bluuebunny/crossref_metadata_2025 huggingface dataset:
Embedding, aligning and reconstructing clinical notes to explore sepsis
Authors: Zhu Xudong , Plasek Joseph M. , Tang Chunlei , Al-Assad Wasim , Zhang Zhikun , Xiong Yun , Wang Liqin , Yerneni Sharmitha , Ortega Carlos , Kang Min-Jeoung , Zhou Li , Bates David W. , Dykes Patricia C.
Published: April 2021

Objective

Our goal was to research and develop exploratory analysis tools for clinical notes, which now are underrepresented to limit the diversity of data insights on medically relevant applications.

Results

We characterize how exploratory analysis can affect representation learning on clinical narratives and present several self-developed tools to explore sepsis. Our experiments focus on patients with sepsis in the MIMIC-III Clinical Database or in our institution’s research patient data repository. We found that global embeddings assist in learning local representations of clinical notes. Second, aligning at any specific time facilitates the use of learning models by pooling more available clinical notes to form a training set. Furthermore, reconstruction of the timeline enhances downstream-processing techniques by emphasizing temporal expressions and temporal relationships in clinical documentation. We demonstrate that clustering helps plot various types of clinical notes against a scale, which conveys a sense of the range or spread of the data and is useful for understanding data correlations. Appropriate exploratory analysis tools provide keen insights into preprocessing clinical notes, thereby further enhancing downstream analysis capabilities, making data driven medicine possible. Our examples can help generate better data representation of clinical documentation for models with improved performance and interpretability.
Monitoring skin blood flow to rapidly identify alterations in tissue perfusion during fluid removal using continuous veno-venous hemofiltration in patients with circulatory shock
Authors: Mongkolpun Wasineenart , Bakos Péter , Vincent Jean-Louis , Creteur Jacques
Published: April 2021

Background

Continuous veno-venous hemofiltration (CVVH) can be used to reduce fluid overload and tissue edema, but excessive fluid removal may impair tissue perfusion. Skin blood flow (SBF) alters rapidly in shock, so its measurement may be useful to help monitor tissue perfusion.

Methods

In a prospective, observational study in a 35-bed department of intensive care, all patients with shock who required fluid removal with CVVH were considered for inclusion. SBF was measured on the index finger using skin laser Doppler (Periflux 5000, Perimed, Järfälla, Sweden) for 3 min at baseline (before starting fluid removal, T0), and 1, 3 and 6 h after starting fluid removal. The same fluid removal rate was maintained throughout the study period. Patients were grouped according to absence (Group A) or presence (Group B) of altered tissue perfusion, defined as a 10% increase in blood lactate from T0 to T6 with the T6 lactate ≥ 1.5 mmol/l. Receiver operating characteristic curves were constructed and areas under the curve (AUROC) calculated to identify variables predictive of altered tissue perfusion. Data are reported as medians [25th–75th percentiles].

Results

We studied 42 patients (31 septic shock, 11 cardiogenic shock); median SOFA score at inclusion was 9 [8–12]. At T0, there were no significant differences in hemodynamic variables, norepinephrine dose, lactate concentration, ScvO2 or ultrafiltration rate between groups A and B. Cardiac index and MAP did not change over time, but SBF decreased in both groups (p < 0.05) throughout the study period. The baseline SBF was lower (58[35–118] vs 119[57–178] perfusion units [PU], p = 0.03) and the decrease in SBF from T0 to T1 (ΔSBF%) higher (53[39–63] vs 21[12–24]%, p = 0.01) in group B than in group A. Baseline SBF and ΔSBF% predicted altered tissue perfusion with AUROCs of 0.83 and 0.96, respectively, with cut-offs for SBF of ≤ 57 PU (sensitivity 78%, specificity 87%) and ∆SBF% of ≥ 45% (sensitivity 92%, specificity 99%).

Conclusion

Baseline SBF and its early reduction after initiation of fluid removal using CVVH can predict worsened tissue perfusion, reflected by an increase in blood lactate levels.
End-to-end network slice architecture and distribution across 5G micro-operator leveraging multi-domain and multi-tenancy
Authors: Badmus Idris , Laghrissi Abdelquoddouss , Matinmikko-Blue Marja , Pouttu Ari
Published: April 2021

Local 5G networks are emerging as a new form for 5G deployment, targeting service delivery for vertical-specific purposes and other local users. These networks are also known as micro-operator networks for which prior work has established different deployment scenarios, namely Closed, Open and Mixed Networks. To achieve network flexibility, customization and privacy required by various vertical sectors, such as industry, health and energy, it is essential to have a well-defined network slicing architecture and adequate implementation procedure. In this paper, a sophisticated end-to-end network slicing architecture is proposed for different deployment scenarios of the local 5G micro-operator concept. The proposed architecture incorporates a broad four-layer concept, leveraging a multi-tenancy layer for different tenants and their end users, a descriptive service layer, a multi-domain slicing management and orchestration layer, and a resource layer. We further propose a network slice instance (NSI) communication service distribution technique for local 5G micro-operators. This is achieved by expanding/leveraging the communication service management function in the multi-tenant layer into a multi-tenant manager and an orchestrator of communication services. In addition, we describe how the communication service orchestrator will address all the possible multitenant-slice situations during the distribution of a network slice instance to multiple tenants. The novel methods described in the paper present a solution for not only network slice communication service distribution across different micro-operator’s tenants but also for future use cases, especially, when the allocated slice is responsible for multiple tenants or when a tenant requests multiple NSIs.
Mapping evidence on the effects of gender-affirming hormone therapy on the hard and soft tissues of the craniofacial complex in transgender people: a protocol for a scoping review
Authors: Van den Bosch M. F. , Wiepjes C. M. , Den Heijer M. , Schoonmade L. J. , Jonkman R. E. G. , Meursinge Reynders R. A.
Published: April 2021

