bluuebunny/crossref_metadata_2025 huggingface dataset:
Distributed IT championing: A process theory
Authors: Negoita Bogdan , Rahrovani Yasser , Lapointe Liette , Pinsonneault Alain
Published: May 2021

Championing is key to the success of an IT implementation. Recently, changes in the nature of technologies used in organizational contexts and changing organizational structures call for a renewed focus on IT championing to explain its distributed nature. Following an analytic induction approach and drawing from semi-structured interviews with 37 practitioners (physicians, residents, nurses, IT staff, and administrators) in three healthcare-related settings, the study conceptualizes distributed IT championing as a process constituted of multiple individuals’ behaviors, unfolding over time, that proactively go beyond formal job requirements in support of an IT implementation. While multiple individuals may enact similar championing behaviors, the data indicate that multiple individuals may also enact distinct, yet complementary, championing behaviors over the course of the IT implementation. Overall, distributed IT championing evolves through cycles of distinct stages of bridging-in, bonding, and bridging-out, with each stage being shaped by different dimensions of social capital. Also, IT artifacts that are particularly generative appear more conducive to distributed IT championing than closed ones. This article contributes to extant literature on IT championing by developing a process model of distributed IT championing in the context of an IT implementation.
Telemedicine for management of patients with lung cancer during COVID-19 in an Italian cancer institute: SmartDoc Project
Authors: Pardolesi Alessandro , Gherzi Lorenzo , Pastorino Ugo
Published: May 2021

Background:

Telemedicine, and particularly video-consulting, has rapidly accelerated since the coronavirus disease 2019 (COVID-19) pandemic outbreak. The role of e-healthcare for the management of patients with lung diseases is evolving. We report the results of the initial experience of the SmartDoc Project, a telemedicine program activated in a cancer center (Istituto Nazionale Tumori) at the epicenter of the COVID-19 pandemic onset in Italy.

Method:

The SmartDoc project was established to guarantee continuity of healthcare services for patients with lung cancer during the COVID-19 pandemic crisis. The project was promoted within the National Health System to create a regulatory framework to authorize and reimburse telemedicine in its care delivery for all patients. At the end of the virtual meeting, patients were asked to answer an online survey.

Results:

From June 19 to December 1, 2020, 83 patients participated in the SmartDoc project and received a teleconsultation. The majority of patients were older than 65 years. Among the 83 televisits, 14 (16.9%) were new visits, 2 (2.4%) second opinions, 4 (4.8%) 30-day postsurgery controls, and 63 (75.9%) long-term follow-up visits. A “complete satisfaction” score (5 out of 5 points) was reported in 70.59% of all the respondents; most patients (76.5%) preferred video-consulting and defined it as better than or comparable to an in-person visit.

Conclusion:

The favorable initial results of this study suggest that telemedicine should continue beyond the pandemic crisis and should be embedded in a more efficient and accessible healthcare system.
From the uneven de-diversification of local financial resources to planning policies: The residentialization hypothesis
Authors: Grandclement Antoine , Boulay Guilhem
Published: May 2021

This paper builds a theoretical framework to question the ramifications of the rise of consumption-based economy also known as residential economy in the context of a growing circulation of populations and income. We propose the term residentialization to describe the self-reinforcing and spatially uneven expansion of the residential economy, and its intertwined impacts on land use and tax revenues that are likely to influence future local planning policies. In local areas with a developing residential economy, demographic attractiveness and urbanization strongly affect the fiscal bases of property taxes and household-related taxes in general as opposed to business taxes. This process provides local governments with new fiscal revenues but also induces a growing dependence on these incomes, especially in an austerity era. This de-diversification of local financial resources results in inequalities that weigh on local governments’ financial leeway and hence on planning policies. Using a comprehensive database of the fiscal and financial resources of France's 35,000 municipalities over the last 15 years, we provide cartographic and statistical evidence of this uneven fiscal de-diversification. We build a multivariate classification of France's municipalities and show strong links between the structure and evolutions of local financial resources and the pace and forms of urbanization. These results draw attention to the economic, social, and environmental sustainability of consumption-oriented planning strategies in an austerity era.
Drivers Still Have Limited Knowledge About Adaptive Cruise Control Even When They Own the System
Authors: DeGuzman Chelsea A. , Donmez Birsen
Published: May 2021

Much of the existing research on drivers’ understanding of adaptive cruise control (ACC), a type of advanced driver assistance system, was conducted several years ago. Through an online survey, this study aimed to assess ACC knowledge among ACC owners and non-owners now that this system is more widely available. Along with knowledge of ACC features and limitations, demographic information, experience with technology, and experience with ACC (for owners) were also collected to investigate which factors predicted knowledge of ACC features and limitations. Results showed that owners today may have a better understanding of some of the main limitations of ACC compared with research conducted over 10 years ago. However, a large percentage of owners still had misperceptions about their ACC system. While owners had a slightly higher percentage of correct answers overall, they did not differ from non-owners in their knowledge of limitations. As this technology is becoming more common, even non-owners may be becoming aware of common limitations; owning and using ACC does not seem to result in a better system understanding. Higher income was associated with a higher percentage of correct responses on the ACC knowledge questionnaire for both owners and non-owners, and for non-owners, higher education level was also significantly associated with a higher percentage of correct responses. Future research should focus on developing training materials that are accessible to all drivers, so that drivers in lower education and income groups are also supported to understand how advanced driver assistance systems work and benefit from these technologies.
Holistic simulation-based optimisation methodology for facility layout design with consideration to production and logistics constraints
Authors: Ruiz Zúñiga Enrique , Flores García Erik , Urenda Moris Matías , Fathi Masood , Syberfeldt Anna
Published: May 2021

