bluuebunny/crossref_metadata_2025 huggingface dataset:
Dose response effects of the BWF Shuttle Time Programme on children’s actual and perceived fundamental movement skill competence
Authors: Duncan Michael J , Noon Mark , Clark Cain CT , Eyre Emma LJ
Published: April 2021

This study examined dose-response effects of the Badminton World Federation (BWF) Shuttle Time programme on fundamental movement skills (FMS) and perceived FMS competence in 6–9-year olds. Children (n = 158, 83 boys, 75 girls, Mean ±  SD age = 7.6 ± .97) were randomly allocated into three conditions: Shuttle Time 2Xweek; Shuttle Time 1Xweek; 3) control (CON) group. The intervention groups undertook the BWF Shuttle Time programme over a 10-week period in place of both or one of their statutory Physical Education lessons. FMS was assessed from the Test of Gross Motor Development 2. Perceived competence was assessed via the Pictorial Scale of Perceived Movement Skill Competence. Assessments were undertaken pre, post and 10 weeks post intervention. For FMS, a significant time X group interaction (P = .001) was evident. There was no significant difference in FMS between groups at pre (P > .05). Post intervention there were significant differences in FMS between 2X week and 1XWeek (P = .007), 2Xweek and control (P = .0001) and 1X Week and control (P = .007). From post to 10-weeks post there were significant improvements in FMS (P = .001) for the 2X week group. A significant time X group interaction (P = .0001) also indicated that perceived competence increased significantly pre to post for 1Xweek and 2Xweek groups, but not CON groups and was maintained at 10 weeks post (all P = .001).
Field hockey from the performance analyst’s perspective: A systematic review
Authors: Lord Felicity , Pyne David B , Welvaert Marijke , Mara Jocelyn K
Published: April 2021

Field hockey is an evolving sport, but it is unclear whether performance analysis techniques are reflective of current best practice. The objective of this review was to identify performance analysis methods used in field hockey, assess their practicality, and provide recommendations on their implementation in the field. A systematic search of the databases SPORTDiscus, Web of Science, Scopus, MEDLINE and PubMed was performed. Key words addressed performance analysis methods and field hockey, with all other disciplines of sport science excluded. A total of 8 articles were identified from the systematic review. Three studies explored patterns of play in relation to goal scoring opportunities, two articles examined penalty corner strategies and three compared specific actions in hockey. The limited performance analysis research in field hockey has focused on game actions in patterns of play. However, greater insights may be gained by analysing hockey using a holistic approach that incorporates spatio-temporal variables and player-opposition interactions. There is an opportunity to employ novel performance analysis techniques in hockey which provide more practical and effective approaches for analysing strategies and tactics.
Evaluating basketball player’s rotation line-ups performance via statistical markov chain modelling
Authors: Kolias Pavlos , Stavropoulos Nikolaos , Papadopoulou Alexandra , Kostakidis Theodoros
Published: April 2021

Coaches in basketball often need to know how specific rotation line-ups perform in either offense or defense and choose the most efficient formation, according to their specific needs. In this research, a sample of 1131 ball possession phases of Greek Basket League was utilized, in order to estimate the offensive and defensive performance of each formation. Offensive and defensive ratings for each formation were calculated as a function of points scored or received, respectively, over possessions, where possessions were estimated using a multiple regression model. Furthermore, a Markov chain model was implemented to estimate the probabilities of the associated formation’s performance in the long run. The model could allow us to distinguish between overperforming and underperforming formations and revealed the probabilities over the evolution of the game, for each formation to be in a specific rating category. The results indicated that the most dominant formation, in terms of offense, is Point Guard-Point Guard-Small Forward-Power Forward-Center, while defensively schema Point Guard-Shooting Guard-Small Forward-Center-Center had the highest rating. Such results provide information, which could operate as a supplementary tool for the coach’s decisions, related to which rotation line-up patterns are mostly suitable during a basketball game.
Endovascular intervention for basilar artery occlusion in the elderly
Authors: Luo Weidong , Huang Wenguo , Zhang Min , Liu Xing , Guo Zhangbao , Zhou Peiyang , Wang Li , Fu Xinmin , Yang Shiquan , Zhang Shuai , Zhou Zhiming , Zhang Min , Yuan Junjie , Liu Shuai , Song Jiaxing , Qiu Zhongming , Sang Hongfei , Li Fengli , Zi Wenjie , Wu Deping , Liu Wenhua , Yang Qingwu
Published: April 2021

Background:

To date, few data have been reported on clinical outcomes following interventions in elderly populations with acute basilar artery occlusion. Using data from the Endovascular Treatment for Acute Basilar Artery Occlusion Study (BASILAR), we evaluated the efficacy and safety of intervention and determined predictors of outcomes among elderly patients in China.

Methods:

Patients from January 2014 to May 2019 were dichotomized into elderly (75 years or older) and nonelderly patients (under 75 years). Pearson’s Chi-square test and multivariate logistic regression were performed to assess 90-day favorable functional outcome (defined as a modified Rankin scale score of 0–3), mortality and symptomatic intracranial hemorrhage between intervention and conservative cohorts in elderly patients.

