bluuebunny/crossref_metadata_2025 huggingface dataset:
Breast Cancer in Adolescents and Young Adults Less Than 40 Years of Age in Nigeria: A Retrospective Analysis
Authors: Ntekim Atara , Oluwasanu Mojisola , Odukoya Oluwaponmile
Published: July 2022

Background. Breast cancer among adolescents and young adult (AYA) females aged 15-39 years is associated with different patterns of aggressiveness, as well as psychosocial and economic issues. At present, the burden of breast cancer among this age group is unknown in Nigeria. There is a need to determine the proportion of AYA with breast cancer in Nigeria. This will inform the development of breast cancer care programs appropriate for this age group. Objective. The objective of this study was to highlight the burden of breast cancer with an emphasis on AYAs in Nigeria and its implications. Methods. A retrospective review of data from cancer registries in Nigeria between 2009 and 2016 was carried out. Results. Among AYA females in Nigeria, breast cancer was by far the most common cancer, constituting 50% of all cancers and 51% (2798 of 5469) of all breast cancer cases. IA third (30.8%) of breast cancer cases in all centers studied were AYAs. Conclusion. The high proportion of AYA with breast cancer is an important feature suggesting that urgent actions are required to ensure early detection and improve breast cancer care among this age group.
Business and the Climate Crisis: Toward Engagement With Climate Assemblies
Authors: Pek Simon
Published: July 2022

Businesses and business scholars interested in tackling climate change can benefit by engaging with the innovative but nascent movement of climate assemblies. I articulate three promising ways they can meaningfully engage with this movement.
Employees’ Perspectives on the Costs and Benefits of Organizations’ Environmental Initiatives
Authors: Allen Stuart
Published: July 2022

Employee participation is essential to organizations’ corporate social responsibility (CSR)-related environmental initiatives (EIs). Employees’ attitudes to participating in pro-environmental behaviors are addressed in workplace literature drawing upon the theory of planned behavior. However, antecedents to employees’ attitude formation, including perceptions of the costs and benefits of participating in EIs, have not been adequately researched. Greater understanding of EI attitude formation can support efforts to foster EI participation. This study explores employees’ perceptions of EI costs and benefits to employees personally, to their organization, and to society by applying goal framing theory. A sample of 120 survey participants described 150 initiatives and identified personal, organizational, and societal costs and benefits of the EIs. Cost and benefit categories are presented along with a taxonomy and themes. The findings of this study provide a reference point for researchers and managers in understanding how employees view EIs and how employees might be encouraged to participate.
Wearable Sensing and Mining of the Informativeness of Older Adults’ Physiological, Behavioral, and Cognitive Responses to Detect Demanding Environmental Conditions
Authors: Torku Alex , Chan Albert P. C. , Yung Esther H. K. , Seo JoonOh , Antwi-Afari Maxwell F.
Published: July 2022

Due to the decline in functional capability, older adults are more likely to encounter excessively demanding environmental conditions (that result in stress and/or mobility limitation) than the average person. Current efforts to detect such environmental conditions are inefficient and are not person-centered. This study presents a more efficient and person-centered approach that involves using wearable sensors to collect continuous bodily responses (i.e., electroencephalography, photoplethysmography, electrodermal activity, and gait) and location data from older adults to detect demanding environmental conditions. Computationally, this study developed a Random Forest algorithm—considering the informativeness of the bodily response—and a hot spot analysis-based approach to identify environmental locations with high demand. The approach was tested on data collected from 10 older adults during an outdoor environmental walk. The findings demonstrate that the proposed approach can detect demanding environmental conditions that are likely to result in stress and/or limited mobility for older adults.
Effectiveness of a Point-of-Decision Prompt to Encourage Physical Distancing on Greenways and Rail-Trails During the COVID-19 Pandemic
Authors: Christiana Richard W. , Daily Shay M. , Bias Thomas K. , Haas Vaike , Dyer Angela M. , Shay Elizabeth , Hege Adam , Broce Robert , Venrick Heather , Abildso Christiaan G.
Published: July 2022

