bluuebunny/crossref_metadata_2025 huggingface dataset:
Intervention by a clinical pharmacist carried out at discharge of elderly patients admitted to the internal medicine department: influence on readmissions and costs
Authors: Lázaro Cebas Andrea , Caro Teller José Manuel , García Muñoz Carmen , González Gómez Carlos , Ferrari Piquero José Miguel , Lumbreras Bermejo Carlos , Romero Garrido José Antonio , Benedí González Juana
Published: February 2022

Background

Patient education on pharmacological treatment could reduce readmissions. Our objective was to carry out a pharmacist intervention focused on providing information about high-risk medications to chronic patients and to analyse its influence on readmissions and costs.

Methods

A single-centre study with an intervention group and a retrospective control group was conducted. The intervention was carried out in all polymedicated patients ≥ 65 years who were admitted to internal medicine and signed the informed consent between June 2017 and February 2018. Patients discharged to nursing homes or long-term hospitals were excluded. The control group were all the patients who were admitted during the same months of 2014 who met the same inclusion criteria. The patients were classified according to the HOSPITAL score as having a low, intermediate, or high risk of potentially avoidable readmission. Outcome measures were 30-day readmission and cost data. To analyse the effect of the intervention on readmission, a logistic regression was performed.

Results

The study included 589 patients (286 intervention group; 303 control group). The readmission rate decreased from 20.13% to 16.43% in the intervention group [OR = 0.760 95% CI (0.495–1.166); p = 0.209)]. The incremental cost for the intervention to prevent one readmission was €3,091.19, and the net cost saving was €1,301.26. In the intermediate- and high-risk groups, readmissions were reduced 10.91% and 10.00%, and the net cost savings were €3,3143.15 and €3,248.71, respectively.

Conclusions

The pharmacist intervention achieved savings in the number of readmissions, and the net cost savings were greater in patients with intermediate and high risks of potentially avoidable readmission according to the HOSPITAL score.
Inhaled diesel exhaust particles result in microbiome-related systemic inflammation and altered cardiovascular disease biomarkers in C57Bl/6 male mice
Authors: Phillippi Danielle T. , Daniel Sarah , Pusadkar Vaidehi , Youngblood Victoria L. , Nguyen Kayla N. , Azad Rajeev K. , McFarlin Brian K. , Lund Amie K.
Published: February 2022

Background

The gut microbiota plays a vital role in host homeostasis and is associated with inflammation and cardiovascular disease (CVD) risk. Exposure to particulate matter (PM) is a known mediator of inflammation and CVD and is reported to promote dysbiosis and decreased intestinal integrity. However, the role of inhaled traffic-generated PM on the gut microbiome and its corresponding systemic effects are not well-characterized. Thus, we investigated the hypothesis that exposure to inhaled diesel exhaust particles (DEP) alters the gut microbiome and promotes microbial-related inflammation and CVD biomarkers. 4–6-week-old male C57Bl/6 mice on either a low-fat (LF, 10% fat) or high-fat (HF, 45% fat) diet were exposed via oropharyngeal aspiration to 35 μg DEP suspended in 35 μl saline or saline only (CON) 2x/week for 30 days. To determine whether probiotics could prevent diet or DEP exposure mediated alterations in the gut microbiome or systemic outcomes, a subset of animals on the HF diet were treated orally with 0.3 g/day (~ 7.5 × 108 CFU/day) of Winclove Ecologic® Barrier probiotics throughout the study.

Results

Our results show that inhaled DEP exposure alters gut microbial profiles, including reducing Actinobacteria and expanding Verrucomicrobia and Proteobacteria. We observed increased circulating LPS, altered circulating cytokines (IL-1α, IL-3, IL-13, IL-15, G-CSF, LIF, MIP-2, and TNF-α), and CVD biomarkers (siCAM, PAI-1, sP-Selectin, thrombomodulin, and PECAM) in DEP-exposed and/or HF diet mice. Furthermore, probiotics attenuated the observed reduction of Actinobacteria and expansion of Proteobacteria in DEP-exposed and HF-diet mice. Probiotics mitigated circulating cytokines (IL-3, IL-13, G-CSF, RANTES, and TNF- α) and CVD biomarkers (siCAM, PAI-1, sP-Selectin, thrombomodulin, and PECAM) in respect to DEP-exposure and/or HF diet.

Conclusion

Key findings of this study are that inhaled DEP exposure alters small intestinal microbial profiles that play a role in systemic inflammation and early CVD biomarkers. Probiotic treatment in this study was fundamental in understanding the role of inhaled DEP on the microbiome and related systemic inflammatory and CVD biomarkers.
The primary spine practitioner as a new role in healthcare systems in North America
Authors: Murphy Donald R. , Justice Brian , Bise Christopher G. , Timko Michael , Stevans Joel M. , Schneider Michael J.
Published: February 2022

Background

In an article published in 2011, we discussed the need for a new role in health care systems, referred to as the Primary Spine Practitioner (PSP). The PSP model was proposed to help bring order to the chaotic nature of spine care. Over the past decade, several efforts have applied the concepts presented in that article. The purpose of the present article is to discuss the ongoing need for the PSP role in health care systems, present persistent barriers, report several examples of the model in action, and propose future strategies.

Main body

The management of spine related disorders, defined here as various disorders related to the spine that produce axial pain, radiculopathy and other related symptoms, has received significant international attention due to the high costs and relatively poor outcomes in spine care. The PSP model seeks to bring increased efficiency, effectiveness and value. The barriers to the implementation of this model have been significant, and responses to these barriers are discussed. Several examples of PSP integration are presented, including clinic systems in primary care and hospital environments, underserved areas around the world and a program designed to reduce surgical waiting lists. Future strategies are proposed for overcoming the continuing barriers to PSP implementation in health care systems more broadly.