Facility layout design is becoming more challenging as manufacturing moves from traditionally emphasised mass production to mass customisation. The increasing demand for customised products and services is driving the need to increase flexibility and adaptability of both production processes and their material handling systems. A holistic approach for designing facility layouts with optimised flows considering production and logistics systems constraints seems to be missing in the literature. Several tools, including traditional methods, analytic hierarchy process, multiple-attribute decision making, simulation, and optimisation methods, can support such a process. Among these, simulation-based optimisation is the most promising. This paper aims to develop a facility layout design methodology supported by simulation-based optimisation while considering both production and logistics constraints. A literature review of facility layout design with simulation and optimisation and the theoretical and empirical challenges are presented. The integration of simulation-based optimisation in the proposed methodology serves to overcome the identified challenges, providing managers and stakeholders with a decision support system that handles the complex task of facility layout design.
Decoupling motion tracking control for 4WD autonomous vehicles based on the path correction
Authors: Yu Yinghong , Li Yinong , Liang Yixiao , Zheng Ling , Ren Yue
Published: May 2021

Since one control loop input disturbs the control of another loop, the dynamic coupling of the longitudinal and lateral directions adversely affects the motion tracking accuracy of autonomous vehicles. With the ability to minimize the interactions between the longitudinal and lateral dynamics, the inverse system learned by the neural network is an effective way to decouple vehicle dynamics. After tracking the vehicle states projected from the desire motion, the dynamic decoupling and the motion tracking are both realized. However, the accumulation of vehicle state tracking errors causes the stable yaw tracking error and the lateral tracking divergence. To solve the accompanying problem, a path correction model is designed to periodically update the desired vehicle states. Moreover, the applicability of the inverse system decoupling method is improved in this paper, because the method usually adopted in distributed drive electric vehicles is applied to four-wheel driving vehicles representing the traditional driving form. Simulation results indicate that the decoupling motion tracking method with the path correction model is suitable for long-distance and complex conditions and has the highest comprehensive tracking accuracy compared with the integrated MPC (model predictive control) and the pure pursuit in the dynamic coupling conditions.
Madame President, Madame Ambassador? Women Presidents and Gender Parity in Latin America’s Diplomatic Services
Authors: Erlandsen Matthias , Hernández-Garza María Fernanda , Schulz Carsten-Andreas
Published: May 2021

This study focuses on the gendered nature of ambassadorial appointments. Analyzing the diplomatic services of ten Latin American countries between 2000 and 2018, we examine the factors that explain the designation of women to ambassadorships. More especially, we are interested in whether the election of women to the presidency in Argentina, Brazil, Chile, and Costa Rica had an impact on the gender gap at the top of those countries’ foreign services. Drawing on an original dataset on diplomatic appointments, we show that the presence of women ambassadors has increased only marginally over the past two decades. Furthermore, multivariate regression analysis demonstrates that women presidents on the left have (partially and temporarily) corrected the gender gap in their foreign services through political appointments, provided they had the discretionary powers to do so. Our findings suggest that the impact of women-led presidencies is conditional on the chief executive’s vested interest in gender parity and the scope of presidents’ prerogatives to appoint ambassadors. In so doing, the study contributes to debates on the descriptive underrepresentation of women in executive positions and the gender gap in diplomacy.
Discourses of Belonging: Intersections of Truth, Power, and Ethics in Evaluation With Migrant Youth
Authors: Rodriguez Sophia , Acree Jeremy
Published: May 2021

This article problematizes methodological practices, specifically the use of surveys as tools of measurement in evaluation with migrant youth. Drawing from Foucault’s Genealogy of Ethics, we investigate the knowledge created about particular minoritized groups through the author’s current evaluation, the power relations involved, and the ethical dimensions of evaluation. We argue that ethical questions for evaluators are entangled in an era of neoliberal, audit culture in educational research. We offer a theoretical orientation for productive critique of methodological practice.
Novel external stenting for reconstruction of high flow arteriovenous fistula
Authors: Matoussevitch Vladimir , Kalmykov Egan , Shahverdyan Robert
Published: May 2021

Background:

High-flow arteriovenous fistulae (HF-AVF) may lead to adverse cardiac remodeling in hemodialysis patients. We have investigated whether a novel external stent is safe and effective in reducing and stabilizing flow rates during a 1-year follow-up after HF-AVF reconstruction.

Methods:

All patients with HF-AVF (access flow rate ⩾ 1500 ml/min), who underwent HF-AVF reconstruction with external stenting in two centers between June 2018 and May 2020, were included in this retrospective analysis. During HF-AVF reconstruction, the dilated vein segment was resected, underwent volume reduction, and was externally stabilized using a braided cobalt-chromium external stent. AVF flow rates were assessed preoperatively, intraoperatively, and at follow up visits using duplex ultrasound.