Adherence to public health messaging recommending physical distancing in public outdoor spaces during the early months of the COVID-19 pandemic and strategies to promote physical distancing are currently unknown. This study examined the effectiveness of a point-of-decision prompt to increase physical distancing (maintaining at least 6 ft of distance) on greenways and rail-trails using systematic observation with passive infrared cameras. Results indicate that the intervention did not have a significant effect on interacting groups maintaining physical distance. However, groups maintaining physical distance increased from baseline (72%) to post-intervention (79%) and likelihood of maintaining physical distance at baseline and post-intervention was higher when: passing in the opposite direction compared to passing in the same direction; using 12-foot-wide trails compared to 10-foot-wide trails; and only one person was in each group. These results provide important implications for public health and parks and recreation professionals to promote physical distancing on multi-use trails.
Gender and Leadership Positions in Spanish Dentistry
Authors: Hernández-Ruiz Rocío E. , Rosel-Gallardo Eva M. , Cifuentes-Jiménez Carolina , González-López Santiago , Bolaños-Carmona María Victoria
Published: July 2022

Dentists in Spain reached equal gender representation in 2012 and the number of female dentists has continued to grow (until 57.3% in 2020). This study aims to increase evidence about the gender distribution on the high responsibility positions and opinion leaders of the dental profession and academia. Composition of the executive comities of the main dental institutions of Spain (regional professional associations, national dental association, and scientific societies), members of the Faculty of Dentistry of the University of Granada in 2020 and speakers of the main dental congresses of 2019 (due to the lack of congress in 2020) were recorded and analyzed by genders using chi-squared test ( P < .05). Mean representation of female dentists in executive committees of professional associations was 35.6%. More than 70% of presidents and vice-presidents of professional colleges and more than 60% of these positions in scientific societies were occupied by male dentists. None of dental congresses of 2019 reached equal gender participation, being 81.3% of lecturers presenting on main auditoriums male dentists. Although dental workforce in Spain is slightly overrepresented by females, leadership positions and figures among Spanish dentists doesn’t seem to reflect the gender distribution of the collective. There is a lack of women occupying high-level positions in dentistry that proves the existence of the so-called “glass ceiling effect” on the profession. Further studies about sociodemographic aspects of dental workforce are needed to develop evidence-based policies for the collective.
Leaving the Lectures Behind: Using Community-Engaged Learning in Research Methods Classes to Teach about Sustainability
Authors: Soyer Mehmet , McCrackin Gina , Ziyanak Sebahattin , Givens Jennifer , Jump Vonda , Schad Jessica
Published: July 2022

This article explores the outcomes of using community-engaged learning in a sustainability-focused social sciences research course titled Methods of Social Research. The integrated components of the course were designed to teach students about the research process while addressing sustainability issues at Utah State University. Throughout the course, students learned how to collect, analyze, and interpret data; work in research teams; write a grant; and write and present a final research paper. Student sustainability surveys and the final course evaluation were used to analyze student learning outcomes. We found that students demonstrated increased confidence in collecting, analyzing, and interpreting data and an improved effectiveness and enjoyment in working in teams toward a final product. Students also exhibited their knowledge of small- and large-scale sustainability challenges as well as a decisiveness in answering questions related to sustainability. These outcomes resulted in heightened student self-efficacy and critical thinking skills when performing research and engaging with issues related to sustainability.
Machine Learning and Image Recognition Technologies to Identify Built Environment Barriers and Incentives to Walk
Authors: Trichês Lucchesi Shanna , de Abreu e Silva João , Margarita Larranaga Ana , Zechin Douglas , Beatriz Bettella Cybis Helena
Published: July 2022

The local built environment characteristics deeply influence pedestrians’ behavior, favoring or imposing barriers on walking trips. However, identifying micro-scale built environment data is challenging and time consuming, and in developing countries there is a general lack of reliable information at street level. The recent development of machine learning and image recognition algorithms is helping researchers to collect data quickly, automatically, and on a large scale. Therefore, this study aims to test the application of an existing semantic segmentation algorithm to represent urban scenes in the city of São Paulo. A confirmatory multivariate technique (structural equation model [SEM]) is used to test if a combination of the predetermined categories derived from machine learning algorithms helps to understand which type of environment (urban scenes) represents barriers or incentives to walk. The impacts of the urban scenes on the walking behavior mediated by the walkability perceptions were tested using the aforementioned SEM model. Car-oriented and unoccupied areas, with a high presence of heavy vehicles and a large presence of vegetation, are considered detrimental to the walkability perception and consequently to the walking frequency. On the other hand, densified areas, proximity to public transportation routes, and the presence of lighting and other pedestrians are considered friendlier for pedestrians, encouraging residents to walk.
Effects of the Covid-19 Pandemic on the Prevalence of Insomnia, Anxiety, and Depression During Pregnancy: A Systematic Review and Meta-Analysis
Authors: Cevik Ayseren , Onat Koroglu Cemile , Karacam Zekiye , Gokyildiz Surucu Sule , Alan Sultan
Published: July 2022

