bluuebunny/crossref_metadata_2025 huggingface dataset:
E-learning adoption: Does the instructional design model matter? An explanatory sequential study on midwifery schools in Uganda
Authors: Bigirwa June Patrick , Ndawula Stephen , Naluwemba Esther Frances
Published: July 2020

E-learning has become an integral part of mainstream society and hence revolutionizing distance education endeavours. A number of change agents and bureaucrats in Uganda have embraced this pedagogy constructing it as an alternative to the traditional brick and mortar educational systems, which have become difficult to develop and maintain. However, despite the high level of investment on e-learning programs, there is a slow adoption of this new pedagogy amongst students and faculty, and those who do start to use the system opt out later. This trend of slow adoption is likely to constrain government’s efforts of improving the skill mix, competencies and numbers of midwives in the country. This research intended to ascertain whether instructional design was an influencer of e-learning adoption and profile the salient instructional design traits relevant to e-learning adoption in midwifery schools in Uganda. Ten schools were sampled with 224 participants. Data collection was conducted in two phases, the first entailed quantitative data collection and analysis to ascertain whether instructional design played a significant role in e-learning adoption and the second embraced a qualitative data collection and analysis to ascertain the salient traits of instructional design to be relied on by midwifery schools. Simple linear regression analysis established that instructional design had a significant influence on e-learning adoption with p value of (p = 0.016), and it accounted for 38.7% of the variance in e-learning adoption, with a moderate positive relationship and its key salient traits includes: choosing an appropriate instructional design model to guide the entire e-learning process, interactivity of e-learning materials, collaborative working in developing and updating e-learning materials, eliciting feedback on instructional materials, and engaging in more than one e-learning activity. Midwifery schools therefore have to focus on these six traits if they are to improve e-learning adoption.
Patients’ satisfaction with quality of care in general hospitals in Ebonyi State, Nigeria, using SERVQUAL theory
Authors: Umoke MaryJoy , Umoke Prince Christian Ifeanachor , Nwimo Ignatius O , Nwalieji Chioma Adaora , Onwe Rosemary N , Emmanuel Ifeanyi Nwafor , Samson Olaoluwa Agbaje
Published: July 2020

Background:

Patient satisfaction is an essential parameter in the assessment of quality of care and healthcare facility performance.

Objective:

To investigate patients’ satisfaction with quality of care in general hospitals in Ebonyi State, South East, Nigeria, using the SERVQUAL.

Methods:

A cross-sectional descriptive study design was employed on a sample of 400 patients using a 27-item structured open-ended patients’ satisfaction questionnaire with a multi-stage cluster sampling technique. Patients included in the study were those who must have come for an outpatient clinic within the period, be 18 years and above, and those who gave consent to participate. Of 400 questionnaires administered, 396 (99%) were retrieved. SPSS version 20 was used for data analysis. Descriptive statistics, such as frequencies, percentages, mean score ( x), and standard deviation, were employed for interpretation.

Results:

Out of 396 patients, 156 (39.4%) were male and 240 (60.6%) were females. Most patients were 18–39 years (233 (58.8%)), had secondary education (139 (35.1%)), married (221 (55.8%)), earned <18,000 (170(42.9%)), and were traders (136 (34.3%)). Patients were satisfied with tangibility (2.57 ± 0.99) and reliability (2.84 ± 0.95) and very satisfied with responsiveness (3.06 ± 0.63), assurance (3.07 ± 0.63), and empathy (3.12 ± 0.57).

Conclusions:

Patients were satisfied with the quality of care. However, satisfaction was highest with empathy and lowest with tangibility. Thus, managers should focus their quality improvement efforts on areas of the neat appearance of health workers, waiting facilities for attendants and patients, and hygienic conditions at the hospital. Also, biannual assessment of patients’ satisfaction should be done and the results generated use judiciously to provide a platform for health sector reform.
Effectiveness of behavioral activation for depression treatment in medical students: Study protocol for a quasi-experimental design
Authors: Domínguez Rodríguez Alejandro , Martinez-Maqueda Gustavo Iván , Arenas Landgrave Paulina , Martínez Luna Sofía Cristina , Ramírez-Martínez Flor Rocío , Salinas Saldivar Jasshel Teresa
Published: July 2020

Introduction:

Depression is a frequent mood disorder among medical students that can lead to multiple negative consequences at individual and social level (such as academic achievement and interpersonal conflicts) as well as patient care performance. Therefore, the need of depression decreasing treatments in medical students is important. This study is designed to evaluate the effectiveness of the Behavioral Activation Treatment for Depression in a sample of Mexican medical students.

Methods:

This study will be performed under a quasi-experimental design to verify the effectiveness of the Behavioral Activation Treatment for Depression to reduce depressive symptoms in medical students from two public universities in northwestern Mexico. The participants will be assessed with the Center for Epidemiologic Studies Depression Scale, the Depression Anxiety Stress Scales, the Pittsburgh Sleep Quality Index, and the Plutchik Suicide Risk Scale. In addition to the psychometric assessment, there will be an electroencephalogram evaluation using the EMOTIV (v 1.1) device.

Results:

A pre-post intervention of 10 Behavioral Activation Treatment for Depression sessions will be implemented. The results of the effectiveness of the Behavioral Activation Treatment for Depression will be analyzed in five measures at pre-post intervention and two follow-ups of 3 and 6 months.