Background

Gender-affirming hormone (GAH) therapy aims to support the transition of transgender people to their gender identity. GAHs can induce changes in their secondary sex characteristics such as the development of breasts in transgender females and increased muscle mass in transgender males. The face and its surrounding tissues also have an important role in gender confirmation. The aim of this scoping review is to systematically map the available evidence in order to provide an overview of the effects of GAH therapy on the hard and soft tissues of the craniofacial complex in transgender people.

Methods/design

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA) extension for Scoping Reviews was consulted for reporting this protocol. The methods were based on the Arksey and O’Malley’s framework and the Reviewer’s Manual of the Joanna Briggs Institute for conducting scoping reviews. Ten transgender people were involved in the development of the primary research question through short interviews. The eligibility criteria were defined for transgender people undergoing GAH therapy and for quantitative and qualitative outcomes on the hard and soft tissues of the craniofacial complex. Eligible sources of evidence include observational, experimental, qualitative, and mixed method studies. No exclusion criteria will be applied for the language of publication and the setting. To identify eligible sources of evidence, we will conduct searches from inception onwards in PubMed, Embase.com, the Cochrane Library, Web of Science Core Collection, Scopus, CINAHL, LIVIVO, and various grey literature sources such as Google Scholar. Two reviewers will independently select eligible studies in these information sources and will subsequently conduct data extraction. The same operators will chart, categorize, and summarize the extracted data. A narrative summary of findings will be conducted. Frequency counts of quantitative and qualitative data on items such as concepts, populations, interventions, and other characteristics of the eligible sources will be given. Where possible, these items will be mapped descriptively.

Discussion

We chose the scoping review over the systematic review approach, because the research questions are broad-spectrum and the literature is expected to be widely scattered. No systematic review has previously assessed this topic. Identifying knowledge gaps in this area and summarizing and disseminating research findings are important for a wide spectrum of stakeholders, in particular, for transgender people who want to undergo additional interventions such as plastic or orthognathic surgery or orthodontics.

Systematic review registration

This protocol was registered in the Open Science Framework: https://osf.io/e3qj6
BSS: a brokering model for service selection using integrated weighting approach in cloud environment
Authors: Chauhan Sameer Singh , Pilli Emmanuel S. , Joshi R. C.
Published: April 2021

Cloud providers shares their resources and services through collaboration in order to increase resource utilization, profit and quality of services. The offered services with different access patterns, similar characteristics, varied performance levels and cost models create a heterogeneous service environment. It becomes a challenging task for users to decide a suitable service as per their application requirements. Cloud broker, an inter-mediator is required in service management to help both cloud providers and users. Cloud broker has to store all the information related to services and feedback of users on those services in order to provide the best services to end-users. Brokering model for service selection (BSS) has been proposed which employs integrated weighting approach in cloud service selection. Subjective and objective weights of QoS attributes are combined to compute integrated total weight. Subjective weight is obtained from users’ feedback on QoS attributes of a cloud service while objective weight is computed from benchmark tested data of cloud services. Users’ feedback and preferences given to QoS parameters are employed in subjective weight computation. Objective weight is computed using Shannon’s Entropy method. Total weight is obtained by combining subjective and objective weights. BSS method is employed to rank cloud services. Simulation with a case study on real dataset has been done to validate the effectiveness of BSS. The obtained results demonstrate the consistency of model for handling rank reversal problem and provides better execution time than other state-of-the art solutions.
TNFα secreted by glioma associated macrophages promotes endothelial activation and resistance against anti-angiogenic therapy
Authors: Wei Qingxia , Singh Olivia , Ekinci Can , Gill Jaspreet , Li Mira , Mamatjan Yasin , Karimi Shirin , Bunda Severa , Mansouri Sheila , Aldape Kenneth , Zadeh Gelareh
Published: April 2021