This systematic review and meta-analysis study aims to determine the effects of the Covid-19 pandemic on the prevalence of insomnia, anxiety, and depression symptoms during pregnancy. Reviews were done through PubMed, EBSCO (Medline, CINAHL), Embase (OVID), Web of Science, PsycINFO, TR Index, Turkish Thesis Center databases using (pregnancy OR pregnant) and (sleep OR sleep disorders OR insomnia), and (anxiety OR depression) keywords between April and May 2021. The meta-analysis included 48 articles (sample: 77,299). It was found that the Covid-19 pandemic did not affect the prevalence of depression symptoms and anxiety during pregnancy, but it increased insomnia. While insomnia ratio was reported 39.6% (95% CI: 0.253–0.560) in the studies conducted before the pandemic, it was reported 88.8% (95% CI: 0.821–0.921) in the studies conducted during the pandemic. This study found that the Covid-19 pandemic did not have effects on depression symptoms and anxiety, but it increased insomnia complaints.
Meritocracy, education, and the civic project: A reply to commentaries on The Tyranny of Merit
Authors: Sandel Michael J.
Published: July 2022

Michael Sandel replies to commentaries on his book The Tyranny of Merit, focusing on meritocracy and education, the role of merit and grace in economic discourse, and the resentment that fueled the populist backlash against elites.
A non-asymptotic analysis of adaptive TD(λ) learning in wireless sensor networks
Authors: Li Bing , Li Tao , Liu Muhua , Zhu Junlong , Zhang Mingchuan , Wu Qingtao
Published: July 2022

Wireless sensor network has been widely used in different fields, such as structural health monitoring and artificial intelligence technology. The routing planning, an important part of wireless sensor network, can be formalized as an optimization problem needing to be solved. In this article, a reinforcement learning algorithm is proposed to solve the problem of optimal routing in wireless sensor networks, namely, adaptive TD([Formula: see text]) learning algorithm referred to as ADTD([Formula: see text]) under Markovian noise, which is more practical than i.i.d. (identically and independently distributed) noise in reinforcement learning. Moreover, we also present non-asymptotic analysis of ADTD([Formula: see text]) with both constant and diminishing step-sizes. Specifically, when the step-size is constant, the convergence rate of [Formula: see text] is achieved, where [Formula: see text] is the number of iterations; when the step-size is diminishing, the convergence rate of [Formula: see text] is also obtained. In addition, the performance of the algorithm is verified by simulation.
Research on lightweight and fatigue life of engine hood based on multi-objective particle swarm optimization
Authors: Li Wei , Long Yan , Liu Xueqiang , Zhang Henghai , Wang Xiaojun
Published: July 2022

A multi-objective optimization method is presented in this paper, aiming at improving the fatigue life of the engine hood while achieving light weight. By analyzing the factors affecting the fatigue life of the engine hood, a multi-objective optimization model was established that considered five design variables including the thickness of the inner plate, the thickness of the outer plate, the stiffness of the hook, the stiffness of the sealing strip, and the height of the buffer block. Then, the multi-objective particle swarm method was used for optimization, and the optimal solution was obtained in the form of a Pareto set. The ideal compromise solution was determined from the Pareto set by using fuzzy membership functions. On this basis, the optimal solution was determined from the Pareto set by comprehensively considering the steel plate material specification, mold and cost constraints. The torsional deformation test and switch fatigue test show that for the optimized engine hood, the fatigue life is increased by 117%, the mass is reduced by 0.51 kg, and the torsional deformation of the engine hood does not increase significantly. The proposed multi-objective optimization method is proved to be feasible and effective in improving engine hood fatigue life and lightweight design.
Predicting the individualized risk of nonadherence to zoledronic acid among osteoporosis patients receiving the first infusion of zoledronic acid: development and validation of new predictive nomograms
Authors: Li Chong , Lu Ke , Shi Qin , Gong Ya-qin
Published: July 2022

Introduction:

Achieving optimal adherence to zoledronic acid (ZOL) among osteoporosis (OP) patients is a challenging task. Here, we aimed to develop and validate a precise and efficient prediction tool for ZOL nonadherence risk in OP patients.