Conclusions:

This study looks for evidence regarding the efficacy and feasibility of the Behavioral Activation Treatment for Depression in a sample of medical students from two public universities in Mexico with high levels of depression along with stress and anxiety.
Principled sentencing for drug supply offences: Revised methamphetamine sentencing guidelines in New Zealand
Authors: Foulds James A , Nutt David
Published: July 2020

Methamphetamine was reclassified as a Class A drug in New Zealand in 2003. This meant harsher sentences for people convicted of its manufacture, importation or supply. Despite this, the number of convictions for methamphetamine-related offending continued to increase. In 2019, the New Zealand Court of Appeal agreed to review the sentencing of people convicted of methamphetamine offences on the grounds that some sentences were disproportionately severe. This resulted in a guideline judgment which lowered penalties for offences involving small amounts of methamphetamine (up to 5 grams). Community-based sentences replaced imprisonment as the lower bound of the starting point for sentence calculation. The Court of Appeal highlighted that the presence of addiction, mental health problems or social disadvantage should be taken into account as potential mitigating factors in sentencing. The Court accepted that these factors diminished moral culpability and reduced the deterrent impact of prison sentences. In this article we review the law and policy background to the New Zealand Court of Appeal proceedings, and discuss the reasoning behind the Court’s judgment.
The use of 5‐aminosalicylate for patients with Crohn’s disease in a prospective European inception cohort with 5 years follow‐up – an Epi‐IBD study
Authors: Burisch Johan , Bergemalm Daniel , Halfvarson Jonas , Domislovic Viktor , Krznaric Zeljko , Goldis Adrian , Dahlerup Jens F , Oksanen Pia , Collin Pekka , de Castro Luisa , Hernandez Vicent , Turcan Svetlana , Belousova Elena , D’Incà Renata , Sartini Alessandro , Valpiani Daniela , Giannotta Martina , Misra Ravi , Arebi Naila , Duricova Dana , Bortlik Martin , Gatt Kelly , Ellul Pierre , Pedersen Natalia , Kjeldsen Jens , Andersen Karina W , Andersen Vibeke , Katsanos Konstantinos H , Christodoulou Dimitrios K , Sebastian Shaji , Barros Luisa , Magro Fernando , Midjord Jóngerð MM , Nielsen Kári R , Salupere Riina , Kievit Hendrika AL , Kiudelis Gediminas , Kupčinskas Juozas , Fumery Mathurin , Gower‐Rousseau Corinne , Kaimakliotis Ioannis P , Schwartz Doron , Odes Selwyn , Lakatos Laszlo , Lakatos Peter L , Langholz Ebbe , Munkholm Pia ,   for the Epi‐IBD group
Published: July 2020

Background

The lack of scientific evidence regarding the effectiveness of 5‐aminosalicylate in patients with Crohn’s disease is in sharp contrast to its widespread use in clinical practice.

Aims

The aim of the study was to investigate the use of 5‐aminosalicylate in patients with Crohn’s disease as well as the disease course of a subgroup of patients who were treated with 5‐aminosalicylate as maintenance monotherapy during the first year of disease.

Methods

In a European community‐based inception cohort, 488 patients with Crohn’s disease were followed from the time of their diagnosis. Information on clinical data, demographics, disease activity, medical therapy and rates of surgery, cancers and deaths was collected prospectively. Patient management was left to the discretion of the treating gastroenterologists.

Results

Overall, 292 (60%) patients with Crohn’s disease received 5‐aminosalicylate period during follow‐up for a median duration of 28 months (interquartile range 6–60). Of these, 78 (16%) patients received 5‐aminosalicylate monotherapy during the first year following diagnosis. Patients who received monotherapy with 5‐aminosalicylate experienced a mild disease course with only nine (12%) who required hospitalization, surgery, or developed stricturing or penetrating disease, and most never needed more intensive therapy. The remaining 214 patients were treated with 5‐aminosalicylate as the first maintenance drug although most eventually needed to step up to other treatments including immunomodulators (75 (35%)), biological therapy (49 (23%)) or surgery (38 (18%)).

Conclusion

In this European community‐based inception cohort of unselected Crohn’s disease patients, 5‐aminosalicylate was commonly used. A substantial group of these patients experienced a quiescent disease course without need of additional treatment during follow‐up. Therefore, despite the controversy regarding the efficacy of 5‐aminosalicylate in Crohn’s disease, its use seems to result in a satisfying disease course for both patients and physicians.
Learning from lines: Critical COVID data visualizations and the quarantine quotidian
Authors: Bowe Emily , Simmons Erin , Mattern Shannon
Published: July 2020

In response to the ubiquitous graphs and maps of COVID-19, artists, designers, data scientists, and public health officials are teaming up to create counter-plots and subaltern maps of the pandemic. In this intervention, we describe the various functions served by these projects. First, they offer tutorials and tools for both dataviz practitioners and their publics to encourage critical thinking about how COVID-19 data is sourced and modeled—and to consider which subjects are not interpellated in those data sets, and why not. Second, they demonstrate how the pandemic’s spatial logics inscribe themselves in our immediate material landscapes. And third, they remind us of our capacity to personalize and participate in the creation of meaningful COVID visualizations—many of which represent other scales and dimensions of the pandemic, especially the quarantine quotidian. Together, the official maps and counter-plots acknowledge that the pandemic plays out differently across different scales: COVID-19 is about global supply chains and infection counts and TV ratings for presidential press conferences, but it is also about local dynamics and neighborhood mutual aid networks and personal geographies of mitigation and care.
Bit by (Twitch) Bit: “Platform Capture” and the Evolution of Digital Platforms
Authors: Partin William Clyde
Published: July 2020

