bluuebunny/crossref_metadata_2025 huggingface dataset:
Pregnancy in patients with systemic lupus erythematosus after cyclophosphamide therapy
Authors: Sen Mitali , Kurl Anu , Khosroshahi Arezou
Published: June 2021

Systemic lupus erythematosus (SLE) often affects females of reproductive age and Cyclophosphamide, an alkylating agent leading to premature ovarian insufficiency (POF) and labelled category D for pregnancy is used as induction therapy for severe manifestations of lupus. There have been multiple case series reflecting variable outcomes of pregnancies after cyclophosphamide use for cancers and autoimmune diseases. With increasing maternal age, we have an increasing population of lupus patients who may wish to conceive after having received cyclophosphamide therapy. The objective of our study was to improve our understanding of the impact of cyclophosphamide exposure on fertility and pregnancy outcomes in patients with SLE.

We retrospectively reviewed the charts of all patients who had received intravenous cyclophosphamide at our academic institute in the time period from 2000–2018 and identified 440 patients which included 157 female patients of reproductive age. There were 37 documented pregnancies after the cyclophosphamide infusion, of which 23 patients had successful outcomes; 4 elective abortion and 10 miscarriages. There were 17 patients who developed POF, of which 7 also had end stage renal disease. The average cumulative dose of cyclophosphamide in the patients who had successful pregnancy was 4080.37 mg compared to 2806.25 mg in those who had a miscarriage (p 0.164) and 5526.47 mg in those who developed POF (p 0.046). Using multiple regressions to evaluate risk factors impacting pregnancy outcomes, when taken as a set, the predictors including race, serological profile, exposure to steroids and Mycophenolate mofetil, age at cyclophosphamide infusion, age at pregnancy, and cumulative cyclophosphamide dose accounted for 46.29% of the variance in outcome of pregnancy (p 0.23) and 39.58% of the variance in development of premature ovarian failure (p 0.008). We noted statistical significance in the impact of maternal age at time of pregnancy (p 0.04) and duration of time between the last infusions to subsequent pregnancy (p 0.02) to pregnancy outcome.

Our findings suggest that a longer time interval between the last cyclophosphamide infusion and subsequent pregnancy was favorable for a successful outcome and higher cumulative cyclophosphamide dose is more likely to be associated with premature ovarian failure.
Risk of osteonecrosis in systemic lupus erythematosus: An 11-year Chinese single-center cohort study
Authors: Long Yin , Zhang Shangzhu , Zhao Jiuliang , You Hanxiao , Zhang Li , Li Jing , Leng Xiaomei , Wang Qian , Tian Xinping , Li Mengtao , Zeng Xiaofeng
Published: June 2021

Objective

Osteonecrosis (ON), which can lead to physical disability, is a common complication of systemic lupus erythematosus (SLE). The purpose of this study was to determine the prevalence of ON and identify possible risk factors in Chinese SLE patients.

Methods

SLE patients who fulfilled the 1997 American College of Rheumatology SLE classification criteria were recruited from the Peking Union Medical College Hospital. The chi-square test (χ 2 test) and multivariate regression analyses were used to evaluate risk factors. The Cox proportional-hazards model was used to construct the survival curves and estimate the simultaneous effects of prognostic factors on survival.

Results

We consecutively enrolled 1,158 patients, of which 88 patients (7.6%) developed ON. Among ON patients, 57.1% of patients had isolated femoral head necrosis and 42.9% had multiple joint involvement. The mean age of ON patients (24.62 ± 8.89 years) was significantly younger than SLE patients without ON (27.23 ± 10.16 years, p = 0.09). The ON group presented with a much longer disease course (10.68 ± 5.97 years, p < 0.001) and increased incidence of arthritis, kidney, and central nervous system (CNS) involvement (65.9% [ p < 0.05], 57.6% [ p < 0.05], and 16.5% [ p < 0.05], respectively, in the ON group). ON patients were more likely to be treated with glucocorticoid (GC) and to receive a high dose of prednisolone at the initial stage of SLE ( p < 0.05). The percentage of patients who received hydroxychloroquine was much higher in the control group ( p < 0.001). Cox regression analysis suggested that CNS involvement and GC therapy were two independent risk factors for ON in SLE patients. The presence of anti-phospholipid antibodies (aPLs) was a risk factor for multiple joint necrosis (odds ratio: 6.28, p = 0.009).

