bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Covid-19 on the Use of Laptops by College Students and the Effects on Posture and Discomfort
Authors: Kotowski Susan E. , Davis Kermit G.
Published: November 2021

Over the past year, the Covid-19 pandemic has led to a switch from a majority of classes being taught in-person to a majority being taught online. The switch has led to an increase in the amount of time students are utilizing technology for learning purposes. This study assessed how technology use has changed during the pandemic, particularly related to laptop use, and the postures students work in and the discomfort they’re experiencing while participating in online learning. The results of the survey (n=1,074) found that laptop use is up significantly (used the majority of the time by 70.2% of students), students are working in poor postures (up to 80% working with deviated neck postures), and are experiencing high levels of discomfort (up to ~60% reporting moderate/extreme discomfort in their upper extremities). The results bring to light the urgent need to provide ergonomics education and training for designing good work environments.
Robot-Led Piano Lessons May Improve Cognitive Function: AFeasibility Study in a Sample with Mild Cognitive Impairment
Authors: Collette Bailey , Mois George , Beer Jenay M. , Boccanfuso Laura , Ramachadran Aditi , Gibson Paul , Emerson Kerstin G. , Renzi-Hammond Lisa M.
Published: November 2021

Cognitive training has been shown to increase neural plasticity and cognitive reserve, potentially reducing the risk of developing dementia. Music learning, specifically piano playing, has been shown to be an effective form of multimodal cognitive training. This pilot study explored the feasibility and efficacy of using a socially assistive robot to provide a piano learning cognitive training intervention to older adults with mild cognitive impairment. Participants (N=11) engaged in a four-week feasibility study, which included a one-hour piano lesson per week led by a remotely controlled robot. Participants experienced improved cognitive function in the verbal memory ( p=0.04), executive function ( p=0.01), reaction time ( p=0.04), and cognitive flexibility ( p=0.003) domains, as well as in the calculated neurocognitive index score ( p=0.03). Socially assistive robots may have the potential to provide cognitive training in the form of piano lessons for older adults with mild cognitive impairment, especially adults who cannot access traditional services.
No Ticket To Ride: A Systematic Definition of Transit Insecurity
Authors: Chen Andy , Karagoel Ilayda , Friedman-Biglin Noah , Nathan-Roberts Dan
Published: November 2021

While the concept of ‘transit insecurity’ may seem self-explanatory, the phrase is not widely used in the current lexicon of city planning, public discourse, or in policy research. The term also lacks a widely accepted definition, scale, or metric of assessment. This scoping review will provide a definition, and explore metrics that demonstrate the extent to which a person or community is transit insecure. To arrive at this definition and set of metrics, a systematic search was conducted in three electronic databases for studies pertaining to transit insecurity. Articles were screened and assessed based on inclusion/exclusion criteria. Over 200 articles were initially identified and after review, a total of 15 articles were included in the final analysis, ranging in publication from 2005 to 2020. There were four factors found to affect transit insecurities: income level; travel distance; duration; and accessibility. By examining the impact of transit insecurity we hope to shed light on these problems and assist in proposing and studying solutions to transit insecurity.
Adding Pre-Training and Feedback Enhances the Benefits of Adaptive Flashcard Training
Authors: Johnson Cheryl I. , Whitmer Daphne E. , Marraffino Matthew D. , Conner Lindsay B. , Garibaldi Allison E. , Sobel Briana M.
Published: November 2021

Adaptive training is tailored instruction designed to target an individual’s strengths and weaknesses, and it has been shown to improve learning outcomes and efficiency in a variety of domains, including flashcard training. The goal of this experiment was to determine whether the addition of other instructional strategies, such as enhanced feedback and pre-training, would further boost the learning benefits of an adaptive flashcard trainer. Thirty-nine college students learned to identify U.S. Navy ships using either a base version of the flashcard trainer, a version that included enhanced feedback, or a version that included pre-training and enhanced feedback. Results showed that the pre-training and enhanced feedback group significantly outperformed the other groups on delayed retention and transfer tests and showed higher learning efficiency. Implications for adaptive training and the Cognitive Theory of Multimedia Learning are discussed.
Smartphone and Digital Home Assistant Use Among Older Adults: Understanding Adoption and Learning Preferences
Authors: Harris Maurita T. , Blocker Kenneth A. , Rogers Wendy A.
Published: November 2021

Smart technologies have increased dramatically within the last decade. Their availability has improved opportunities for productivity, health, and entertainment, and this is especially true for technologies that act as central hubs to link other devices and applications that expand their capabilities (e.g., smartphones and digital home assistants). Older adults may significantly benefit from integrating these devices into their lives to mitigate the various challenges they face with increasing age (e.g., cognitive, mobility changes). To understand the potential of these technologies for this population, we investigated use patterns, learning preferences, and other perceptions related to the adoption of these devices. Seventy older adult participants responded to an online survey regarding their use and preferences with smartphones and digital home assistants. The results informed our understanding of current adoption rates as well as provided key perspectives to inform their design for older adults.
Simplifying Dialysis Through User-Centered Design and Sensor-Based Interactions on the Tablo Hemodialysis System
Authors: Lim Brittany , Kerdok Amy
Published: November 2021