This article considers the history of donation management tools on the livestreaming platform Twitch. In particular, it details the technical and economic contexts that led to the development of Twitch Bits, a first-party donation management service introduced in 2016. Two contributions to research on the platformization of cultural production are made. One, this article expands the empirical record regarding Twitch by chronicling the role of viewer donations in livestreaming since 2010, as well as the many tools that have facilitated this practice. It is argued that this history traces the complex and co-productive interactions between Twitch as a sociotechnical architecture and a political economy. Two, by considering how the first-party donation tool Twitch Bits has gradually challenged the dominance of the third-party tools that preceded it, this article theorizes the notion of platform capture, a critical rereading of platform envelopment, a popular concept in business studies. Ultimately, it is argued that platform capture demonstrates how platform owners leverage power asymmetries over dependents to aid in their platform’s technical evolution.
What Is WhatsApp for? Developing Transmedia Skills and Informal Learning Strategies Through the Use of WhatsApp—A Case Study With Teenagers From Spain
Authors: Costa-Sánchez Carmen , Guerrero-Pico Mar
Published: July 2020

Smartphones and WhatsApp are, respectively, the medium and application that Spanish teenagers most want. However, research into the use of WhatsApp is still quantitatively and qualitatively limited. In addition, little research has been carried out regarding its impact on the development of transmedia skills and informal learning strategies outside the classroom. This article aims to expand the knowledge on teenagers’ motivations and their development of transmedia skills and informal learning strategies in relation to their use of WhatsApp. Specifically, a qualitative analysis of data gathered from workshops, interviews, and media diaries is applied as part of a case study methodology involving teenagers from 10 schools located in five different Spanish regions. The results reveal the new WhatsApp uses teenagers are applying in their daily lives as well as the skills and strategies they are developing through said uses in the context of interpersonal and group (WhatsApp groups) interactions: on one hand, production, social, content, and individual management skills, and on the other hand, learning by doing, teaching, and evaluating strategies.
Learning Language, Learning Culture: Teaching Language to the Whole Student
Authors: Kim Deoksoon
Published: July 2020

Purpose:

This article develops a conceptualization of language pedagogy that engages the whole student. Instead of teaching language as if it were just a collection of grammar and vocabulary, we need to think about language as extending into many aspects of life and engaging whole people.

Design/Approach/Methods:

This article builds an original conceptualization of language learning and teaching that imagines language learning as a tool for developing whole people. It brings together research on learning culture through language, together with cultural-historical activity theory (CHAT), to develop a vision for language learning and human development.

Findings:

When we teach language, we should be helping people participate in ways of life. This goes beyond knowledge of subject matter, and it goes beyond any simple type of well-being. Language learning can immerse students in others’ worlds, and it can foster empathy and understanding across social and political divides. But it can do so only if we base our research and pedagogy on an adequate account of language and culture.

Originality/Value:

In our rapidly changing, increasingly interconnected contemporary world, we need a more dynamic conception of culture than has typically been used to design language teaching and learning. This article draws on CHAT, especially the ideas of dialogue and critique, to develop an account of language pedagogy that can engage the whole student.
The Origin and Early Development of Chinese Connections at the University of Pennsylvania Law School
Authors: Chen Li
Published: July 2020

The University of Pennsylvania Law School has had a long relationship with Chinese students; indeed, it was among the pioneers in the admission of Chinese students in America. To better understand the origin of this affiliation, this article traces the relationship between the celebrated Chinese diplomat Wu Ting-Fang and the then Dean William Draper Lewis, exploring the pivotal role this relationship played in forging the law school’s Chinese ties. The association was cemented when Penn Law School welcomed its first Chinese undergraduate student in 1906 and graduate student in 1908. The lesser known details of these two pioneering Chinese law students’ backgrounds, academic pursuits at Penn Law School and their key achievements upon graduation are revealed in this article as well. Against a backdrop of racial prejudice and the legal subordination of Asian peoples in a new American empire, the personal efforts of men such as Dean Lewis were critical in the admission of the first cohort of Chinese law students to American law schools in the early part of the twentieth century.
Prospective Analysis of Arthroscopic Hip Anatomic Labral Repair Utilizing Knotless Suture Anchor Technology: The Controlled-Tension Anatomic Technique at Minimum 2-Year Follow-up
Authors: Maldonado David R. , Chen Sarah L. , Chen Jeffery W. , Shapira Jacob , Rosinksy Philip J. , Annin Shawn , Lall Ajay C. , Domb Benjamin G.
Published: July 2020

Background:

Labral tears are the most common abnormalities in patients undergoing hip arthroscopic surgery. Appropriate management is crucial, as it has been shown that better overall outcomes can be achieved with labral restoration.

Purpose:

To report the patient-reported outcomes (PROs) at minimum 2-year follow-up of patients who underwent hip arthroscopic surgery for labral tear repair using the knotless controlled-tension anatomic technique in the setting of femoroacetabular impingement syndrome (FAIS).