Results:

Among the 829 patients in the BASILAR, 182 patients aged 75 years or older were analyzed. These patients were divided into intervention (127 patients) and conservative (55 patients) cohorts. Compared with the conservative cohort, the intervention cohort presented more frequently with a favorable functional outcome (28.3% versus 12.7%; p = 0.023) and with a decreased mortality (54.3% versus 76.4%; p = 0.005). There was no difference in symptomatic intracranial hemorrhage (4.7% versus 0, p = 0.235). Multivariate analysis indicated that intervention was associated with favorable functional outcome (adjusted odds ratio, 0.262; 95% confidence interval, 0.088–0.778, p = 0.016) and lower mortality (adjusted odds ratio, 0.257; 95% confidence interval, 0.109–0.606, p = 0.002). In the intervention cohort, initial National Institutes of Health Stroke Scale (NIHSS) score and occlusion site were associated with functional outcome, and initial NIHSS score and recanalization were associated with mortality.

Conclusions:

Although the overall outcome following intervention was worse with age, intervention was more effective and safer than conservative treatment for elderly Chinese patients with basilar artery occlusion. Predictors of desirable outcome in elderly patients undergoing intervention included lower initial NIHSS score, occlusion site and successful recanalization. Clinical Trial Registration-URL: http://www.chictr.org . Unique identifier: ChiCTR-1800014759
The MSBase pregnancy, neonatal outcomes, and women’s health registry
Authors: Jokubaitis Vilija G. , Skibina Olga , Alroughani Raed , Altintas Ayse , Butzkueven Helmut , Eichau Sara , Fragoso Yara , Hellwig Kerstin , Hughes Stella E. , Rath Louise , van der Walt Anneke , Gray Orla
Published: April 2021

Background:

Family planning and pregnancy decisions are key considerations in the management of women with multiple sclerosis (MS), who are typically diagnosed between the ages of 20–40 years. Despite a strong evidence base that pregnancy is not harmful for women with MS, many knowledge gaps remain. These include: best management strategies through pregnancy in the era of highly effective disease-modifying therapies (DMT); foetal risks associated with DMT exposure in utero or in relation to breastfeeding; knowledge base around the use of assisted reproductive technologies; the long-term impact of pregnancy on disease outcomes, as well as the impact of long-term DMT use on women’s health and cancer risk.

Methods:

Here, we describe the new MSBase pregnancy, neonatal outcomes and women’s health registry. We provide the rationale for, and detailed description of, the variables collected within the registry, together with data acquisition details.

Conclusion:

The present paper will act as a reference document for future studies.
Urinary catheterization from 1997 to 2018: a Dutch population-based cohort
Authors: Berendsen Sophie A. , van Doorn Tess , Blok Bertil F. M.
Published: April 2021

Background:

Our aim was to evaluate the use of indwelling, intermittent and external urinary catheters in neurogenic and non-neurogenic bladder patients in the Netherlands from 1997 to 2018.

Methods:

Data were retrieved from a population-based cohort containing information about the extramural use of medical devices in the insured population in the Netherlands. The insured population increased from 9.9 million people in 1997 to 17.1 million people in 2018 (64–100% of the Dutch population). Users are expressed by users per 100,000 insured people and total users, corrected for the overall Dutch population. The expenditures are corrected for inflation and expressed by total costs and costs per user.

Results:

During this 21-year period, indwelling catheter (IC) users doubled from 159 per 100,000 people (24,734 users) to 315 per 100,000 people (54,106 users). Clean intermittent catheter (CIC) users increased from 92 per 100,000 people (14,258 users) in 1997 to 267 per 100,000 people (45,909 users) in 2018. Of all users, 20.7% had an associated neurogenic disorder and 44.9% a non-neurogenic disorder in 2018. The total expenditure on extramural use of urinary catheters increased from 27.7 million euros in 1997 to 84.4 million euros in 2018. IC costs increased from 6.0 million euros in 1997 to 6.7 million euros in 2018, while CIC costs rose from 16.4 million euros to 74.6 million euros. Urine drainage bag costs decreased from 17.2 million in 2001 to 5.3 million in 2018.

Conclusions:

IC use has increased substantially over the past 21 years, despite the fact that CIC use increased as well. It seems that the main driver behind the prevalence in IC and CIC use, is the rise in incontinence care in older patients and the adaption of preferred CIC use in professional guidelines. At least one fifth of all users catheterize due to neurogenic reasons.
Alfuzosin for the medical treatment of benign prostatic hyperplasia and lower urinary tract symptoms: a systematic review of the literature and narrative synthesis
Authors: Mari Andrea , Antonelli Alessandro , Cindolo Luca , Fusco Ferdinando , Minervini Andrea , De Nunzio Cosimo
Published: April 2021

Background:

Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are a bothersome frequent symptom in adult males. This systematic review analyzed the available evidence on the pharmacokinetic and pharmacodynamic features of alfuzosin, and its clinical efficacy both as monotherapy and in combination with other drugs for the treatment of male LUTS/BPH.

Methods:

A systematic review of the last 10 years was performed using the MEDLINE, EMBASE and Cochrane libraries in March 2020. The protocol for this systematic review was registered on PROSPERO (Central Registration Depository: CRD42020136120) and is available in full on the University of York website.