Methods:

We prospectively collected and analyzed survey data from a clinical registry. A total of 1010 OP patients treated for the first time with ZOL in two separate hospitals were selected for nonadherence analysis. The evaluation included a 16-item ZOL Nonadherence Questionnaire and potential risk factors for ZOL nonadherence were assessed via univariate and multivariate analyses. We next developed and validated two distinct-stage nomograms. Discrimination, calibration, and clinical usefulness of the predicting models were assessed using the area under the curve (AUC), calibration curves, and decision curve analysis (DCA).

Results:

The total nonadherence rate was 20.30% after the first ZOL infusion. To generate a model predicting ZOL nonadherence risk, six predictors of 16 items were retained. Model 2 (AUC, 0.8486; 95% confidence interval [CI], 0.8171–0.8801) exhibited considerably more discrimination in desirable functional outcomes, relative to Model 1 (AUC, 0.7644; 95% CI, 0.7265–0.8024). The calibration curves displayed good calibration. DCA revealed that a cutoff probability of 5–54% (Model 1) and 1–85% (Model 2) indicated that the models were clinically useful. External validation also exhibited good discrimination and calibration.

Conclusions:

This study developed and validated two novel, distinct-stage prediction nomograms that precisely estimate nonadherence risk among OP patients receiving the first infusion of ZOL. However, additional evaluation and external validation are necessary prior to widespread implementation.
The top 100 most impactful articles on the anterior cruciate ligament: An altmetric analysis of online media
Authors: Civilette Matthew D , Rate William R , Haislup Brett D , Cohen Andrew S , Camire Lyn , Bodendorfer Blake M , Gould Heath P
Published: July 2022

Objectives:

To identify the top 100 most impactful anterior cruciate ligament articles in online media as measured by the Altmetric Attention Score and compare their characteristics to the most-cited anterior cruciate ligament articles in the scientific literature.

Methods:

The Altmetric database was queried to identify all published articles pertaining to the anterior cruciate ligament. The search yielded 9445 articles, which were stratified by highest to lowest Altmetric Attention Score. The top 100 articles were included. Collected data included article type, article topic, journal name, and online mentions in news, blogs, Twitter, Facebook, Wikipedia, and other sources. The geographic origin of each article was also determined based on the institutional affiliation of the first author.

Results:

Altmetric Attention Score of the top 100 anterior cruciate ligament articles ranged from 109 to 2193 (median 172.0, interquartile range 137.5–271.5). Of the 100 articles, 65 were published in three journals: American Journal of Sports Medicine, British Journal of Sports Medicine, and Journal of Orthopaedic & Sports Physical Therapy. The most prevalent article type was original research (60%), followed by systematic review/meta-analysis (18%). The most prevalent article topic was rehabilitation and return to play after anterior cruciate ligament reconstruction (22%), followed by epidemiology/risk factors (16%), injury prevention (14%), and biomechanics of anterior cruciate ligament injuries (14%). Of the top 100 articles, 54% were American, 31% were European, and 15% were published in other countries outside of the United States and Europe.