Study Design:

Case series; Level of evidence, 4.

Methods:

Data were prospectively collected for patients who underwent hip arthroscopic surgery for FAIS for labral tear repair using the knotless controlled-tension anatomic technique. Patients were excluded if they had prior hip conditions, prior ipsilateral surgery, Tönnis grade >1, a lateral center-edge angle (LCEA) <25°, or workers’ compensation claims. Preoperative and postoperative scores at minimum 2-year follow-up were recorded for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain. The proportion of patients who achieved the minimal clinically important difference (MCID) or patient acceptable symptomatic state (PASS) for the mHHS, HOS-SSS, and iHOT-12 were also reported.

Results:

A total of 309 hips were included. The mean patient age was 36.2 years (range, 12.8-75.9 years). The mean preoperative LCEA and alpha angle were 31.9° and 57.1°, respectively. A significant improvement on the mHHS (62.6 ± 15.7 preoperatively vs 86.9 ± 16.2 at 2-year follow-up), NAHS (63.1 ± 16.7 vs 86.1 ± 16.7), and HOS-SSS (39.8 ± 22.0 vs 74.2 ± 27.3) was found ( P < .001 for all). A significant decrease was shown for VAS scores ( P < .001). Also, 78.6% and 82.2% of patients achieved the MCID and PASS for the mHHS, respectively; 60.8% and 69.9% of patients met the MCID and PASS for the HOS-SSS, respectively; and the MCID for the iHOT-12 was met by 77.3% of patients.

Conclusion:

In the setting of FAIS and labral tears, patients who underwent hip arthroscopic surgery for labral tear repair using the knotless controlled-tension anatomic technique demonstrated significant improvement in several validated PRO measures, the VAS pain score, and patient satisfaction at a minimum 2 years of follow-up. Based on this evidence, labral tear repair using the knotless controlled-tension anatomic technique seems to be a safe option.
Effect of Trochlear Dysplasia on Commonly Used Radiographic Parameters to Assess Patellar Instability
Authors: Pace J. Lee , Cheng Chris , Joseph Sheeba M. , Solomito Matthew J.
Published: July 2020

Background:

Trochlear dysplasia (TD) is an important anatomic risk factor for patellar instability (PI). Several imaging-based risk factors for PI have been established, but it is unclear what effect TD has on these measurements, and the Dejour method of categorizing TD has been shown to be unreliable. The lateral trochlear inclination (LTI) is a quantifiable measurement of proximal trochlear morphology. Recently, a modified technique for measuring LTI referencing the posterior condylar angle has demonstrated near-perfect reliability and may serve as a new standard for quantifying TD.

Purpose/Hypothesis:

The purpose of this study was to evaluate how TD, expressed in terms of LTI, affects historically used measures of PI, including the sulcus angle (SA), tibial tuberosity to trochlear groove (TT-TG) distance, lateral patellar inclination (LPI), and Caton-Deschamps (CD) ratio. We hypothesized that lower LTI (ie, more dysplastic trochlea) will correlate with higher SA and TT-TG distances, increased patellar tilt, and more patella alta.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Patients aged 9 to 18 years treated for PI between January 2014 and August 2017 were queried. On magnetic resonance imaging (MRI), LTI, SA, LPI, and the TT-TG measured at the most proximal (pTT-TG) and distal (dTT-TG) aspects of the fully formed trochlear groove were measured on axial images. CD ratio was measured using sagittal MRI as well as lateral radiographs. All measurements were performed by 2 independent observers. Patients were included if there was a diagnosis of PI that was confirmed with a chart review and if there were appropriate imaging studies to analyze.

Results:

A total of 65 patients met inclusion criteria for this study. Average pTT-TG distance (15.7 ± 4.5 mm) was not significantly different from dTT-TG distance (15.7 ± 4.2 mm) ( P = .94). LTI had a weak but significant inverse correlation with pTT-TG ( r = –0.40; β = –0.15 mm; P < .001) and SA ( r = –0.43; β = –0.478°; P < .001). There was a moderate and significant inverse correlation of LTI with dTT-TG ( r = –0.593; β = –0.21 mm; P < .001) and with LPI ( r = –0.69; β = –0.54°; P < .001). There was a weak but significant correlation between LTI and the MRI-based CD ratio ( r = 0.279; β = 0.149; P = .005). Radiograph-based CD ratio did not show a significant correlation with LTI ( r = –0.189; P = .135).

Conclusion:

Smaller (ie, more dysplastic) LTI values correlated significantly with larger TT-TG, SA, LPI, and MRI-based CD ratio measurements. The relationship between SA and LTI is intuitive, but the relationship between LTI and the other analyzed variables suggests that they are dependent variables to TD and may not be consistent independent risk factors for PI. Together, these suggest that TD alters the radiographic interpretation of TT-TG and patellar tilt. The correlation between TD and patellar height is unclear and warrants further investigation.
Stroke care in Italy: An overview of strategies to manage acute stroke in COVID-19 time
Authors: Zedde Marialuisa , Pezzella Francesca Romana , Paciaroni Maurizio , Corea Francesco , Reale Nicoletta , Toni Danilo , Caso Valeria
Published: July 2020

Purpose

To analyse structural and non-structural modifications of acute stroke care pathways undertaken at healthcare institutions across the regions of Italy due to the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Research on National decrees specific for the pandemic was carried out. The stroke pathways of four Italian regions from North to South, such as Lombardy, Veneto, Lazio and Campania, were analysed before and after the pandemic outbreak.