Results:

Alfuzosin is a quinazoline derivative and, although a nonspecific α1-blocker, exhibits a selective concentration in the prostate compared with plasma in patients with BPH. Three registration trials assessed the safety and efficacy of alfuzosin. The 10 mg daily formulation has a three-layered matrix containing the active substance between two inactive coats allowing a drug release over 20 h. Alfuzosin showed high tolerability, few vasodilatory effects and a low rate of ejaculation disorders over older alpha-blocking compounds thanks to the high uroselectivity of alfuzosin and its preferential concentration at urinary level. Six randomized clinical trials (RCTs) assessed efficacy and safety of alfuzosin versus other alpha-blockers ± placebo: three studies comparing with tamsulosin, one with doxazosin, and two with silodosin or tamsulosin. One RCT investigated the clinical outcomes of alfuzosin with finasteride, two with propiverine and two with phosphodiesterase-5 inhibitors.

Conclusions:

Alfuzosin is an effective drug for the treatment of LUTS/BPH, with a lower rate of sexual disorders compared with other alpha-blockers. Alfuzosin is also safe with low adverse events in case of concomitant antihypertensive therapy and in patients with cardiovascular morbidity. Safety and efficacy of alfuzosin has been reported also in case of combination therapy with antimuscarinic agents and PDE5i.
Individual and community experience of rising burden of non-communicable diseases in two case districts of Nepal: a qualitative exploration
Authors: Sharma Sudesh R. , Matheson Anna , Lambrick Danielle , Faulkner James , Lounsbury David W. , Vaidya Abhinav , Page Rachel
Published: April 2021

Introduction:

Non-communicable diseases (NCDs) are a rapidly emerging global health challenge with multi-level determinants popularly known as social determinants. The objective of this paper is to describe the individual and community experiences of NCDs in the two case districts of Nepal from a social determinants of health perspective.

Method:

This study adopted qualitative study design to identify the experiences of NCDs. Sixty-three interviews were conducted with key informants from different sectors pertinent to NCD prevention at two case districts and at the policy level in Nepal. Twelve focus group discussions were conducted in the selected communities within those case districts. Data collection and analysis were informed by the adapted Social Determinants of Health Framework. The research team utilised the framework approach to carry out the thematic analysis. The study also involved three sense-making workshops with policy level and local stakeholders.

Results:

Three key themes emerged during the analysis. The first theme highlighted that individuals and communities were experiencing the rising burden of NCDs and metabolic risks in both urban and rural areas. The other two themes elaborated on the participant’s experiences based on their socio-economic background and gender. Disadvantaged populations were more vulnerable to the risk of NCDs. Further, being female put one into an even more disadvantaged position in experiencing NCD risks and accessing health services.

Conclusion:

The findings indicated that key social determinants such as age, geographical location, socio-economic status and gender were driving the NCD epidemic. There is an urgent need to take action on social determinants of health through multi-sectoral action, thus also translating the spirit of the recommendations made a decade ago by the Commission on Social Determinants of Health in addressing a complex challenge like NCDs in Nepal.
Prevalence, therapy and tumour response in patients with rheumatic immune-related adverse events following immune checkpoint inhibitor therapy: a single-centre analysis
Authors: Verspohl Sophia H. , Holderried Tobias , Behning Charlotte , Brossart Peter , Schäfer Valentin S.
Published: April 2021

Background:

Immune checkpoint inhibitors (ICIs) improved cancer therapy by inducing a higher immune system activity. This effect can cause rheumatic immune-related adverse events (rh-irAEs), which have not yet been extensively studied.

Methods:

We analysed 437 patients between 2014 and 2019, treated with ipilimumab (anti-CTLA-4) and/or nivolumab (anti-PD-1) or pembrolizumab (anti-PD-1) at the Clinic for Internal Medicine III, Oncology, Haematology and Rheumatology at the University Hospital Bonn, Germany.

Results:

Of the 437 patients 60% were males. Patients were mainly treated for melanoma, lung cancer, head and neck tumour and urothelial carcinoma. At least one immune-related adverse event (irAE) was observed in 163 patients (37.3%), including rh-irAE. Most common side effects were rash, colitis and hepatitis. We identified 19 patients (4.3%) with a minimum of one rh-irAE due to ICI therapy; three of those had a pre-existing rheumatic disease. Arthralgia developed most frequently in eight patients (42.1%). Other rh-irAEs were: arthritis ( n = 7; distinguished in rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis and undifferentiated arthritis), myalgia ( n = 2) and myositis ( n = 3). Most rh-irAEs were classified as moderately severe (Common Terminology Criteria of Adverse Events grade 2: 68.4%). Median time between starting ICI therapy and the occurrence of rh-irAE was 109 days (interquartile range 40–420 days). Fifteen patients (78.9%) were treated with glucocorticosteroids. In four cases additional therapy with methotrexate or tocilizumab was required. Even though patients benefited from ICI treatment, therapy had to be discontinued in six of the participants due to rh-irAE. Interestingly, patients with rh-irAE had a significantly higher tumour response compared with patients without rh-irAE (94.4% versus 43.5%; p < 0.0001).