Conclusion

Significant progress has been made toward integrating the PSP role into health care systems over the past 10 years. However, much work remains. This requires substantial effort on the part of those involved in the development and implementation of the PSP model, in addition to support from various stakeholders who will benefit from the proposed improvements in spine care.
PET/CT-based adaptive radiotherapy of locally advanced non-small cell lung cancer in multicenter yDEGRO ARO 2017-01 cohort study
Authors: Mäurer Matthias , Käsmann Lukas , Fleischmann Daniel F. , Oertel Michael , Jazmati Danny , Medenwald Daniel ,   Young DEGRO Trial Group
Published: February 2022

Background

Stage III non-small cell lung cancer (NSCLC) represents a highly heterogeneous disease and treatment burden. Advances in imaging modality show promising results for radiotherapy planning. In this multicentric study, we evaluated the impact of PET/CT-based radiotherapy planning on the prognosis of patients with stage III NSCLC.

Method and patients

A retrospective observational cohort study (ARO 2017-01/NCT03055715) was conducted by the young DEGRO trial group of the German Society for Radiation Oncology (DEGRO) with the primary objective to assess the effect of tumour volume change during chemoradiotherapy and the secondary objective to assess the effect of treatment planning on survival. Three hundred forty-seven patients with stage III NSCLC treated at 21 university centers between January 2010 and December 2013 were enrolled in this trial. Patients received primary curative chemoradiotherapy with an intended dose of 50 Gy (hypofractionated) or > 60 Gy (normofractionated). To assess the effect of radiotherapy planning modality on overall survival, we used multivariate frailty models. Models were adjusted for gross tumor volume at the initiation of therapy, age, sex, simultaneous chemotherapy, lung comorbidities, RT dose and tumor grade. By considering the random effect, we can account for heterogeneity in survival and considered covariates within the model in relation to the study side.

Results

Patients were predominantly male (n = 269, 78.4%) with mainly adenocarcinoma (56.4%) and an average of 67.2 years. Adaptation of radiotherapy with consecutive reduction of irradiation volume showed no significant disadvantage for patient survival (HR = 1.21, 95% CI 0.89–1.64). The use of PET/CT co-registration in radiation planning tended to result in better oncologic outcomes, although no significant association could be shown (HR = 0.8, 95% CI 0.56–1.16). Centers with a consistent planning strategy performed better than those without a preferred planning method (0.62, 95% CI 0.41–0.94).

Conclusion

A consistent planning strategy has positive effects on overall survival. The use of PET/CT-based adaptive radiotherapy planning shows a similar survival prospect with the prospective of lower treatment volumes. In future research, toxicities need to be analysed in order to assess such reasoning.
Effect of traditional chinese medicine (TCM) and its fermentation using Lactobacillus plantarum on ceftriaxone sodium-induced dysbacteriotic diarrhea in mice
Authors: Guo Xin , Yan Zipeng , Wang Jixiang , Fan Xinfeng , Kang Jie , Niu Ruiyan , Sun Zilong
Published: February 2022

Background

Buzhongyiqi decoction (BD), Sijunzi decoction (SD), and Shenlingbaizhu decoction (SHD) have been extensively used clinically for the treatment of diseases caused by spleen-Qi deficiency and microbial fermentation has historically been utilized in traditional Chinese medicine (TCM). This study aimed to investigate the mitigative effect of TCM and fermented TCM (FTCM) with Lactobacillus plantarum (LP) on antibiotic-associated diarrhea, and to select an optimal formula and then identify its compounds.

Methods

Dysbacteriosis in mice was induced by ceftriaxone sodium (CS). The mice were then treated with LP, BD, SD, SHD, fermented BD, fermented SD (FSD), and fermented SHD. Diarrhea indexes, the abundances of gut bacteria, intestinal morphometrics, and mRNA expressions of genes related to intestinal barrier function were assessed. Then, ultra-high-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF/MS) were employed to identify and relatively quantify the compounds in the selected decoctions.

Results

CS significantly increased the fecal output weight, the total number of fecal output, and fecal water content, indicating the occurrence of diarrhea. Bacterial culture tests showed that the above symptoms were accompanied by the disruption of specific intestinal flora. TCM, LP, and FTCM alleviated the diarrhea index and recovered the intestinal microbiota. FTCM showed more advantageous than TCM or LP alone. The mRNA expressions of aquaporins (AQPs) and tight junctions (TJs) decreased by CS were enhanced by TCM, LP, and FTCM. In addition, through UHPLC-Q-TOF/MS, (S)-(-)-2-hydroxyisocaproic acid, L-methionine, 4-guanidinobutyric acid (4GBA), and phenyllactate (PLA) in SD and FSD were identified and relatively quantified.

Conclusions

TCM, LP, and TCM fermented with LP alleviated CS-induced diarrhea symptoms, and improved the intestinal flora and barrier function. Four compounds including (S)-(-)-2-hydroxyisocaproic acid, L-methionine, 4GBA, and PLA in FSD, which were identified by UHPLC-Q-TOF/MS, might function in modulating intestinal flora and improving villi structure.
Whole genome sequencing-based classification of human-related Haemophilus species and detection of antimicrobial resistance genes
Authors: Diricks Margo , Kohl Thomas A. , Käding Nadja , Leshchinskiy Vladislav , Hauswaldt Susanne , Jiménez Vázquez Omar , Utpatel Christian , Niemann Stefan , Rupp Jan , Merker Matthias
Published: February 2022

Background

Bacteria belonging to the genus Haemophilus cause a wide range of diseases in humans. Recently, H. influenzae was classified by the WHO as priority pathogen due to the wide spread of ampicillin resistant strains. However, other Haemophilus spp. are often misclassified as H. influenzae. Therefore, we established an accurate and rapid whole genome sequencing (WGS) based classification and serotyping algorithm and combined it with the detection of resistance genes.