Findings

On 29 February 2020, the Italian Minister of Health issued national guidelines on how to address the COVID-19 emergency. Stroke management was affected and required changes, basically resulting in the need to prioritise the ongoing COVID-19 emergency. In the most affected regions, the closure of departments and hospitals led to a complete reorganisation of previously functioning stroke networks. With the closure of several Stroke Units and Stroke Centres, the transportation time to hospital lengthened significantly, especially for the outlying populations.

Discussion

The COVID-19 pandemic outbreak has been spreading rapidly in Italy and placing an overwhelming burden on healthcare systems. In response to this, political and healthcare decision-makers worked together to develop and implement efforts to sustain the national healthcare system while fighting the pandemic. Stroke care pathways changed during the pandemic and different organisational models were applied in the most affected regions.

Conclusions

Stroke treatment pathways will need to be redesigned so to guarantee that severe and acute disease patients do not lose their rights to the access and delivery of care during the COVID-19 pandemics.
Comparing First Metatarsophalangeal Joint Flexibility in Hallux Rigidus Patients Pre- and Postcheilectomy Using a Novel Flexibility Device
Authors: Henry Jensen K. , Kraszewski Andrew , Volpert Lauren , Cody Elizabeth , Hillstrom Howard , Ellis Scott J.
Published: July 2020

Background:

Hallux rigidus (HR) is a common pathology of the first metatarsophalangeal (MTP) joint causing pain and stiffness. However, severity of symptoms and radiographic findings are not always concordant. A novel flexibility device, which measures the mobility of the MTP joint through its arc of motion, has been validated. This study compares flexibility in patients before and after cheilectomy (with or without proximal phalanx osteotomy) for HR.

Methods:

This is a single-center study of adult patients with HR who were indicated for cheilectomy or cheilectomy and Moberg (dorsiflexion closing wedge) osteotomy of the proximal phalanx based on symptoms and radiographs from 2013 to 2015. Pre- and postoperatively, patients underwent testing with a validated flexibility protocol to generate flexibility curves. Parameters included early and late flexibility, laxity torque, and laxity angle. Patients completed Foot and Ankle Outcomes Scores (FAOS) pre- and postoperatively. Twelve operative patients underwent preoperative testing, with 9 completing postoperative testing (mean age, 53.0 years; 67% female; mean 2.8-year follow-up).

Results:

Patients had significant improvements in early sitting and standing flexibility, sitting and standing laxity angles, standing laxity torque, and both sitting and standing maximum dorsiflexion after surgery (all P < .05). While preoperative early flexibility, laxity angle, and maximum dorsiflexion all differed significantly between patients and controls ( P < .015), postoperative early flexibility was similar to controls ( P > .279). FAOS scores for pain, symptoms, sport, and quality improved significantly after surgery.

Conclusion:

Surgical treatment with cheilectomy was associated with significant improvements in nearly all flexibility parameters for sitting and standing positions. However, most postoperative flexibility parameters did not improve to the level of normal controls. Regardless, patients still experienced significant improvements in outcomes. This study demonstrated that surgical correction is associated with significant biomechanical and clinical results. The flexibility device can be used in further studies to assess outcomes after other HR procedures.

Level of Evidence:

Level II, prospective comparative study.
Office Examinations–Directed Treatment Paradigms Reduce Travel Burden, Decrease Treatment Cost, and Improve Quality-Adjusted Life-Years for Patients With Exudative Age-Related Macular Degeneration Undergoing Antivascular Endothelial Growth Factor Therapy
Authors: Emerson Geoffrey G. , Thompson John T. , Vo Loi V. , Mason Robert W.H. , Lee Gregory D. , Leder Henry A.
Published: July 2020

Purpose:

In the United States, most intravitreal injections are performed the same day as an office examinations; however, federal agencies and insurance payers suggest these same-day examinations charges are overused and have recommended scrutiny. In this study, we estimate the cost vs benefit to society of same-day office examinations during intravitreal injections for wet age-related macular degeneration (wAMD).

Methods:

An Excel spreadsheet was used to model different antivascular endothelial growth factor treatment scenarios for wAMD, including automatic treatment, injection series' treat and extend (T&E), and as-needed treatment, with increasing same-day examinations in the order listed. Treatment parameters were estimated using US population statistics, published literature, and Centers for Medicare & Medicaid Services, provider utilization data. Costs and benefits were compared for the 4 treatment scenarios.

Results:

Although yearly examinations and optical coherence tomography costs were higher for injection series, T&E, and as-needed protocols compared with automatic treatment, our model predicts reduced yearly injection and travel costs for those same treatment scenarios also, saving $2.9 billion (injection series), $7.2 billion (T&E), and $6.1 billion (as-needed) annually for the US population. Same-day injections accounted for 21%, 8%, and 9% of the savings, respectively, because of reduced travel burden. Furthermore, early detection of wAMD in the fellow eye during office examinations allows for a 1.8, 2.1, and 2.5 quality-adjusted life-year benefit, respectively.

