bluuebunny/crossref_metadata_2025 huggingface dataset:
Number of Affected Relatives, Age, Smoking, and Hypertension Prediction Score for Intracranial Aneurysms in Persons With a Family History for Subarachnoid Hemorrhage
Authors: Zuurbier Charlotte C.M. , Bourcier Romain , Constant Dit Beaufils Pacôme , Redon Richard , Desal Hubert ,   The ICAN Investigators, Bor Anne S.E. , Lindgren Antti E. , Rinkel Gabriel J.E. , Greving Jacoba P. , Ruigrok Ynte M.
Published: February 2022

Background:

Persons with a positive family history of aneurysmal subarachnoid hemorrhage are at increased risk of aneurysmal subarachnoid hemorrhage. Preventive screening for intracranial aneurysms (IAs) in these persons is cost-effective but not very efficient. We aimed to develop and externally validate a model for predicting the probability of an IA at first screening in persons with a positive family history of aneurysmal subarachnoid hemorrhage.

Methods:

For model development, we studied results from initial screening for IA in 660 prospectively collected persons with ≥2 affected first-degree relatives screened at the University Medical Center Utrecht. For validation, we studied results from 258 prospectively collected persons screened in the University Hospital of Nantes. We assessed potential predictors of IA presence in multivariable logistic regression analysis. Predictive performance was assessed with the C statistic and a calibration plot and corrected for overfitting.

Results:

IA were present in 79 (12%) persons in the development cohort. Predictors were number of affected relatives, age, smoking, and hypertension (NASH). The NASH score had a C statistic of 0.68 (95% CI, 0.62–0.74) and showed good calibration in the development data. Predicted probabilities of an IA at first screening varied from 5% in persons aged 20 to 30 years with two affected relatives, without hypertension who never smoked, up to 36% in persons aged 60 to 70 years with ≥3 affected relatives, who have hypertension and smoke(d). In the external validation data IA were present in 67 (26%) persons, the model had a C statistic of 0.64 (95% CI, 0.57–0.71) and slightly underestimated IAs risk.

Conclusions:

For persons with ≥2 affected first-degree relatives, the NASH score improves current predictions and provides risk estimates for an IA at first screening between 5% and 36% based on 4 easily retrievable predictors. With the information such persons can now make a better informed decision about whether or not to undergo preventive screening.
Reevaluation of von Willebrand disease diagnosis in a Croatian paediatric cohort combining bleeding scores, phenotypic laboratory assays and next generation sequencing
Authors: Zadro Renata , Rogić Dunja , Coen-Herak Désirée , Bilić Ernest , Dejanović Bekić Sara , Radić Antolic Margareta , Lapić Ivana
Published: February 2022

This study reevaluated von Willebrand disease (vWD) diagnosis in a Croatian paediatric cohort by combining bleeding scores (BS), phenotypic laboratory testing, and next-generation sequencing (NGS).
A total of 25 children (11 males and 14 females, median age 10 years, from 2 to 17) previously diagnosed with vWD were included. BS were calculated using an online bleeding assessment tool. Phenotypic laboratory analyses included platelet count, platelet function analyser closure times, prothrombin time, activated partial thromboplastin time, von Willebrand factor antigen (vWF:Ag), vWF gain-of-function mutant glycoprotein Ib binding activity (vWF:GPIbM), vWF collagen binding activity (vWF:CBA), factor VIII activity (FVIII:C) and multimeric analysis. Next-generation sequencing covered regions of both vWF and FVIII genes and was performed on MiSeq (Illumina, San Diego, USA).
Disease-associated variants identified in 15 patients comprised 11 distinct heterozygous vWF gene variants in 13 patients and one novel FVIII gene variant (p.Glu2085Lys) in two male siblings. Four vWF variants were novel (p.Gln499Pro, p.Asp1277Tyr, p.Asp1277His, p.Lys1491Glu). Three patients without distinctive variants had vWF:GPIbM between 30 and 50%. Patients with identified vWF gene variants had statistically significant lower values of vWF:GPIbM (P = 0.002), vWF:Ag (P = 0.007), vWF:CBA (P < 0.001) and FVIII:C (P = 0.002), compared to those without. Correlations between BS and phenotypic laboratory test results were not statistically significant for either of the tests.
The applied diagnostic approach confirmed the diagnosis of vWD in 13 patients and mild haemophilia A in two. Limited utility of BS in the paediatric population was evidenced.
Investigating the Design and Implementation of an In-Line Near-Infrared Probe Using Computational Fluid Dynamics for Measurement of Non-Newtonian Fluids
Authors: Haroon Kiran , John Thomas , Fonte Cláudio P. , Mendoza Ćesar , Baker Michael , Martin Philip
Published: February 2022