Conclusion:

This study used Altmetric Attention Score to identify the 100 most engaged anterior cruciate ligament articles in online media. The characteristics of these articles differed substantially from the most-cited anterior cruciate ligament articles in the literature with regard to article type, article topic, geographic origin, and publication journal. These findings suggest that alternative metrics measure distinct components of anterior cruciate ligament article engagement and add an important dimension to understanding the overall impact of published research on the anterior cruciate ligament.
“Even Being a Citizen Is Not a Privilege Here”: Undocumented Latinx Immigrant Youth and Perceptions of Racialized Citizenship
Authors: Rodriguez Sophia , Macias Eric
Published: July 2022

This three-year multi-site ethnographic study centers undocumented high school youth’s ( N = 53) perspectives on citizenship. Challenging legal conceptions of citizenship, the article advances the notion of racialized citizenship, which is grounded in youth experiences and argues that deeper racial meanings and hierarchies undergird categories of citizenship. By highlighting a nuanced context of reception in the U.S. Southeast, the authors document how youth are racialized in school-community contexts and their perceptions of citizenship. This ethnographic work humanizes undocumented student’s experiences and urges educators and policymakers to reject pervasive anti-immigrant discourses and practices.
Implementing a “Distance Traveled” Question to Improve Resident Diversity: Process and Feasibility
Authors: Epstein Sherise , Konuthula Neeraja , Meyer Tanya K. , Whipple Mark E. , Bowe Sarah N. , Bly Randall A. , Abuzeid Waleed M.
Published: July 2022

Increasing diversity in the physician workforce is important to improving racial and ethnic disparities in health outcomes in the United States. We describe the implementation of a “distance traveled” question (DTQ) in our residency application process. For the 2021‐2022 cycle, all applicants to the University of Washington otolaryngology residency program were allowed to complete an optional DTQ. Responses were shared with the application review committee. Following the distribution of interview invites, an anonymous survey was sent to all faculty reviewers. The response rate was 26 of 36 (72%). Among respondents, 20 (77%) felt that the DTQ helped them learn something new about the applicant, and 19 (73%) reported that the DTQ influenced their decision making about the applicant. Thus, a DTQ may provide faculty with new and influential information regarding residency applicants.
Massive Juvenile Psammomatoid Ossifying Fibroma in the Mandible With a Complex Clinical Course: Case Report and Literature Review
Authors: Silver Eric , Yusupov Steve , Lam Lydia , Schultz Kathleen , Hoffman David
Published: July 2022

The juvenile ossifying fibroma is a rare subset of the benign ossifying fibroma. These tumors have an aggressive behavior and often cause severe destruction of bone and surrounding tissue. JOF can be separated into the juvenile trabecular ossifying fibroma and juvenile psammomatoid ossifying fibroma. In this article, we present a case of an 18 year old male who presented with a rapidly growing massive tumor originating in the right mandible that caused severe local destruction. Due to the size of the tumor, the patient had impairment in many activities of daily living. Pre-operative management was further complicated due to the vascular nature of the tumor which resulted in spontaneous bleeding. The tumor was successfully resected and final pathology revealed a diagnosis of juvenile psammomatoid ossifying fibroma. In this article, we describe treatment of a debilitating mandibular tumor and provide recommendations for other clinicians who encounter similar cases. Additionally, the demographics and histopathological features of the juvenile ossifying fibroma and its subtypes are described.
Older adults’ exposure to anticholinergic medications: Implications for pharmaceutical care for Nigerian older adults
Authors: Okoro Roland Nnaemeka , Idris Algoni Idris
Published: July 2022

Introduction:

Anticholinergic medications which are commonly prescribed to older adults can produce more pronounced adverse effects compared to the younger population.

Objectives:

To investigate the prevalence of polypharmacy, describe the prescription patterns of anticholinergic medications, determine the prevalence of exposure to high-risk anticholinergic cognitive burden (ACB) medications, and identify the potential predictors of exposure to high-risk ACB medications in older adults in a Nigerian secondary hospital.

Methods:

This cross-sectional study that included older adults prescribed at least one anticholinergic medication was conducted at a secondary care hospital in Nigeria. The study data were initially summarized using descriptive statistics, whereas multivariable logistic regression analysis was used to identify the potential predictors of exposure to high-risk ACB medications. In this study, the cumulative ACB scores were dichotomized into low risk (score 1–2) and high risk (score ⩾ 3). A p value less than 0.05 was considered to be statistically significant.

Results:

A total of 256 older adults were included in this study; 113 (44.1%) had polypharmacy, whereas 26.6% (188/256) were exposed to high-risk ACB medications. Of a total of 391 anticholinergic medications used by the population, furosemide (36.57%) was the most commonly prescribed. The adjusted multivariable logistic regression analysis indicated that patients who had acute diseases were 2.5 times (adjusted odds ratio (AOR) = 2.49, 95% confidence interval (CI): 1.40–4.45) more likely to be exposed to high-risk ACB medications than those with chronic diseases.