Conclusions

ON remains a serious and irreversible complication in SLE. In addition to glucocorticoid therapy, we found that CNS system involvement was a risk factor for ON, while the administration of hydroxychloroquine was a protective factor. The clinical characteristics of multiple site ON patients were distinct from isolated femoral head necrosis patients. The presence of aPLs was a risk factor for multiple site osteonecrosis.
Once again—never before—too late: Competing modalities of temporal comparison in German politics (1790–1945)
Authors: Steinmetz Willibald
Published: June 2021

Comparisons across historical times can appear in various shapes. Apart from simple then/now contrasts, three basic modalities may be distinguished: (1) Comparisons that stress similarity and repeatability (“once again”), (2) comparisons that claim absolute novelty, if not incommensurability between present and past (“never before”), and (3) comparisons that suggest a time lag between two entities which, although synchronous in calendar time, appear nonsynchronous in other respects (“too late”/“not yet”/“far ahead”). Relying on a broad range of comparison-performing utterances by leading politicians and observers, this article will assess the conjunctures of those three modalities of temporal comparison in 19th- and 20th-century German politics. Prima facie, one might expect an increase in the use of novelty claims (“never before”) and comparisons of the “too late”-type in that period of frequent upheavals. By contrast, the “once again”-variant should be declining because it builds on the historia magistra vitae topos which, according to Reinhart Koselleck, was dissolved in the post-1789 age of revolution. However, there is abundant evidence to show that historical examples and analogies continued to play a significant role all through the 19th and 20th centuries, whereas allegations of absolute novelty or of being too late remained limited to situations of imminent crisis. Even though the examples presented in this article refer to Germany’s special case, it will be argued that the pattern is typical for Western modernity at large: Modern political rhetoric and action are characterized not by one dominant regime, but a copresence of all three—competing—modalities of temporal comparison.
Congenital Methemoglobinemia in Neonate—An Easily Missed Cause of Cyanosis
Authors: Guntupalli Vamsi Krishna , Bhoojata Gondi , Paturi Venkata RamaRao
Published: June 2021

Congenital methemoglobinemia is a rare diagnosis. Due to its rare occurrence in the neonatal period, its incidence is sporadically reported. Cyanosis in newborn is a common finding in day-to-day practice. It often points to either cardiac or respiratory problems. Congenital methemoglobinemia in newborn period is rare. If occurred, it is associated with severe disease. This case report highlights the importance of considering methemoglobinemia even in a newborn. The interesting feature of this case is that though the methemoglobin levels were only mildly deranged, the baby was significantly cyanosed and needed treatment from birth.
Constitutionally entrenched Voice to Parliament: Representation and good governance
Authors: Larkin Dani , Galloway Kate
Published: June 2021

In 2017, the Uluru Statement from the Heart provided a consensus position on constitutional reform derived from Regional Dialogues drawing on experiences, views and aspirations of First Nations people. Among its recommendations is a constitutionally entrenched Voice to Parliament. While the government supports a watered-down Voice, this article identifies the key features of constitutional enshrinement that would enhance Australia’s institutions of governance. It focuses on its capacity for representation and its contribution to good governance and articulates the imperative for Voice to be an institution under the Australian Constitution, outlining the risks of settling for a legislated body alone.
Modified Lapidus vs Scarf Osteotomy Outcomes for Treatment of Hallux Valgus Deformity
Authors: Reilly Megan E. , Conti Matthew S. , Day Jonathan , MacMahon Aoife , Chrea Bopha , Caolo Kristin C. , Williams Nicholas , Drakos Mark C. , Ellis Scott J.
Published: June 2021

Background:

The Lapidus procedure and scarf osteotomy are indicated for the operative treatment of hallux valgus; however, no prior studies have compared outcomes between the procedures. The aim of this study was to compare clinical and radiographic outcomes between patients with symptomatic hallux valgus treated with the modified Lapidus procedure versus scarf osteotomy.

Methods:

This retrospective cohort study included patients treated by 1 of 7 fellowship-trained foot and ankle surgeons. Inclusion criteria were age older than 18 years, primary modified Lapidus procedure or scarf osteotomy for hallux valgus, minimum 1-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and minimum 3-month postoperative radiographs. Revision cases were excluded. Clinical outcomes were assessed using 6 PROMIS domains. Pre- and postoperative radiographic parameters were measured on anteroposterior (AP) and lateral weightbearing radiographs. Statistical analysis utilized targeted minimum-loss estimation (TMLE) to control for confounders.

Results:

A total of 136 patients (73 Lapidus, 63 scarf) with an average of 17.8 months of follow-up were included in this study. There was significant improvement in PROMIS physical function scores in the modified Lapidus (mean change, 5.25; P < .01) and scarf osteotomy (mean change, 5.50; P < .01) cohorts, with no significant differences between the 2 groups ( P = .85). After controlling for bunion severity, the probability of having a normal postoperative intermetatarsal angle (IMA; <9 degrees) was 25% lower ( P = .04) with the scarf osteotomy compared with the Lapidus procedure.

Conclusion:

Although the modified Lapidus procedure led to a higher probability of achieving a normal IMA, both procedures yielded similar improvements in 1-year patient-reported outcome measures.

Level of Evidence:

Level III, retrospective cohort.
Quantifying Proximal Collecting Tubule Deficiency in Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Fetopathy
Authors: Saunders Jessica , Callejas Salgado Allison Marie , Ting Joseph Y , Mammen Cherry , Terry Jefferson , Bush Jonathan W
Published: June 2021

Introduction

Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers (AAs) are used for several indications, with cessation recommended in pregnancy due to toxic effects. AA fetopathy phenotype is similar to renal tubular dysgenesis including reduced proximal convoluted tubules (PCTs). Our study aimed to quantify the reduction of PCTs in fetuses and infants with prenatal exposure to AAs.