Process analytical technology (PAT) has developed significantly since its introduction in pharma where many in situ analytical probes and measuring devices are now commercially available, replacing the use of off-line quality control measurements that are typically laborious and time intensive. The use of PAT instrumentation should not interfere with the process itself and subsequently should have no effect on the product whilst measuring representative samples. Implementation of these devices is typically arbitrary using empirical means. Therefore, the objective of this study is to highlight the use of computational fluid dynamics modeling to investigate the effect of interfacing parameters and process parameters of an inline near-infrared (NIR) probe used to determine the viscosity of a non-Newtonian micellar liquid. The parameters investigated for the probe were immersion depth, immersion angle, gap size, and fluid velocity. The results conclude that the immersion angle and depth should both be optimized to prevent stagnant fluid accumulating in the measuring gap ensuring that the NIR measurements are representative of the bulk. The gap size determines the optical pathlength and therefore was also investigated against an existing predictive viscosity model showing no changes in model performance with varying gap size. The use of computational modeling to develop a digital twin prior to PAT implementation at the equipment design stage ensures the technology can perform at its best and will also aid in calibration transfer studies.
A Hierarchical Personality Approach Toward a Fuller Understanding of Onychophagia and Compulsive Buying
Authors: Rizzo Cristian , Sestino Andrea , Pino Giovanni , Guido Gianluigi , Nataraajan Rajan , Harnish Richard J.
Published: February 2022

Purpose

Employing a hierarchical model of personality, prior research suggests that cardinal traits such as conscientiousness and agreeability predict central traits such as materialism and need for arousal that in turn impact surface traits such as onychophagia and compulsive buying. More research is needed to explore additional central traits and their effect on onychophagia and compulsive buying. Thus, the goal of the current research is to examine how another central trait—negative perfectionism—impacts onychophagia and compulsive buying.

Design/Methodology/Approach

A survey was administered both online and face-to-face resulting in a sample of 634 subjects of which 391 were individuals with onychophagia. Through a multi-group analysis, a causal model was tested to identify personality traits and their relationship with compulsive buying.

Results

Results showed that onychophagia was affected by other obsessive-compulsive disorders—particularly trichotillomania, and excoriation disorder, which significantly increased the likelihood that the participant was a compulsive buyer.
Conceptualizing the Friendzone Phenomenon
Authors: LeFebvre Leah E. , Rasner Ryan D. , Kickert Carli-Jo , McLelland Bert , Owen Emily , Iyer Aishwarya
Published: February 2022

This study explores the friendzone, or the lexicon surrounding the nexus between platonic and romantic relationships. The friendzone situates layperson and scholarly depictions of platonic and romantic relationships. Minimal scholarship explores this common vernacular from either perspective—those that communicate romantic attraction or those that react. Specifically, this study investigates how initiators (those who communicate interest) and respondents (those who react to declarations) participate in the communicative and relational process of friendzoning. Participants ( N = 787) completed open-ended questions about their friendzone experiences, communication from initiators, reaction of respondents, and changes to friendships. This study utilizes analytic induction to provide further conceptualization and delineation of the friendzone through identifying friendzoning types, initiator communication strategies, respondent reactions, and relationship changes. Findings allowed for: the conceptualizing of the friendzone, highlighting obstacles for navigating non-normative relationship scripts, and identifying risks involved with relationship change.
Patterns of cardiac involvement in different muscular dystrophies assessed by magnetic resonance imaging
Authors: Goebel Juliane , Schult Karolin , Schara Ulrike , Neudorf Ulrich , Forsting Michael , Schlosser Thomas , Nassenstein Kai
Published: February 2022

Background

In muscular dystrophies, it is not only skeletal muscles that can be affected, but also the myocardium. This cardiac involvement can represent a major cause of morbidity and mortality.

Purpose

To investigate cardiac involvement in Duchenne (DMD), Becker (BMD), and limb girdle muscular dystrophy (LGMD) patients, and carriers of DMD/BMD by cardiac magnetic resonance (CMR) imaging and to search for differences in the pattern of cardiac involvement.

Material and Methods

All patients with genetically or histologically proven DMD, BMD, and LGMD, or confirmed carriers of DMD/BMD who had undergone CMR at our clinic between January 2008 and November 2018 were retrospectively included and re-evaluated for regional and global left ventricular function, increased trabecularization, and late enhancement.

Results

A total of 26 DMD, 10 BMD, 11 LGMD, and seven DMD/BMD carriers were included. Only one carrier of DMD presented with normal CMR results; all other participants showed cardiac abnormalities. Regional wall motion abnormalities (RWMA; prevalence in LGMD patients: 55%) and late enhancement (prevalence in LGMD patients: 82%) were frequent. RWMA were accentuated basal inferolateral in DMD/BMD carriers, while in LGMD they were accentuated apical. In all groups late enhancement was located mainly subepicardial/midmyocardial with a basal inferolateral accentuation. Apart from the different RWMA distribution, no further group-specific differences were found.