Methods

A gene presence/absence-based classification algorithm was developed, which employs the open-source gene-detection tool SRST2 and a new classification database comprising 36 genes, including capsule loci for serotyping. These genes were identified using a comparative genome analysis of 215 strains belonging to ten human-related Haemophilus (sub)species (training dataset). The algorithm was evaluated on 1329 public short read datasets (evaluation dataset) and used to reclassify 262 clinical Haemophilus spp. isolates from 250 patients (German cohort). In addition, the presence of antibiotic resistance genes within the German dataset was evaluated with SRST2 and correlated with results of traditional phenotyping assays.

Results

The newly developed algorithm can differentiate between clinically relevant Haemophilus species including, but not limited to, H. influenzae, H. haemolyticus, and H. parainfluenzae. It can also identify putative haemin-independent H. haemolyticus strains and determine the serotype of typeable Haemophilus strains. The algorithm performed excellently in the evaluation dataset (99.6% concordance with reported species classification and 99.5% with reported serotype) and revealed several misclassifications. Additionally, 83 out of 262 (31.7%) suspected H. influenzae strains from the German cohort were in fact H. haemolyticus strains, some of which associated with mouth abscesses and lower respiratory tract infections.

Resistance genes were detected in 16 out of 262 datasets from the German cohort. Prediction of ampicillin resistance, associated with blaTEM-1D, and tetracycline resistance, associated with tetB, correlated well with available phenotypic data.

Conclusions

Our new classification database and algorithm have the potential to improve diagnosis and surveillance of Haemophilus spp. and can easily be coupled with other public genotyping and antimicrobial resistance databases. Our data also point towards a possible pathogenic role of H. haemolyticus strains, which needs to be further investigated.
Prevalence of complications in eyes with nanophthalmos or microphthalmos: protocol for a systematic review and meta-analysis
Authors: Ally Naseer , Ismail Sarah , Alli Hassan Dawood
Published: February 2022

Introduction

Microphthalmos and nanophthalmos are uncommon ocular conditions, whereby affected eyes have smaller dimensions compared to the normal population. Microphthalmos and nanophthalmos present several challenges to ophthalmologists; they have spontaneous and post-operative sequelae such as high hyperopia, angle-closure glaucoma, uveal effusion syndrome, and retinal detachment.

This systematic review and meta-analysis intends to assess the prevalence of both the spontaneous complications associated with nanophthalmos and microphthalmos, as well as the post-surgical complications associated with nanophthalmos or microphthalmos.

Methods and analysis

Articles will be searched for, on four online databases: PubMed, EMBASE, Scopus, and Web of Science. Two independent reviewers will identify the studies according to prespecified inclusion and exclusion criteria. All studies included with participants diagnosed with microphthalmos or nanophthalmos in one or both eyes, will be included if they have (i) more than 4 cases and (ii) defined microphthalmos/nanophthalmos as an axial length of < 21 mm or a high lens/eye volume ratio. Nanophthalmos may have an additional diagnostic criterion of posterior wall thickness greater than 1.7 mm. The prevalence of the following complications will be assessed: high hyperopia (spherical equivalent >3D), angle closure glaucoma, uveal effusion syndrome, retinal detachment, and chorioretinal folds.

Studies that will be excluded are those that have not adequately defined the criteria for the diagnosis of nanophthalmos or microphthalmos, those studies that have less than five cases, studies with criteria not defined above, and deemed unsuitable, and studies in languages other than English with no published translation.

Relevant data will be extracted and assessed for the risk of bias in each article using a modified Joanna Briggs Institute (JBI) assessment tool. The data will then be pooled to determine the prevalence of complications among patients with microphthalmos and nanophthalmos. If the data allows, subgroup analysis will be carried out according to axial length as well as subtype of microphthalmos/nanophthalmos (simple, complex, relative anterior, and posterior).

Discussion

Although nanophthalmos is an uncommon condition that affects the eye, its management and complications can be sight-threatening. Thus, it is important to counsel patients and their families correctly (in the case of children) upon diagnosis and prior to any surgical intervention. This can only be done if the overall prevalence of complications is known.

Registration

PROSPERO CRD42021227847
Bridging the gap to advance the care of individuals with cancer: collaboration and partnership in the Cardiology Oncology Innovation Network (COIN)
Authors: Brown Sherry-Ann , Beavers Craig , Martinez Hugo R. , Marshall Catherine H. , Olaye Iredia M. , Guha Avirup , Cho David , Bailey Alison , Bergom Carmen , Bansal Neha , Bauer Brenton , Cheng Richard K.
Published: February 2022

Cardiovascular diseases and cancer continue to be the two leading causes of death in the United States. While innovations in artificial intelligence, digital health, and telemedicine may revolutionize cardio-oncology clinical practice, barriers to widespread adoption continue to exist. The most effective way to advance these technologies is through a broad range of stakeholders sharing a common vision. Additionally, as we enter the digital era in healthcare, we must help lead this charge for the benefit of our cardiology and oncology patients. Bolstering collaborations in cardiology and oncology is key, in partnership with technology firms, industry, academia, and private practice, with an emphasis on various forms of innovation. The ultimate goal is to connect our patients and their health to informatics-based opportunities to advance cardiovascular disease prevention in cancer patients. We have established the Cardiology Oncology Innovation Network in accordance with this vision, to develop new care delivery options through the use of innovative technological strategies. Our tripartite mission – innovation, collaboration, and education – aims to increase access to and expertise in digital transformation to prevent cardiovascular diseases in cancer patients. Here we describe network initiatives, early accomplishments, and future milestones.
Predicting in-hospital mortality of cirrhotic patients hospitalized with hepatic encephalopathy
Authors: Abbasy Mohamed , Zaghla Hassan , Elhelbawy Mostafa , Ramadan Mostafa , Zakareya Talaat
Published: February 2022