Conclusion:

Rh-irAEs occur under ICI therapy, especially in patients with higher tumour response. However, they are not the most frequent irAE after ICI exposure: 9.3% of all irAEs were rheumatic (20 rh-irAE cases in 19 patients of a total of 215 irAE cases in 163 patients).
Concomitant beta-blocker use is associated with a reduced rate of remission in patients with rheumatoid arthritis treated with disease-modifying anti-rheumatic drugs: a post hoc multicohort analysis
Authors: Abuhelwa Ahmad Y. , Foster David J. R. , Manning-Bennett Arkady , Sorich Michael J. , Proudman Susanna , Wiese Michael D. , Hopkins Ashley M.
Published: April 2021

Background:

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease associated with increased risk of cardiovascular disease (CVD). Treatment for CVD may involve pharmacological agents that antagonise beta adrenergic receptors. These receptors may play an important role in immunology, and the effects of beta-blockers (BB) in RA is unknown. The aim of this study was to investigate the association between BB use and remission in patients with RA initiating tocilizumab +/− conventional synthetic (cs-) DMARD therapy.

Methods:

Data was pooled from five randomised trials investigating tocilizumab and/or csDMARD treatment in RA (primarily methotrexate). The association between BB use and remission according to the Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) was assessed by Cox proportional hazard analysis. Sensitivity analysis in patients with pre-existing CVD and an exploratory analysis of the impact of other CVD drugs were conducted.

Results:

Data were available from 5502 participants, 594 (10.8%) of whom were using systemic BB. BB use was associated with less frequent SDAI remission in the total [adjusted hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.57–0.87, p = 0.001] and CVD cohort [adjusted HR 0.72 (0.57–0.90, p = 0.005)]. The association was consistent between trials (interaction p = 0.44) and treatment arms (interaction p = 0.06). No significant association between remission and β1-receptor selectivity was identified ( p = 0.16), and the association was independent from other cardiovascular drug use. Similar associations between BB use and CDAI remission were observed.

Conclusion:

In a large, pooled cohort of RA patients initiating csDMARDs and/or tocilizumab, BB use was independently associated with less frequent remission.
Democratic Russia: Why it is not a contradiction in terms
Authors: Gozman Leonid
Published: April 2021

Doubts about building a stable democracy in Russia are usually associated with the peculiarities of both the country’s history and the Russian people’s mentality. However, rather than being exclusively defined by a series of tyrants, Russian history is also marked by impressive attempts at democracy building. The long-standing battle continues to rage between those who advocate that Russia should be developed as a European country and those who adhere to the idea of Russia finding its own peculiar way, defined by autocracy. Indeed, we are witnessing a dramatic escalation of this battle. The specific features of the Russian nation have never been an obstacle to the proper operation of democratic institutions. In addition to sharing democratic values and being ready to implement them in real life, the younger generation of Russian citizens is also able to fight for them as they are now entering the political arena. What precludes democracy in Russia is not its history or the psyche of its citizens but its archaic and incompetent state. Russian society is thus now ready for democracy.
Signet ring cell cancer of Ampulla of Vater—first ever case reported in a teenager and a review of literature
Authors: Kerawala Asad Ali , Jamal Abid , Saleem Lubna
Published: April 2021

Ampullary cancers are rare accounting for 0.2% of all gastrointestinal cancers. Signet ring is a rare variant of adenocarcinoma, characterized by having more than 50% of mucin secreting cells and clinically having a worse prognosis. We present the case of a teenage girl with this tumor, the youngest ever reported in medical literature. An 18 years old girl with no significant past medical history presented to our clinic with symptoms of upper abdominal pain and jaundice. Her upper GI endoscopy showed an ampullary lesion which was biopsied—diagnosing it as adenocarcinoma. She underwent a pancreato-duodenectomy (Whipple’s procedure) with Child’s reconstruction and a feeding jejunostomy. Her final histopathology report was documented as infiltrating adenocarcinoma of Signet Ring variety arising from the Ampulla of Vater. Being such a rare entity, there is a lack of randomized trials advising the optimum treatment for such cases. Till then anecdotal experiences will drive the optimum management of this rare disease.
Retrospective study of clinical characteristics and viral etiologies of patients with viral pneumonia in Beijing
Authors: Zhao Xiang , Meng Yao , Li Duo , Feng Zhaomin , Huang Weijuan , Li Xiyan , Wei Hejiang , Zeng Xiaoxu , Wang Dayan
Published: April 2021

Aims

The virus is common in patients with viral pneumonia. However, the viral etiology and clinical features of patients with viral pneumonia in China remain unclear. The main purpose of this study was to analyze the viral causes and epidemiology of patients with viral pneumonia in Beijing, which can significantly improve the pertinence and accuracy of clinical treatment of the disease.

Methods

Firstly, 1539 respiratory specimens of pneumonia (oropharyngeal swabs, nasopharyngeal swabs, saliva samples and bronchoalveolar lavage fluid) were collected from 19 hospitals in Beijing from September 2015 to August 2018. Then, TaqMan low‐density microfluidic chip technology was used to detect viral pneumonia specimens in 1539 respiratory tract specimens of pneumonia and determine the types of viral bacteria in them. Lastly, the analysis of demographic, clinical and etiological data of patients with viral pneumonia was performed.

Results

The results showed that among the 1539 respiratory tract specimens with pneumonia, 760 were detected as viral pneumonia specimens, with a positive rate of 49.4%. Among which, 467 were infected with mono‐viral and 293 were infected with multi‐viral. Influenza A virus (Flu A), mycoplasma pneumoniae (MPn), Ebola virus (EBV) and herpes simplex virus type 1 (HSV‐1) were the major viral components in the samples of these patients. Furthermore, these viral species were significantly associated with sample sources, onset season and certain clinical characteristics.