Conclusion

We found a high rate of cardiac involvement not only in DMD/BMD, but also in LGMD and DMD/BMD carriers with a different RWMA accentuation (apical in LGMD and basal inferolateral in DMD/BMD) as a single group-specific difference.
Effect of Process Control Parameters on the Workability and Strength Characteristics of Microsurfacing Mix
Authors: Bhargava Nishant , Siddagangaiah Anjan Kumar , Ryntathiang Teiborlang v
Published: February 2022

This study investigates the effect of production process variation on the workability and strength evolution of microsurfacing mix. Overall, 35 different mixes were produced by varying aggregate gradation, emulsion content, and water content, within the allowable limits. Results showed that when aggregate gradation was coarser, and emulsion and water content higher than the optimum, the mix failed to meet the workability criteria. However, the variation of process control parameters within the allowable limits had minimal effect on strength (cohesion). It was interesting to note that the mix failed to meet the workability limits when the water content was 1% lower than the optimum, or emulsion content was at the lower limit with finer gradation, or both. Regression models were, therefore, developed to understand the individual and interaction effect of process control parameters. Sensitivity analysis of model parameters showed that emulsion and water content predominantly influenced workability, whereas aggregate gradation had the highest impact on strength. In particular, the mix would tend to prematurely break when the total surface area (TSA) increased to 1.1 times the optimum, and emulsion and water content reduced to 0.9 times the optimum. Alternatively, if TSA is 0.9 times and emulsion and water content is 1.1 times the optimum, the mix would be too workable and could potentially lead to segregation. Findings suggested that limiting the variation of water content within ±1% of the optimum ensures acceptable workability. Further, mix with finer gradation and emulsion content on the lower limit should be avoided during production.
Evaluation of Maintenance Procedures for Bridge Spalling on Parapet Walls
Authors: Miller Richard A. , Delatte Norbert J. , Deshpande Abhijeet , Hartell Julie Ann , Twine Sarah , Karunaratne Evan
Published: February 2022

Parapet wall deterioration concerns the Ohio Department of Transportation as well as other transportation agencies. The spalling of parapet walls presents a danger to the traveling public, as pieces of deteriorated concrete may fall onto the road below. The current repair method is to chip off the weakened concrete using pneumatic chipping hammers. However, this process not only damages the sound concrete, but it also leaves an unprotected surface. This project implemented hydrodemolition as a means of removing spalled concrete. A hydrodemolition robot was utilized in the field to remove concrete on the interior and exterior face of a parapet wall. This method was determined as promising as it does not damage the sound concrete surface and exposed reinforcing steel, it mitigates silica dust, and it efficiently removes unsound concrete. Polyaspartic polyureas are a concrete protectant/sealant that may be rolled onto a prepped concrete surface using a paint roller. This material not only seals the concrete but may provide a reinforcing barrier that retains loose pieces of concrete. This material was used to coat several parapet walls in the field, and it was observed that three of the five polyaspartic products appeared effective in the field at providing a protective barrier. In contrast, all were equally effective in laboratory testing.
Community Violence Exposure and Stress Reactivity in African American and Non-Latino White Adolescents With Overweight/Obesity
Authors: Hasson Rebecca E. , Hofsess Rachel C. , Adams Tessa E. , Gill Amaanat K. , Mazin Lauren N. , Gerras Julia M.
Published: February 2022

Adolescents who experience community violence are exposed to toxic stressors at a critical period of growth and development. The purpose of this study was to examine the relationship between community violence exposure and stress reactivity in African American and non-Latino white adolescents with overweight/obesity. Fifty-one adolescents (47% female, 55% African American; aged 14–19) participated in this study. Community violence was assessed using the Survey of Children’s Exposure to Community Violence. Stress reactivity was assessed via salivary cortisol and alpha-amylase area under the curve (AUC) during a Trier Social Stress Test (TSST). Race was a significant predictor of alpha-amylase reactivity (β = 10740±3665, p = 0.0006), with a higher alpha-amylase AUC observed in African American compared to non-Latino white adolescents. There was also a significant difference in the relationship between community violence exposure and alpha-amylase AUC by race (β = −3561±1226, p = 0.007). At similar increases in violence exposure, African Americans demonstrated a significant decline in alpha-amylase AUC while non-Latino whites demonstrated a significant increase in alpha-amylase AUC. Neither race nor violence exposure were significant predictors of cortisol AUC and there were no significant differences in the relationship between community violence exposure and cortisol AUC by race (all p’s > .05). These preliminary findings suggest exposure to community violence may act to exacerbate autonomic dysregulation in African American adolescents with overweight/obesity. Longitudinal studies are needed to confirm the mechanisms by which community violence exposure differentially impacts stress responses by race.
Impingement in total hip arthroplasty: A geometric model
Authors: Pryce Gregory M , Sabu Bismaya , Al-Hajjar Mazen , Wilcox Ruth K , Thompson Jonathan , Isaac Graham H , Board Tim , Williams Sophie
Published: February 2022

Total Hip Arthroplasty (THA) is one of the most common and successful surgical interventions. The survivorship at 10 years for the most commonly used systems is over 95%. However, the incidence of revision is usually much higher in the 0–1 year time period following the intervention. The most common reason for revision in this early time period is dislocation and subluxation, which may be defined as complete or permanent, and partial or temporary loss of contact between the bearing surfaces respectively. This study comprises the development of a geometric model of bone and an in situ total hip replacement, to predict the occurrence and location of bone and component impingement for a wide range of acetabular cup positions and for a series of frequently practiced activities of daily living. The model developed predicts that anterior-superior component impingement is associated with activities that result in posterior dislocation. The incidence may be reduced by increased cup anteversion and inclination. Posterior-inferior component impingement is associated with anterior dislocation activities. Its incidence may be reduced by decreased cup anteversion and inclination. A component impingement-free range was identified, running from when the cup was positioned with 45° inclination and 25° anteversion to 70° inclination and 15°–20° anteversion.
Costing of Health and Wellness Centres: A Case Study of Gujarat
Authors: Gupta Indrani , Trivedi Mayur , Jani Vishal , Barman Kanksha , Ranjan Avantika , Sharma Manas , Mokashi Tushar
Published: February 2022