Results:

Forty-three HF-AVFs in 42 patients were reconstructed and supported with an external stent (mean age 49 years, range 20–86 years; 74% men). Fifty-one percent were forearm AVFs, 49% were upper arm. The mean preoperative flow rate was 2622 ± 893 ml/min (range: 1500–6000 ml/min) and was decreased to 710 ± 221 ml/min (range: 300–1300 ml/min) intra-operatively after HF-AVF reconstruction. At 6 and 12-months follow-up, the mean flow rates were 1132 ± 320 ml/min (range: 470–1700 ml/min) and 1453 ± 888 ml/min (range: 300–3800 ml/min), respectively. Recurrence of high flow (>1500 ml/min) occurred in 16% and 25% of the patients at 6 and 12 months and primary patency rates were 86% and 70%, respectively.

Conclusions:

This early experience with novel external stenting for HF-AVF reconstruction demonstrates that it is a safe and effective method for reducing and stabilizing flow rates up to 1-year post procedure. Additional studies are required to evaluate the durability of this procedure over the longer term and assess its effect on cardiac remodeling.
Aid, Peacebuilding, and Human Security: Japan’s Engagement in South Sudan, 2011–2017
Authors: Tana Maria Thaemar C.
Published: May 2021

The article examines the case of Japan’s peacebuilding in South Sudan from 2011 to 2017 and asks how Japan’s shift towards a more proactive defence posture affects the place of human security in its foreign policy agenda. Using the framework of neoclassical realism, the article argues that human security remains a critical element of Japanese foreign policy despite changes in its strategic orientation because, international predicaments notwithstanding, Japan’s foreign policy decision making is still significantly constrained by domestic variables such as state–society relations, elite perceptions, elite consensus, and domestic institutional arrangements. Changes in Japan’s overall foreign and security policies do not diminish the importance of human security. Despite the shift to a more assertive foreign policy, Japan still retains the essential features of its diplomacy. External variables influence policymakers’ decision making, but domestic variables constrain policy choices and outcomes.
Understanding the role of local educational departments in school collaboration for improvement: Two districts in China
Authors: Wei Feng , Ni Yongmei , Yoon Irene H
Published: May 2021

As improving low-performing schools has become a critical strategy to achieve educational equity in China, local educational departments have implemented various school collaboration programs. Drawing on international literature and empirical data from in-depth interviews and policy documents in two Chinese urban districts, this multiple-case qualitative study examines local educational departments’ roles in the school collaboration implementation. Our analysis shows that both local educational departments set clear district-wide expectations of school collaborations. While various strategies were implemented to improve low-performing schools, limited opportunities were provided for school-based educators to contribute to decision-making processes. Both districts relied more on structural changes to create conditions to improve teaching and learning, and lacked long-term investments in building professional capacity and fostering data-use cultures. Finally, local educational departments’ goals of equity and school improvement were sometimes overshadowed by other political and economic priorities. This study offers new evidence on the leadership roles that local educational departments play in Chinese school reform implementation, thus responding to a scarcity of district-level empirical research in Chinese literature. It also expands the existing international research base that is largely Western-focused and not necessarily applicable to all countries, especially developing countries where school improvement efforts are often situated in conflicting policy systems.
The role of PARP inhibitors in BRCA mutated pancreatic cancer
Authors: Chi Jeffrey , Chung Su Yun , Parakrama Ruwan , Fayyaz Fatima , Jose Jyothi , Saif Muhammad Wasif
Published: May 2021

Pancreatic ductal adenocarcinoma (PDAC) accounts for about 3% of all cancers in the United States and about 7% of all cancer deaths. Despite the lower prevalence relative to other solid tumors, it is one of the leading causes of cancer-related death in the US. PDAC is highly resistant to chemotherapy as well as radiation therapy. Current standard-of-care chemotherapeutic regimens provide transient disease control but eventually tumors develop chemoresistance. Tumors that are deficient in DNA damage repair mechanisms such as BRCA mutants respond better to platinum-based chemotherapies. However, these tumor cells can utilize the poly adenosine diphosphate (ADP)-ribose polymerase (PARP) as a salvage DNA repair pathway to prolong survival. Hence, in the presence of BRCA mutations, the inhibition of the PARP pathway can lead to tumor cell death. This provides the rationale for using PARP inhibitors in patients with BRCA mutated PDAC. The phase III POLO trial showed a near doubling of progression-free survival (PFS) compared with placebo in advanced PDAC when a PARP inhibitor, olaparib, was used as maintenance therapy. As a result, the US Food and Drug Administration (FDA) approved olaparib as a maintenance treatment for germline BRCA mutated advanced PDAC that has not progressed on platinum-based chemotherapy. The success of olaparib in treating advanced PDAC opened the new field for utilizing PARP inhibitors in patients with DNA damage repair (DDR) gene defects. Currently, many clinical trials with various PARP inhibitors are ongoing either as monotherapy or in combination with other agents. In addition to germline/somatic BRCA mutations, some trials are enrolling patients with defects in other DDR genes such as ATM, PALB2, and CHEK2. With many ongoing PARP inhibitor trials, it is hopeful that the management of PDAC will continuously evolve and eventually lead to improved patient outcomes.
Towards psychological herd immunity: Cross-cultural evidence for two prebunking interventions against COVID-19 misinformation
Authors: Basol Melisa , Roozenbeek Jon , Berriche Manon , Uenal Fatih , McClanahan William P. , Linden Sander van der
Published: May 2021