Materials and methods

We identified 5 fetal AA exposure cases that underwent autopsy at our institution between 2011 and 2018 and compared with 5 gestational age-matched controls. Immunohistochemistry with CD10 and epithelial membrane antigen (EMA) was utilized.

Results

CD10 and EMA identified a median PCT density of 19.0% ± 12.3% in AA fetopathy patients, significantly less than controls (52.8% ± 4.4%; p < 0.0001). One case with in utero cessation had a PCT density of 34.2% ± 0.2%. Among other AA fetopathy findings, 1 case demonstrated unilateral renal vein thrombosis and 4 had hypocalvaria.

Conclusions

We have quantified the reduction in AA fetopathy PCT density, and demonstrated in utero cessation may recover PCT differentiation. Future studies may benefit from calculating PCT percentage as a potential biomarker to correlate with post-natal renal function and maternal factors including medication type, dosage, duration, and time from medication cessation.
Massive Perivillous Fibrin Deposition and Chronic Histiocytic Intervillositis a Complication of SARS-CoV-2 Infection
Authors: Marton T , Hargitai B , Hunter K , Pugh M , Murray P
Published: June 2021

An emerging complication of COVID-19 (SARS-CoV-2) infection is reported. A 23-year-old patient presented with high temperature and reduced fetal movements at 25 + 5/40 weeks of gestation. RT-PCR proved maternal COVID-19 infection. Ultrasound examination confirmed intrauterine death. Placenta histology showed necrosis of the villous trophoblast, associated with Chronic Histiocytic Intervillositis (CHI) and Massive Perivillous Fibrin Deposition (MPFD) with up to 90% - of the intervillous spaces being involved. Immunohistochemistry showed CD68 positive histiocytes in the intervillous spaces and the villous trophoblast was positive for the COVID-19 spike protein. RNA scope signal was indicative of the presence of the viral genome and active viral replication in the villous trophoblastic cells, respectively. MPFD is a gradually developing end-stage disease with various etiology, including autoimmune and alloimmune maternal response to antigens expressed at the feto-maternal interface and frequently accompanies chronic alloimmune villitis or histiocytic intervillositis. Covid-19 infection is associated with similar pattern of histological changes of the placenta leading to placental insufficiency and fetal death. This case report supports maternal- fetal vertical transmission of SARS-CoV-2 virus leading to placental insufficiency and fetal demise. MPFD and CHI appear to be the typical placental histology for SARS-CoV-2 virus infection associated fetal demise.
Effect of Methylprednisolone on Inflammation and Coagulation in Patients with Severe COVID-19: A Retrospective Cohort Study
Authors: Tromp Katja , van der Zee Philip , Rokx Casper , van Kampen Jeroen , Gommers Diederik , Endeman Henrik
Published: June 2021

Corticosteroids reduced mortality rate in patients with coronavirus disease 2019 (COVID-19). Previously, we hypothesized that corticosteroids mitigate the inflammation response resulting in reduced coagulation and thrombosis. In this retrospective study, we included 27 patients with COVID-19 that received high-dose corticosteroids (methylprednisolone 1000 mg i.v. daily for 3 days) for persistent respiratory failure or an excessive inflammation response. We found that inflammation, coagulation, and ventilation parameters improved significantly after methylprednisolone. The viral loads of SARS-CoV-2 remained stable or decreased. These results provides insight into the reduced mortality rate observed in patients with COVID-19 treated with corticosteroids.
A parameter design method for multifrequency perfect sound-absorbing metasurface with critical coupled Helmholtz resonator
Authors: Wei Sun , Li Li , Zhigang Chu , Linyong Li , Xiaopeng Fan
Published: June 2021

The low-frequency harmonic components of urban substation noise are easy to annoy the residents. Multi-frequency perfect sound-absorbing metasurface based on the Helmholtz resonator (HR) is an alternative solution to suppress the low-frequency harmonic noise. This paper proposes an efficient design method of structural parameter for the multi-frequency perfect sound-absorbing metasurface. Taking the perfect sound absorption at the target frequency as objective and the structural parameters of HR as optimization variables, the structural parameter optimization model of multi-frequency perfect sound-absorbing metasurface is established and solved by the sequential quadratic programming algorithm. The proposed design method effectively overcomes the deterioration of sound absorption performance caused by the combined design of multiple perfect sound absorption units. Utilizing the proposed method, we designed a multi-frequency perfect sound-absorbing metasurface to absorb the four harmonic components of an urban substation noise simultaneously. The finite element simulation results and the experimental results of the physical sample indicate that the designed multi-frequency perfect sound-absorbing metasurface can satisfy critical coupling to achieve perfect sound absorption at all target frequencies.
Controlling academics: Power and resistance in the archipelago of post-COVID-19 audit regimes
Authors: Welsh John
Published: June 2021