The National Health Policy 2017 recommended the establishment of health and wellness centres (HWC) as the primary platform to deliver comprehensive primary health care in India and emphasised that about two-thirds of the health budget of the government should be invested on primary care. In February 2018, the government announced its plan to create 150,000 HWCs under the Ayushman Bharat initiative by transforming the already existing sub-centres (SCs), primary health centres (PHCs) and urban PHCs as HWCs by 2022. The operationalisation of HWCs has been planned in a phased manner. However, for scaling up and replicability, it is imperative for the government to know how much to budget for this initiative, so that there are no interruptions in the smooth flow of services. Taking Gujarat as a case study, the study took a sample of eight HWCs for estimating the total and per-unit costs for each type of HWC. OPD footfalls were taken as an indicator for measuring output. The incremental unit costs were estimated by calculating the difference between the pre and post-conversion unit costs, in order to understand the cost implications of the conversion. The study also estimated the possible total costs in relation to the health budget of the state to understand the financial implications of scaling up HWCs. The results indicated that though the costs have gone up after conversion, outpatient department (OPD) footfalls have also increased at all facilities, but most significantly for the SCs, resulting in costs per OPD footfalls coming down significantly. For nearly all the centres, there has been a fall in the incremental costs per OPD visits indicating that the conversion to HWC has been quite economical. It was estimated that a total of about ₹7.13 billion will be spent on running 1,500 HWCs in the year 2020–2021, though, the incremental costs of scaling up would be significantly less at about ₹940 million. If, however, the entire gamut of services envisaged to be a part of the HWC initiative are added, the costs are likely to increase. More research with additional data points would be required to confirm these tentative findings, but the results could be used as a baseline for future such studies.
A touristic tale of four cities on instagram
Authors: Tugores-Ques Juan , Bonilla-Quijada María
Published: February 2022

Social media has become a basic source of information for visitors and its capacity to generate interest in touristic destinations gains relevance. This paper identifies elements capable of generating greater user engagement with the official accounts of four European capitals with a high number of tourists: London, Paris, Berlin and Madrid. Our findings, based on the 862 posts published by these cities on their Instagram accounts over the course of one year, show how various aspects of the content of these posts are crucial factors in generating engagement. They also reveal the potential of including in posts variables with elements of interaction between users’ contents and official accounts. Moreover, the variables that may generate the most engagement are identified, and both differences and illustrative similarities between the strategies implemented by the cities are noted. These results suggest not only interesting theoretical conclusions, but also important implications for the tourism sector.
No one-size-fits-all! Eight profiles of digital inequalities for customized inclusion strategies
Authors: Asmar Axelle , Mariën Ilse , Van Audenhove Leo
Published: February 2022

This article presents a conceptual model that explores the extent to which various (non)-users can be subjected to mechanisms of inclusion or exclusion. The model consists of eight profiles of digital inequalities, ranging from deep exclusion to deep inclusion, and is based upon a combination of five key indicators at the social level (income, education, social participation, agency, well-being) and eight key indicators at the digital level (access, attitudes, digital skills, soft skills, media richness of the environment, autonomy of use, user practices and social support). This conceptual model, by going further than socio-demographics, (a) allows the formulation of an alternative lens through which to look at mechanisms of inclusion and exclusion and (b) brings a significant contribution to existing research by highlighting the co-action of social and digital indicators in mechanisms of inclusion and exclusion.
Beyond accessibility: Exploring digital inclusivity in US progressive politics
Authors: Trevisan Filippo
Published: February 2022

This article explores inclusivity in the context of digital politics. As online campaigns and digital participation become increasingly central to democratic politics, it is essential to better understand the implications of this shift for marginalized and politically vulnerable people. Focusing on people with disabilities, this study applies a grounded theory approach to investigate what factors shape inclusivity in digital politics and begins to theorize this under-researched concept. Through interviews with self-advocates and election professionals with disabilities involved in innovative digital mobilization efforts for progressive US political organizations and campaigns, as well as a review of related strategies, this article illuminates digital inclusivity as a “process” connected to, but also distinct from the “outcomes” of social and political inclusion and exclusion. Key incentives and obstacles are identified, and emerging principles of digital inclusivity that are simultaneously community-rooted and sensitive to the context of contemporary US politics are discussed.
Being in the wood: Using a presuppositional interview in hermeneutic phenomenological research
Authors: Barrett-Rodger Lewis , Goldspink Sally , Engward Hilary
Published: February 2022