Conclusions:

Office examinations–directed antivascular endothelial growth factor therapy for wAMD reduces travel and treatment expenses and improves screening of the fellow eye, resulting in robust cost savings and quality-adjusted life-year benefit for the US population.
Sutureless Scleral-Fixated Intraocular Lens Implantation for Refractive Rehabilitation in Eyes With Spherophakia
Authors: Kannan Naresh Babu , Sen Sagnik , Damodaran Sourav , Debbarma Meri , Rajan Renu P. , Kumar Karthik , Ramasamy Kim
Published: July 2020

Purpose:

Spherophakia is a rare, debilitating congenital ocular disorder.

Methods:

This institution-based, retrospective, interventional study evaluated medical records of 16 patients with spherophakia with a median age of 19.5 years. Twenty-six eyes underwent scleral-fixated intraocular lens implantation. The technique involved 2 parallel-to-limbus scleral tunnels fashioned using a microincision vitrectomy blade, followed by lensectomy, core vitrectomy, externalization of haptics through 2 separate diametrically opposite sclerotomies, and tucking in of the haptics into the tunnels. Anterior and posterior segment examination, visual acuity, and intraocular pressure (IOP) were noted at baseline and final follow-up.

Results:

Baseline best-corrected visual acuity (BCVA) of all eyes was 0.49 ± 0.51 logarithm of the minimum angle of resolution (logMAR) (Snellen equivalent, 6/18). BCVA of more than 6/60 was present in 28 of 32 (87.5%) eyes, and 13 of 26 (50%) eyes that were operated on had a baseline BCVA of more than 6/18. Postoperative BCVA in 26 eyes improved from 0.43 ± 0.32 logMAR to 0.19 ± 0.21 logMAR (Snellen equivalent, 6/9) ( P = .002). Postoperative BCVA was more than 6/18 in 20 of 26 (76.9%) operated-on eyes ( P = .046), and all eyes had a final BCVA of more than 6/60. In 20 of 26 (76.9%) eyes, BCVA improved from preoperative status. Postoperatively, spherical equivalent improved from –9.55 ± 5.17 diopters to –0.29 ± 1.45 diopters ( P < .001). Apart from 2 patients with Marfan syndrome, 1 with Weill-Marchesani syndrome, and 1 with homocystinuria, the remaining patients had isolated spherophakia. Six eyes presented with an IOP greater than 21 mm Hg, and 50% of these eyes had a final IOP that decreased to less than 15 mm Hg after lensectomy.

Conclusions:

Lensectomy with pars plana vitrectomy and scleral-fixated intraocular lens is an effective method of refractive rehabilitation for patients with spherophakia presenting with visual disability.
Update on endoscopic treatment of Barrett’s oesophagus and Barrett’s oesophagus–related neoplasia
Authors: Pech Oliver , Alqahtani Saleh A.
Published: July 2020

Endoscopic therapy of early Barrett’s oesophagus–related neoplasia is the treatment of choice for low-grade-dysplasia, high-grade dysplasia and mucosal Barrett’s cancer. Low-grade-dysplasia without any visible lesion should be ablated, preferably with radiofrequency ablation. In cases with the presence of a visible lesion, high-grade dysplasia and early Barrett’s adenocarcinoma, endoscopic resection techniques like multiband ligation endoscopic resection or endoscopic submucosal dissection should be applied. After complete resection of all visible neoplastic lesions, ablation of the remaining Barrett’s oesophagus should be performed to prevent recurrence. Ablation techniques available are radiofrequency ablation, argon plasma coagulation and cryoablation.
C/EBPβ isoforms sequentially regulate regenerating mouse hematopoietic stem/progenitor cells
Authors: Sato Atsushi , Kamio Naoka , Yokota Asumi , Hayashi Yoshihiro , Tamura Akihiro , Miura Yasuo , Maekawa Taira , Hirai Hideyo
Published: July 2020

The transcription factor CCAAT enhancer-binding protein β (C/EBPβ) is required for stress-induced granulopoiesis at the level of hematopoietic stem/progenitor cells (HSPCs); however, its role and mechanisms of action in HSPCs are unknown. In this study, we assessed the regulation and functions of C/EBPβ in HSPCs, especially under stress conditions. After 5-fluorouracil treatment or bone marrow transplantation, Cebpb−/− HSPCs exhibited impaired cell-cycle activation and myeloid differentiation at the early and late phases of regeneration, respectively, whereas at steady state, Cebpb deficiency did not affect HSPCs. C/EBPβ was upregulated in response to hematopoietic stress, especially in CD150high long term-hematopoietic stem cells (LT-HSCs). Intracellular flow cytometric analysis that detected distinct domains of C/EBPβ revealed that, among the 3 isoforms of C/EBPβ, liver-enriched inhibitory protein (LIP) was upregulated in LT-HSCs prior to liver-enriched activating protein (LAP)/LAP* during regeneration. Early upregulation of LIP promoted cell-cycle entry of LT-HSCs by positively regulating Myc and expanded the HSPCs pool. Subsequent myeloid differentiation of amplified HSPCs was mediated by LAP/LAP*, which were upregulated at a later phase of regeneration. Collectively, our findings show that stress-induced sequential upregulation of C/EBPβ isoforms is critical for fine-tuning the proliferation and differentiation of regenerating HSPCs.
OvCa-Chip microsystem recreates vascular endothelium–mediated platelet extravasation in ovarian cancer
Authors: Saha Biswajit , Mathur Tanmay , Handley Katelyn F. , Hu Wei , Afshar-Kharghan Vahid , Sood Anil K. , Jain Abhishek
Published: July 2020