Government response to the ongoing COVID-19 pandemic promises to entrench austerity politics deeper into the organization of academic life, and audit regimes are the likely means of achieving this. Redoubled efforts to understand the operation of audit as a strategic technology of control are therefore clearly a priority. A distinctly anthropological literature has emerged over recent years to analyse and understand audit culture in academia, but what seems to be missing are analyses capable of bringing the disparate techniques experienced in academic audit together into coherent technologies, and identifying how these technologies thereby constitute a distinct audit regime within the broader audit culture. While the anthropological literature implicitly calls for further historical and conceptual exploration of the rationality to these techniques, what is required is the translation of our understanding of audit rationality into a presentation of the concrete techniques of control as they are experienced, so that more effective counter-conducts and resistances can be conceived. This article indicates how an excursion into the Soviet Gulag, and the political technology of the ‘camp’ that is its principal apparatus, can reveal not merely how the techniques of audit operate, but also indicate how those techniques might be engaged tactically in the academic setting. This kind of analogic analysis can allow us to understand audit in ways more promising for resistance to its idiomatic power, replacing demoralized and helpless resignation with inspirational exempla. Politically, the article argues that ‘techniques of the self’ are not only necessary to engage audit techniques through particular kinds of counter-conduct, but how these counter-conducts are contributory to the organized and concerted kind of resistance that we so desperately desire. The practice of tukhta is singled out and introduced as an illustrative means for combining survival strategies with the development of critical rationality in praxis.
Experiences of secure transport in outdoor behavioral healthcare: A narrative inquiry
Authors: Dobud Will W
Published: June 2021

Often synonymous with wilderness therapy, outdoor behavioral healthcare (OBH) is a residential treatment in the United States for young people, more than half of whom are sent via secure transport services. While empirical evidence suggests the secure transport of adolescents to OBH does not impact quantitative outcomes, limited research exists exploring client voice and the lived experience of OBH participants. This qualitative study, utilizing narrative inquiry, builds knowledge on experiences of secure transport services from nine past OBH adolescent participants. Findings are analyzed, interpreted, and discussed through a social work and trauma-informed lens. Recommendations for ethical practice, linking with human rights, and future research are provided.
Pilot design for underwater MIMO cosparse channel estimation based on compressed sensing
Authors: Li Yun , Liao Lingxia , Sun Shanlin , Tan Zhicheng , Yao Xing
Published: June 2021

In multiple-input multiple-output–orthogonal frequency-division multiplexing underwater acoustic communication systems, the correlation of the sampling matrix is the key of the channel estimation algorithm based on compressed sensing. To reduce the cross-correlation of the sampling matrix and improve the channel estimation performance, a pilot design algorithm for co-sparse channel estimation based on compressed sensing is proposed in this article. Based on the time-domain correlation of the channel, the channel estimation is modeled as a common sparse signal reconstruction problem. When replacing each pilot indices position, the algorithm selects multiple pilot indices with the least cross-correlation from the alternative positions to replace the current pilot indices position, and it uses the inner and outer two-layer loops to realize the bit-by-bit optimal replacement of the pilot. The simulation results show that the channel estimation mean squared error of pilot design algorithm for co-sparse channel estimation based on compressed sensing can be reduced by approximately 18 dB compared with the least square algorithm. Compared with the genetic algorithm and search space size methods, the structural sequence search proposed by pilot design algorithm for co-sparse channel estimation based on compressed sensing is used to design the pilot to complete the channel estimation. Thus, the mean squared error of the channel estimation can be reduced by 2 dB. At the same bit error rate of 0.03, the signal-to-noise ratio can be decreased by approximately 7 dB.
Adaptive coverage control for multi-USV system in complex environment with unknown obstacles
Authors: Yao Yao , Cao Jun-Hua , Guo Yi , Fan Zhun , Li Bing , Xu Biao , Li Ke
Published: June 2021

Aiming at the shortcomings of the existing control law based on the global information, this article studies the coverage problem of a given region in the plane using a team of USVs. The coverage goal, which is to cover a given search domain using multiple mobile sensors so that each point is surveyed until a certain preset level is achieved, is formulated in a mathematically precise problem statement. The adaptive control law is presented which enables multi-USV to navigate in a complex environment in the presence of unknown obstacles and guarantees that a fully connected multi-USV system attains the coverage goal. In particular, the dangerous area was divided into two different parts in order to enhance the searching efficiency. Finally, simulation results are presented to validate the feasibility and efficiency of the proposed approach.
Unassisted and multiple microcatheter coiling of distal basilar aneurysms: Outcomes and literature review
Authors: Zaitoun Mohamed MA , Malky Islam El , Winklhofer Sebastian , Valavanis Anton , Baltsavias Gerasimos
Published: June 2021

Purpose

The best treatment for distal basilar artery aneurysms is controversial. We aimed to review our single-centre experience with coil embolisation of aneurysms at this location and compare it with the surgical and endovascular literature.

Methods

Forty-two aneurysms in a distal basilar location in 42 consecutive patients (15 ruptured and 27 unruptured) were treated endovascularly from 2010 to 2015. Unassisted single and multiple microcatheter coil embolisation alone was used in all cases. We studied our immediate and long-term anatomical results, operative complications, and outcome.