The purpose of this paper is to explain and describe the use of presuppositional interviews as means of the researcher being able to expose their own, often unknown, assumptions about the phenomena of interest. Within this, we provide a philosophical and practical account for the development and use of a presuppositional interview from an insider perspective to expose insights which influence researcher reflexivity and directly impact on the research process. Author A’s hermeneutic phenomenological study seeks to gain insights into the lived experience of children learning mathematics in outdoor environments, such as forests and woodland. The paper describes how the reflexive method of presuppositional interviewing helped him to understand more about his research position and find a clearing in his ‘Being in the Wood.’ A template for a presupposition interview schedule is presented.
Compound mechanical fault diagnosis based on CMDE
Authors: Yu Guangwei , Wang Xianzhi , Da Chunlin
Published: February 2022

The fault diagnosis technique is of important for the safety operation of the rotating machinery. In the fault diagnosis framework, the entropy-based method is a promising tool for the feature extraction and signal processing. Among the entropy-based methods, the diversity entropy has arisen increasing attention due to its merits of high consistency, strong robustness, and high calculation efficiency. However, it suffers the defect that the multiscale procedure leads to unstable complexity estimation at higher scales. This induces a poor cluster performance in analyzing the compound mechanical fault signals. To address this issue, this paper presents a novel feature extraction method called composite multiscale diversity entropy (CMDE). The proposed CMDE utilizes the mean complexity value of multiple sliding windows for each scale to enhance the stability, which enables the diversity entropy could dig richer fault information from deeper scales for the compound fault diagnosis of rotating machinery. Then, the stability of CMDE has been evaluated using synthetic gear signals. At last, the proposed CMDE has been applied in the compound mechanical fault diagnosis. The experimental results show that the CMDE achieves the highest diagnosis accuracy compared to the existing entropy-based feature extraction methods.
Effectiveness of fourth-line dual immunotherapy in hepatocellular carcinoma with simultaneous steroid administration for immune-related hepatitis
Authors: Lowes Kristina , Reinecke Johanna , Brunner Marius , Scholz Matthias , Kitz Julia , Michels Beate , Mekolli Ardian , Gaedcke Jochen , Seif Amir Hosseini Ali , Ströbel Philipp , Ghadimi Michael , Ellenrieder Volker , Koenig Alexander , Koenig Ute
Published: February 2022

Medical therapy of advanced hepatocellular carcinoma (HCC) remains an emerging subject, but therapeutic sequences together with toxicity management are rarely described. Herein, we report the case of a therapeutic sequence and toxicity management in a 72-year old White male with advanced non-cirrhotic HCC. The HCC of this patient was refractory against treatment with several tyrosine kinase inhibitors, including lenvatinib and cabozantinib or immune combination of pembrolizumab and lenvatinib. Double immune combination of nivolumab and ipilimumab was effective in fourth-line treatment but resulted in immunotherapy-related grade 4 hepatitis. This toxicity responded well to high doses of corticosteroids, and reinduction of dual immune combination remained effective despite continuation of high-dose corticosteroids in a non-cirrhotic HCC. This case demonstrated the efficacy of double immune therapy in higher treatment lines in advanced non-cirrhotic HCC even if the patient was treated with other immune modulatory therapies earlier. Moreover, it can remain effective under concomitant administration of high-dose corticosteroids.
Cerebral Amyloid Angiopathy and Atrial Fibrillation: An up to Date Case Report
Authors: Battistin Umberto , AlQassim Noora , Hallak Yusuf , Mohammed Marwa , Hasan Ahmedyar , Oluwole Olusegun J.
Published: February 2022

Concurrent Cerebral Amyloid Angiopathy (CAA) and Atrial Fibrillation are becoming an increasingly common dilemma in clinical practice due to the aging population and the comorbidities associated with it. In such patients, the physician must appreciate and strike the difficult balance between the risk of ischemic strokes from atrial fibrillation on one hand, and that of intracerebral hemorrhage from coexisting CAA on the other. Anticoagulation is necessary for the former but potentially deleterious for the latter. In this case report, we present the case of a 67-year-old woman with a long history of atrial fibrillation on rivaroxaban who recently began to experience recurrent transient neurological deficits that were later diagnosed as amyloid spells related to concomitant CAA. While there is no clear-cut consensus in published literature on how to best manage these patients regarding the use of anticoagulation, it is recommended to involve a multidisciplinary team for optimal management of these patients.
A rare case of postmenopausal hyperandrogenism due to ovarian hyperthecosis and hilus cell hyperplasia
Authors: Johnson Jean-Ellen , Hussain Munawar , Rathore Ali , Wolfe Konrad
Published: February 2022

Postmenopausal hyperandrogenism is rare, and without consensus on specific investigative indices, diagnosis is challenging. A 77-year-old woman had a three-year history of hirsutism, male-pattern baldness and increased libido alongside elevated androstenedione, total testosterone and free androgen index levels. A magnetic resonance imaging (MRI) scan showed bilateral ovarian lesions, suggesting ovarian hyperthecosis. Histopathology obtained after a laparoscopic bilateral salpingo-oophorectomy confirmed ovarian hyperthecosis and hilus cell hyperplasia. We believe it’s the first time they have been reported to occur in combination. The symptoms resolved within a month of surgery. This case highlights the difficulties of diagnosis alongside demonstrating the importance of management by a multidisciplinary team.
Improving Immunization Rates During the 2019 Measles Outbreak
Authors: Rosas Steven Louis , Simpson Henry J. , Martinez Christopher , Walker James A. , Forster Jeremy , Deyo-Svendsen Mark , Phillips Michael , Evers Kaylie
Published: February 2022