Background

Hepatic encephalopathy (HE) is a serious condition associated with high rates of mortality. Many scoring systems are used to predict the outcome of HE in patients admitted to the intensive care unit (ICU). The most used scores are Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD), Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II). These scores were thoroughly investigated in HE associated with acute liver failure (type A). In the present study, we aimed to evaluate the prognostic value of these scores in patients with HE on a background of liver cirrhosis (type C). Two hundred cirrhotic patients hospitalized with HE were included in the study. Diagnosis and classification of HE were based on the West Haven criteria. APACHE II, CLIF-SOFA, MELD, MELD-Na, and CTP scores were calculated for all patients within the first 24 h after admission. According to survival outcomes, patients were categorized into either improved or deceased. Demographic, clinical, and laboratory data as well as prognostic scores were compared in both deceased and improved groups. The receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUROC) was calculated for each score. Backward logistic regression analysis was used to identify the predictors of mortality.

Results

60.5% of patients were males. The mean age was 61.09 ± 8.94 years. The main precipitating factors of HE was infections predominantly spontaneous bacterial peritonitis (n = 108, 54.0%) followed by variceal bleeding (n = 39, 19.5%). All scores were significantly higher in the deceased patients. AUROC were 0.734 (CI95% 0.666–0.803), 0.717 (CI95% 0.647–0.787), 0.663 (CI95% 0.589–0.738), 0.626 (CI95% 0.549–0.704), and 0.609 (CI95% 0.531–0.686) for CLIF-SOFA, MELD-Na, MELD, APACHE II, and CTP scores, respectively. MELD, MELD-Na, and CLIF-SOFA scores were the independent predictors of mortality. Among these scores, CLIF-SOFA was the strongest independent predictor of mortality (OR = 1.142, CI95% = 0.888–1.467, p = 0.001).

Conclusions

CLIF-SOFA score was superior to other prognostic scores in predicting mortality in hospitalized patients with HE type C.
Smartphone addiction and its impact on musculoskeletal pain in neck, shoulder, elbow, and hand among college going students: a cross-sectional study
Authors: Ahmed Sohel , Mishra Arushi , Akter Rahemun , Shah Md. Hasanuzzaman , Sadia Asima Akter
Published: February 2022

Introduction

Prolonged physical exposure during smartphone usage results in poor posture causing pain in neck, shoulder, elbow, and hands. So, our aim was to investigate the effect of smartphone addiction on musculoskeletal pain.

Methods

This cross-sectional study was carried out by a random sampling method from recognized institute in Bangladesh and India. Three hundred twenty-six participants, including male and female, aged between 18 and 30 years participated in this study. Candidates were requested to fill-up a performa containing demographics, Smartphone addiction scale-short form (SAS-SF), Shoulder pain and disability index (SPADI), Neck disability index (NDI), Oxford elbow score (OEC), and Cornell Hand Discomfort Questionnaire (CHDQ).

Results

The mean age were 22.58 ± 3.19 years, weight 60 ± 11.30 kg, height 162.83 ± 9.74 cm, and body mass index (BMI) of the participants were 22.69 ± 4.36 kg/m2. 43.3% participants reported neck pain, 42.9% shoulder pain, and 27.9% reported pain on their elbow while prolonged smartphone use. There was major difference in NDI (p = 0.047), SPDI (p = 0.005), OES (p = 0.002), and CHDQ (p = < 0.001) among Bangladeshi and Indian population. The SAS has a significant association with NDI; p < 0.001, SPDI; p < 0.001, OES; p < 0.001, and CHDQ; p < 0.001.

Conclusion

Smartphone addiction negatively impacted and positively related with the musculoskeletal pain in neck, shoulder, elbow, and hand. Care should be given towards the proper use of smartphone and increase public awareness regarding the negative consequences of this serious issue.
Phase II Study of Taselisib in PIK3CA-Mutated Solid Tumors Other Than Breast and Squamous Lung Cancer: Results From the NCI-MATCH ECOG-ACRIN Trial (EAY131) Subprotocol I
Authors: Krop Ian E. , Jegede Opeyemi A. , Grilley-Olson Juneko E. , Lauring Josh D. , Mitchell Edith P. , Zwiebel James A. , Gray Robert J. , Wang Victoria , McShane Lisa M. , Rubinstein Larry V. , Patton David , Williams P. Mickey , Hamilton Stanley R. , Kono Scott A. , Ford James M. , Garcia Agustin A. , Sui Xingwei D. , Siegel Robert D. , Slomovitz Brian M. , Conley Barbara A. , Arteaga Carlos L. , Harris Lyndsay N. , O'Dwyer Peter J. , Chen Alice P. , Flaherty Keith T.
Published: February 2022

PURPOSE

PIK3CA mutations frequently contribute to oncogenesis in solid tumors. Taselisib, a potent and selective inhibitor of phosphoinositide 3-kinase, has demonstrated clinical activity in PIK3CA-mutant breast cancer. Whether PIK3CA mutations predict sensitivity to taselisib in other cancer types is unknown. National Cancer Institute–Molecular Analysis for Therapy Choice Arm EAY131-I is a single-arm, phase II study of the safety and efficacy of taselisib in patients with advanced cancers.