Hemodialysis is a complicated process that comes with many risks to both the user and the patient. The Tablo Hemodialysis System demonstrates how applying user-centered approaches to design could greatly improve device usability, and in turn, user and patient safety. Even with the Covid-19 pandemic creating unexpected hurdles to this approach, Tablo’s sensor-based technology offers a unique solution to ensure that user needs continue to be met.
Understanding Learning Environments, Personality, and Proctoring During Mandatory Remote Delivery
Authors: Stone Nancy J.
Published: November 2021

To evaluate students’ online learning environments, the relationship between personality and online learning success, and students’ perceptions about online proctoring during mandatory remote delivery due to the pandemic, students responded to an online survey. Learning environments generally included houses and rarely included on-campus housing. The specific room type was predominantly the bedroom. Only conscientiousness was related positively to anticipated semester GPA. The positive relationship between anticipated and overall GPA supports the notion that more conscientious students tend to be successful in online learning situations, as online education was rated as slightly ineffective. A majority of students did not see a need for online proctoring due to the inability or time required to search for materials, which would only harm one’s performance. There is a need to research further the impact of the study environment, relationship of the students’ personality to learning success, and consequences of online proctoring during remote learning.
A Meta-Review of Learning Research in Immersive Virtual Reality
Authors: McGowin Gregory , Fiore Stephen M. , Oden Kevin
Published: November 2021

Research and development in virtual reality (VR) continues to influence all sectors of society. This has been particularly the case in the application of VR for learning and training. Due to the affordability of VR, it increasingly is providing a safe and cost-effective technology for studying learning and training. In this paper, we summarize findings from recent compilations of research in virtual reality that examined VR and learning. From this, we identify a set of recommendations distilled from these reviews in order to help the training research community structure their research based upon the extent empirical base. Our goal is to help the training community more effectively explore VR as a technology for learning.
Lessons Learned While Designing A Next-Generation Firefighting Hel- met: Preliminary Data
Authors: Chowdhury Suman
Published: November 2021

In this study, we evaluated the effects of weight and profile (center of gravity location) of three different most widely used firefighting helmets on the head-neck kinematics, positional instability, visual range,and comfort. we compared three different firefighter helmets: a traditional-look (with-brim) helmet (58 oz),a jet-style helmet (62.25 oz), and the jet-style helmet with lighting and communication systems (70.85 oz); all are large.. Since our preliminary investigation showed promising results for the jet-style helmet type, a thorough systematic analysis on a large sample is warranted. Some legitimate concerns that we observed in the preliminary study include: 1) excessive helmet weight caused neck hyper-flexion and imbalanced lateral bending, 2) the CoG of the helmet system lies away from the mid-sagittal plane, and 3) the weight and the displaced CoG poses the threat of an increased risk of cervical spinal disc loading, which can result in disc herniation and degenerated disc.
Establishment and Characterization of a Novel Dedifferentiated Chondrosarcoma Cell Line DDCS2
Authors: Li Xiaoyang , Dean Dylan C. , Ferreira Al , Nelson Scott D. , Hornicek Francis J. , Yu Shengji , Duan Zhenfeng
Published: November 2021

Background

The dedifferentiated variant of chondrosarcoma is highly aggressive and carries an especially grim prognosis. While chemotherapeutics has failed to benefit patients with dedifferentiated chondrosarcoma significantly, preclinical chemosensitivity studies have been limited by a scarcity of available cell lines. There is, therefore, an urgent need to expand the pool of available cell lines.

Methods

We report the establishment of a novel dedifferentiated chondrosarcoma cell line DDCS2, which we isolated from the primary tumor specimen of a 60-year-old male patient. We characterized its short tandem repeat (STR) DNA profile, growth potential, antigenic markers, chemosensitivity, and oncogenic spheroid and colony-forming capacity.

Results

DDCS2 showed a spindle to polygonal shape and an approximate 60-hour doubling time. STR DNA profiling revealed a unique genomic identity not matching any existing cancer cell lines within the ATCC, JCRB, or DSMZ databases. There was no detectable contamination with another cell type. Western blot and immunofluorescence assays were consistent with a mesenchymal origin, and our MTT assay revealed relative resistance to conventional chemotherapeutics, which is typical of a dedifferentiated chondrosarcoma. Under ex vivo three-dimensional (3D) culture conditions, the DDCS2 cells produced spheroid patterns similar to the well-established CS-1 and SW1353 chondrosarcoma cell lines.