In 2019, there were multiple outbreaks of measles in the United States. In the context of the public awareness of these outbreaks, we performed an intervention with the intent to improve the rate of measles immunization in our pediatric population. Pediatric patients that were lacking adequate measles immunization were identified by electronic medical record (EMR) survey. Charts were reviewed and updated if records were found to be incomplete. Parents of the remaining children were sent a letter, personally signed by the child’s primary care provider, encouraging measles immunization. A measles fact sheet, produced by the United States Center for Disease Control, was also included with the letter. There were 44 patients in the study group whose parents received a letter and measles fact sheet. As a result, 5 of these children were brought in for a measles, mumps, and rubella (MMR) immunization. The 44 patients whose parents received a letter included 20 patients whose parents had previously expressed intent to not vaccinate their children as documented in the EMR. None of these children received an MMR immunization. Although small in scope, this project provides a glimpse into the importance of personal provider guidance to parents who are inclined to immunize their children. Unfortunately, it also demonstrated that provider advice did not change the opinions of parents who had already taken a stance against vaccination, even in the context of an urgent public health situation that had garnered widespread coverage in the lay press and social media.
Rates and Determinants of Returning to Australian Rules Football in Male Nonprofessional Athletes After Anterior Cruciate Ligament Reconstruction
Authors: Webster Kate E. , Klemm Haydn J. , Feller Julian A.
Published: February 2022

Background:

Return to sport is a goal for most patients who undergo anterior cruciate ligament (ACL) reconstruction. However, at a nonelite level, there are limited sport-specific data regarding rates or factors associated with return to play.

Purpose:

To report rates and determinants of returning to play Australian Rules football after ACL reconstruction in male nonprofessional athletes.

Study Design:

Case-series; Level of evidence, 4.

Methods:

A total of 354 male nonprofessional Australian Rules football players who had undergone primary ACL reconstruction were asked to complete detailed sports activity questions at 12 months and 2 to 5 years (mean, 3 years) after surgery. Rates of return to play were calculated for both timepoints, along with preoperative patient expectations and postoperative sport performance. The following predictors of return to play were examined: age at surgery; height; weight; frequency of weekly football participation; sport participation level; psychological readiness to return to sport; and knee-related quality of life. Further ACL injuries were also documented. Descriptive statistics were used to summarize return-to-play data and contingency analysis for predictors of return to sport.

Results:

The rate of return to any level of play was 35% (95% CI, 30%-41%; n = 284) at the 12-month follow-up and 78% (95% CI, 72%-83%; n = 233) at the 2- to 5-year follow-up. Overall, 64% (95% CI, 57%-70%) of the patients were able to return to their same or higher level of play. Before surgery, 92% of the patients expected to return to their same preinjury level of Australian Rules football participation. At the 2- to 5-year follow-up, 61% who returned to play felt that they could perform as well as they could before their ACL injury. A greater psychological readiness to return to sport preoperatively and higher level of sport participation were significant predictors of a return at 2 to 5 years. Further ACL injuries were sustained by 21% of the cohort (15% graft rupture; 6% contralateral ACL injury).

Conclusion:

Most male athletes who participate in Australian Rules football returned to some level of play after ACL reconstruction; however, only 64% returned to preinjury levels. Preoperative expectations were not met, and high reinjury rates are a cause for concern.
Diagnostic performance of MRI, SPECT, and PET in detecting renal cell carcinoma: a systematic review and meta-analysis
Authors: Yin Qihua , Xu Huiting , Zhong Yanqi , Ni Jianming , Hu Shudong
Published: February 2022

Background

Renal cell carcinoma (RCC) is one of the most common malignancies worldwide. Noninvasive imaging techniques, such as magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and positron emission tomography (PET), have been involved in increasing evolution to detect RCC. This meta-analysis aims to compare to compare the performance of MRI, SPECT, and PET in the detection of RCC in humans, and to provide evidence for decision-making in terms of further research and clinical settings.

Methods

Electronic databases including PubMed, Web of Science, Embase, and Cochrane Library were systemically searched. The keywords such as “magnetic resonance imaging”, “MRI”, “single-photon emission computed tomography”, “SPECT”, “positron emission tomography”, “PET”, “renal cell carcinoma” were used for the search. Studies concerning MRI, SPECT, and PET for the detection of RCC were included. Pooled sensitivity, specificity, and the area under the summary receiver operating characteristic (SROC) curve (AUC), etc. were calculated.

Results

A total of 44 articles were finally detected for inclusion in this study. The pooled sensitivities of MRI, 18F-FDG PET and 18F-FDG PET/CT were 0.80, 0.83, and 0.89, respectively. Their respective overall specificities were 0.90, 0.86, and 0.88. The pooled sensitivity and specificity of MRI studies at 1.5 T were 0.86 and 0.94, respectively. With respect to prospective PET studies, the pooled sensitivity, specificity and AUC were 0.90, 0.93 and 0.97, respectively. In the detection of primary RCC, PET studies manifested a pooled sensitivity, specificity, and AUC of 0.77, 0.80, and 0.84, respectively. The pooled sensitivity, specificity, and AUC of PET/CT studies in detecting primary RCC were 0.80, 0.85, and 0.89.