One of the most prominent features of glioblastoma (GBM) is hyper-vascularization. Bone marrow-derived macrophages are actively recruited to the tumor and referred to as glioma-associated macrophages (GAMs) which are thought to provide a critical role in tumor neo-vascularization. However, the mechanisms by which GAMs regulate endothelial cells (ECs) in the process of tumor vascularization and response to anti-angiogenic therapy (AATx) is not well-understood. Here we show that GBM cells secrete IL-8 and CCL2 which stimulate GAMs to produce TNFα. Subsequently, TNFα induces a distinct gene expression signature of activated ECs including VCAM-1, ICAM-1, CXCL5, and CXCL10. Inhibition of TNFα blocks GAM-induced EC activation both in vitro and in vivo and improve survival in mouse glioma models. Importantly we show that high TNFα expression predicts worse response to Bevacizumab in GBM patients. We further demonstrated in mouse model that treatment with B20.4.1.1, the mouse analog of Bevacizumab, increased macrophage recruitment to the tumor area and correlated with upregulated TNFα expression in GAMs and increased EC activation, which may be responsible for the failure of AATx in GBMs. These results suggest TNFα is a novel therapeutic that may reverse resistance to AATx. Future clinical studies should be aimed at inhibiting TNFα as a concurrent therapy in GBMs.
Why participation in an international clinical trial platform matters during a pandemic? Launching REMAP-CAP in Japan
Authors: Kamata Kazuhiro , Jindai Kazuaki , Ichihara Nao , Saito Hiroki , Kato Hideaki , Kunishima Hiroyuki , Shintani Ayumi , Nishida Osamu , Fujitani Shigeki
Published: April 2021

REMAP-CAP, a randomized, embedded, multifactorial adaptive platform trial for community-acquired pneumonia, is an international clinical trial that is rapidly expanding its scope and scale in response to the COVID-19 pandemic. Japan is now joining REMAP-CAP with endorsement from Japanese academic societies. Commitment to REMAP-CAP can significantly contribute to population health through timely identification of optimal COVID-19 therapeutics. Additionally, it will promote the establishment of a national and global network of clinical trials to tackle future pandemics of emerging and re-emerging infectious diseases, in collaboration with multiple stakeholders, including front-line healthcare workers, governmental agencies, regulatory authorities, and academic societies.
Groundwater aquifer detection using the electrical resistivity method at Ito Campus, Kyushu University (Fukuoka, Japan)
Authors: Wahab Shafiqullah , Saibi Hakim , Mizunaga Hideki
Published: April 2021

An electrical resistivity survey was carried out using the pole–pole configuration around the Sayanokami spring area in the northern part of Ito Campus (Kyushu University, Fukuoka, Japan) to study the groundwater aquifer and its electrical characteristics. A Code Division Multiple Transmission (CDMT) system was used. The CDMT system transmits 24 currents simultaneously and measures 24 potential responses with monitoring of actual current waveforms. The system can inject current from multiple electrodes into the underground environment simultaneously using different individual current waveforms. The two-dimensional (2-D) inversion results of the electrical resistivity data indicate three layers from top to bottom, as follows: (a) a thin layer with a thickness of 3 m and a low resistivity (< 50 Ω m) representing topsoil; (b) a groundwater aquifer layer with an average resistivity between 50 and 170 Ω m and with a thickness ranging from 7 to 10 m, and (c) a highly resistive bedrock layer with resistivities higher than 200 Ω m and occupying depths from 15 m to the base of the model.
Machine learning methods in sport injury prediction and prevention: a systematic review
Authors: Van Eetvelde Hans , Mendonça Luciana D. , Ley Christophe , Seil Romain , Tischer Thomas
Published: April 2021

Purpose

Injuries are common in sports and can have significant physical, psychological and financial consequences. Machine learning (ML) methods could be used to improve injury prediction and allow proper approaches to injury prevention. The aim of our study was therefore to perform a systematic review of ML methods in sport injury prediction and prevention.

Methods

A search of the PubMed database was performed on March 24th 2020. Eligible articles included original studies investigating the role of ML for sport injury prediction and prevention. Two independent reviewers screened articles, assessed eligibility, risk of bias and extracted data. Methodological quality and risk of bias were determined by the Newcastle–Ottawa Scale. Study quality was evaluated using the GRADE working group methodology.

Results

Eleven out of 249 studies met inclusion/exclusion criteria. Different ML methods were used (tree-based ensemble methods (n = 9), Support Vector Machines (n = 4), Artificial Neural Networks (n = 2)). The classification methods were facilitated by preprocessing steps (n = 5) and optimized using over- and undersampling methods (n = 6), hyperparameter tuning (n = 4), feature selection (n = 3) and dimensionality reduction (n = 1). Injury predictive performance ranged from poor (Accuracy = 52%, AUC = 0.52) to strong (AUC = 0.87, f1-score = 85%).

Conclusions

Current ML methods can be used to identify athletes at high injury risk and be helpful to detect the most important injury risk factors. Methodological quality of the analyses was sufficient in general, but could be further improved. More effort should be put in the interpretation of the ML models.
Sharing meals: promising nutritional interventions for primary health care including nursing students and elderly people
Authors: Alne Ellen Kristine Frøyland , Øie Tove , Søiland Malene , Gjesdal Kine
Published: April 2021

Background

The risk of malnutrition among elderly people is high and living alone increases the risk. As the number of older persons living alone is expected to increase due to the demographic development of an increasing older population, more knowledge about low-cost, sustainable nutritional interventions is needed. The purpose of this study was to investigate how nursing students can be a resource in the nutritional care of older persons living alone by sharing weekly meals.

Methods

Twenty-three nursing students and 23 elderly people who lived alone and received home nursing care participated in the project period of 9 weeks and shared 1–2 weekly meals. Shortly after the study period, 13 students and 4 elderly persons were interviewed in individual, face-to-face, semi-structured interviews. The questions included their experiences, the perceived impact of sharing meals, and facilitators and barriers of such meal interventions. The interview material was transcribed and analyzed using qualitative content analysis as described by Graneheim and Lundman.