Conclusion

Our findings confirm DDCS2 is a novel model for dedifferentiated chondrosarcoma and therefore adds to the limited pool of current cell lines urgently needed to investigate the chemoresistance within this deadly cancer.
Obstetric Violence in Their Own Words: How Women in Mexico and South Africa Expect, Experience, and Respond to Violence
Authors: Smith-Oka Vania , Rubin Sarah E. , Dixon Lydia Z.
Published: November 2021

This article, based on ethnographic research in Mexico and South Africa, presents two central arguments about obstetric violence: (a) structural inequalities across diverse global sites are primarily linked to gender and lead to similar patterns of obstetric violence, and (b) ethnography is a powerful method to give voice to women's stories. Connecting these two arguments is a temporal model to understand how women across the world come to expect, experience, and respond to obstetric violence—that is, before, during, and after the encounter. This temporal approach is a core feature of ethnography, which requires long-term immersion and attention to context.
Screening and surveillance of venous stenosis in AVG: Is it time to rethink our assumptions?
Authors: Kingsmore David B , Thomson Peter , Stevenson Karen
Published: November 2021

Guidelines make no firm recommendations about surveillance of arteriovenous grafts as several randomised trials (RCT) have not shown a clear benefit in patency. However a more thorough review of these RCT based on epidemiological principles reveals significant limitations. In particular a key weakness of these older studies is the interventions performed for venous stenosis detected that was largely angioplasty. However, the observational data of modern stent-grafts shows a clear benefit over angioplasty, and thus seems to suggest that a modern well considered RCT is now mandated.
Two-dimensional generalized non-Newtonian EHL lubrication: Shear rate-based solution versus shear stress-based solution
Authors: Liu Hai Chao , Zhang Bin Bin , Schneider Volker , Venner C.H. , Poll G.
Published: November 2021

Lubricant behaves non-Newtonian at high shear stress and high shear rate. The non-Newtonian shear behavior of oil such as shear-thinning, viscoelasticity, and limiting shear stress could have influences on almost all characteristics of an elastohydrodynamic lubrication (EHL) contact, that is, the central film thickness, the coefficient of friction, and the temperature rise in the lubricating film. For example, for lubricants of large molecular weight or of polymer blended ones, there can be inlet shear-thinning, which would reduce the EHL film thickness. For the EHL traction in a rolling/sliding EHL contact, it cannot be reasonably predicted without the consideration of non-Newtonian rheology. In EHL numerical studies, the non-Newtonian properties and the constitutive equations are expressed by the concept of generalized viscosity [Formula: see text], which can be either a function of shear rate [Formula: see text] or a function of shear stress [Formula: see text]. In this way, a non-Newtonian lubrication problem could be solved as a generalized Newtonian problem based on solvers for a Newtonian EHL problem. According to the function of the generalized viscosity [Formula: see text], numerical solutions can be classified into shear rate-based ones and shear stress-based ones. In this work, these two kinds of numerical solutions are revisited. And their efficiency is compared for a two-dimensional (2D) non-Newtonian point contact EHL problem (here 2D means non-Newtonian flow in both the x and y directions). Results show that the shear rate-based numerical solution has a higher efficiency than the shear stress-based one. The shear rate-based 2D generalized Newtonian method is more suitable to analyze multiple EHL contacts in angular contact ball bearings and gears with complex 2D flow and/or transient EHL lubrication problems.
Upper Limb Motor Improvement after Traumatic Brain Injury: Systematic Review of Interventions
Authors: Subramanian Sandeep K. , Fountain Melinda K. , Hood Ashley F. , Verduzco-Gutierrez Monica
Published: November 2021

Background

Traumatic brain injury (TBI) is a leading cause of adult morbidity and mortality. Individuals with TBI have impairments in both cognitive and motor domains. Motor improvements post-TBI are attributable to adaptive neuroplasticity and motor learning. Majority of the studies focus on remediation of balance and mobility issues. There is limited understanding on the use of interventions for upper limb (UL) motor improvements in this population.

Objective

We examined the evidence regarding the effectiveness of different interventions to augment UL motor improvement after a TBI.

Methods

We systematically examined the evidence published in English from 1990–2020. The modified Downs and Black checklist helped assess study quality (total score: 28). Studies were classified as excellent: 24–28, good: 19–23, fair: 14–18, and poor: ≤13 in quality. Effect sizes helped quantify intervention effectiveness.

Results

Twenty-three studies were retrieved. Study quality was excellent (n = 1), good (n = 5) or fair (n = 17). Interventions used included strategies to decrease muscle tone (n = 6), constraint induced movement therapy (n = 4), virtual reality gaming (n = 5), non-invasive stimulation (n = 3), arm motor ability training (n = 1), stem cell transplant (n = 1), task-oriented training (n = 2), and feedback provision (n = 1). Motor impairment outcomes included Fugl-Meyer Assessment, Modified Ashworth Scale, and kinematic outcomes (error and movement straightness). Activity limitation outcomes included Wolf Motor Function Test and Motor Activity Log (MAL). Effect sizes for majority of the interventions ranged from medium (.5-.79) to large (≥.8). Only ten studies included retention testing.