Misinformation about the novel coronavirus (COVID-19) is a pressing societal challenge. Across two studies, one preregistered ( n1 = 1771 and n2 = 1777), we assess the efficacy of two ‘prebunking’ interventions aimed at improving people’s ability to spot manipulation techniques commonly used in COVID-19 misinformation across three different languages (English, French and German). We find that Go Viral!, a novel five-minute browser game, (a) increases the perceived manipulativeness of misinformation about COVID-19, (b) improves people’s attitudinal certainty (confidence) in their ability to spot misinformation and (c) reduces self-reported willingness to share misinformation with others. The first two effects remain significant for at least one week after gameplay. We also find that reading real-world infographics from UNESCO improves people’s ability and confidence in spotting COVID-19 misinformation (albeit with descriptively smaller effect sizes than the game). Limitations and implications for fake news interventions are discussed.
Effects of delayed suprapubic port removal on post-laparoscopic shoulder pain: a randomized controlled trial
Authors: Chalermchockcharoenkit Amphan , Hengrasmee Pattaya , Sophontanarak Paiboon , Sirimai Korakot , Sutchritpongsa Pavit , Srichaikul Pisutt
Published: May 2021

Background

One of the major drawbacks of gynecologic laparoscopy is post-laparoscopic shoulder pain (PLSP) that is believed to result from intra-abdominal CO2 retention leading to peritoneal and diaphragmatic stretching and causing referred pain in C4 dermatome. Several interventions have been applied to prevent and reduce its incidence and severity, with contradictory results. Only pulmonary recruitment maneuver, extended assisted ventilation, and active intra-abdominal gas aspiration have been mentioned to be effective interventions for CO2 evacuation. However, in our experience, an alternative technique of delayed suprapubic port removal (DSPR) was found to be an effective method in CO2 expulsion. Therefore, we conducted this randomized trial to determine the effectiveness of the DSPR technique in reducing the incidence and severity of PLSP. The trial was conducted at a single, tertiary hospital between May 2015 and May 2016. Having complied with the criteria, 220 patients scheduled for elective gynecological laparoscopy were randomly allocated into 2 groups after giving informed consent. Laparoscopic procedures were performed through 10-mm umbilical port and at least 2 ancillary, including suprapubic, ports. In conventional group, ancillary ports were removed at the end of surgery leaving only opened umbilical cannula for pneumoperitoneum deflation. Abdominal compression from periphery towards umbilicus was performed to further expel CO2 before removing the umbilical cannula. In DSPR group, both umbilical and suprapubic cannulas were retained. Two-step abdominal compression was undertaken, primarily towards umbilicus and secondarily towards pelvic cavity, before sequentially removing the umbilical and the suprapubic cannulas. Postoperatively, each patient was asked to rate PLSP level on 100-mm VAS during 0–6, 6–12, 12–24, and 24–48 h, respectively. Statistical analysis was performed to determine both incidence and severity of PLSP during 24- and 48-h post-laparoscopy.

Results

Patients in DSPR group demonstrated significantly lower incidence of PLSP within 24 h (43.8% vs 59.0%; p = 0.027) and 48 h (43.8% vs 60.0%; p = 0.019), and expressed apparently lower pain scores (0 (0–0) vs 0 (0–8); p = 0.020) during 24–48 h post-surgery.

Conclusion

DSPR is an effective CO2 expulsion technique, resulting in significant reduction of both incidence and severity of PLSP within 24–48 h post-laparoscopy.

Trial registration

Thai Clinical Trials Registry, TCTR20160208003. Registered 8 February 2016 — retrospectively registered; http://www.thaiclinicaltrials.org/
The effects of interventional mitral valve repair using the MitraClip System on the results of pulmonary function testing, pulmonary pressure and diffusing capacity of the lung
Authors: Kretzler Lucie , Große Stephan , Wiedemann Stephan , Wunderlich Carsten , Nowak Chris , Riedel Christian , Sieger Tomáš , Schoen Steffen
Published: May 2021

Background

The study analyzes changes in lung function, pulmonary pressure and diffusing capacity of the lung in patients with mitral valve regurgitation (MR) treated by MitraClip implantation.

Methods

A total of 43 patients (19 women and 24 men with an average age of 78.0 ± 6.6 years) who were able to perform pulmonary function testing including diffusing capacity of the lung for carbon monoxide (DLCO), vital capacity (VC), total lung capacity (TLC), residual volume (RV) and forced expiratory volume in 1 s (FEV1) before and 6 weeks after MitraClip implantation participated in this study. Furthermore, clinical and echocardiographic parameters including systolic pulmonary artery pressure (sPAP), left ventricular ejection fraction (LVEF) and left atrial diameter (LAD) measurements were recorded in all patients.