Discussion

Our findings may provide corresponding treatment strategies for viral pneumonia patients infected with specific viruses.
Incidence and prognostic significance of pleural effusions in pulmonary arterial hypertension
Authors: Chandel Abhimanyu , Verster Alison , Rahim Husna , Khangoora Vikramjit , Nathan Steven D. , Ahmad Kareem , Aryal Shambhu , Bagnola Aaron , Singhal Anju , Brown A. Whitney , Shlobin Oksana A. , King Christopher S.
Published: April 2021

It has been suggested pleural effusions may develop in right heart failure in the absence of left heart disease. The incidence and prognostic significance of pleural effusions in pulmonary arterial hypertension is uncertain. Patients with pulmonary arterial hypertension followed at our tertiary care center were reviewed. Survival was examined based on the subsequent development of a pleural effusion. A total of 191 patients with pulmonary arterial hypertension met the inclusion criteria. The prevalence of pleural effusions on initial assessment was 7.3%. Among patients without a pleural effusion on initial imaging and at least one follow‐up computerized tomography (N = 142), pleural effusion developed in 27.5% (N = 39) of patients. No alternative etiology of the effusion was identified in 19 (48.7%) cases and effusions deemed related to pulmonary arterial hypertension occurred at an incident rate of 38.6 cases per 1000 person‐years. Of these, 14 (73.7%) were bilateral, 3 (15.8%) were right‐sided, and 2 (10.5%) were left‐sided. Effusion size was trace or small in 18 patients (94.7%). Development of a new pleural effusion was associated with attenuated survival in unadjusted survival analysis (HR: 3.80; 95% CI: 1.55–9.31), multivariate analysis (HR: 5.13; 95% CI: 1.86–14.16), and after the multivariate model was adjusted for concomitant pericardial effusion (HR: 4.86; 95% CI: 1.51–15.71). Negative impact on survival remained unchanged when effusions more likely related to an alternative cause were removed from analysis. In conclusion, pleural effusions can complicate pulmonary arterial hypertension in the absence of left heart disease. These effusions are frequently small in size, bilateral in location, and their presence is associated with decreased survival. Attenuated survival appears independent of the risk associated with a new pericardial effusion.
Inspiratory flow patterns with dry powder inhalers of low and medium flow resistance in patients with pulmonary arterial hypertension
Authors: Faria‐Urbina Mariana , Ung Keith T. , Lawler Laurie , Zisman Lawrence S. , Waxman Aaron B.
Published: April 2021

Inhalation profiles to support use of dry powder inhalers for drug delivery in patients with pulmonary arterial hypertension have not been reported. We aimed to evaluate the inspiratory flow pattern associated with low and medium flow resistance dry powder inhaler devices (RS01‐L and RS01‐M, respectively) in patients with pulmonary arterial hypertension. This single‐center study enrolled patients with pulmonary arterial hypertension associated with connective tissue disease (n = 10) and idiopathic pulmonary arterial hypertension (n = 10) to measure the following inhalation parameters: inspiratory effort (kPa), peak inspiratory flow rate (L/min), inhaled volume (L), and flow increase rate (L/s2) using the two devices. We identified a trend toward higher mean pulmonary artery pressure in the idiopathic pulmonary arterial hypertension group (50 ± 13 mmHg vs. 40 ± 11 mmHg in pulmonary arterial hypertension associated with connective tissue disease; p = 0.077). On average, peak inspiratory flow rate was higher with RS01‐L vs. RS01‐M (84 ± 19.7 L/min vs. 70.4 ± 13.2 L/min; p = 0.015). In the overall group, no differences between RS01‐L and RS01‐M were observed for inhaled volume, inspiratory effort, or flow increase rate. Inhaled volume with RS01‐L was higher in pulmonary arterial hypertension associated with connective tissue disease vs. idiopathic pulmonary arterial hypertension patients: 1.6 ± 0.4 L vs. 1.3 ± 0.2 L; p = 0.042. For the RS01‐L, inhaled volume correlated with forced expiratory volume in one second (r = 0.460, p = 0.030) and forced vital capacity (r = 0.507, p = 0.015). In patients with pulmonary arterial hypertension associated with connective tissue disease using RS01‐L, both inspiratory effort and flow increase rate were highly correlated with pulmonary vascular compliance (r = 0.903, p = 0.0001 and r = 0.906, p = 0.0001; respectively); while with RS01‐M, inspiratory effort was highly correlated with pulmonary vascular compliance (r = 0.8, p = 0.001). Our data suggest that the use of RS01‐L and RS01‐M dry powder inhaler devices allowed adequate inspiratory flow in pulmonary arterial hypertension patients. The correlation between flow increase rate and pulmonary vascular compliance in pulmonary arterial hypertension associated with connective tissue disease deserves further investigation.
Study of clinical characteristics, risk factors and outcomes for tuberculosis post allogeneic stem cell transplant: never count it out
Authors: Kapoor Jyotsna , Mirgh Sumeet Prakash , Khushoo Vishvdeep , Mehta Pallavi , Ahmed Rayaz , Bansal Nitin , Bhurani Dinesh , Agrawal Narendra
Published: April 2021

Background:

Allogeneic stem cell transplant (AlloSCT) recipients remain at a higher risk of developing tuberculosis (TB), especially in endemic populations. We conducted a retrospective study to identify the incidence, clinical presentation, and risk factors for active TB among our alloSCT recipients.