Conclusion

There is preliminary evidence that using some interventions may enhance UL motor improvement after a TBI. Answers to emergent questions can help select the most appropriate interventions in this population.
Incentives and payments in pragmatic clinical trials: Scientific, ethical, and policy considerations
Authors: Garland Andrew , Weinfurt Kevin , Sugarman Jeremy
Published: November 2021

Pragmatic clinical trials are increasingly used to generate knowledge about real-world clinical interventions. However, they involve some distinctive ethical and regulatory challenges. In this article, we examine a set of issues related to incentives and other payments to patients in pragmatic clinical trials. Although many of the ethical concerns related to incentives and payments in explanatory trials pertain to pragmatic clinical trials, the pragmatic features may introduce additional challenges. These include those related to the risk of incentives and payments undermining the scientific validity and social value of pragmatic clinical trials, the sources of data used in pragmatic clinical trials, and when the pragmatic clinical trials are conducted under waivers of consent. Based on our examination of these matters, we offer some preliminary recommendations regarding incentives and payments in pragmatic clinical trials, recognizing that additional data and experiences are needed to refine them.
A service improvement project of a legacy nurse programme to improve the retention of late career nurses
Authors: Haines Sue , Evans Kerry , Timmons Stephen , Cutler Ellen
Published: November 2021

Background

A Nottingham Legacy Nurse Programme was developed in response to the reducing supply of new nursing registrants and an ageing workforce. The programme comprised components of focussed mentorship, knowledge transition, support and development of new learners in practice.

Aims

The work-based development programme aimed to improve the retention and experience of late career registered nurses.

Methods

The programme was informed by the evidence base and co-produced with late career registered nurses (aged 55 years or over, approaching retirement). A small pilot programme ( n = 6) was evaluated through a mixed-methods approach. Refinements and recommendations were proposed in response to findings of a scoping search of the literature, feedback from participants and stakeholder groups across the NHS Midlands and East regions ( n = 238).

Results

A Legacy Nurse programme has potential to address nurses’ individual career development needs, valuing and retaining them in the workforce, enabling them to share professional knowledge and skills within clinical teams and offers a cost-effective solution to improving retention of late career nurses.

Conclusions

Addressing the needs of late career registered nurses is required to improve retention, job satisfaction, quality-of-care provision and facilitate knowledge transfer. The programme requires evaluation in other care settings and should be considered as part of an integrated approach to nurse retention, inclusive talent management and workforce planning, alongside financial and careers advice.
Misretrieval but not misrepresentation: A feature misbinding account of post-interpretive effects in number attraction
Authors: Dempsey Jack , Christianson Kiel , Tanner Darren
Published: November 2021

Attraction effects in comprehension have reliably shown a grammaticality asymmetry in which mismatching plural attractors confer facilitatory interference for ungrammatical verbs, but no processing cost for grammatical verbs. While this has favoured cue-based retrieval accounts of attraction phenomena in comprehension, Patson and Husband offered offline evidence suggesting that comprehenders systematically misrepresent number information in attraction phrases, leaving open the possibility for faulty noun phrase (NP) representations later in processing. The current study employs two self-paced reading discourse experiments to test for number attraction misrepresentations in real time. Specifically, the attraction phrases occurred as embedded direct object phrases, allowing for a direct test of the role of attractor noun number in head noun number misrepresentation (i.e., no number cue from verb). Although no online evidence for misrepresentation was found, a third single-sentence rapid serial visual presentation experiment showed error rates to offline probes corroborating the post-interpretive findings from Patson and Husband, suggesting that a search in memory for associative features may not employ the same processes as the formation of dependencies in discourse comprehension. The findings are discussed in the framework of feature misbinding in memory in line with recent post-interpretive accounts of offline comprehension errors.
Burning Karen’s Headquarters: Gender, Race, & the United Daughters of the Confederacy Headquarters
Authors: Maurantonio Nicole
Published: November 2021

In the early morning hours of 31 May 2020 in Richmond, Virginia, along with graffiti to the monuments lining the city’s historic Monument Avenue, the nearby headquarters of the United Daughters of the Confederacy was covered in colorful graffiti and set aflame. This article explores the gendered and raced critiques of the United Daughters of the Confederacy’s memory work communicated by this protest action, using the “Karen meme” as its point of departure. Invocations of “Karen” on Twitter in response to the Richmond protest made pointed arguments about narrative, place, and aesthetics, critiquing not only the Daughters’ role in remembering the Confederacy but the “Southern lady” trope within American public memory. Rather than an oblique reference, the Karen meme, this article argues, underscored Twitter’s potential as a site of anti-racist resistance during times of crisis.
Making memory work: The SARS memory and China’s war on COVID-19
Authors: Qian Licheng
Published: November 2021

In the global fight against COVID-19, a “pandemic memory thesis” emerges. This thesis argues that nations with memories of past pandemics, such as East Asian countries with SARS memories, can better control the COVID-19 pandemic today. Yet, if this thesis holds, why hadn’t the SARS memory helped China prevent the outbreak of COVID-19? Why, however, can China swiftly contain the pandemic in its later stages by exploiting the SARS memory? To address this contradiction, I treat the pandemic as an ontological crisis and put forward a theory centering on the construction of ontological consensus by the state and society. By studying symbolic events in China’s war on COVID-19, particularly the Li Wenliang and Zhong Nanshan cases, I argue that the state’s acknowledgment of the crisis, society’s awareness and cultural preparedness, and the re-fusion of state-society relations are crucial for memory to work in the fight against a new pandemic.
A systematic review of relapse rates during pregnancy and postpartum in patients with relapsing multiple sclerosis
Authors: Hellwig Kerstin , Verdun di Cantogno Elisabetta , Sabidó Meritxell
Published: November 2021

Introduction:

Pregnancy is widely accepted as a period when relapses of multiple sclerosis (MS) are decreased, with an increased risk of relapse in the first months postpartum. This systematic review evaluated relapses during pregnancy and postpartum, according to disease-modifying therapy (DMT) exposure before, during, and after pregnancy, and the influence of DMT on these outcomes.