Results

The immediate angiographic results showed complete occlusion in 34 (81%), a neck remnant in seven (16.6%) and a residual aneurysm in one patient (2.4%). There were two thromboembolic events (4.7%) without clinical sequelae; therefore, the operative morbidity and mortality were zero. Three patients with ruptured aneurysms (7.1%) died due to complicated vasospasm. Thirty-nine patients (93%) had clinical and MR imaging follow-up (mean 32.3 months ± 18.6, range from 12 to 66 months). There was recanalization in 30.8% with a retreatment rate of 15.3% and no new bleedings. The aneurysm size was the most important predictor of early anatomical outcome and recurrence.

Conclusion

Unassisted and multiple microcatheter coiling is a safe treatment for distal basilar aneurysms. Early anatomical results and recurrence depend on the aneurysm size. Morbidity and mortality are lower and recurrence rates are higher in comparison with clipping or other adjunctive endovascular techniques.
Inhibition of calcium-stimulated adenylyl cyclase subtype 1 (AC1) for the treatment of neuropathic and inflammatory pain in adult female mice
Authors: Zhou Zhaoxiang , Shi Wantong , Fan Kexin , Xue Man , Zhou Sibo , Chen Qi-Yu , Lu Jing-Shan , Li Xu-Hui , Zhuo Min
Published: June 2021

Cortical long-term potentiation (LTP) serves as a cellular model for chronic pain. As an important subtype of adenylyl cyclases (ACs), adenylyl cyclase subtype 1 (AC1) is critical for the induction of cortical LTP in the anterior cingulate cortex (ACC). Genetic deletion of AC1 or pharmacological inhibition of AC1 blocked behavioral allodynia in animal models of neuropathic and inflammatory pain. Our previous experiments have identified a lead candidate AC1 inhibitor, NB001, which is highly selective for AC1 over other AC isoforms, and found that NB001 is effective in inhibiting behavioral allodynia in animal models of chronic neuropathic and inflammatory pain. However, previous experiments were carried out in adult male animals. Considering the potential gender difference as an important issue in researches of pain and analgesia, we investigated the effect of NB001 in female chronic pain animal models. We found that NB001, when administered orally, has an analgesic effect in female animal models of neuropathic and inflammatory pain without any observable side effect. Genetic deletion of AC1 also reduced allodynia responses in models of neuropathic pain and chronic inflammation pain in adult female mice. In brain slices of adult female mice, bath application of NB001(20 μM) blocked the induction of LTP in ACC. Our results indicate that calcium-stimulated AC1 is required for injury-related cortical LTP and behavioral allodynia in both sexes of adult animals, and NB001 can be used as a potential therapeutic drug for treating neuropathic and inflammatory pain in man and woman.
Bored, distracted, and forgetful: The impact of mind wandering and boredom on memory encoding
Authors: Blondé Philippe , Sperduti Marco , Makowski Dominique , Piolino Pascale
Published: June 2021

Mind wandering, defined as focusing attention towards task-unrelated thoughts, is a common mental state known to impair memory encoding. This phenomenon is closely linked to boredom. Very few studies, however, have tested the potential impact of boredom on memory encoding. Thus, the present study aimed at manipulating mind wandering and boredom during an incidental memory encoding task, to test their differential impact on memory encoding. Thirty-two participants performed a variant of the n-back task in which they had to indicate if the current on-screen object was the same as the previous one (1-back; low working memory load) or the one presented three trials before (3-back; high working memory load). Moreover, thought probes assessing either mind wandering or boredom were randomly presented. Afterwards, a surprise recognition task was delivered. Results showed that mind wandering and boredom were highly correlated, and both decreased in the high working memory load condition, while memory performance increased. Although both boredom and mind wandering predicted memory performance taken separately, we found that mind wandering was the only reliable predictor of memory performance when controlling for boredom and working memory load. Model comparisons also revealed that a model with boredom only was outperformed by a model with mind wandering only and a model with both mind wandering and boredom, suggesting that the predictive contribution of boredom in the complete model is minimal. The present results confirm the high correlation between mind wandering and boredom and suggest that the hindering effect of boredom on memory is subordinate to the effect of mind wandering.
Scaling up a National Extracorporeal Membrane Oxygenation Referral Service for adult patients in acute severe respiratory failure at the time of a pandemic
Authors: Jooste Rachel , Rowan Kathryn M , Symes Nicola , Vuylsteke Alain
Published: June 2021

The National ECMO Service for patients in acute severe respiratory failure in England responded to the challenge of the coronavirus pandemic by implementing a central electronic referral system within days. Prior to this, each ECMO centre managed independently around 20 ECMO referrals per month. Early during the pandemic, we recognised the need for a referral system to co-ordinate the anticipated increased number of referrals. We implemented rapidly a referral system with universal access across England. This allowed the five National ECMO centres to manage over 1000 referrals in the first seven weeks of the pandemic. Key benefits of the new system included facilitated communication and collaboration between centres; data on demand; and capacity shared in real-time. We believe this was instrumental in allowing us to continue to provide for the whole country, respond at scale, and facilitate our collaborative work as a multidisciplinary team.
Influence of Feet Position and Execution Velocity on Muscle Activation and Kinematic Parameters During the Inclined Leg Press Exercise
Authors: Martín-Fuentes Isabel , Oliva-Lozano José M. , Muyor José M.
Published: June 2021

Background:

The leg press is one of the most typical exercises for strengthening the lower limbs. The objectives of this study were to compare 5 inclined leg press exercise conditions, varying the feet width stance (100% or 150% hip width), the feet rotation (0° or 45° external rotation) on the footplate and using 2 different movement velocities (MVs; maximum intended, and 2:2 seconds steady-paced velocities) to determine their effect on muscle activation as well as on the kinematic parameters between trained men and trained women.