Methods:

Records of all patients transplanted between 1 January 2012 and 31 July 2020 were reviewed. Patients were followed up for outcome until 30 September 2020. None of the patients received prophylactic anti-tubercular drugs. Proven diagnosis of active TB was considered if Mycobacterium tuberculosis (MTB) was cultured from clinical samples or acid-fast bacilli (AFB) or MTB demonstrated on Ziehl-Neelsen (ZN) staining or histopathology or XPERT MTB, while probable diagnosis of TB was considered if histopathology findings were suggestive of caseation necrosis/epithelioid cell granulomas without any evidence of malignancy or lymphocyte rich exudative effusions (pleural/pericardial) without an alternative cause.

Results:

Among 381 alloSCT recipients, 15 patients (3.9%) developed TB at median of 246 (74–279) days post AlloSCT, after being symptomatic for a median of 22 (7–60) days, amounting to a cumulative incidence of 4.9%. All patients were started on four-drug anti tubercular therapy, ATT [Rifampicin, Isoniazid, Ethambutol, Pyrazinamide (RHEZ)], of which five patients developed hepatotoxicity at a median of 12 days after start of ATT, leading to drug modification. At last follow up, TB was cured in 13 (86.67%) patients, one succumbed to disease relapse, while others are still on treatment. Age ⩾ 30 years, immunosuppression for graft versus host disease (GvHD) > 6 months, prior use of tyrosine kinase inhibitors (TKI) and chronic GvHD on univariate analysis and immunosuppression for GvHD > 6 months on multivariate analysis were found to be associated with development of TB.

Conclusion:

A high index of suspicion with timely workup and treatment of TB is the key in AlloSCT recipients, especially in endemic TB populations.
From friend to foe: Post-9/11 Pakistan–US relations; a realist perspective
Authors: Zaidi Syed Muhammad Saad , Ahmad Azhar
Published: April 2021

The relations between Pakistan and the United States, throughout the course of history, have witnessed many ups and downs. At times, when their interests were aligned, strong socio-economic and military cooperation was seen between the two states. Yet, on other occasions they were at odds with and distant from each other. However, post 9/11, Pakistan–US relations were at its zenith, when Pakistan became the frontline ally of the US in the war against terrorism in Afghanistan, and the US granted Pakistan the prestigious status of non-NATO ally. Soon after, though, the partnership between the two states was in troubled waters: when the US repeatedly violated Pakistan’s sovereignty through drone strikes and covert ops, it diplomatically painted Pakistan as the bad guy by claiming it to be part of the problem (terrorism), not the solution, and by promoting India within the region. Furthermore, when Pakistan became part of China’s New Silk Road initiative, commonly known as the Belt and Road Initiative, Pakistan–US relations saw its lowest point in history. This article critically analyzes post-9/11 Pakistan–US relations by application of two mainstream theories of international relations in tandem: Realism and (Neo)structural Realism. Realism explains the US foreign policy rationale, while Structural Realism explains Pakistan’s foreign policy choices in relation to the US.
Chidamide induces long-term remission in rare subcutaneous panniculitis-like T-cell lymphoma: An unusual case report and literature review
Authors: Li Liangliang , Wu Chongyang , Chai Ye , Dong Chi , Zhao Li
Published: April 2021

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare primary cutaneous lymphoma composed of CD8+ cytotoxic T-cell that is primarily localized in the subcutaneous tissue. No standard treatments are currently available for SPTCL due to its rarity. Chemotherapy, radiotherapy, immunosuppressive agents, and hematopoietic stem cell transplantation (HSCT) have been used frequently, however, the effects of these treatment approaches remain controversial. In this report, we present an unusual case of SPTCL in a 47-year-old woman whose initial symptoms were atypical. The patient was started on etoposide, vincristine, cyclophosphamide, doxorubicin, and prednisone (EPOCH) chemotherapy once diagnosed. After two cycles of chemotherapy, her clinical symptoms were not significantly improved. Subsequently, histone deacetylase (HDAC) inhibitor chidamide was added to the chemotherapy from the third cycle. She recovered gradually and achieved complete remission (CR) after four cycles of chemotherapy combined with chidamide, followed by chidamide monotherapy for maintenance. More than 1 year after the therapy, she remained in CR. Our case illustrates, for the first time, chidamide can be an effective agent to induce long-term remission for rare SPTCL.
Emotion work via digital visual communication: A comparative study between China and Japan
Authors: Wang Xinyuan , Haapio-Kirk Laura
Published: April 2021

Through the smartphone, the production and circulation of digital visual media have become as costless and accessible as audio and text-based communication. It would be challenging to be a contemporary ethnographer without engaging with digital practices which in Japan and China at least, tend towards being highly visual. Digital visual communication is recognised in literature as an effective and accessible form of communication, with an increasing number of studies in the field of digital anthropology, media studies and Internet studies exploring the consequences of digital images on social media. There is a pressing need to understand local forms of visual communication in the digital age, where the visual has become an essential part of daily communication. This article deals particularly with the rise of visual digital communication among older adults in China and Japan. Drawing on 16-month ethnographies conducted simultaneously between 2018 and 2019 in China and Japan, this article contributes to the discussion of visual communication in light of this semiotic shift happening online, which is then contextualised within people’s offline lives. The ethnographies in both China and Japan find that, first of all, visual communication via digital media enables more effective and efficient phatic communication and emotion work. In addition, the ethnographies point to a question about ‘authenticity’ in interpersonal communication. The ethnographies show that in some cases, the deployment of visual communication via the smartphone is not so much about being able to express ‘authentic’ personal feelings but rather, in being able to effectively establish a digital public façade according to social norms.
Feasibility of Colocating a Nutrition Education Program into a Medical Clinic Setting to Facilitate Pediatric Obesity Prevention
Authors: Shilts Mical K. , Diaz Rios L. Karina , Panarella Katherine H. , Styne Dennis M. , Lanoue Louise L. , Drake Christiana M. , Ontai Lenna , Townsend Marilyn S.
Published: April 2021