METHODS

Eligible patients had tumors with an activating PIK3CA mutation. Patients with breast or squamous cell lung carcinoma, or whose cancer had KRAS or PTEN mutations, were excluded. Patients received taselisib 4 mg, orally once daily continuously, until disease progression or unacceptable toxicity. The primary end point was objective response rate. Secondary end points included progression-free survival (PFS), 6-month PFS, overall survival (OS), and identification of predictive biomarkers.

RESULTS

Seventy patients were enrolled, and 61 were eligible and initiated protocol therapy. Types of PIK3CA mutations included helical 41 of 61 (67%), kinase 11 of 61 (18%), and other 9 of 61 (15%). With a median follow-up of 35.7 months, there were no complete or partial responses. Six-month PFS was 19.9% (90% CI, 12.0 to 29.3) and median PFS was 3.1 months (90% CI, 1.8 to 3.7). Six-month OS was 60.7% (90% CI, 49.6 to 70.0) and median OS was 7.2 months (90% CI, 5.9 to 10.0). Individual comutations were too heterogeneous to correlate with clinical outcome. Fatigue, diarrhea, nausea, and hyperglycemia were the most common toxicities, and most were grade 1 and 2.

CONCLUSION

In this study, taselisib monotherapy had very limited activity in a heterogeneous cohort of heavily pretreated cancer patients with PIK3CA-mutated tumors; the presence of a PIK3CA mutation alone does not appear to be a sufficient predictor of taselisib activity.
FGF23-Klotho Axis and Fractures in Patients Without and With Early CKD: A Case-Cohort Analysis of CARTaGENE
Authors: Desbiens Louis-Charles , Sidibé Aboubacar , Ung Roth-Visal , Mac-Way Fabrice
Published: February 2022

Context

Whether fibroblast growth factor-23 (FGF23) and α-Klotho are associated with fractures, especially in chronic kidney disease (CKD), remains controversial.

Objective

We evaluated how FGF23, α-Klotho, and traditional mineral parameters predict fractures in individuals with and without early CKD.

Methods

We conducted a stratified case-cohort analysis using CARTaGENE, a population-based survey from Quebec, Canada. Individuals aged 40 to 69 years were selected according to outcome and CKD status (non-CKD: eGFR > 60 mL/min/1.73 m2; CKD stage 3: eGFR 30-60 mL/min/1.73 m2]). Baseline levels of c-terminal FGF23 (cFGF23), α-Klotho, parathyroid hormone (PTH), phosphate, and calcium were analyzed for associations with osteoporotic fracture incidence from recruitment (2009-2010) through March 2016. Adjusted Cox models were used, and predictors were treated linearly or flexibly using splines.

Results

A total of 312 patients (159 non-CKD; 153 CKD) were included; 98 had ≥ 1 fracture at any site during a median follow up of 70 months. Compared with non-CKD, CKD patients had increased levels of cFGF23 but similar levels of α-Klotho. cFGF23 was linearly associated with increased fracture incidence (adjusted HR = 1.81 [1.71, 1.93] per doubling for all participants). The association of α-Klotho with fracture followed a U-curve (overall P = 0.019) but was attenuated by adjustment for potential mediators (bone mineral density, phosphate, PTH). PTH and phosphate also had U-shaped associations with fracture. Associations were mostly similar between non-CKD and CKD. Adjustment for cFGF23 strongly attenuated the association between CKD status and fractures.

Conclusion

cFGF23 is associated linearly with fracture incidence while α-Klotho, PTH, and phosphate levels have a U-shaped association.
ED 90 of Intrathecal Chloroprocaine With Fentanyl for Prophylactic Cervical Cerclage: A Sequential Allocation Biased-Coin Design
Authors: Sharawi Nadir , Tan Hon Sen , Taylor Cameron , Fuller Matthew E. , Landreth Riley A. , Diomede Olga I. , Williams Matthew , Martinello Caroline , Mhyre Jill M. , Habib Ashraf S.
Published: February 2022

BACKGROUND:

Chloroprocaine is a short-acting local anesthetic that has been used for spinal anesthesia in outpatient surgery. There is limited experience with spinal chloroprocaine for prophylactic cervical cerclage placement. We sought to determine the effective dose of intrathecal chloroprocaine for 90% of patients (ED90) undergoing prophylactic cervical cerclage placement. We hypothesized that the ED90 of intrathecal chloroprocaine when combined with 10-ug fentanyl would be between 33 and 54 mg.

METHODS:

In this prospective 2-center double-blinded study, we enrolled women undergoing prophylactic cervical cerclage placement under combined spinal-epidural anesthesia. A predetermined dose of intrathecal 3% chloroprocaine with fentanyl 10 ug was administered. The initial dose was 45-mg intrathecal chloroprocaine. Subsequent dose adjustments were determined based on the response of the previous subject using an up-down sequential allocation with a biased-coin design. A dose was considered effective if at least a T12 block was achieved, and there was no requirement for epidural activation or intraoperative analgesic supplementation during the procedure. The primary outcome was the ED90 of intrathecal chloroprocaine with fentanyl 10 ug. Secondary outcomes included duration of surgery, anesthetic side effects, time to resolution of motor and sensory block, time to achieve recovery room discharge criteria, and patient satisfaction with anesthetic care. Isotonic regression was used to estimate the ED90.