Hypotheses:

There will be no significant differences in muscle activation with regard to the feet position. The higher the MV, the greater the muscle activation.

Study Design:

A cross-sectional cohort study.

Level of Evidence:

Level 3.

Methods:

A repeated-measures between-group design was performed to examine muscle activation and kinematic parameters for the different conditions between gender groups. The level of significance was set at alpha = 0.05 for all statistical analyses.

Results:

Muscle activation presented no differences between conditions regarding feet width stance or feet rotation. Furthermore, muscle activation was greater during positive phases than negative phases of the exercise for all conditions and was also greater under maximum intended velocity conditions compared with steady-paced conditions. Otherwise, the muscle activation pattern presented slight differences by gender. In men, the greatest muscle activation was for the vastus medialis, followed by the vastus lateralis (VL), rectus femoris (RF), and gluteus medialis (GMED), while in women, the greatest muscle activation was for the vastus medialis, followed by the RF, VL, and GMED. Finally, greater mean propulsive velocity, maximum velocity, maximum power, and footplate displacement values were reported for men than for women under all the conditions.

Conclusion:

The inclined leg press exercise produces the highest muscle activation in the vastus medialis, regardless of the velocity, feet stance, or gender.

Clinical Relevance:

Given that there are no differences in muscle activation regarding the feet stance, a participant’s preferred feet stance should be encouraged during the inclined leg press exercise. Furthermore, the MV would preferably depend on the session objective (a training or a rehabilitation program), being aware that there is greater muscle activation at higher speeds. The inclined leg press exercise could be performed as a closed kinetic chain exercise when the main objective is to activate the vastus medialis.
Pulmonary embolism in chronic kidney disease and end-stage renal disease hospitalizations: Trends, outcomes, and predictors of mortality in the United States
Authors: Singh Jagmeet , Khadka Sushmita , Solanki Dhanshree , Kichloo Asim , Shah Harshil , Vyas Manasee J , Chugh Savneek , Patel Neil , Solanki Shantanu
Published: June 2021

Background:

It is well-known that patients with chronic kidney disease and end-stage renal disease are at increased risk of pulmonary embolism than patients with normal kidney function. However, the data on trends, outcomes, and predictors of mortality in pulmonary embolism patients with chronic kidney disease and end-stage renal disease in the United States are limited.

Methods:

We queried the National Inpatient Sample database from 2010 to 2014. International Classification of Diseases-Ninth Revision-Clinical Modification codes were used to identify patients with normal kidney function, chronic kidney disease, and end-stage renal disease. The frequency of pulmonary embolism, complications, in-hospital mortality, and length of stay were calculated for each cohort. Multivariable logistic regression models were constructed to determine the predictors of mortality.

Results:

In the study population (2010–2014), there were 766,176 pulmonary embolism hospitalizations with normal kidney function, 79,824 with chronic kidney disease, and 9147 with end-stage renal disease. Among the study cohorts, the mortality rate was 2.7% in normal kidney function, 4.5% in chronic kidney disease, and 6.8% in end-stage renal disease hospitalizations. Median length of stay was highest in the end-stage renal disease cohort and lowest in the normal kidney function cohort. After adjusting for confounders, pulmonary embolism patients with chronic kidney disease died 1.15 times more often than those with normal kidney function and pulmonary embolism patients with end-stage renal disease died 4.2 times more often than those with normal kidney function.

Conclusion:

The mortality rate and length of stay in pulmonary embolism patients with chronic kidney disease and end-stage renal disease were significantly higher than those in pulmonary embolism patients with normal kidney function. Also, pulmonary embolism patients with chronic kidney disease and end-stage renal disease were at higher risk of in-hospital mortality than those with normal kidney function. There was statistically significant higher risk of mortality in elderly and Black patients with pulmonary embolism and concurrent chronic kidney disease or end-stage renal disease.
Perspectives of older adults with chronic disease on the use of wearable technology and video games for physical activity
Authors: Simmich Joshua , Mandrusiak Allison , Russell Trevor , Smith Stuart , Hartley Nicole
Published: June 2021

Background

There is increasing interest in technology to deliver physical rehabilitation and allow clinicians to monitor progress. Examples include wearable activity trackers and active video games (AVGs), where physical activity is required to play the game. However, few studies have explored what may influence the effectiveness of these as technology-based physical activity interventions in older adults with chronic diseases.

Objective

This study aimed to explore: 1) perceptions about wearable physical activity trackers; 2) perceptions about using technology to share physical activity information with clinicians; 3) barriers and motivators to playing games, including AVGs for rehabilitation.

Methods

Qualitative study based on semi-structured interviews with older adults ( n = 19) with chronic obstructive pulmonary disease (COPD).