Conclusion:

The study demonstrates a high prevalence of polypharmacy and exposure to high-risk ACB medications suggesting the need for pharmaceutical care in this high-risk population. Older adults’ exposure to high-risk ACB medications was significantly associated with prescriptions for acute diseases.
Development and Analysis of a New Cylindrical Lithium-Ion Battery Thermal Management System
Authors: Sun Yasong , Bai Ruihuai , Ma Jing
Published: July 2022

With the development of modern technology and economy, environmental protection and sustainable development have become the focus of global attention. The promotion and development of electric vehicles (EVs) have bright prospects. However, many challenges need to be faced seriously. Under different operating conditions, various safety problems of electric vehicles emerge one after another, especially the hidden danger of battery overheating which threatens the performance of electric vehicles. This paper aims to design and optimize a new indirect liquid cooling system for cylindrical lithium-ion batteries. Various design schemes for different cooling channel structures and cooling liquid inlet directions are proposed, and the corresponding solid-fluid coupling model is established. COMSOL Multiphysics simulation software is adopted to simulate and analyze the cooling systems. An approximate model is constructed using the Kriging method, which is considered to optimize the battery cooling system and improve the optimization results. Sensitivity parameter analysis and the optimization design of system structure are performed through a set of influencing factors in the battery thermal management. The results indicate that the method used in this paper can effectively reduce the maximum core temperature and balance the temperature differences of the battery pack. Compared with the original design, the optimized design, which is based on the non-dominated sorting genetic algorithm (NSGA-II), has an excellent ability in the optimized thermal management system to dissipate thermal energy and keep the overall cooling uniformity of the battery and thermal management system. Furthermore, the optimized system can also prevent thermal runaway propagation under thermal abuse conditions. In summary, this research can provide some practical suggestions and ideas for the engineering and production applications and structural optimization design carried by electric vehicles.
Ultrasound-assisted modified paramedian technique for spinal anesthesia in elderly
Authors: Zeng Wei , Shi Yisa , Zheng Qihui , Du Shengfang
Published: July 2022

Background

At present, there are two techniques which are widely applied clinically; the midline and the paramedian. Both methods are difficult for clinicians when treating the elderly. The aim of this work is to explore the feasibility of an ultrasound-assisted modified paramedian technique for spinal anesthesia in the elderly. This would provide clinicians with a new and easy-to-operate technique.

Methods

A total of 150 elderly patients who were scheduled for urology surgery under spinal anesthesia in our hospital were randomly divided into three groups (n = 50): (i) midline technique group (group M), (ii) paramedian technique group (group P), and (iii) modified paramedian technique group (group PM). All spinal anesthesia were performed by the same second-year resident.

Results

Compared with groups M and P, group PM had significantly higher first-attempt success rate (P < 0.05, especially in patients aged 65-74 years), fewer attempts (P < 0.05), and higher patient satisfaction score (P < 0.05). Compared with group M, the time taken to perform spinal anesthesia and the number of needle redirections were significantly reduced in group PM (P < 0.05). There was no statistically significant difference between groups PM and P. There were also no statistically significant differences in the cases of inconsistency between ultrasound-assisted and landmark-guided location of intervertebral space, the time taken to ultrasound-assisted location, the onset time to pain block at T10, the incidence of hypotension, anesthesia effect and the incidence of headache, lower back pain, or nausea and vomiting, within 24 h after surgery.

Conclusions

The modified paramedian technique in spinal anesthesia for elderly patients can significantly improve the first-attempt success rate, reduce both the number of attempts and procedure time, and minimize tissue damage during the operation. Compared with the traditional techniques, the modified paramedian technique combines the advantages of both the midline and the paramedian methods, and is easy to learn. It is worthy of further research and application.