Methods:

We searched Medline and EMBASE to identify relevant publications from November 2009 to 2019 along with references lists of selected articles. Publications were filtered and assessed by two independent reviewers to ensure appropriate data extraction.

Results:

Of 469 articles identified, 28 were included for analysis including 4739 pregnancies in 5324 patients. All five studies comparing natalizumab or fingolimod (high-efficacy DMTs) use preconception versus interferon beta, glatiramer acetate, or dimethyl fumarate, or no DMT suggested that there was a greater risk of relapse during pregnancy following withdrawal of the high-efficacy DMTs. Of 10 studies evaluating relapses during pregnancy, five studies found that continuing DMTs into early pregnancy reduced relapses compared to discontinuing treatment. DMT exposure preconception generally had no effect on postpartum relapses versus no DMT; however, natalizumab or fingolimod use preconception was associated with postpartum relapse versus no high-efficacy DMT in one study. DMT exposure during pregnancy was associated with fewer postpartum relapses versus no DMT exposure in four of seven studies, while three found no difference between groups.

Conclusion:

Results of this systematic review concerning women with relapsing MS show a complex and often conflicting picture regarding DMT exposure and relapses during and after pregnancy. Although our data are limited by variability between studies, there is some evidence suggesting the use of natalizumab or fingolimod preconception is associated with increased risk of relapses during pregnancy, highlighting the need for effective disease-management strategies in these especially high-risk patients.
Willingness to Pay for Environmental Quality: The Effects of Pro-Environmental Behavior, Perceived Behavior Control, Environmental Activism, and Educational Level
Authors: Vicente Paula , Marques Catarina , Reis Elizabeth
Published: November 2021

Environmental quality is one of the major concerns in contemporary societies. The main goal of this research is to investigate citizens’ willingness to pay for environmental quality and whether this propensity differs in line with education level. Structural equation modeling is used to explore the associations between several constructs; specifically, a multigroup analysis is conducted to assess the invariance of two educational level segments.

Results suggest that willingness to pay more for environmental quality is positively associated with perceived behavior control and environmental activism. Pro-environmental behavior does not impact willingness to pay for environmental quality but is positively related to perceived behavior control and environmental activism. The relationships between constructs hold true for both groups of education. Implications for public policy and marketing actions are addressed.
Effect of Skeletal Maturity on Fixation Techniques for Tibial Eminence Fractures
Authors: Thome Andrew P. , O’Donnell Ryan , DeFroda Steven F. , Cohen Brian H. , Cruz Aristides I. , Fleming Braden C. , Owens Brett D.
Published: November 2021

Background:

Several fixation methods have been reported for the operative treatment of tibial eminence fractures. Previous biomechanical studies have demonstrated that suture fixation may be a stronger construct; however, the maturity status of these specimens was not scrutinized.

Purpose:

To examine if suture fixation remains a biomechanically superior fixation method to screw fixation in both skeletally mature and immature specimens.

Study Design:

Controlled laboratory study.

Methods:

Sixteen total matched porcine (Yorkshire) knees (8 skeletally immature knees and 8 skeletally mature knees) were procured, and a standardized tibial eminence fracture was created. In each age-matched group of knees, 4 knees underwent randomization to fixation with 2 screws while 4 knees were randomized to fixation using a dual-suture technique. Once fixation was complete, the specimens underwent cyclic loading (200 cycles) in the anteroposterior plane of the tibia and load-to-failure testing, both with the knee positioned at 30° of flexion. Relevant measurements were recorded, and data were analyzed.

Results:

Among mature specimens, load to failure was 1.9 times higher in the suture fixation group compared with the screw fixation group (1318.84 ± 305.55 vs 711.66 ± 279.95 N, respectively; P = .03). The load to failure was not significantly different between the groups in immature specimens (suture: 470.00 ± 161.91 N vs screw: 348.79 ± 102.46; P = .08).

Conclusion:

These findings suggest that suture fixation may represent a better construct choice for fixation of tibial eminence fractures in the skeletally mature population. However, in the skeletally immature population, fixation with screws or suture may be equivalent. Displacement after cyclic loading did not appear to differ by fixation method, nor did stiffness.