Results

The procedure was performed successfully in all 43 patients leading to a reduction of MR in 97.7% of cases. One patient died on day 4 after the intervention most likely due to pulmonary artery embolism. Six weeks after the implantation 79.1% of patients showed a MR of at most mild to moderate. Furthermore, we could demonstrate a significant reduction of systolic pulmonary artery pressure during follow-up (from 48.8 ± 11.4 mmHg to 42.9 ± 9.0 mmHg (t(41) = − 2.6, p = 0.01). However, no changes in LVEF were detected. Comparing pre and post implant lung function tests, no significant alterations were seen for VC, TLC, DLCO and FEV1. Though, in a subgroup of patients with moderate to severe preexisting deterioration of DLCO at the baseline (max. 50%) the MitraClip procedure resulted in a significant improvement in DLCO (37.8% ± 9.0 to 41.6% ± 10.0, p < 0.001).

Conclusions

Treatment of MR with the MitraClip system successfully reduces MR severity in the vast majority of patients. Consecutively, a reduction in pulmonary pressure could be observed, however no changes in LVEF were obvious. Lung function tests remained unaltered during follow-up. However, in a subgroup of patients with severe preexisting deterioration of DLCO the MitraClip procedure resulted in a significant improvement in DLCO.

Trial registration

Name of the registry: Die Auswirkung der interventionellen Mitralklappenreparatur mit MitraClip-System auf die Ergebnisse der Lungenfunktionsmessung.

Trial registration number

DRKS00022435; Date of registration: 09/07/2020 'Retrospectively registered'; URL of trial registry record: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022435.
Subdivision of de-novo metastatic nasopharyngeal carcinoma based on tumor burden and pretreatment EBV DNA for therapeutic guidance of locoregional radiotherapy
Authors: Yang Jin-Hao , Sun Xue-Song , Xiao Bei-Bei , Liu Li-Ting , Guo Shan-Shan , Liang Jia-Dong , Jia Guo-Dong , Tang Lin-Quan , Chen Qiu-Yan , Mai Hai-Qiang
Published: May 2021

Background

Nasopharyngeal carcinoma (NPC) is a malignancy predominantly associated with infection by the Epstein-Barr virus (EBV). Approximately 12,900 new cases of NPC occur each year, with more than 70% of cases occurring in the east and southeast Asia. NPC is different from ordinary head and neck squamous cell carcinoma due to its particular biological properties and it is highly sensitive to radiotherapy. With the development of RT technology, the 3-year local control rate and survival rates of non-metastatic NPC reached 80–90% in the intensity-modulated RT (IMRT) era. However, whether distant metastatic NPC (de novo mNPC, dmNPC) should receive locoregional RT (LRRT) needs to be clarified.

Results

Multivariate analysis identified three independent prognostic factors: Epstein-Barr virus (EBV) DNA, number of metastatic lesions, and number of metastatic organs. Through these factors, all patients were successfully divided into 3 subgroups: low-risk (single metastatic organ, EBV DNA ≤ 25,000 copies/ml, and ≤ 5 metastatic lesions), intermediate-risk (single metastatic organ, EBV DNA > 25,000 copies/ml, and ≤ 5 metastatic lesions), and high-risk (multiple metastatic organs or > 5 metastatic lesions or both). By comparing LRRT and non-LRRT groups, statistical differences were found in OS in the low-risk and intermediate-risk subgroups (p = 0.039 and p = 0.010, respectively) but no significant difference was found in OS in the high-risk subgroup (p = 0.076). Further multivariate analysis of different risk stratifications revealed that LRRT can improve OS of low- and intermediate-risk subgroups.

Conclusions

The risk stratification of dmNPC may be used as a new prognostic factor to help clinicians organize individualized LRRT treatment to improve the survival outcomes of dmNPC patients.
Characteristics and recurrence of pterygium in Saudi Arabia: a single center study with a long follow‐up
Authors: Alsarhani Waleed , Alshahrani Saeed , Showail Mahmood , Alhabdan Nawaf , Alsumari Osama , Almalki Abdullah , Alsarhani Abdulaziz , Alluhaidan Adel , Alqahtani Bader
Published: May 2021

Background

This study described the clinical features of patients with pterygium and analyzed the recurrence rate of conjunctival autografting alone, conjunctival autografting combined with intraoperative mitomycin C, and amniotic membrane grafting.

Methods

A retrospective cohort study of primary pterygium was conducted between January 2017 and February 2020. Factors associated with pterygium severity and recurrence were analyzed by univariate analysis and logistic regression models.

Results

The study included 292 patients with an average age of 53.3 ± 14.1 years, while the number of operated cases was 94. Pterygia involving the cornea were observed in 55 % of the cases. The overall rate of recurrence for the three procedures was 17 %. The average time of recurrence was 14.2 ± 11.9 months, with 37 % of the recurrences occurring after the first year. The only factor associated with a significant risk of recurrence was dry eye disease in both univariate (p = 0.021) and multivariate analysis (p = 0.026). The recurrence rates following conjunctival autografting with and without mitomycin C were 15.6 and 15.8 %, respectively. The recurrence rate following the amniotic membrane graft was  twofold (OR= 2.02)  (27 %) that following the conjunctival autograft (15.8 %).