Trial registration

Prospectively registered at the China Clinical Trial Registry, registration number ChiCTR2100047635, date of registration: 21/06/2021.
Kinetics of 2 different high-sensitive troponins during targeted temperature management in out-of-hospital cardiac arrest patients with acute myocardial infarction: a post hoc sub-study of a randomised clinical trial
Authors: Larsen Alf Inge , Grejs Anders Morten , Vistisen Simon Tilma , Strand Kristian , Skadberg Øyvind , Jeppesen Anni Nørgaard , Duez Christophe H. V. , Kirkegaard Hans , Søreide Eldar
Published: July 2022

Introduction

Short term hypothermia has been suggested to have cardio protective properties in acute myocardial infarction (AMI) by reducing infarct size as assessed by troponins. There are limited data on the kinetics of these biomarkers in comatose out-of-hospital cardiac arrest (OHCA) patients, with and without AMI, undergoing targeted temperature management (TTM) in the ICU.

Purpose

The aim of this post hoc analyses was to evaluate and compare the kinetics of two high-sensitivity cardiac troponins in OHCA survivors, with and without acute myocardial infarction (AMI), during TTM of different durations [24 h (standard) vs. 48 h (prolonged)].

Methods

In a sub-cohort (n = 114) of the international, multicentre, randomized controlled study “TTH48” we measured high-sensitive troponin T (hs-cTnT), high-sensitive troponin I (hs-cTnI) and CK-MB at the following time points: Arrival, 24 h, 48 h and 72 h from reaching the target temperature range of 33 ± 1 °C. All patients diagnosed with an AMI at the immediate coronary angiogram (CAG)—18 in the 24-h group and 25 in the 48-h group—underwent PCI with stent implantation. There were no stent thromboses.

Results

Both the hs-cTnT and hs-cTnI changes over time were highly influenced by the cause of OHCA (AMI vs. non-AMI). In contrast to non-AMI patients, both troponins remained elevated at 72 h in AMI patients. There was no difference between the two time-differentiated TTM groups in the kinetics for the two troponins.

Conclusion

In comatose OHCA survivors with an aetiology of AMI levels of both hs-cTnI and hs-cTnT remained elevated for 72 h, which is in contrast to the well-described kinetic profile of troponins in normotherm AMI patients. There was no difference in kinetic profile between the two high sensitive assays. Different duration of TTM did not influence the kinetics of the troponins.

Trial registration: Clinicaltrials.gov Identifier: NCT01689077, 20/09/2012.
Prevalence of cardiovascular diseases and risk factors in adult patients with haemophilia: a cross-sectional study in a tertiary care hospital clinic in Sri Lanka
Authors: Vithanage Thamudika , Ratnamalala Visaka , Wickramaratne Chandana , Katulanda Gaya , Rodrigo Chithramali Hasanthika
Published: July 2022

Background

Management of cardiovascular disease (CVD) in patients with haemophilia is extremely challenging. Therefore, knowing the prevalence of CVD and risk factors in this population is imperative.

Methods

All consented patients ≥ 18 years of age attending the haemophilia clinic at a tertiary care centre were recruited to the study. Data were collected using a pretested, investigator administered questionnaire. Seated blood pressure, anthropometric measurements and blood samples were obtained using standard techniques. Lipid profile and fasting plasma glucose were estimated. Prevalence of risk factors for CVD was compared with those of age matched males in the general population. P values < 0.05 were considered significant.

Results

Of the total 109 participants, 92 (84.4%) had haemophilia A. The median age of the study group was 36 years. Three (2.8%) had at least one cardiovascular disease. There were 10 (9.2%), 30 (27.5%), 13 (11.9%) and 4 (3.7%) participants with diabetes, hypertension, current smoking and obesity (Body Mass Index (BMI) ≥ 30 kg/m2) respectively. 32 (29.4%) and 37 (33.9%) participants had waist circumference ≥ 90 cm and waist hip ratio ≥ 0.9 respectively. 38 (34.9%) had total cholesterol ≥ 200 mg/dl, 43 (39.5%) had low density lipoprotein (LDL) cholesterol ≥ 130 mg/dl, 25 (22.9%) had triglycerides (TG) ≥ 150 mg/dl and 58 (53.2%) had High density lipoprotein (HDL) cholesterol < 40 mg/dl. Diabetes was significantly associated with factor levels below 5% (p = 0.038). BMI, waist circumference and dyslipidaemia in the study were significantly higher compared to the general population.