Conclusion

Our study manifests that MRI and PET/CT present better diagnostic value for the detection of RCC in comparison with PET. MRI is superior in the diagnosis of primary RCC.
Transcriptome analysis of cervical cancer exosomes and detection of HPVE6*I transcripts in exosomal RNA
Authors: Bhat Anjali , Yadav Joni , Thakur Kulbhushan , Aggarwal Nikita , Chhokar Arun , Tripathi Tanya , Singh Tejveer , Jadli Mohit , Veerapandian Veeramohan , Bharti Alok Chandra
Published: February 2022

Background

Exosomes play a key role in cell-to-cell communication and are integral component of the tumor microenvironment. Recent observations suggest transfer of RNA through tumor-derived exosomes that can potentially translate into regulatory proteins in the recipient cells. Role of cervical cancer-derived exosomes and their transcript cargo is poorly understood.

Materials and methods

The total RNA of exosomes from HPV-positive (SiHa and HeLa) and HPV-negative (C33a) cervical cancer cell lines were extracted and the transcripts were estimated using Illumina HiSeq X. Further, validation of HPV transcripts were performed using RT-PCR.

Results

3099 transcripts were found to be differentially-exported in HPV-positive vs. HPV-negative exosomes (p value <0.05). Analysis of top 10 GO terms and KEGG pathways showed enrichment of transcripts belonging to axon guidance and tumor innervation in HPV-positive exosomes. Among top 20 overexpressed transcripts, EVC2, LUZP1 and ANKS1B were the most notable due to their involvement in Hh signaling, cellular migration and invasion, respectively. Further, low levels of HPV-specific reads were detected. RT-PCR validation revealed presence of E6*I splice variant of HPV18 in exosomal RNA of HeLa cells. The E6*I transcripts were consistently retained in exosomes obtained from HeLa cells undergoing 5-FU and cisplatin-induced oxidative stress.

Conclusion

Our data suggests the enrichment of poly-A RNA transcripts in the exosomal cargo of cervical cancer cells, which includes pro-tumorigenic cellular RNA and viral transcripts such as HPV E6, which may have clinical utility as potential exosomal biomarkers of cervical cancer.
Investigating the effect of inquiry-based stress reduction on mortality awareness and interpersonal problems among intensive care unit nurses
Authors: Tajnia Soheila , Iranmanesh Sedigheh , Asadi Neda , McDermott Mark
Published: February 2022

Introduction

Caring for dying patients is one of the job stressors. Nurses in intensive care units are among the medical staff who have a close interaction with dying patients. Studies have shown that psychological interventions are very helpful in improving thinking about death and its problems. Therefore, this study was conducted to investigate the effect of Inquiry-Based Stress Reduction on mortality awareness and interpersonal problems among intensive care unit nurses in southeastern Iran.

Materials and methods

This was a Quasi-experimental study with a pretest-posttest design in southeast of Iran in 2021. Nurses were selected using the convenience sampling method and divided into intervention (n = 32) and control (n = 35) groups using the block randomization method. The intervention group received a two-hour Inquiry-Based Stress Reduction counseling session every week for 6 weeks. Data were gathered using Multidimensional Mortality Awareness Measure and Inventory of Interpersonal Problems before, immediately after, and 6 weeks after the intervention. IBM SPSS Statistics software version 25 was used for data analysis.

Results

In the intervention group, the mean scores of Mortality Awareness before, immediately after, and 6 weeks after the intervention were 130.41 ± 5.91, 164.47 ± 8.66, and 163.91 ± 9.29, respectively. Therefore, in the intervention group, the increase of Mortality Awareness mean score was statistically significant (P < 0.001). In the control group, the mean scores of Mortality Awareness before, immediately after, and 6 weeks after intervention were 129.63 ± 5.59, 135.26 ± 11.14, and 132.66 ± 5.62, respectively. Difference between the two groups was significant (P < 0.001). The results also showed that in the intervention group the mean scores of Interpersonal Problems immediately after and 6 weeks after the intervention were lower than before the intervention (P < 0.001). In the control group, Interpersonal Problems increased over time (P < 0.001). Accordingly, the difference between the two groups in terms of Interpersonal Problems during the study was statistically significant (P < 0.001).

Conclusion

The study results suggest that the Inquiry-Based Stress Reduction is an appropriate intervention method to improve mortality awareness and reduce interpersonal problems in intensive care unit nurses.
Joint modelling of anaemia and stunting in children less than five years of age in Lesotho: a cross-sectional case study
Authors: Gaston Rugiranka Tony , Habyarimana Faustin , Ramroop Shaun
Published: February 2022

Background

 Anaemia and stunting remain jointly a serious health issue worldwide especially in developing countries. In Lesotho, their prevalence is high, particularly among children less than 5 years of age.