RESULTS:

Forty-seven patients were enrolled into the study. Two patients were excluded (1 protocol violation and 1 failed block). In total, 45 patients completed the study. The estimated ED90 (95% confidence interval) for intrathecal chloroprocaine combined with fentanyl 10 ug was 49.5 mg (45.0–50.1 mg). The median (interquartile range [IQR]) duration of surgery was 15 (10–24) minutes. Resolution of the motor (Bromage 0) and sensory block took a median time of 60 (45–90) minutes and 90 (75–105) minutes, respectively. The median time to achieve recovery room discharge criteria was 150 (139–186) minutes. Satisfaction with anesthetic management was high in all patients. There were no reports of postdural puncture headache or transient neurological symptoms postoperatively

CONCLUSIONS:

The ED90 of intrathecal chloroprocaine combined with fentanyl 10 ug was 49.5 mg. Intrathecal chloroprocaine was associated with rapid block recovery and high patient satisfaction, which makes it well suited for outpatient obstetric procedures.
Improvements in Maximal Oxygen Uptake After Sprint-Interval Training Coincide with Increases in Central Hemodynamic Factors
Authors: MANDIĆ MIRKO , HANSSON BJÖRN , LOVRIĆ ALEN , SUNDBLAD PATRIK , VOLLAARD NIELS B. J. , LUNDBERG TOMMY R. , GUSTAFSSON THOMAS , RULLMAN ERIC
Published: February 2022

Introduction

Sprint-interval training has been shown to improve maximal oxygen uptake, in part through peripheral muscle adaptations that increase oxygen utilization. In contrast, the adaptations of central hemodynamic factors in this context remain unexplored.

Purpose

The aim of the current study was to explore the effects of sprint-interval training on maximal oxygen uptake and central hemodynamic factors.

Methods

Healthy men and women (n = 29; mean age, 27 ± 5 yr; height, 175 ± 8 cm; body mass, 72.5 ± 12.0 kg) performed 6 wk of sprint-interval training consisting of three weekly sessions of 10-min low-intensity cycling interspersed with 3 × 30-s all-out sprints. Maximal oxygen uptake, total blood volume, and maximal cardiac output were measured before and after the intervention.

Results

Maximal oxygen uptake increased by 10.3% (P < 0.001). Simultaneously, plasma volume, blood volume, total hemoglobin mass, and cardiac output increased by 8.1% (276 ± 234 mL; P < 0.001), 6.8% (382 ± 325 mL; P < 0.001), 5.7% (42 ± 41 g; P < 0.001), and 8.5% (1.0 ± 0.9 L·min−1; P < 0.001), respectively. Increased total hemoglobin mass along with measures of body surface area had a significant impact on the improvements in maximal oxygen uptake.

Conclusions

Six weeks of sprint-interval training results in significant increases in hemoglobin mass, blood volume, and cardiac output. Because these changes were associated with marked improvements in maximal oxygen uptake, we conclude that central hemodynamic adaptations contribute to the improvement in maximal oxygen uptake during sprint-interval training.
Πολιτισμικές κινητικότητες, εργασία και συγγένεια
Authors: Παντελέου Μαρία
Published: February 2022

Η παρούσα διατριβή υιοθετεί την προσέγγιση των πολιτισμικών κινητικοτήτων στην μελέτη της μετανάστευσης και εξετάζει την κινητικότητα των ανθρώπων εντός και μεταξύ εθνικών συνόρων, μέσα από τη μελέτη της αλβανικής μετανάστευσης. Διερευνά από ανθρωπολογική οπτική, αφενός διάφορες μορφές κινητικότητας Αλβανών μεταναστών, όπως εξωτερικές, εσωτερικές, πολυτοπικές, διασυνοριακές και φαντασιακές και αφετέρου πώς αυτές οργανώνουν αλλά και οργανώνονται μέσα από την εργασία και τη συγγένεια στην Ελλάδα και στην Αλβανία από τη δεκαετία του 1990 έως τη δεκαετία του 2010. Πιο συγκεκριμένα, η διατριβή εξετάζει, μέσα από μακρόχρονη πολυ-τοπική και πολυ-εθνική επιτόπια έρευνα (2015-2018) με Αλβανούς/ίδες μετανάστες της ευρύτερης περιοχής της Κορινθίας και με Αλβανούς/ίδες της βόρειας Αλβανίας, το ευρύ φάσμα κινητικοτήτων τους. Πρώτον, μελετά τις μεταναστευτικές μνήμες και νοηματοδοτήσεις της εργασιακής κινητικότητας των Αλβανών/ίδων της Κορινθίας «από τα κάτω» από τη δεκαετία του 1990 έως και την οικονομική «κρίση» στην Ελλάδα τη δεκαετία του 2010. Δεύτερον, εξετάζει τις διεθνικές, πολυτοπικές και διασυνοριακές πρακτικές κινητικότητας των Αλβανών μεταναστών στην Κορινθία και των κοινωνικών δικτύων («γνωστών»), με τα οποία συνδέονται. Οι «γνωστοί» εξασφαλίζουν την εποχική εργασία στην Ελλάδα αλλά και την εύρεση θέσεων εργασίας σε άλλες χώρες τους κόσμου μέσω των πολυτοπικών ψηφιακών κοινωνικών δικτύων ομοεθνών («γνωστών»), που οι Αλβανοί διαθέτουν σε ποικίλα εθνικά πλαίσια. Τρίτον, μελετά τις προσωρινές επιστροφές των Αλβανών μεταναστών και το αίσθημα ξενότητας που βιώνουν στην Αλβανία, αποσυνδέοντας τις νοηματοδοτήσεις του «σπιτιού» και της «πατρίδας» από τη χώρα προέλευσης. Τέταρτον, διερευνά ζητήματα αμοιβαιότητας και συγκεκριμένα την παροχή αμοιβαίας «βοήθειας» μεταξύ των Αλβανών μεταναστών και των συγγενών τους στο πλαίσιο τελετουργικών αλλά και καθημερινών πρακτικών στην Αλβανία. Αυτές οι πρακτικές εντοπίζονται και στην Ελλάδα, φανερώνοντας πώς η κινητικότητα και η εγγραφή τους σε ένα διαφορετικό πολιτισμικό πλαίσιο επιτρέπει στους Αλβανούς άλλοτε να αναπαράγουν τις οικείες πολιτισμικές αντιλήψεις και δράσεις τους και άλλοτε να τις μετασχηματίζουν και τις ανασημασιοδοτούν αναλόγως των νοημάτων που οι ίδιοι επιθυμούν να τις προσδώσουν. Πέμπτον, εξετάζει τις φαντασιακές κινητικότητες στη «δύση», που στο λόγο των Αλβανών μεταναστών εξιδανικεύεται και λειτουργεί ως μέτρο σύγκρισης εμπειριών με το ελληνικό κράτος από τη δεκαετία του 1990 έως και τη δεκαετία του 2010 στην Κορινθία.
Genre analysis of introduction section in electrical engineering undergraduate laboratory reports
Authors: Veerappan Veeramuthu , Ahmad Mokhtarrudin , Aris Mohd Afizal , Suan Wei Hui
Published: February 2022