Clinical Relevance:

A stronger fixation construct may be beneficial and allow for earlier range of motion to help potentially decrease postoperative stiffness. Clinical studies are warranted to see if these results may be replicated in humans.
Heregulin Activity Assays for Residual Testing of Cell Therapy Products
Authors: Monje Paula V. , Bacallao Ketty , Aparicio Gabriela I. , Lalwani Anil
Published: November 2021

Background

Heregulin is a ligand for the protooncogene product ErbB/HER that acts as  a key mitogenic factor for human Schwann cells (hSCs). Heregulin is required for sustained hSC growth in vitro but must be thoroughly removed before cell collection for transplantation due to potential safety concerns. The goal of this study was to develop simple cell-based assays to assess the effectiveness of heregulin addition to and removal from aliquots of hSC culture medium. These bioassays were based on the capacity of a β1-heregulin peptide to elicit ErbB/HER receptor signaling in adherent ErbB2+/ErbB3+ cells.

Results

Western blotting was used to measure the activity of three different β1-heregulin/ErbB-activated kinases (ErbB3/HER3, ERK/MAPK and Akt/PKB) using phospho-specific antibodies against key activating residues. The duration, dose-dependency and specificity of β1-heregulin-initiated kinase phosphorylation were investigated, and controls were implemented for assay optimization and reproducibility to detect β1-heregulin activity in the nanomolar range. Results from these assays showed that the culture medium from transplantable hSCs elicited no detectable activation of the aforementioned kinases in independent rounds of testing, indicating that the implemented measures can ensure that the final hSC product is devoid of bioactive β1-heregulin molecules prior to transplantation.

Conclusions

These assays may be valuable to detect impurities such as undefined soluble factors or factors for which other biochemical or biological assays are not yet available. Our workflow can be modified as necessary to determine the presence of ErbB/HER, ERK, and Akt activators other than β1-heregulin using native samples, such as fresh isolates from cell- or tissue extracts in addition to culture medium.
d-Chiro-Inositol improves testosterone levels in older hypogonadal men with low-normal testosterone: a pilot study
Authors: Nordio Maurizio , Kumanov Philip , Chiefari Alfonsina , Puliani Giulia
Published: November 2021

Background

Several recent journal articles report that d-chiro-inositol (DCI), primarily known as insulin second messenger, influences steroidogenesis. In particular, new evidence is arising on DCI ability to regulate aromatase expression and testosterone biosynthesis. In this regard, DCI administration could represent a good therapeutic opportunity in case of reduced levels of testosterone.

Older men generally have lower testosterone concentrations than younger men, and recent randomized controlled trials have examined whether testosterone treatment might improve health outcomes in this age group. There is limited information about the safety of testosterone replacement therapy in these men, hence DCI could represent an interesting alternative for future trials. Therefore, this study aims to evaluate the effect of DCI treatment on testosterone levels in older male patient.

Results

Ten older men with basal low testosterone levels were enrolled in this study. Patients took 600 mg of DCI, two-times per day, for 30 days. We evaluated hormonal and glycaemic parameters, weight, waist circumference, and Body-Mass Index at baseline (T0) and after 30 days (T1). Finally, all patients also filled in the standardized International Index of Erectile Function questionnaire and performed the Handgrip test at T0 and T1. Men receiving DCI showed increased androgen and reduced oestrogen concentrations, and improved glycaemic profiles. DCI was also associated with reduced weight, Body-Mass Index, waist circumference, and improved grip strength and self-reported sexual function. All these effects led to the improvement of sexual function and physical strength.

Conclusions

In this pilot study, DCI treatment improved the levels of testosterone and androstenedione at the expense of oestrogens in elder men with low basal levels of these hormones without adverse effects.

Trial registration

Clinicaltrials.gov: D-chiroinositol Administration in Hypogonadal Males, NCT04708249
Comparison of risk factors for ischemic stroke and coronary events in a population-based cohort
Authors: Muhammad Iram Faqir , Borné Yan , Zaigham Suneela , Söderholm Martin , Johnson Linda , Persson Margaretha , Melander Olle , Engström Gunnar
Published: November 2021

Background

Although coronary events (CE) and ischemic stroke share many risk factors, there are also some important differences. The aim of this paper was to assess the association of risk factors in relation to incident CE and ischemic stroke and to evaluate the heterogeneity in patterns of risk factors between the two outcomes.

Method

Traditional risk factors and inflammatory markers associated with coronary events and ischemic stroke were measured in the Malmö Diet and Cancer Cohort (MDCS, n = 26 519), where a total of 2270 incident ischemic stroke and 3087 incident CE occurred during a mean follow up time 19 ± 6 years, and in relation to inflammatory markers in the cardiovascular sub-cohort (MDC-CV, n = 4795). Cox regression analysis was used to obtain hazard ratios. A modified Lunn-McNeil competing risk analysis was conducted to assess the significance of any differences in risk profiles of these outcomes.

Results

Most cardiovascular risk factors were associated both with incident CE and ischemic stroke. However, current smoking, ApoB, low ApoA1, male sex and education level of ≤ 9 years of schooling were preferentially associated with CE compared to ischemic stroke. Conversely, age showed a stronger association with ischemic stroke than with CE.