Results

Wearable activity trackers were perceived as useful to quantify activity, facilitate goal-setting, visualize long-term improvements and provide reminders. Participants generally wished to share data with their clinicians to gain greater accountability, receive useful feedback and improve the quality of clinical care. Participants were motivated to play games (including AVGs) by seeking fun, social interaction and health benefits. Some felt that AVGs were of no benefit or were too difficult. Competition was both a motivator and a barrier.

Conclusions

The findings of the present study seek to inform the design of technology to encourage physical activity in older adults with chronic diseases.
The Impact of Technology Perception and Government Support on E-Commerce Sales Behavior of Farmer Cooperatives: Evidence From Liaoning Province, China
Authors: Huang Yanan , Li Xu , Zhang Guangsheng
Published: June 2021

The sales-related difficulties faced by cooperatives can be solved by expanding their sales channels through e-commerce. However, extant studies have only examined cooperatives’ e-commerce sales behavior from either a technology perception or government support perspective. To fill this gap, based on survey data of 215 farmer cooperatives in Liaoning province, China, this study employs a probit model to analyze the impact of both technology perception and government support on these cooperatives’ e-commerce sales behavior, as well as their marginal and accelerating effects. Both factors were shown to have a significant positive impact. Technology perception has a greater impact on e-commerce sales behavior than government support, while perceived effectiveness has the most significant impact. This study also found that government support has an accelerating effect on the relationship between technology perception and farmer cooperatives’ e-commerce sales behavior. Therefore, governments should improve cooperative members’ technology perception to aid them in expanding sales.
Veterans Health Administration’s Whole Health System of Care: Supporting the Health, Well-Being, and Resiliency of Employees
Authors: Reddy Kavitha P , Schult Tamara M , Whitehead Alison M , Bokhour Barbara G
Published: June 2021

The Veterans Health Administration (VHA) is implementing a Whole Health System (WHS) of care that empowers and equips Veterans to take charge of their health and well-being and live their lives to the fullest, and increasingly leaders recognize the need and value in implementing a similar approach to support the health and well-being of employees. The purpose of this paper is to do the following: 1) provide an overview of the WHS of care in VHA and applicability in addressing employee resiliency; 2) provide a brief history of employee well-being efforts in VHA to date; 3) share new priorities from VHA leadership as they relate to Employee Whole Health strategy and implementation; and 4) provide a summary of the impacts of WHS of care delivery on employees. The WHS of care utilizes all therapeutic, evidence-based approaches to support self-care goals and personal health planning. Extending these approaches to employees builds upon 10 years of foundational work supporting employee health and well-being in VHA. In 2017, one facility in each of the 18 Veterans Integrated Service Networks (VISNs) in VHA was selected to participate in piloting the WHS of care with subsequent evaluation by VA’s Center for Evaluating Patient-Centered Care (EPCC). Early outcomes, from an employee perspective, suggest involvement in the delivery of the WHS of care and personal use of the whole health approach have a meaningful impact on the well-being of employees and how they experience the workplace. During the COVID-19 pandemic, VHA has continued to support employees through virtual resources to support well-being and resiliency. VHA's shift to this patient-centered model is supporting not only Veteran care but also employee health and well-being at a time when increased support is needed.
Efficacy of Intraoperative Platelet-Rich Plasma Augmentation and Postoperative Platelet-Rich Plasma Booster Injection for Rotator Cuff Healing: A Randomized Controlled Clinical Trial
Authors: Liu Bei , Jeong Hyeon Jang , Yeo Ji Hyun , Oh Joo Han
Published: June 2021

Background:

Platelet-rich plasma (PRP) has been applied as an adjuvant treatment for arthroscopic rotator cuff repair (ARCR) to enhance rotator cuff healing. However, it remains debatable whether PRP enhances tendon-to-bone healing.

Purpose:

To assess the efficacy of intraoperative augmentation and postoperative injection of PRP that was prepared using the double-spin method and calcium activation without thrombin in patients with ARCR.

Study Design:

Randomized controlled trial; Level of evidence, 1; and cohort study; Level of evidence, 3.

Methods:

A total of 58 patients underwent ARCR using intraoperative PRP augmentation. Half of the patients were randomly assigned to receive an additional ultrasound-guided PRP injection at the repair site at 2 weeks postoperatively (PRP-booster group); the other half did not receive the booster injection (PRP-only group). A control group that did not receive any PRP treatment was retrospectively matched using propensity score matching. Structural integrity was assessed using magnetic resonance imaging at 1 year postoperatively, and healing rates were compared between patients with tear sizes ≤2 cm versus >2 cm. Functional outcomes were assessed using the visual analog scale (VAS) for pain; VAS for satisfaction; shoulder range of motion; and Constant, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores at minimum 2-year follow-up.

Results:

In patients with tears >2 cm, the rate of healing failure at 1-year follow-up was significantly less in the overall PRP group than in the control group (12.9% vs 35.7%, respectively; P = .040), however, the PRP-booster group did not present a better healing rate than did the PRP-only group. The overall PRP group had lower VAS for pain scores compared with the control group (0.5 ± 1.1 vs 1.3 ± 1.8, respectively; P = .016) and higher VAS for satisfaction scores (9.2 ± 1.2 vs 8.6 ± 1.7; P = .023) at the final follow-up, whereas no statistical difference was found between the PRP-only and PRP-booster groups in functional outcomes.