Results

Our study found that both nursing students and older persons expressed positive experiences from sharing meals. Nursing students with some nutritional knowledge can provide a useful, sustainable supplement to the home-care nursing staff’s limited resources and time. Improvements were found, including preparation of ready meals and the meal environment, different facilitators and barriers of the meal experience, and the possible positive impact on the elderly persons’ nutritional status, which affects meal enjoyment, appetite, food intake and weight.

Conclusion

During their practical placement in the community, nursing students can provide a useful contribution to the nutritional care of elderly persons who are at nutritional risk living alone at home by the intervention of sharing a meal together. This is a low-cost supplement to other primary health-care measures that can affect both nutritional status and adjust the appropriate care for patients. This study demonstrates a small contribution to the complex nutritional care literature based on the growing elderly population in home care and the nursing student as a valuable resource for the multidisciplinary team approach necessary to meet this challenge.
Efficacy of extracellular vesicles from dental pulp stem cells for bone regeneration in rat calvarial bone defects
Authors: Imanishi Yuka , Hata Masaki , Matsukawa Ryohei , Aoyagi Atsushi , Omi Maiko , Mizutani Makoto , Naruse Keiko , Ozawa Shogo , Honda Masaki , Matsubara Tatsuaki , Takebe Jun
Published: April 2021

Background

Extracellular vesicles (EVs) are known to be secreted by various cells. In particular, mesenchymal stem cell (MSC)-derived EVs (MSC-EVs) have tissue repair capacity and anti-inflammatory properties. Dental pulp stem cells (DPSCs), which are MSCs isolated from pulp tissue, are less invasive to the body than other MSCs and can be collected from young individuals. In this study, we investigated the efficacy of EVs secreted by DPSCs (DPSC-EVs) for bone formation.

Methods

DPSC-EVs were isolated from the cell culture medium of DPSCs. DPSC-EVs were unilaterally injected along with collagen (COL), beta-tricalcium phosphate (β-TCP) or hydroxyapatite (HA) into rat calvarial bone defects. The effects of DPSC-EVs were analyzed by micro-computed tomography (micro-CT) and histological observation.

Results

Micro-CT showed that administration of DPSC-EVs with the abovementioned scaffolds resulted in bone formation in the periphery of the defects. DPSC-EVs/COL specifically resulted in bone formation in the center of the defects. Histological observation revealed that DPSC-EVs/COL promoted new bone formation. Administration of DPSC-EVs/COL had almost the same effect on the bone defect site as transplantation of DPSCs/COL.

Conclusions

These results suggest that DPSC-EVs may be effective tools for bone tissue regeneration.
Prediction of early mortality after primary decompressive craniectomy in patients with severe traumatic brain injury
Authors: Abouhashem Safwat , Albakry Amr , El-Atawy Shawkat , Fawzy Faten , Elgammal Sahar , Khattab Omar
Published: April 2021

Objectives

Traumatic brain injury (TBI) is a worldwide major health problem associated with a high rate of morbidity and mortality. Intracranial hypertension following TBI is the main but not the only cause of early mortality. Decompressive craniectomy (DC) is used to decrease the intracranial pressure (ICP) and prevent brain herniation following TBI; however, the clinical outcome after DC for patients with TBI generates continuous debate. Prediction of early mortality after DC will help in making the surgery decision.

The aim of this study is to predict early mortality after DC based on the initial clinical and radiological findings.

Methods

In this study, 104 patients with severe traumatic brain injury have been treated by decompressive craniectomy and were retrospectively analyzed. Patients were divided into two groups; group I involved 32 patients who died within 28 days while group II involved 72 patients who survived after 28 days. The relationship between initial Glasgow Coma Scale score (GCS), pupil size and reactivity, associated injuries, and radiological findings were analyzed as predictor factors for early mortality.

Results

A total of 104 patients with severe TBI have been treated by DC and were analyzed; the early mortality occurred in 32 patients, 30.77%. There is a significant difference between groups in gender, mean GCS, Marshall scale, presence of isochoric pupils, and lung injury.

After stratification, odds of early mortality increases with the lower GCS, higher Marshall scale, lung injury, and abdominal injury while male gender and the presence of isochoric pupils decrease the odds of mortality. After univariate regression, the significant impact of GCS disappears except for GCS-8 which decreases the odds of mortality in comparison to other GCS scores while higher Marshall scale, presence of isochoric pupils, and lung injury increase the odds of mortality, but most of these effects disappear after multiple regressions except for lung injury and isochoric pupils.

Conclusion

Prediction of early mortality after DC is multifactorial, but the odds of early mortality after decompressive craniectomy in severe traumatic brain injury are progressively increased with the lower GCS, higher Marshall scale, and the presence of lung or abdominal injury.
Oral acute toxicity and antimalarial potentials of aqueous and methanolic extracts of roots, leaves and stem of Dictyandra arborescens (Welw.) on Plasmodium berghei infected mice
Authors: Enenebeaku Uchechi E. , Ukwandu Nnamdi C. , Mgbemena Ifeyinwa C. , Nwigwe Harriet C. , Enenebeaku Conrad K. , Duru Chidi E. , Ogidi Odangowei I.
Published: April 2021

Background

Malaria is one of the tropical diseases of universal concern particularly with continuous appearance of resistant strains ofP.falciparum. This calls for continous screening of traditional plants such that new and effective antimalarial agents will be developed. This study therefore explored the oral acute toxicity and antimalarial potentials of aqueous and methanolic extracts of roots, leaves and stem ofDictyandra arborescensonPlasmodium bergheiinfected mice.