In ovarian cancer, platelet extravasation into the tumor and resulting metastasis is thought to be regulated mostly by the vascular endothelium. Because it is difficult to dissect complex underlying events in murine models, organ-on-a-chip methodology is applied to model vascular and platelet functions in ovarian cancer. This system (OvCa-Chip) consists of microfluidic chambers that are lined by human ovarian tumor cells interfaced with a 3-dimensional endothelialized lumen. Subsequent perfusion with human platelets within the device’s vascular endothelial compartment under microvascular shear conditions for 5 days uncovered organ-to-molecular–level contributions of the endothelium to triggering platelet extravasation into tumors. Further, analysis of effluents available from the device’s individual tumor and endothelial chambers revealed temporal dynamics of vascular disintegration caused by cancer cells, a differential increase in cytokine expression, and an alteration of barrier maintenance genes in endothelial cells. These events, when analyzed within the device over time, made the vascular tissue leaky and promoted platelet extravasation. Atorvastatin treatment of the endothelial cells within the OvCa-Chip revealed improved endothelial barrier function, reduction in inflammatory cytokines and, eventually, arrest of platelet extravasation. These data were validated through corresponding observations in patient-derived tumor samples. The OvCa-Chip provides a novel in vitro dissectible platform to model the mechanisms of the cancer-vascular-hematology nexus and the analyses of potential therapeutics.
Fetal/neonatal alloimmune thrombocytopenia: a systematic review of impact of HLA-DRB3*01:01 on fetal/neonatal outcome
Authors: Kjeldsen-Kragh Jens , Fergusson Dean A. , Kjaer Mette , Lieberman Lani , Greinacher Andreas , Murphy Michael F. , Bussel James , Bakchoul Tamam , Corke Stacy , Bertrand Gérald , Oepkes Dick , Baker Jillian M. , Hume Heather , Massey Edwin , Kaplan Cecile , Arnold Donald M. , Baidya Shoma , Ryan Greg , Savoia Helen F. , Landry Denise , Shehata Nadine
Published: July 2020

The most common, severe cases of fetal and neonatal alloimmune thrombocytopenia among whites are caused by antibodies against human platelet antigen 1a (HPA-1a). The aims of this systematic review and meta-analysis are to determine the association between maternal HLA-DRB3*01:01 and: (1) HPA-1a-alloimmunization and (2) neonatal outcome in children born of HPA-1a-immunized women. A systematic literature search identified 4 prospective and 8 retrospective studies. Data were combined across studies to estimate pooled odds ratios (ORs) and the associated 95% confidence intervals (CIs). The population represented by the prospective studies was more than 150 000. In the prospective studies, there were 64 severely thrombocytopenic newborns (platelet count <50 × 109/L) of whom 3 had intracranial hemorrhage. The mothers of all 64 children were HLA-DRB3*01:01+. The number of severely thrombocytopenic children born of HPA-1a-alloimmunized women in the retrospective studies was 214; 205 of whom were born of HLA-DRB3*01:01+ women. For HLA-DRB3*01:01− women, the OR (95% CI) for alloimmunization was 0.05 (0.00-0.60), and for severe neonatal thrombocytopenia 0.08 (0.02-0.37). This meta-analysis demonstrates that the risk of alloimmunization and of having a child with severe thrombocytopenia are both very low for HPA-1a− women who are HLA-DRB3*01:01−.
Insights into the skin of caecilian amphibians from gene expression profiles
Authors: Torres-Sánchez María , Wilkinson Mark , Gower David J. , Creevey Christopher J. , San Mauro Diego
Published: July 2020

Background

Gene expression profiles can provide insights into the molecular machinery behind tissue functions and, in turn, can further our understanding of environmental responses, and developmental and evolutionary processes. During vertebrate evolution, the skin has played a crucial role, displaying a wide diversity of essential functions. To unravel the molecular basis of skin specialisations and adaptations, we compared gene expression in the skin with eight other tissues in a phylogenetically and ecologically diverse species sample of one of the most neglected vertebrate groups, the caecilian amphibians (order Gymnophiona).

Results

The skin of the five studied caecilian species showed a distinct gene expression profile reflecting its developmental origin and showing similarities to other epithelial tissues. We identified 59 sequences with conserved enhanced expression in the skin that might be associated with caecilian dermal specialisations. Some of the up-regulated genes shared expression patterns with human skin and potentially are involved in skin functions across vertebrates. Variation trends in gene expression were detected between mid and posterior body skin suggesting different functions between body regions. Several candidate biologically active peptides were also annotated.

Conclusions

Our study provides the first atlas of differentially expressed sequences in caecilian tissues and a baseline to explore the molecular basis of the skin functions in caecilian amphibians, and more broadly in vertebrates.
Self-care behavior: a new insight of the role of impulsivity into decision making process in persons with heart failure
Authors: Al-Hammouri Mohammed Munther , Rababah Jehad A. , Hall Lynne A. , Moser Debra K. , Dawood Zainab , Jawhar Wa’ed , Alawawdeh Ayat
Published: July 2020

Background

Self-care behavior has been reported to be below optimum in persons with heart failure, while the underlying decision making is not well understood. The Hot/Cool System model is a psychological model that may have potential applications in decision making process in persons with heart failure. The aim of this study was to examine the decision making process in self-care behavior in persons with heart failure in the light of the Hot/Cool System model.