Background

This study examines the genre of Engineering Laboratory Reports (ELR) introduction section written by Electrical Engineering Undergraduates in a higher learning institution. The aims of this study are to identify the rhetorical moves and combinations of move patterns used by engineering students to write introduction section of ELR. 

Method

A genre analysis was conducted to identify writing patterns and convention practices of engineering undergraduate students thus a corpus of N= 35 was selected from electrical engineering students in their final year of study. This study adopted Genre Theory as its theoretical framework, [1] analytical framework and [2] BCU approach for analysis procedure. A pilot test was conducted to determine the model that fits the best to describe moves and steps of ELR. The study benchmarks a move or step to be present in at least 60% of the reports. 

Results

The finding shows the introduction consists of one main move which is providing background information of the experiment and followed by four subsequent steps which are reference to research purposes, reference to theoretical knowledge in the field, providing an overview of the study and identification of main research apparatus. The move 1 and all four steps identified above are viewed as conventional move and steps of introduction section only among undergraduates in academic context. The exemplification of finding pave ways to address grey areas of improvement in scientific written genre among laboratory instructors and academics. The method employed in this study may be replicated to analyse other sections of scientific and technical reports such as method, result, discussion and conclusion (MRDC). 

Conclusion

This study posits the importance of collaboration between English for Academic (EAP) practitioners such as English-writing instructors and discipline specific specialist from engineering field to further improve on genre-based writing instruction, and to identify student learning needs.
Innovative forest products in the circular bioeconomy
Authors: Hassegawa Mariana , Karlberg Anna , Hertzberg Magnus , Verkerk Pieter Johannes
Published: February 2022

Background: The forest-based industry has been moving towards the manufacture of bio-based products in response to the increasing concern by consumers and governments regarding the use of non-renewable materials and the generation of residues. Various innovative technologies geared towards reducing the environmental footprint of products and processes are currently being developed and applied in the forest-based industry. This study presents some innovative wood-based products that are about to enter the market or that are already being commercialized but have the potential to expand in market size.

Methods: We collected data from interviews and a survey with organisations working with product development and manufacturing, and from the literature.

Results: Many innovative products that are already produced at an industrial scale, such as cross-laminated timber, wood-based composites, and lyocell, can still increase their market share in the coming years. Some of the up-and-coming products with high potential to substitute fossil-based materials and will likely enter the market in the near future are wood foam, lignin-based adhesives, glycols, bioplastics, and textile fibres. Our study indicates that, although biomass demand is expected to increase, stakeholders do not consider future supply a limiting factor.

Conclusions: The ease of market introduction of innovative products relies heavily on the products’ ability to take advantage of existing value chains. Overall, many of the reviewed products have the advantage of being ‘drop-in’. This is because products that require adjustments to production lines are less likely to get into the market without strong external drivers that push for bio-based alternatives. According to stakeholders, the economic viability and the market expansion of these products could be encouraged to a certain extent by EU policies, and certain barriers could be alleviated by reducing bureaucracy, increasing the support for pilot-scale to full-scale production, and increasing subsidies for bio-based alternatives.
Violência doméstica e sofrimento ético-político: redes de cuidados informais de usuárias do centro de atenção psicossocial e do centro de referência em assistência social no contexto brasileiro
Authors: Gomes da Silva Rafaela , Severo Ana Kalliny , Silva Fernandes de Medeiros Kyra Kadma , Palhares Bezerra Luiza Celeste , Nunes Pinheiro Eslia Maria
Published: February 2022

O presente estudo objetivou identificar e discutir as redes de cuidados informais de mulheres em situação de violência doméstica, e que são usuárias de serviços de atenção especializada em saúde mental e assistência social de uma cidade do interior do Nordeste. A perspectiva teórico-metodológica adotada foi a Análise Institucional, com ênfase na pesquisa-intervenção, que permite visualizar as forças que tendem à reprodução (instituído), e as que tendem à transformação de determinado fenômeno (instituinte). Para tanto, foram realizadas, ao todo, seis rodas de conversa com os profissionais dos serviços acerca da temática da violência  doméstica, e entrevistas com quatro mulheres escolhidas nas rodas de conversas. Além disso, outros instrumentos utilizados neste estudo foram o diário de pesquisa, os ecomapas e os prontuários dos serviços. Dessa maneira, a análise dos dados permitiu identificar três analisadores acercado que tem permanecido e o que tem se transformado nas redes informais de cuidado de mulheres em situação de violência doméstica. O primeiro analisador se refere à configuração da rede informal das mulheres a partir da violência doméstica; o segundo consiste na relaçãoentre a rede formal e informal; e o terceiro, nas redes quentes e vivas possivelmente construídas com a contribuição do processo de pesquisa. Destaca-se, ainda, o importante papel da rede informal como dispositivo de cuidado às mulheres em situação de violência doméstica e sofrimento ético-político, na medida em que se apresenta como rede capaz de contribuir na participação e autonomia das usuárias no cuidado em saúde.
Ofsted reports reinforce need for parent partnerships
Authors: Edwards Helen
Published: February 2022