Conclusions

The only factor associated with the recurrence of pterygium was dry eye disease. More than one-third of recurrences developed after the first year, which stresses the importance of a long follow-up. The recurrence rate in our study following conjunctival graft was slightly higher compared to the literature mainly due to differences in study areas, populations, and follow-up periods.
Lower regional grey matter in alcohol use disorders: evidence from a voxel-based meta-analysis
Authors: Li Lei , Yu Hua , Liu Yihao , Meng Ya-jing , Li Xiao-jing , Zhang Chengcheng , Liang Sugai , Li Ming-li , Guo Wanjun , QiangWang  , Deng Wei , Ma Xiaohong , Coid Jeremy , Li Tao
Published: May 2021

Background

Previous research using whole-brain neuroimaging techniques has revealed structural differences of grey matter (GM) in alcohol use disorder (AUD) patients. However, some of the findings diverge from other neuroimaging studies and require further replication. The quantity of relevant research has, thus far, been limited and the association between GM and abstinence duration of AUD patients has not yet been systematically reviewed.

Methods

The present research conducted a meta-analysis of voxel-based GM studies in AUD patients published before Jan 2021. The study utilised a whole brain-based d-mapping approach to explore GM changes in AUD patients, and further analysed the relationship between GM deficits, abstinence duration and individual differences.

Results

The current research included 23 studies with a sample size of 846 AUD patients and 878 controls. The d-mapping approach identified lower GM in brain regions including the right cingulate gyrus, right insula and left middle frontal gyrus in AUD patients compared to controls. Meta-regression analyses found increasing GM atrophy in the right insula associated with the longer mean abstinence duration of the samples in the studies in our analysis. GM atrophy was also found positively correlated with the mean age of the samples in the right insula, and positively correlated with male ratio in the left middle frontal gyrus.

Conclusions

GM atrophy was found in the cingulate gyrus and insula in AUD patients. These findings align with published meta-analyses, suggesting they are potential deficits for AUD patients. Abstinence duration, age and gender also affect GM atrophy in AUD patients. This research provides some evidence of the underlying neuroanatomical nature of AUD.
Smoking among inpatients in treatment for substance use disorders: prevalence and effect on mental health and quality of life
Authors: Lien Lars , Bolstad Ingeborg , Bramness Jørgen G.
Published: May 2021

Background

Smoking is still prevalent among people with substance use disorders. The objective of this study was to investigate the prevalence of smoking among patients in treatment for substance use disorders and to analyze the effect of smoking both at baseline and follow-up on drop-out, mental health and quality of life.

Methods

One hundred and twenty-eight inpatients (26% female), mainly with alcohol use disorder, staying at three different rehabilitation clinics in Eastern Norway, were interviewed at admission, and at 6 weeks and 6 months follow-up. The interview contained mental health-related problems, trauma, questions on alcohol and other substances and quality of life. Non-parametric tests were used to test group differences and unadjusted and adjusted linear regression to test the associations between smoking and the main outcome variables, while logistic regression was used to test the association between smoking and drop-out.

Results

At admission, 75% were daily smokers. Compared to non-smokers at baseline, the smokers had higher drop-out rates (37% vs. 13%), more mental distress, and lower quality of life from baseline up to 6 months follow-up. Those quitting smoking while admitted improved in mental distress and quality of life at the same rate as non-smokers. Alcohol-related factors did not differ between smokers and non-smokers.

Conclusions

Smoking was associated with mental distress, quality of life and treatment drop-out among patients in primary alcohol use disorder treatment. The results indicate that smoking cessation should be recommended as an integral part of alcohol use treatment both before and during inpatient treatment to reduce drop-out.
Understanding regional activation of thoraco-lumbar muscles in chronic low back pain and its relationship to clinically relevant domains
Authors: Serafino Francesca , Trucco Marco , Occhionero Adele , Cerone Giacinto Luigi , Chiarotto Alessandro , Vieira Taian , Gallina Alessio
Published: May 2021

Background

Altered regional activation of the lumbar extensors has been previously observed in individuals with low back pain (LBP) performing high-effort and fatiguing tasks. It is currently unknown whether similar alterations can be observed during low-effort functional tasks. Similarly, previous studies did not investigate whether side differences in regional activation are present in individuals with LBP. Finally, there is limited evidence of whether the extent of the alteration of regional activation is associated with clinical factors. Therefore, the aim of this study was to investigate whether individuals with LBP exhibit asymmetric regional activation of the thoraco-lumbar extensor muscles during functional tasks, and if the extent of neuromuscular control alteration is associated with clinical and psychosocial outcome domains.

Methods

21 participants with and 21 without LBP performed five functional tasks (gait, sit-to-stand, forward trunk flexion, shoulder flexion and anterior pelvic tilt). The spatial distribution of activation of the thoraco-lumbar extensor muscles was assessed bilaterally using high-density electromyography. For each side, the distribution of electromyographic (EMG) amplitude was characterized in terms of intensity, location and size. Indices of asymmetry were calculated from these features and comparisons between groups and tasks were performed using ANOVA. The features that significantly differed between groups were correlated with self-reported measures of pain intensity and other outcome domains.