Results

No mortality was recorded in any of the experimental animal groups even at the highest tested dose (5000 mg/kg b.wt) of the extract after monitoring them for 4hrs and subsequently for 7 days. Out of the six extracts, methanolic extracts of the roots and leaves exhibited more antimalarial activity than others. A significant difference (P < 0.05) was statistically observed in the parasite count of groups that received methanol extracts of roots and leaves ofD. arborescens. This observation was made when these two extracts were compared with other groups as well as the negative control. However, activity of the standard antimalarial drug (artesunate) was higher (p˂0.05) than those of the extracts. Phytochemicals such as tannins, alkaloids, saponins, terpenoids, flavonoids etc. were present in the extracts in varying quantities. GC–MS analysis of methanol extract of the root of this plant showed different chemical compounds.

Conclusion

Administration of aqueous and methanol extracts of roots, leaves and stem ofD. arborescensin mice is not harmful at any dose less than or equal to 5000 mg/kg. Methanol extracts exhibited more antimalarial activity than aqueous extracts suggesting that antimalarial activity of the plant parts could be affected by the solvent used for extraction and antimalarial activity may be more in a particular part of a plant. The presence of different bioactive compounds identified in phytochemical and GC–MS analysis could be the fundamental scientific evidence for the antimalarial activity exhibited by this plant especially in the root.
Classic Cornelia de Lange syndrome with variant of unknown significance detected in NIPBL gene mutation: a case report
Authors: Desai Jay J. , Nair Sreelata B. , Pappachan S.
Published: April 2021

Background

Cornelia de Lange syndrome is a relatively uncommon disorder associated with multiple congenital anomalies/mental retardation of unknown etiology with its incidence varying from 1:10,000 to 1:50,000 live births in different population groups without any known racial predilections. Main clinical features of this syndrome consist of distinctive dysmorphic facial appearance, growth retardation, developmental delay, mental retardation, hirsutism, and skeletal formation anomaly.

Case presentation

This case presents a variation of unknown significance in theNIPBLgene-exon 39, chr5:37048649T>A c.6635T>A (p.Val2212Glu) with clinical phenotype of Cornelia de Lange syndrome. Our patient belonged to South Indian origin with clinical features of synophrys, micrognathia, long smooth philtrum, and clinodactyly with bilateral simian crease.

Conclusion

Cornelia de Lange syndrome is a rare but well-characterized disorder, in which multiple systems of the body are affected. It is important that the treating physician ensures coordination of the diversiform aspects of care in both childhood and adulthood. Proper and timely diagnosis using next generation sequencing helps in management and possibility of prenatal diagnosis.
Pharmacological comparison of four biopolymeric natural gums as hemostatic agents for management of bleeding wounds: preliminary in vitro and in vivo results
Authors: Kushwah Himanshu , Sandal Nidhi , Chauhan Meenakshi , Mittal Gaurav
Published: April 2021

Background

Uncontrolled bleeding is one of the primary reasons for preventable death in both civilian trauma and military battle field. This study evaluates in vitro and in vivo hemostatic potential of four biopolymeric natural gums, namely, gum tragacanth, guar gum, xanthan gum, and gum acacia. In vitro evaluation of whole blood clotting time and erythrocyte agglutination assay were carried out. In vitro cytotoxicity studies with respect to each gum were done in human lymphocytes to ascertain percent cell viability. In vivo hemostatic potential of each gum (as sponge dressing and powder form) was evaluated in Sprague Dawley rats using tail bleeding assay and compared with commercially available hemostatic sponge. Other important parameters like (a) time taken for complete hemostasis, (b) amount of blood absorbed, (c) adherence strength of developed hemostatic dressing(s), (d) incidence of re-bleeding, and (e) survival of animals were also studied.

Results

Of the four test gums studied, xanthan gum (@3mg/ml of blood) and gum tragacanth (@35mg/ml of blood) were able to clot blood in least time (58.75±6.408 s and 59.00±2.082 s, respectively) and exhibited very good hemostatic potential in vitro. Except for xanthan gum, all other test gums did not exhibit any significant cytotoxicity at different time points till 24 h. In rat tail bleeding experiments, gum tragacanth sponge dressing and powder achieved hemostasis in least time (156.2±12.86 s and 76±12.55 s, respectively) and much earlier than commercially available product (333.3±38.84 s; p˂0.01).

Conclusion

Results indicate potential of gum tragacanth to be developed into a suitable hemostatic product.
Role and efficacy of music therapy in learning disability: a systematic review
Authors: Mina Feeby , Darweesh Mohammed El Sayed , Khattab Ahmed Nabil , Serag Shaimaa Mohammed
Published: April 2021

Background

Kids with learning disabilities can succeed in school and improve their educational level with the help of a correct rehabilitation program; one of the most effective rehabilitation programs is music therapy. As there was little proof educating us knowledge regarding the function of music treatment in the improvement of learning incapacitated kids in this way, it was imperative to gather these bits of studies in a systematic review study to feature the role of music treatment in the restoration of learning disabilities.

