was the most common solicited AE (RZV: 78.0% participants; placebo: 10.9%). Grade-3 pain occurred in 6.4% of RZV and 0.3% of placebo recipients. Myalgia, fatigue, and headache were the most commonly reported general solicited AEs (RZV: 44.7%, 44.5%, and 37.7%, respectively; placebo: 11.7%, 16.5%, and 15.5%, respectively). Most symptoms were mild to moderate in intensity with a median duration of 2–3 days. The intensity of reactogenicity symptoms did not differ substantially after the first and second vaccine doses. The pooled analysis of the pivotal Phase-3 trials did not identify any clinically relevant differences in the overall incidence of serious adverse events (SAEs), fatal AEs or potential immune-mediated diseases (pIMDs) between RZV and placebo. Reactogenicity in five studies of immunocompromised patients ⩾18 years (autologous stem cell transplant, human immunodeficiency virus, solid tumors, hematological malignancies, and renal transplant; NCT01610414, NCT01165203, NCT01798056, NCT01767467, and NCT02058589) was consistent with that observed in the pivotal Phase-3 trials. There were no clinically relevant differences between RZV and placebo in the immunocompromised populations with regard to overall incidence of SAEs, fatal AEs, pIMDs, or AEs related to patients’ underlying condition. Post-marketing surveillance found that the most commonly reported AEs were consistent with the reactogenicity profile of the vaccine in clinical trials. Overall, the clinical safety data for RZV are reassuring.

[Formula: see text]