Results

Indices of asymmetry did not differ between participants with and without LBP (p > 0.11). The cranio-caudal location of the activation differed between tasks (p < 0.05), but not between groups (p = 0.64). Participants with LBP showed reduced EMG amplitude during anterior pelvic tilt and loading response phase during gait (both p < 0.05). Pearson correlation revealed that greater pain intensity was associated with lower EMG amplitude for both tasks (R<-0.5, p < 0.05).

Conclusions

Despite clear differences between tasks, individuals with and without LBP exhibited similar distributions of EMG amplitude during low-effort functional activities, both within and between sides. However, individuals with LBP demonstrated lower activation of the thoraco-lumbar muscles during gait and anterior pelvic tilt, especially those reporting higher pain intensity. These results have implications in the development or refinement of assessment and intervention strategies focusing on motor control in patients with chronic LBP.
Virtual patients reflecting the clinical reality of primary care – a useful tool to improve cultural competence
Authors: Rothlind Erica , Fors Uno , Salminen Helena , Wändell Per , Ekblad Solvig
Published: May 2021

Background

Virtual patients are educational tools that may be described as case-based interactive computer simulations of clinical scenarios. In terms of learning outcomes, improved clinical reasoning skills and knowledge acquisition have been shown. For further exploring the role of virtual patients in medical education, a greater focus on context-specific cases, combined with suitable educational activities, has been suggested. A knowledge gap has been identified in cultural competence in primary care. As primary care physicians are often the main medical providers for patients with refugee backgrounds, they would probably benefit from improved training focusing on how to apply cultural competence in everyday work. Using virtual patient cases, as a complement to clinical training, may be one way forward. The aim of this study was therefore to explore a learner perspective on the educational use of a virtual patient system designed to contribute to training in cultural competence in a primary care context.

Methods

Three virtual patient cases portraying patients with refugee backgrounds were developed. The cases addressed various issues and symptoms common in primary care consultations, while also incorporating intercultural aspects. The system also provided the informants with individualized feedback. Primary care physicians and medical students were invited to test the cases and participate in an interview about their experience. Data was analyzed using qualitative content analysis.

Results

The analysis generated the themeVirtual patients might help improve cultural competence in physicians and medical students by complementing knowledge gained through the informal curriculum.Informants at different educational levels found it suitable as a tool for introducing the topic and for reflecting on one’s own consultations. It could also compensate for the predominant informal manner of learning cultural competence, described by the informants.

Conclusions

Virtual patients could be useful for gaining cultural competence in a primary care context. Advantages that could benefit learners at both pre- and post-graduate levels are decreased dependence on the informal curriculum and being presented with an illustrative way of how cultural competence may be applied in the consultation.
MATISSE: a method for improved single cell segmentation in imaging mass cytometry
Authors: Baars Matthijs J. D. , Sinha Neeraj , Amini Mojtaba , Pieterman-Bos Annelies , van Dam Stephanie , Ganpat Maroussia M. P. , Laclé Miangela M. , Oldenburg Bas , Vercoulen Yvonne
Published: May 2021

Background

Visualizing and quantifying cellular heterogeneity is of central importance to study tissue complexity, development, and physiology and has a vital role in understanding pathologies. Mass spectrometry-based methods including imaging mass cytometry (IMC) have in recent years emerged as powerful approaches for assessing cellular heterogeneity in tissues. IMC is an innovative multiplex imaging method that combines imaging using up to 40 metal conjugated antibodies and provides distributions of protein markers in tissues with a resolution of 1 μm2 area. However, resolving the output signals of individual cells within the tissue sample, i.e., single cell segmentation, remains challenging. To address this problem, we developed MATISSE (iMaging mAss cyTometry mIcroscopy Single cell SegmEntation), a method that combines high-resolution fluorescence microscopy with the multiplex capability of IMC into a single workflow to achieve improved segmentation over the current state-of-the-art.

Results

MATISSE results in improved quality and quantity of segmented cells when compared to IMC-only segmentation in sections of heterogeneous tissues. Additionally, MATISSE enables more complete and accurate identification of epithelial cells, fibroblasts, and infiltrating immune cells in densely packed cellular areas in tissue sections. MATISSE has been designed based on commonly used open-access tools and regular fluorescence microscopy, allowing easy implementation by labs using multiplex IMC into their analysis methods.

Conclusion

MATISSE allows segmentation of densely packed cellular areas and provides a qualitative and quantitative improvement when compared to IMC-based segmentation. We expect that implementing MATISSE into tissue section analysis pipelines will yield improved cell segmentation and enable more accurate analysis of the tissue microenvironment in epithelial tissue pathologies, such as autoimmunity and cancer.
Associations of sleep apnoea with glaucoma and age-related macular degeneration: an analysis in the United Kingdom Biobank and the Canadian Longitudinal Study on Aging
Authors: Han Xikun , Lee Samantha Sze-Yee , Ingold Nathan , McArdle Nigel , Khawaja Anthony P. , MacGregor Stuart , Mackey David A.
Published: May 2021

Background

Sleep apnoea, a common sleep-disordered breathing condition, is characterised by upper airway collapse during sleep resulting in transient hypoxia, hypoperfusion of the optic nerve, and spike in intracranial pressure. Previous studies have reported conflicting findings on the association of sleep apnoea with glaucoma, and there are limited reports on the link between sleep apnoea and age-related macular degeneration (AMD).