Having read over 100 recent Ofsted reports, it's clear to me that parent and carer partnerships are very much under scrutiny.
Pancake Day and signs of spring
Authors: Davies Sarah M
Published: February 2022

Pancake Day falls on Tuesday 1st March and provides you and your children a wonderful opportunity to think about the new season and the changing world.
Action Research to Transform Early Language Practice: Exploring Representations of Plurilingualism in a Private Nursery
Authors: Rojas-Bustos Kyara , Panniello Daniela
Published: February 2022

Through an exploration of language practices in an early years setting, this paper aims to examine discourses about transforming monolingual practice generated during an internally driven action research. Based on a small private nursery in an affluent part of London, this action research was conducted with the intention of reviewing internal practices that support young children who speak English as an additional language (EAL). Parents and practitioners took part in an initial questionnaire (n=21). This was followed by semi-structured interviews (n=3) and a focus group (n=5) with practitioners. The data was analysed considering some of the theoretical points proposed by Bourdieu and the discourse analysis tools suggested by van Leeuwen. Despite the recognition of potential barriers, encouraging positive dispositions towards language diversity were identified. The most significant feature of our examination was the value of local knowledge and the diverse language repertoires encountered in the setting. Our analysis evidence that action research can empower practitioners to challenge monolingual mindsets and to move towards an exploration of alternative (plurilingual) ideas, despite the monolingual ethos imposed by the curriculum and other external regulatory forces.
MODIFICAÇÃO DA SUPERFÍCIE DO RESÍDUO DE CASCA DE LARANJA PARA ADSORÇÃO DE CORANTES
Authors: Nascimento Gabriel Neri
Published: February 2022

Diversas indústrias usam corantes na fabricação de seus produtos, principalmente as indústrias têxteis, curtumes, indústrias de papel, de alimentos, entre outras. Os corantes sintéticos são amplamente utilizados, por causa de suas vantagens em relação aos corantes naturais (Kharat, 2015). A produção anual de corantes sintéticos chega a 700000 toneladas/ano e cerca de 10 a 15% dos corantes utilizados pelas indústrias chegam aos efluentes (Kyzas, 2013). A remoção de corantes de forma economicamente viável permanece um problema importante. Os processos de adsorção, pela sua não especificidade, são os mais apropriados para purificação de efluentes, uma vez que são capazes de remover vários tipos de substâncias, em níveis que vão do mais concentrado até o traço. Como o custo deste processo é alto para tratamento de efluentes, a busca por materiais alternativos tem interessado os cientistas nos últimos anos.O resíduo da laranja pode causar muitos problemas econômicos e ambientais devido principalmente à sua elevada fermentação, pois contém cerca de 86% (b.u) de água (Tripodo, 2004). O bagaço pode ser utilizado como aditivo na alimentação de ruminantes na forma de ensilagem ou ração peletizada, diminuindo assim o consumo de grãos para os animais e, consequentemente, os custos de alimentação. Segundo Ítavo et al. (2000), o valor nutricional do bagaço de laranja é semelhante ao dos demais grãos utilizados na alimentação dos animais, além de apresentar elevada digestibilidade, atribuída sobretudo ao seu alto teor de carboidratos solúveis e pectina; além do uso como ração animal, a indústria tem grande interesse em desenvolver novas aplicações para o bagaço da laranja, destacando-se a utilização deste material como adsorvente no tratamento de efluentes (FIORENTIN, 2015).
QUANTIFICAÇÃO DE FLAVONOIDES EM EXTRATOS DE Passiflora spp.
Authors: Oliveira Igor Kennedy Pereira
Published: February 2022

O gênero Passiflora é o mais importante da família Passifloraceae, visto que espécies deste gênero são frequentemente empregadas na medicina popular principalmente devido às suas propriedades sedativas e ansiolíticas. As folhas de várias espécies de Passiflora são usadas popularmente sob a forma de chás, como calmante e suave indutor do sono (COSTA, 2013). Além disso, o gênero Passiflora está incluso na Relação Nacional de Plantas Medicinais de Interesse no SUS de 2010 (RENISUS), como plantas medicinais que podem gerar produtos de interesse no desenvolvimento de fitoterápicos para uso da população, com segurança e eficácia para o tratamento de determinadas doenças. Desta forma, o Ministério da Saúde incentiva estudos com os gêneros presentes no RENISUS, evidenciando a importância do estudo do gênero Passiflora. De acordo com Ferreira (2006), no Brasil, o acervo de germoplasma de Passiflora consta de mais de 57 espécies e 599 acessos, sendo que o banco de germoplasma da Embrapa apresenta o maior número de acessos, incluindo híbridos do programa de melhoramento genético. Apesar do grande interesse pelo estudo de plantas com reconhecida atividade medicinal, ainda existem espécies do gênero Passiflora que não foram estudadas do ponto de vista fitoquímico. Os flavonoides se apresentam em abundância no gênero Passiflora. A importância farmacológica torna-os a classe de compostos com maior interesse de estudo. Os mesmos são responsáveis pela atividade ansiolítica apresentada por algumas espécies, sendo alguns desses flavonoides considerados marcadores quimiotaxônomicos (SAKALEM et al., 2012). Atualmente a técnica mais utilizada, e uma das principais, para a detecção e quantificação de flavonoides é a Cromatografia Líquida de Alta Eficiência na região do UV-Visível através de um sistema de arranjo de diodos (CLAE-DAD) (GOMES, 2013).