The aim of this work is to study the relation between music therapy and learning disabilities, to define the music therapy role and efficacy in the enhancement of learning disabled children to be able to delineate an efficient program therapy later on.

This study is a systematic review and was carried out according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol.

Main text

The reviewed included studies were intervention studies that used different groups of cases (learning disabled, dyslexic, or with mathematical problems children) which received the music therapy versus different control groups (normal or dyslexic) receiving normal reading program, cognitive or placebo therapy; also they applied different methods and programs of music therapy. Most of the included studies reported that music therapy is a useful aiding factor in rehabilitation therapy of reading and phonological awareness disorders, however little evidence for positive effectiveness regarding spelling, arithmetic, writing, cognitive abilities, working memory, auditory attention, and rapid auditory processing.

Conclusion

Music therapy (with or without cognitive therapy) has an important and augmenting role in improving reading skills and phonological awareness problems in dyslexic children but does not replace the current methods of rehabilitation. There is little evidence found that music therapy (with or without cognitive therapy) is an effective aiding factor in rehabilitation therapy regarding spelling, arithmetic, writing, cognitive abilities, working memory, auditory attention, and rapid auditory processing in learning disabled children.
PARP Inhibitor in Platinum-Resistant Ovarian Cancer: Single-Center Real-World Experience
Authors: Agarwal Amit , Baghmar Saphalta , Dodagoudar Chandragouda , Qureshi Suhail , Khurana Aseem , Vaibhav Vikas , Kumar Guresh
Published: April 2021

PURPOSE

Poly (ADP-ribose) polymerase inhibitors (PARPi) have proven efficacy in treatment of BReast CAncer ( BRCA) gene mutation-positive platinum-sensitive ovarian cancers. There is paucity of data for their role in platinum-resistant ovarian cancer (PROC). We report here retrospective analysis of outcome of PARPi treatment in a group of patients including those of PROC.

PATIENTS AND METHODS

We analyzed all consecutive patients who received PARPi. The efficacy of PARPi monotherapy was assessed in patients with relapsed high-grade serous ovarian carcinoma with g BRCAm. The drug was procured through compassionate program. Drugs (olaparib and talazoparib) were provided in capsule form.

RESULTS

Between July 1, 2015, and June 30, 2019, 28 patients with ovarian cancer received PARPi. At the time of data censoring (September 30, 2019), four (14.3%) patients are still on treatment. Median age was 54.5 years (range, 39-75 years). Median number of previous lines of chemotherapy received was three (range, 1-6). Eleven platinum-sensitive patients received the drug as maintenance (five in complete response and six in partial response after chemotherapy), whereas 17 (60.7%) had platinum-resistant progressive disease while starting the drug. In PROC, objective response rate (complete response plus partial response) was 47%, median progression-free survival was 8.2 months (5.3-11.3), and overall survival was 14.9 months (11.2-18.5). No new side effects were observed.

CONCLUSION

This is the first study from India evaluating PARPi in platinum-resistant ovarian cancer. This study suggests that PARPi is a viable treatment option in patients with PROC with gBRCAm. This should be further evaluated in randomized clinical trial.
Disparities Between Provider Assessment and Documentation of Care Needs in the Care of Adolescent and Young Adult Patients With Sarcoma
Authors: McKay Grace E. , Zakas Anna L. , Osman Fauzia , Lee-Miller Cathy , Pophali Priyanka , Parkes Amanda
Published: April 2021

PURPOSE:

Given the occurrence of cancer during a complex developmental time, adolescent and young adult (AYA) patients have unique psychosocial needs that necessitate supportive care, which is optimally provided using National Comprehensive Cancer Network (NCCN) AYA guidelines. We sought to explore compliance with NCCN AYA guidelines and compare with oncology providers' perceptions of AYA care needs.

METHODS:

Retrospective chart reviews of AYA patients (15-39 years at time of cancer diagnosis) with sarcoma seen at least once in 2019 at the University of Wisconsin identified documentation of discussions deemed critical per NCCN AYA guidelines. As per the ASCO Quality Oncology Practice Initiative certification, we considered a threshold of these factors being discussed 75% of the time or higher to be compliant. Compliance was compared with an electronic survey of University of Wisconsin oncology providers regarding AYA patient needs, with items determined to have adequate resources if noted sufficient by at least 75% of providers.

RESULTS:

We identified 43 AYA patients with sarcoma. Less than 75% of patients had documentation of discussion of contraception, sexual health, fertility, finances, genetics, social work referral, and clinical trials indicating noncompliance with NCCN guidelines. Surveys, completed by 38 oncology providers, showed significant discordance between providers' perceptions of AYAs' access to resources and providers' documented discussions of supportive care resources.