Purpose:

Within a medical clinic environment, pediatric obesity prevention education for families faces challenges. Existing long-term government-funded nutrition education programs have the expertise and staff to deliver. The purpose is to determine feasibility of colocating the Expanded Food and Nutrition Education Program (EFNEP) into a medical clinic setting to support pediatric obesity prevention.

Methods:

Physicians from a large university teaching and research hospital (n = 73) and 4 small Medicaid-serving community clinics (n = 18) in the same geographic area in northern California were recruited and trained in the patient-referral protocol for a primary prevention intervention provided by EFNEP. The 8-week intervention deployed in the medical clinics, included general nutrition, physical activity and parenting topics anchored with guided goal setting and motivational modeling. Referral, enrollment, and attendance data were collected for 2 years. Parent and physician feasibility surveys, parent interviews and parent risk assessment tools were administered. Paired-sample t-test analysis was conducted.

Results:

Twenty intervention series with parents of patients (n = 106) were conducted at 5 clinics. Physicians (n = 92) generated 686 referrals. Every 6 referrals generated 1 enrolled parent. Physicians (91%, n = 34) reported the intervention as useful to families. Parents (n = 82) reported improved child behaviors for sleep, screen time, physical activity, and food and beverage offerings ( P < .0001) and at family mealtime ( P < .001). Focus group interviews (n = 26) with 65 participants indicated that parents (97%) reacted positively to participating in the intervention with about a third indicating the classes were relevant to their needs.

Conclusion:

The intervention is a feasible strategy for the 5 medical clinics. Physicians referred and parents enrolled in the intervention with both physicians and parents indicating positive benefits. Feasibility is contingent upon physician awareness of the intervention and motivation to refer patients and additional EFNEP and clinic staff time to enroll and keep parents engaged.
Description of the Nature of Musculoskeletal Shoulder Injuries in a Cohort of Commercial Truck Drivers: A Retrospective Cross-Sectional Study
Authors: Combs Bryan , Fazeli Pariya L , Brown David A. , Gallagher Sean , Jones Allison , Romeo Bruce , Heaton Karen
Published: April 2021

Background:

Commercial truck drivers (CTDs) are significantly affected by shoulder injuries; however, little is known about the unique mechanisms of injury (MOIs), specific injuries, or possible preventive measures among this group of workers. This study characterized the MOIs, musculoskeletal disorders (MSDs), and factors associated with MSDs of the shoulder among a group of CTDs.

Methods:

A retrospective medical record review was conducted of CTDs between 21 and 65 years of age who were seen for MSDs of the shoulder between 2007 and 2015.

Results:

A total of 130 CTDs were included, who were aged 21 to 65 years. Commercial truck drivers were most often injured during a fall (35%) or while using chains, tarps, or straps (31%). The two most common MSDs were unspecified sprains/strains (58%) and rotator cuff tears (24%). Age was found to be associated with all MSDs ( p = .001) and an increased risk of developing rotator cuff tears ( p =.005). Seventy-four percent of CTDs who experienced a rotator cuff tear were 46 years of age or older.

Conclusion/Application to Practice:

This study highlights the course of the injury in terms of diagnostics such as magnetic resonance imaging (MRI) and referral for surgery and describes the occupational activities associated with CTDs. These findings can inform employer injury prevention programs, patient and health care provider education, and future interventional research.
Free Food at Work: A Concept Analysis
Authors: Horton Dias Cynthia , Dawson Robin M. , Abshire Demetrius A. , Harris Diane , Wirth Michael D.
Published: April 2021

Background:

Employees who spend substantial amounts of time in a workplace away from home are likely to acquire and consume food during work hours. Reportedly, free food at work is a common occurrence in various workplace settings such as business offices and hospitals. Little is known about the nutritional quality, prevalence, or health impact of free food at work. Furthermore, free food at work as a theoretical concept has not been previously analyzed or defined, but it is necessary to differentiate free food from other food sources in the workplace.

Methods:

A concept analysis of free food at work was conducted using the 8-step Walker and Avant framework. A literature review in June and July 2020 provided the basis to delineate the concept and identify its defining attributes including antecedents, consequences, and empirical referents.

Findings:

Free food at work is defined as food that is available for consumption in the workplace at no financial cost to employees. Critical attributes of free food at work include nutritional value, quantity, frequency, and location within the workplace. Antecedents are sources and reasons for free food provision. Consequences include influence on consumption, behaviors, attitudes, emotions, and health outcomes. Additional measurable aspects of the concept and implications are discussed.