Conclusion

CE and ischemic stroke have broadly similar risk factors profiles. However, there are some important differential associations, as well as substantial differences in the magnitude of the association. These could reflect the distinct biology of atherogenesis in different vascular beds. The difference in the determinants highlights the importance of looking at CE and ischemic stroke, two manifestations of cardiovascular disease, separately.
The CADILLAC risk score accurately identifies patients at low risk for in-hospital mortality and adverse cardiovascular events following ST elevation myocardial infarction
Authors: Wilson Ryan S. , Malamas Peter , Dembo Brent , Lall Sumeet K. , Zaman Ninad , Peterson Brandon R.
Published: November 2021

Background

The CADILLAC risk score was developed to identify patients at low risk for adverse cardiovascular events following ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI).

Methods

We performed a single center retrospective review of STEMI hospitalizations treated with PPCI from 2014 to 2018. Patients were stratified using the CADILLAC risk score into low risk, intermediate risk and high risk groups. Patients presenting with cardiac arrest or cardiogenic shock were excluded from the study. The primary outcome was adverse clinical events during initial hospitalization. Secondary outcomes were adverse clinical events at 30 days and 1 year following index hospitalization.

Results

The study included 341 patients. Compared to patients with a low CADILLAC score, adverse clinical events were similar in the intermediate risk group during hospitalization (OR 1.23, CI 0.37–4.05, p 0.733) and at 30 days (OR 2.27, CI 0.93–5.56, p 0.0733) while adverse clinical events were significantly elevated in the high risk group during hospitalization (OR 4.75, CI 1.91–11.84, p 0.0008) and at 30 days (OR 8.73, CI 4.02–18.96, p < 0.0001). At 1 year follow-up, compared to the low risk CADILLAC group (9.4% adverse clinical event rate), cumulative adverse clinical events were significantly higher in the intermediate risk group (22.9% event rate, OR 2.86, CI 1.39–5.89, p 0.0044) and in the elevated risk group (58.6% event rate, OR 13.67, CI 6.81–27.43, p < 0.0001). The mortality rate was 0% for patients defined at low risk by CADILLAC score during hospitalization, as well up to 1 year follow up. On receiver operating curve analysis, discrimination of in-hospital adverse clinical events was fair using CADILLAC (C = 0.66, odds ratio 1.18; 95% CI 1.04–1.33; p = 0.0064) with somewhat better discrimination at 30-day follow-up (C = 0.719) and 1-year follow-up (C = 0.715).

Conclusion

Patients defined as low risk by the CADILLAC score following a STEMI were associated with lower mortality and adverse clinical event rates during hospitalization and up to 1 year following STEMI when compared to those with an intermediate or high CADILLAC score.
Macro-reentrant atrial tachycardia after tricuspid or mitral valve surgery: is there difference in electrophysiological characteristics and effectiveness of catheter ablation?
Authors: Wang Xin-hua , Kong Ling-cong , Shuang Tian , Li Zheng , Pu Jun
Published: November 2021

Background

Macro-reentrant atrial tachycardias (MATs) are a common complication after cardiac valve surgery. The MAT types and the effectiveness of MAT ablation might differ after different valve surgery. Data comparing the electrophysiological characteristics and the ablation results of MAT post-tricuspid or mitral valve surgery are limited.

Methods

Forty-eight patients (29 males, age 56.1 ± 13.3 years) with MAT after valve surgery were assigned to tricuspid valve (TV) group (n = 18) and mitral valve (MV) group (n = 30). MATs were mapped and ablated guided by a three-dimensional navigation system. The one-year clinical effectiveness was compared in two groups.

Results

Nineteen MATs were documented in TV group, including 16 cavo-tricuspid isthmus (CTI)-dependent AFL and 3 other MATs at right atrial (RA) free wall, RA septum and left atrial (LA) roof. Thirty-nine MATs were identified in MV group, including15 CTI-dependent AFL, 8 RA free wall scar-related, 2 RA septum scar-related, 8 peri-mitral flutter, 3 LA roof-dependent, 2 LA anterior scar-related, and 1 right pulmonary vein-related MAT. Compared with TV group, MV group had significantly lower prevalence of CTI-dependent AFL (38.5% vs. 84.2%), higher prevalence of left atrial MAT (35.9 vs.5.3%) and higher proportion of patients with left atrial MAT (40 vs. 5.6%), P = 0.02, 0.01 and 0.01, respectively. The acute success rate of MAT ablation (100 vs. 93.3%) and the one-year freedom from atrial tachy-arrhythmias (72.2 vs. 76.5%) was comparable in TV and MV group. No predictor for recurrence was identified.

Conclusion

Although the types of MATs differed significantly in patients with prior TV or MV surgery, the acute and mid-term effectiveness of MAT ablation was comparable in two groups.