CONCLUSION:

Disparities between oncology provider assessment of AYA care needs and documentation of critical components of AYA patient care demonstrate the need for novel tools to evaluate AYA care needs beyond provider assessments.
Impact of a G-CSF Policy to Reduce Low-Value Care on Guideline Adherence and Mortality
Authors: Orji Chinelo C. , Brown Carolyn M. , Hoverman J. Russell , Richards Kristin M. , Garey Jody , He Bo
Published: April 2021

PURPOSE:

Practice guidelines recommend the prophylactic use of granulocyte colony–stimulating factors (G-CSFs) in patients with high risk of febrile neutropenia, but evidence suggests that G-CSFs are frequently overused. The objectives of this study were (1) to determine the prevalence and prescribing patterns of G-CSF and (2) to evaluate the impact of a program initiative on G-CSF prescribing patterns, adherence to guidelines, and mortality.

METHODS:

In this retrospective cohort study, data were used from the electronic health records of patients with metastatic colorectal cancer who received care at a multicenter oncology practice network during two time periods: July 01, 2013, to December 31, 2014, and July 01, 2017, to December 31, 2017. Beginning 2016, a site-wide program initiative that involved educational materials, appropriate nonuse recommendations, and prior authorization was introduced in the oncology practice network with an aim of reducing G-CSF overutilization. Descriptive statistics, t tests, and chi-squared tests were employed to analyze program impact.

RESULTS:

There were 3,426 chemotherapy regimens corresponding to 2,968 patients. There were a total of 387 (11.3%) G-CSF–treated patients and 3,095 G-CSF administrations during the study period. G-CSF use was significantly lower in the postperiod, compared with the preperiod ( P < .0001). Adherence to guidelines was significantly higher in the postperiod, compared with the preperiod ( P < .0001). Mortality rates did not significantly differ between the two time periods.

CONCLUSION:

This study demonstrates that policy initiatives have the potential to positively affect G-CSF prescription patterns and promote guideline adherence. These findings could help prescribers adopt a cost-effective approach in patients with metastatic colorectal cancer, leading to enhanced clinical practice and value-based care.
Impact of a Virtual Multidisciplinary Sarcoma Case Conference on Treatment Plan and Survival in a Large Integrated Healthcare System
Authors: Pan Minggui , Yu Jeanette , Sidhu Manpreet , Seto Tiffany , Fang Andrew
Published: April 2021

PURPOSE:

Quantifying the impact of a multidisciplinary cancer case conference on patient outcome and care quality remains challenging.

PATIENTS AND METHODS:

We prospectively investigated the impact of our virtual multidisciplinary sarcoma case conference (VMSCC) on treatment plan in patients presented to the VMSCC from July to October 2020 (prospective cohort) and retrospectively in patients with metastatic or locally advanced high-grade soft-tissue sarcoma (STS) reviewed in the VMSCC in 2016 and 2017 (high-grade STS cohort). We also investigated the factors related to the nonadherence to the VMSCC-recommended plan in both cohorts.

RESULTS:

In both cohorts, approximately 28% of the patients were referred to the VMSCC for review without a treatment plan. In significantly more cases, referring physicians outside of the sarcoma group did not have a plan formulated before the VMSCC review compared with the referring physicians within the sarcoma group. In 28.2% (prospective cohort) and 19.5% (high-grade STS cohort) of the patients, VMSCC recommended a different plan. The adherence to the VMSCC-recommended plan was 87.9% and 83.1%, respectively. The causes of the nonadherence were primarily due to disease progression or patient’s decision against recommended therapy. The median overall survival for the high-grade STS cohort was 26 months.

CONCLUSION:

VMSCC affected the treatment plan in approximately 50% of the patients in both cohorts. The median overall survival of the patients with high-grade STS reviewed by the VMSCC in our cohort is comparable with the literature.
COVID-19 vaccine delivery: an opportunity to set up systems for the future
Authors: Weintraub Rebecca , Plotkin Stanley , Liu Margaret , Kim Jerome , Garcon Natalie , Bell David , Storisteanu Dan , Norman Toby , Aronoff-Spencer Eliah
Published: April 2021

The race to develop safe and effective SARS-COV-2 vaccines has moved with unprecedented speed. There are now multiple vaccines that have received emergency use authorization from the United States Food and Drug Administration and a host of candidates positioned for approval worldwide. Attention has now turned to allocation, distribution and verification of these vaccines, yet this focus exposes that the underlying infrastructure for global delivery and monitoring is threadbare and unevenly distributed. This presents both a barrier and an opportunity to deploy sustainable infrastructure. Major global stakeholders must convene quickly, collaborate, and collectively invest in global standards, legal models, common vocabularies and interoperable biometric-supported digital health technologies. As the COVID-19 vaccine effort scales, governments, private sector, and NGOs have the chance to place lasting resources needed for equitable and effective delivery that can pay dividends into the future.
HOW LACK OF EVIDENCE IN POLICE WORK LEADS TO VIOLATIONS OF HUMAN RIGHTS IN SERBIA
Authors: Danilović Neđo , Manojlović Dragan , Bogavac Miladinović Živanka
Published: April 2021