Conclusion/Application to Professional Practice:

The concept of free food at work was analyzed; defining attributes and empirical referents were discussed and presented in a conceptual model to encourage further study and theory development. Identifying the health impact of free food at work is an issue requiring consideration for workplace health-promoting programs.
An Effective Surgical Method for Terminal Syringomyelia: Terminal Ventriculostomy-Associated “V”-Type Ostomy
Authors: Sun Mengchun , Tao Benzhang , Gao Gan , Li Shiqiang , Li Teng , Shang Aijia
Published: April 2021

Study Design:

Retrospective cohort study.

Objectives:

We aimed to evaluate the effectiveness of terminal ventriculostomy in treating tethered cord syndrome (TCS) combined with terminal syringomyelia (TS) and describe “V”-type ostomy as an effective surgical method to avoid relapsing syringomyelia based on terminal ventriculostomy.

Methods:

We retrospectively analyzed the clinical and radiological data of 28 patients admitted to the Department of Neurosurgery, PLA General Hospital who had been diagnosed with TCS combined with TS and underwent terminal ventriculostomy-associated “V”-type ostomy between January 2011 and January 2016. We classified patients’ clinical outcomes into 4 levels according to the Spinal Bifida Neurological Scale: markedly improved, improved, stable, and deteriorated. The size of the syrinx cavity was quantified using the syrinx index, and there was a difference in syrinx cavity size between pre-operation and post-operation.

Results:

Twenty-eight patients were followed up for 36 months. We found that each syrinx cavity shrunk by at least 50%. More than 90% of patients had achieved “markedly improved” and “improved” outcomes during the follow-up visit. Moreover, no patient relapsed for up to 36 months post-surgery.

Conclusion:

Terminal ventriculostomy has a beneficial effect on TS, particularly on the syrinx cavity extending to the filum terminale. For this special cavity, we advocate the use of terminal ventriculostomy-associated “V”-type ostomy to avoid potential relapse. As a safe, convenient, and persistently effective approach, terminal ventriculostomy-associated “V”-type ostomy can be considered a promising alternative method for treating TCS combined with TS in clinical practice.
Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRI of Children and Adolescents With Patellofemoral Instability: Data From the JUPITER Cohort
Authors: Fabricant Peter D. , Heath Madison R. , Veerkamp Matthew , Gruber Simone , Green Daniel W. , Strickland Sabrina M. , Wall Eric J. , Mintz Douglas N. , Emery Kathleen H. ,   JUPITER Study Group, Brady Jacqueline M. , Ellis Henry B. , Farr Jack , Heyworth Benton E. , Koh Jason L. , Kramer Dennis , Magnussen Robert A. , Redler Lauren H. , Sherman Seth L. , Tompkins Marc , Wilson Philip L. , Shubin Stein Beth E. , Parikh Shital N.
Published: April 2021

Background:

Surgical decision making and preoperative planning for children and adolescents with patellofemoral instability rely heavily on a patient’s skeletal maturity. To be clinically useful, radiologic assessments of skeletal maturity must demonstrate acceptable interrater reliability and accuracy.

Purpose:

The purpose of this study was to examine the interrater reliability among surgeons of varying experience levels and specialty training backgrounds when evaluating the skeletal maturity of the distal femur and proximal tibia of children and adolescents with patellofemoral instability.

Study Design:

Cohort study (diagnosis); Level of evidence, 3.

Methods:

Six fellowship-trained orthopaedic surgeons (3 pediatric orthopaedic, 2 sports medicine, and 1 with both) who perform a high volume of patellofemoral instability surgery examined 20 blinded knee radiographs and magnetic resonance images in random order. They assessed these images for clinically relevant growth (open physis) or clinically insignificant growth (closing/closed physis) remaining in the distal femoral and proximal tibial physes. Fleiss’ kappa was calculated for each measurement. After initial ratings, raters discussed consensus methods to improve reliability and assessed the images again to determine if training and new criteria improved interrater reliability.

Results:

Reliability for initial assessments of distal femoral and proximal tibial physeal patency was poor (kappa range, 0.01-0.58). After consensus building, all assessments demonstrated almost-perfect interrater reliability (kappa, 0.99 for all measurements).

Conclusion:

Surgical decision making and preoperative planning for children and adolescents with patellofemoral instability rely heavily on radiologic assessment of skeletal maturity. This study found that initial interrater reliability of physeal patency and clinical decision making was unacceptably low. However, with the addition of new criteria, a consensus-building process, and training, these variables became highly reliable.
Acquired Brain Injuries and Intimate Partner Violence: A Situational Analysis of Help Seeking Barriers in Rural Northern New England
Authors: St Ivany Amanda , Schminkey Donna L. , Munro-Kramer Michelle L.
Published: April 2021

Nurses care for women experiencing non-fatal strangulation and acquired brain injuries whether or not it is disclosed. Situational analysis was used to analyze 23 interviews from Northern New England with survivors, healthcare workers, and violence/legal advocates to explore overlapping relationships between violence, acquired brain injuries, non-fatal strangulation, and seeking care. Findings included the concepts of paying social consequences and the normalization of violence. Non-fatal strangulation was described as increasingly related to violence and other areas. Repetitive acquired brain injuries can impair functioning needed to address violence and healthcare providers and advocates are generally unaware of the impact of acquired brain injuries. A lack of resources, training, and tools for acquired brain injury screening were barriers in recognizing and responding to it, causing hidden symptoms. This study adds to the literature examining intimate partner violence in rural areas; specifically intimate partner violence-related acquired brain injuries in rural areas.