Trial registration: This study was registered as a part of EARLY-MYO-AF clinical trial at the website ClinicalTrials. gov (NCT04512222).
Does the combination of resistance training and a nutritional intervention have a synergic effect on muscle mass, strength, and physical function in older adults? A systematic review and meta-analysis
Authors: Choi MoonKi , Kim Hayeon , Bae Juyeon
Published: November 2021

Background

Health-promoting interventions are important for preventing frailty and sarcopenia in older adults. However, there is limited evidence that nutritional interventions yield additional effects when combined with resistance training. This systematic review and meta-analysis aimed to compare the effectiveness of nutritional interventions with resistance training and that of resistance training alone.

Methods

Randomized controlled trials published in peer-reviewed journals prior to July 2020 were retrieved from databases and other sources. The articles were screened according to the inclusion and exclusion criteria. The methodological quality of the included studies was assessed using Cochrane’s risk of bias tool 2. A meta-analysis was performed using the RevMan 5.4 program and STATA 16 program.

Results

A total of 22 studies were included in the meta-analysis. The results of the meta-analysis showed no significant differences between groups in muscle mass, muscle strength, or physical functional performance. In the subgroup analysis regarding the types of nutritional interventions, creatine showed significant effects on lean body mass (n = 4, MD 2.61, 95% CI 0.51 to 4.72). Regarding the other subgroup analyses, there were no significant differences in appendicular skeletal muscle mass (p = .43), hand grip strength (p = .73), knee extension strength (p = .09), chair stand test results (p = .31), or timed up-and-go test results (p = .31). In the meta-regression, moderators such as the mean age of subjects and duration of interventions were not associated with outcome variables.

Conclusions

This meta-analysis showed that nutritional interventions with resistance training have no additional effect on body composition, muscle strength, or physical function. Only creatine showed synergistic effects with resistance training on muscle mass.

Trial registration

CRD42021224843.
Accurate pancreas segmentation using multi-level pyramidal pooling residual U-Net with adversarial mechanism
Authors: Li Meiyu , Lian Fenghui , Wang Chunyu , Guo Shuxu
Published: November 2021

Background

A novel multi-level pyramidal pooling residual U-Net with adversarial mechanism was proposed for organ segmentation from medical imaging, and was conducted on the challenging NIH Pancreas-CT dataset.

Methods

The 82 pancreatic contrast-enhanced abdominal CT volumes were split via four-fold cross validation to test the model performance. In order to achieve accurate segmentation, we firstly involved residual learning into an adversarial U-Net to achieve a better gradient information flow for improving segmentation performance. Then, we introduced a multi-level pyramidal pooling module (MLPP), where a novel pyramidal pooling was involved to gather contextual information for segmentation, then four groups of structures consisted of a different number of pyramidal pooling blocks were proposed to search for the structure with the optimal performance, and two types of pooling blocks were applied in the experimental section to further assess the robustness of MLPP for pancreas segmentation. For evaluation, Dice similarity coefficient (DSC) and recall were used as the metrics in this work.

Results

The proposed method preceded the baseline network 5.30% and 6.16% on metrics DSC and recall, and achieved competitive results compared with the-state-of-art methods.

Conclusions

Our algorithm showed great segmentation performance even on the particularly challenging pancreas dataset, this indicates that the proposed model is a satisfactory and promising segmentor.
Ramucirumab in combination with dacarbazine in patients with progressive well-differentiated metastatic pancreatic neuroendocrine tumors (RamuNET): study protocol for a multicenter single-arm trial
Authors: Krug Sebastian , Kegel Thomas , Gress Thomas M. , Rinke Anja , Apostolidis Leonidas , Jann Henning , König Alexander , Hörsch Dieter , Schrader Jörg , Ettrich Thomas J. , Richter Michael , Steighardt Jörg , Michl Patrick
Published: November 2021

Background

Cytotoxic chemotherapy combinations and targeted agents represent established treatment concepts in advanced pancreatic neuroendocrine tumors (PNETs). However, response rates, side effects and outcome data strongly vary among these therapeutic approaches. Head-to-head comparisons between chemo- and molecular therapies are missing and secondary resistances frequently occur. The RamuNET trial aims to identify the effectiveness of dual treatment with DTIC and ramucirumab in progressive advanced PNET patients.

Methods

The RamuNET study is an investigator-initiated multicenter prospective single-arm trial to evaluate the efficacy of ramucirumab in combination with dacarbazine (DTIC) over a period of at least 6 months. Patients with progressive well-differentiated and metastatic pancreatic neuroendocrine tumors are eligible. The study aims to include 45 patients over a period of 24 months with a minimum follow-up of 24 months. The primary endpoint is disease control after 6 months. Secondary endpoints include progression-free survival, biochemical response, overall survival, quality of life and toxicity. Based on the hypothesis that 80% of the patients can achieve a disease control after 6 months, the sample size calculation follows an exact binomial single-stage design. H0: p < =p0 = 60% versus H1: p > =p1 = 80%, alpha = 0.05, beta = 0.1.

Discussion

This study investigates a new therapeutic approach using the combination of cytotoxic and targeted antiangiogenic therapy in advanced PNET. If positive, this trial will be the basis for a randomized two-arm study to investigate the combination of ramucirumab and DTIC against other established therapies in PNET.

Trial registration

EudraCT: 2017–001207-68. Date of registration: 2018.01.03.