Methods

Middle-aged and older participants from the longitudinal United Kingdom (UK) Biobank (n = 502,505) and the Canadian Longitudinal Study on Aging (CLSA; n = 24,073) were included in this analysis. Participants in the UK Biobank and the CLSA were followed for 8 and 3 years, respectively. Participants with diagnosed glaucoma or AMD at baseline were excluded from the analysis. In the UK Biobank, sleep apnoea and incident cases of glaucoma and AMD were identified through hospital inpatient admission, primary care records, and self-reported data. Multivariable Cox proportional hazards models were used to explore associations of sleep apnoea with incidence of glaucoma or AMD.

Results

During the 8-year follow-up in the UK Biobank, glaucoma incidence rates per 1000 person-years were 2.46 and 1.59 for participants with and without sleep apnoea, and the AMD incidence rates per 1000 person-years were 2.27 and 1.42 for participants with and without sleep apnoea, respectively. Multivariable adjusted hazard ratios of glaucoma and AMD risk for sleep apnoea were 1.33 (95% confidence interval [CI] 1.10–1.60, P = 0.003) and 1.39 (95% CI 1.15–1.68, P <  0.001) relative to participants without sleep apnoea. In the CLSA cohort, disease information was collected through in-person interview questionnaires. During the 3-year follow-up, glaucoma incidence rates per 1000 person-years for those with and without sleep apnoea were 9.31 and 6.97, and the AMD incidence rates per 1000 person-years were 8.44 and 6.67, respectively. In the CLSA, similar associations were identified, with glaucoma and AMD odds ratios of 1.43 (95% CI 1.13–1.79) and 1.39 (95% CI 1.08–1.77), respectively, in participants with sleep apnoea compared to those without sleep apnoea (both P <  0.001).

Conclusions

In two large-scale prospective cohort studies, sleep apnoea is associated with a higher risk of both glaucoma and AMD. These findings indicate that patients with sleep apnoea might benefit from regular ophthalmologic examinations.
4-Ethylguaiacol modulates neuroinflammation and Th1/Th17 differentiation to ameliorate disease severity in experimental autoimmune encephalomyelitis
Authors: Weng Wen-Tsan , Kuo Ping-Chang , Brown Dennis A. , Scofield Barbara A. , Furnas Destin , Paraiso Hallel C. , Wang Pei-Yu , Yu I-Chen , Yen Jui-Hung
Published: May 2021

Background

Multiple sclerosis (MS) is a progressive autoimmune disease characterized by the accumulation of pathogenic inflammatory immune cells in the central nervous system (CNS) that subsequently causes focal inflammation, demyelination, axonal injury, and neuronal damage. Experimental autoimmune encephalomyelitis (EAE) is a well-established murine model that mimics the key features of MS. Presently, the dietary consumption of foods rich in phenols has been reported to offer numerous health benefits, including anti-inflammatory activity. One such compound, 4-ethylguaiacol (4-EG), found in various foods, is known to attenuate inflammatory immune responses. However, whether 4-EG exerts anti-inflammatory effects on modulating the CNS inflammatory immune responses remains unknown. Thus, in this study, we assessed the therapeutic effect of 4-EG in EAE using both chronic and relapsing-remitting animal models and investigated the immunomodulatory effects of 4-EG on neuroinflammation and Th1/Th17 differentiation in EAE.

Methods

Chronic C57BL/6 EAE and relapsing-remitting SJL/J EAE were induced followed by 4-EG treatment. The effects of 4-EG on disease progression, peripheral Th1/Th17 differentiation, CNS Th1/Th17 infiltration, microglia (MG) activation, and blood-brain barrier (BBB) disruption in EAE were evaluated. In addition, the expression of MMP9, MMP3, HO-1, and Nrf2 was assessed in the CNS of C57BL/6 EAE mice.

Results

Our results showed that 4-EG not only ameliorated disease severity in C57BL/6 chronic EAE but also mitigated disease progression in SJL/J relapsing-remitting EAE. Further investigations of the cellular and molecular mechanisms revealed that 4-EG suppressed MG activation, mitigated BBB disruption, repressed MMP3/MMP9 production, and inhibited Th1 and Th17 infiltration in the CNS of EAE. Furthermore, 4-EG suppressed Th1 and Th17 differentiation in the periphery of EAE and in vitro Th1 and Th17 cultures. Finally, we found 4-EG induced HO-1 expression in the CNS of EAE in vivo as well as in MG, BV2 cells, and macrophages in vitro.

Conclusions

Our work demonstrates that 4-EG confers protection against autoimmune disease EAE through modulating neuroinflammation and inhibiting Th1 and Th17 differentiation, suggesting 4-EG, a natural compound, could be potentially developed as a therapeutic agent for the treatment of MS/EAE.