After the Second World War, the police in the Republic of Serbia introduced the model of the practice of „criminal investigation“ which was used in the former Soviet Union. This model of policing practice was focused on finding enemies among the citizens and informing the public that the enemies had been discovered. Evidence was considered irrelevant in this model of policing practice. By applying this model of police work, human rights have been permanently violated and citizens have been subjected to various types of torture. The results of the research in this paper showed that many reported citizens have never been convicted of indicted crimes. Also, the results of the research showed that this model of police work out many reported citizens, accused a small part of citizens, while a very small number were convicted. By filing criminal charges against citizens who have never been convicted, the police violated basic human rights international legal instruments. One of such rights was the right to justice in criminal proceedings, which should be based not only on legal but also on ethical and moral principles on which modern society develops. This right belongs to the group of basic human rights and it has been permanently violated in the application of the „criminal investigation“ model from the end of the Second World War to the beginning of the second decade of the 21st century. The result of this model of policing was the mass torture of citizens, their imprisonment, arrests, accusations, and investigations without any evidence against them, with many open criminal files that marked a large number of citizens and their families for life.
Trans-scaphoid Perilunate Fracture Dislocation
Authors: Kim Hee-Soo , Oh Won-Tack , Koh Il-Hyun , Choi Yun-Rak , Kang Ho-Jung
Published: April 2021

Trans-scaphoid perilunate fracture dislocations, which account for more than half of total cases of perilunate injuries, are common in young patients and occur as a result of high-energy injuries, and improper management can impair wrist alignment and function. Understanding the related wrist anatomy and pathomechanics may help surgeons evaluate and diagnose patients. Early operation to reduce and fix the injuries should be considered to achieve optimal clinical and radiological outcomes. In this review article, we present an overview of wrist pathoanatomy, the pathomechanics of trans-scaphoid perilunate fracture dislocations, operative treatment options including an arthroscopic procedure, and reported clinical and radiological outcomes.
La invención de los dioses en el ateísmo ilustrado: la Lettre de Thrasybule à Leucippe
Authors: Lorena Zorrilla Natalia
Published: April 2021

Este artículo tiene como objetivo examinar la problemática del surgimiento del culto a los dioses en la Lettre de Thrasybule à Leucippe, manuscrito clandestino atribuido a Nicolás Fréret. Analizamos los distintos estratos del ateísmo que expresa allí Trasíbulo, el ficticio autor de la carta. Reconstruimos y examinamos el proceso mediante el cual, según Trasíbulo, la humanidad originaria habría creado las deidades e instituido rituales de adoración de estas. Nos proponemos mostrar que si bien tal proceso comporta cierto pesimismo acerca del progreso de la secularización, también presupone que la superstición no es necesariamente un destino inexorable de la humanidad.
Nietzsche: por una política del individuo
Authors: Fornari Maria Cristina
Published: April 2021

Aunque Nietzsche nunca formuló una teoría política real, su crítica de la modernidad y la búsqueda de soluciones alternativas para una elevación del “tipo humano” son ciertamente parte de un proyecto de “große Politik”, que sin embargo pertenece más a la esfera de la filosofía y la cultura que a la de una ciencia del gobierno. En oposición a las organizaciones homologadoras –políticas, económicas, morales– que han robado las energías más peculiares del hombre, Nietzsche trabaja por la promoción de una individualidad fuerte que por sí sola pueda puede prometer construcciones duraderas. La originalidad y la capacidad de incorporar elementos disonantes son para Nietzsche síntomas de una cultura superior: el “buen europeo” del futuro será, por tanto, quien, más allá de las estrechas fronteras personales y nacionales, sabrá abrirse a fructíferas hibridaciones.
Olhares feministas sobre o Direito e o TEDH: o caso Carvalho Pinto de Sousa Morais v. Portugal
Authors: Duarte Madalena
Published: April 2021

As teorias feministas do direito têm colocado vários desafios ao Direito, perspetivando-o como uma forma de reprodução de desigualdades sexuais e de género. Neste artigo, partindo da reflexão sobre um caso concreto e das respetivas decisões dos tribunais portugueses e do Tribunal Europeu dos Direitos Humanos, procuro analisar, num espaço e tempo em que os quadros jurídicos normativos nacionais e internacionais reivindicam ser promotores da igualdade de género, as conquistas que o Direito tem efetivamente possibilitado e com que intensidade. A perspetiva que me move funda-se numa política de reconhecimentos, ou seja, procura reconhecer eixos emancipatórios no Direito, para explorar a possibilidade do seu uso em lutas feministas.
El derecho a la libertad religiosa en los sistemas regionales de protección de derechos humanos de Europa y América
Authors: Martinón Quintero Ruth
Published: April 2021

El derecho a la libertad religiosa ha sido abordado con diferente intensidad por el Tribunal Europeo de Derecho Humanos y por las instituciones protectoras del Sistema Interamericano, la Comisión y la Corte. Sin embargo, las diferencias entre ambos ámbitos de protección de los derechos humanos no son solo cuantitativas porque responden a realidades históricas, políticas y sociales distintas. Aun así, también se dan puntos de encuentro en los sujetos titulares y obligados, en la perfilación de su contenido y en sus límites. Lo más llamativo del Tribunal europeo es el recurso constante al margen de apreciación nacional ante la diversidad de posturas de los Estados miembros del Consejo de Europa; y, en el Sistema Interamericano, la vinculación del derecho a la protección de los más vulnerables, bien a través de la cosmovisión de los pueblos indígenas, bien por su relación con el trabajo de muchos activistas de la sociedad civil con los más pobres.