Conclusion:

Intraoperative PRP augmentation during ARCR demonstrated superior anatomic healing results in patients with rotator cuff tears >2 cm as well as reduced pain and increased subjective satisfaction. PRP booster injection provided no additional benefit to tendon integrity or functional recovery.
Automatic delimitation of labour market areas based on multi-criteria optimisation: The case of Spain 2011
Authors: Martínez-Bernabéu Lucas , Casado-Díaz José Manuel
Published: June 2021

Labour market areas (LMAs) are a type of functional region (FR) defined on commuting flows and used in many countries to serve as the territorial reference for regional studies and policy making at local levels. Existing methods rely on manual adjustments of the results to ensure high quality, making them difficult to be monitored, hard to apply to different territories, and onerous to produce in terms of required work-hours. We propose an approach to automatise all stages of the delineation procedure and improve the final results, building upon a state-of-the-art stochastic search procedure that ensures optimal allocation of municipalities/counties to LMAs while keeping good global indicators: a pre-processing layer clusters adjoining municipalities with strong commuting flows to constrain the initial search space of the stochastic search, and a multi-criteria heuristic corrects common deficiencies that derive from global maximisation approaches or simple greedy heuristics. It produces high quality LMAs with optimal local characteristics. To demonstrate this methodology and assess the improvement achieved, we apply it to define LMAs in Spain based on the latest commuting data.
Assessing Pharmacists’ Views and Barriers to Providing and Billing for Pharmacist-Provided Health Care Services
Authors: Biddle Michael A. , Cleveland Kailyn K. , O’Connor Shanna K. , Hruza Hayli , Foster Madeline , Nguyen Elaine , Robinson Renee , Wadsworth Thomas
Published: June 2021

Background: The role of Idaho and Alaska pharmacists in providing health care services has steadily broadened over recent years. With many new pharmacist-provided health care service possibilities, this study assessed the impact of these advancements on community pharmacies. Objective: The objective of this study was to identify current pharmacist-provided health care services and pharmacist-perceived barriers to providing and billing for these services in Idaho and Alaska community pharmacies. Methods: A questionnaire was developed focusing on 2 areas: providing services and billing for services. Pharmacy students on experiential rotations administered the questionnaires to pharmacists at their rotation sites. Pharmacists at community pharmacy practice sites in Idaho and Alaska completed the questionnaire in an interview format conducted by students. Likert-type scale data were analyzed using descriptive statistics. Because the study did not include a comparator group, no power calculation was conducted. All open-response answers were analyzed independently by 2 researchers and discrepancies in coding open-ended questions were resolved by discussion with a group of 4 researchers. Results: Most pharmacists reported that they already provide non-dispensing services, desired to implement new services, and had confidence in their team’s ability to handle new services. Time and resources were the most cited barriers to providing new services; compensation, company support, and education were the most cited barriers to billing for services. Conclusions: Community pharmacists already provide non-dispensing services and many are looking to provide more services, but barriers of time, resources, compensation, company support, and education will need to be overcome to move forward.
The Technical Assistant Model: Efficiency in Maternal Fetal Medicine
Authors: Tepe Victoria , Knott Alexandrea
Published: June 2021

Objective:

To analyze how technical assistants benefit diagnostic medical sonography settings by improving efficiency and patient care.

Materials & Methods:

Credentialed obstetric sonographers who currently work in maternal fetal medicine were surveyed. Closed-ended and open-ended questions were used to examine effectiveness, usefulness, and overall satisfaction with the technical assistant position. In addition, quantitative methods were used to compare the time efficiency of technical assistants with medical assistants in obstetric settings.

Results:

The majority of sonographers and providers view technical assistants in a positive manner and indicated that the existence of the technical assistant role improved clinic flow. When compared with studies regarding medical assistant efficiency, this study showed shorter wait times for patients.

Conclusion:

The data supports that the presence of a technical assistant in clinic increases the overall efficiency of the clinic, which could allow providers to see more patients and reduce wait times for critical appointments. This could also lead to a more cost-effective system, especially when compared to alternative options such as hiring more providers or sonographers. These findings should encourage obstetric and gynecological sonography clinics to implement trained technical assistants to address clinic inefficiency, sonographer burnout, and sonographer and practitioner satisfaction.
The Role of Sonography in a Rare Case of Hepatic Artery Pseudoaneurysm: A Case Study Report
Authors: Chupka Nadia M. , Atwell Thomas D. , McPhail Ian R. , Hunt Talisha M.
Published: June 2021

Hepatic artery pseudoaneurysms (HAPs) are rare, life-threatening complications that arise in response to liver trauma or underlying inflammatory processes. The risk of rupture necessitates prompt diagnosis and treatment. Sonography is an important imaging modality used to evaluate and characterize suspected HAPs. In the case described below, sonography played an important role in the diagnosis and successful treatment of a patient with a large, high-risk HAP.