Methods

We used the Hoot/Cool System Model to guide this study. Participants with heart failure from in-patients setting (N = 107) were recruited. Data were collected using self-report questionnaires. Moderated mediation analysis was used to study complex relationships among study variables.

Results

The current study showed that impulsivity and perceived stress were negatively associated with self-care behavior. The results also showed that self-care confidence and impulsivity significantly predict self-care maintenance. The moderated mediation analysis revealed that self-care confidence mediated the relationship between impulsivity and self-care maintenance at lower levels of perceived stress, but not at higher levels of perceived stress.

Conclusion

Our findings revealed that persons with heart failure tend to make impulsive choices that may negatively affect disease progression under higher levels of perceived stress. This study provides foundational knowledge regarding the decision making process in persons with heart failure.
Comparison of general maternal and neonatal conditions and clinical outcomes between embryo transfer and natural conception
Authors: Pan Haiyan , Zhang Xingshan , Rao Jiawei , Lin Bing , He Jie Yun , Wang Xingjie , Han Fengqiong , Zhang Jinfeng
Published: July 2020

Background

To examine the differences between pregnant women who underwent embryo transfer (ET) and those who conceived naturally, as well as differences in their respective babies, and to determine the causes for these differences, to provide recommendations for women who are planning to undergo ET.

Methods

A retrospective cohort study was performed of women who had received ET and those who had natural conception (NC) who received medical services during pregnancy and had their babies delivered at the Shunde Women and Children’s Hospital of Guangdong Medical University, China between January 2016 and December 2018. In line with the requirements of the ethics committee, before the formal investigation, we first explained the content of the informed consent of the patient to the patient, and all the subjects included agreed to the content of the informed consent of the patient. Respondents agreed to visit and analyze their medical records under reasonable conditions. Each case in an ET group of 321 women was randomly matched with three cases of NC (963 cases) who delivered on the same day. The demographic information, past history, pregnancy and delivery history, and maternal and neonatal outcomes of the two groups were compared using univariate analysis.

Results

Age, duration of hospitalization, number of pregnancies, number of miscarriages, induced abortion, ectopic pregnancy, gestational diabetes mellitus, preeclampsia, gestational anemia, pregnancy risk, mode of fetal delivery, and number of births were significantly different between the two groups (all P < 0.05). However, there were no significant differences in the disease, allergy, infection and blood transfusion histories of the pregnant women, or differences in prevalence of gestational hypothyroidism, gestational respiratory infection, premature rupture of membrane, placental abruption, fetal death, stillbirth, amniotic fluid volume and amniotic fluid clarity between the two groups (all P > 0.05). The percentages for low birth weight and premature birth were significantly higher in the ET group than in the NC group. In contrast, infant gender and prevalence of fetal macrosomia, fetal anomaly, neonatal asphyxia, and extremely low birth weight were not significantly different between the two groups (all P > 0.05).

Conclusions

The clinical outcomes of mothers and the birth status of infants were better in the NC group than in the ET group. Maternal health must be closely monitored and improved in the ET group to reduce the incidence of gestational comorbidity and enhance the quality of fetal life.
Efficient mutation screening for cervical cancers from circulating tumor DNA in blood
Authors: Lee Sun-Young , Chae Dong-Kyu , Lee Sung-Hun , Lim Yohan , An Jahyun , Chae Chang Hoon , Kim Byung Chul , Bhak Jong , Bolser Dan , Cho Dong-Hyu
Published: July 2020

Background

Early diagnosis and continuous monitoring are necessary for an efficient management of cervical cancers (CC). Liquid biopsy, such as detecting circulating tumor DNA (ctDNA) from blood, is a simple, non-invasive method for testing and monitoring cancer markers. However, tumor-specific alterations in ctDNA have not been extensively investigated or compared to other circulating biomarkers in the diagnosis and monitoring of the CC. Therfore, Next-generation sequencing (NGS) analysis with blood samples can be a new approach for highly accurate diagnosis and monitoring of the CC.

Method

Using a bioinformatics approach, we designed a panel of 24 genes associated with CC to detect and characterize patterns of somatic single-nucleotide variations, indels, and copy number variations. Our NGS CC panel covers most of the genes in The Cancer Genome Atlas (TCGA) as well as additional cancer driver and tumor suppressor genes. We profiled the variants in ctDNA from 24 CC patients who were being treated with systemic chemotherapy and local radiotherapy at the Jeonbuk National University Hospital, Korea.

Result

Eighteen out of 24 genes in our NGS CC panel had mutations across the 24 CC patients, including somatic alterations of mutated genes (ZFHX3–83%, KMT2C-79%, KMT2D-79%, NSD1–67%, ATM-38% and RNF213–27%). We demonstrated that the RNF213 mutation could be used potentially used as a monitoring marker for response to chemo- and radiotherapy.

Conclusion

We developed our NGS CC panel and demostrated that our NGS panel can be useful for the diagnosis and monitoring of the CC, since the panel detected the common somatic variations in CC patients and we observed how these genetic variations change according to the treatment pattern of the patient.