Objectives

 The primary objective was to determine the association between anaemia and stunting, and identify factors relating to both conditions among children younger than 5 years in Lesotho.

Methods

 This cross-sectional study used secondary data from 3112 children collected during the 2014 Lesotho Demographic Health Survey (LDHS). Haemoglobin (Hb) levels were adjusted for altitude and a level less than 11 g per deciliters (11 g/dl) was determined as the cutoff for being anaemic. A child with the height-for-age z score (HAZ) below minus two standard deviations (SD) was considered to have stunting. We linked factors relating to anaemia and stunting using a multivariate joint model under the scope of the generalized linear mixed model (GLMM).

Results

The prevalence of anaemia and stunting in children younger than 5 years were 51% and 43% respectively. The multivariate results revealed a strong association between anaemia and stunting. In addition, maternal education, urban vs. rural residence, wealth index and childbirth weight significantly impacted childhood stunting or malnutrition, while having fever and/or diarrhoea was linked to anaemia. Lastly, age was shown to have a significant effect on both stunting and anaemia.

Conclusion

Anaemia and stunting or malnutrition showed linked longitudinal trajectories, suggesting both conditions could lead to synergetic improvements in overall child health. Demographic, socio-economic, and geographical characteristics were also important drivers of stunting and anaemia in children younger than 5 years. Thus, children living in similar resources settings as Lesotho could benefit from coordinated programs designed to address both malnutrition and anaemia.
Bacterial and viral coinfection in idiopathic pulmonary fibrosis patients: the prevalence and possible role in disease progression
Authors: Moghoofei Mohsen , Mostafaei Shayan , Kondori Nasim , Armstrong Michelle E. , Babaei Farhad
Published: February 2022

Background

Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial pneumonia of unknown aetiology with a mean survival rate of less than 3 years. No previous studies have been performed on the role of co-infection (viral and bacterial infection) in the pathogenesis and progression of IPF. In this study, we investigated the role of viral/bacterial infection and coinfection and their possible association with pathogenesis and progression of IPF.

Methods

We investigated the prevalence and impact of bacterial and viral coinfection in IPF patients (n = 67) in the context of pulmonary function (FVC, FEV1and DLCO), disease status and mortality risk. Using principal component analysis (PCA), we also investigated the relationship between distribution of bacterial and viral co-infection in the IPF cohort.

Results

Of the 67 samples, 17.9% samples were positive for viral infection, 10.4% samples were positive for bacterial infection and 59.7% samples were positive coinfection. We demonstrated that IPF patients who were co-infected had a significantly increased risk of mortality compared (p = 0.031) with IPF patients who were non-infected [Hazard ratio: 8.12; 95% CI 1.3–26.9].

Conclusion

In this study, we report for the first time that IPF patients who were coinfected with bacterial and viral infection have significantly decreased FVC and DLCO(% predicted). Besides, the results demonstrated the increased AE-IPF, increased incidence of death and risk of mortality in infected/coinfected patients compared to non-infected IPF patients.
The usefulness of preoperative exocrine function evaluated by the 13C-trioctanoin breath test as a significant physiological predictor of pancreatic fistula after pancreaticoduodenectomy
Authors: Kato Hiroyuki , Asano Yukio , Ito Masahiro , Kawabe Norihiko , Arakawa Satoshi , Shimura Masahiro , Koike Daisuke , Hayashi Chihiro , Kamio Kenshiro , Kawai Toki , Ochi Takayuki , Yasuoka Hironobu , Higashiguchi Takahiko , Tochii Daisuke , Kondo Yuka , Nagata Hidetoshi , Utsumi Toshiaki , Horiguchi Akihiko
Published: February 2022

Background

The association between pancreatic fistula (PF) after pancreaticoduodenectomy (PD) and preoperative exocrine function is yet to be elucidated. This study aimed to evaluate the association between the preoperative results of the 13C-trioctanoin breath test and the occurrence of PF, showing the clinical relevance of the breath test in predicting PF.

Method

A total of 80 patients who underwent 13C-trioctanoin breath tests prior to PD from 2006 to 2018 were included in this study. Univariate and multivariate analyses were conducted to reveal the preoperative predictors of PF, showing the association between 13C-trioctanoin absorption and PF incidence.

Results

Among 80 patients (age, 68.0 ± 11.9 years, 46 males and 34 females; 30 pancreatic ductal adenocarcinoma [PDAC]/50 non-PDAC patients), the incidence of PF was 12.5% (10/80). Logistic regression analysis results revealed that the frequency of PF increased significantly as the 13C-trioctanoin breath test value (Aa% dose/h) increased (odd’s ratio: 1.082, 95% confidence interval: 1.007–1.162, p = 0.032). Moreover, the optimal cutoff value of the preoperative fat absorption level to predict PF was 38.0 (sensitivity, 90%; specificity, 74%; area under the curve, 0.78; p = 0.005). Indeed, the incidence of PF was extremely higher in patients whose breath test value was greater than 38.0 (33%, 9/27) compared with that in patients with values less than 38.0 (1.8%, 1/53).

Conclusions

Favorable preoperative fat absorption evaluated using the 13C-trioctanoin breath test is a feasible and objective predictor of PF after PD.