Conclusion

The study signifies an increased prevalence of risk factors for CVD among patients with haemophilia and the need for preventive measures.
Sample size calculation for prevalence studies using Scalex and ScalaR calculators
Authors: Naing Lin , Nordin Rusli Bin , Abdul Rahman Hanif , Naing Yuwadi Thein
Published: July 2022

Background

Although books and articles guiding the methods of sample size calculation for prevalence studies are available, we aim to guide, assist and report sample size calculation using the present calculators.

Results

We present and discuss four parameters (namely level of confidence, precision, variability of the data, and anticipated loss) required for sample size calculation for prevalence studies. Choosing correct parameters with proper understanding, and reporting issues are mainly discussed. We demonstrate the use of a purposely-designed calculators that assist users to make proper informed-decision and prepare appropriate report.

Conclusion

Two calculators can be used with free software (Spreadsheet and RStudio) that benefit researchers with limited resources. It will, hopefully, minimize the errors in parameter selection, calculation, and reporting. The calculators are available at: (https://sites.google.com/view/sr-ln/ssc).
Patient-reported outcomes after initial conservative fracture treatment in primary healthcare – a survey study
Authors: Vabo Stein , Steen Knut , Brudvik Christina , Hunskaar Steinar , Morken Tone
Published: July 2022

Background

Primary healthcare in Norway has first-line responsibility for medical emergencies, including traumas and fractures. Normally, patients with suspected fractures are referred to specialist care. However, some municipalities have X-ray facilities and handle minor fractures locally. We investigated patient-reported outcome measures after initial treatment of radiologically diagnosed fractures of the wrist, collarbone, and ankle at a primary healthcare centre in a rural municipality with a large ski resort. The patients’ general satisfaction with the treatment was also investigated.

Methods

Validated questionnaires were sent to patients with fractures of the wrist or collarbone (Quick DASH—Disability of Arm, Shoulder and Hand) or the ankle (FAOS -The Foot and Ankle Outcome Score). Patients with wrist and collarbone fractures also answered the Quality-of-life questions that are a subscale of the FAOS questionnaire for ankle fractures. Patient satisfaction was measured for all fracture groups. The Quick DASH scale ranges from 0 (no disability at all) to 100 (great disability), while for FAOS a score of 100 indicates no symptoms and 0 indicates extreme disabilities.

Results

A total of 148 of 238 patients answered the questionnaire (62% response rate). Patients with distal radius fractures had a mean Quick DASH score of 5.1 (median 0, range 0–77), and scores were significantly lower for males (p = 0.013) and increased with age (p = 0.024). Patients with collarbone fractures had a mean Quick DASH score of 2.1 (median 0, range 0–32) with no significant age or gender differences. Patients with ankle fractures had the following mean subscale-scores: Pain, 93.8; Symptoms, 71.4; Activities of daily living, 97.4; Sport, 90.0; and Quality of life, 92.1. The scores did not differ significantly by specialization of the physician. A total of 88% of the patients were highly or very highly satisfied with the handling of their fracture.

Conclusions

The patients reported low rates of functional disability and high rates of satisfaction after initial radiological diagnosis and treatment of their fracture at the primary healthcare centre. Specialisation of the treating physician was not associated with the outcome in any of the fracture types.
Nonsteroidal anti-inflammatory drug exposure and the risk of microscopic colitis
Authors: Yen Eugene F. , Amusin Daniel B. , Yoo Janet , Ture Asantewaa , Gentile Nicole M. , Goldberg Michael J. , Goldstein Jay L.
Published: July 2022

Background

Medication consumption has been suggested as a risk factor for microscopic colitis (MC), but studies of varying design have yielded inconsistent results. Our aim was to evaluate the association between medications and MC.

Methods

A hybrid cohort of prospectively identified patients undergoing colonoscopy with biopsies for suspicion of MC (N = 144) and patients with MC enrolled within three months of diagnosis into an MC registry (N = 59) were surveyed on medication use. Medication use was compared between patients with and without diagnosis of MC by chi-squared test and binomial logistic regression adjusted for known risk factors of MC: age and gender.

Results

In total, 80 patients with MC (21 new, 59 registry) were enrolled. Patients with MC were more likely to be older (p = 0.03) and female (p = 0.01) compared to those without MC. Aspirin and other non-steroidal anti-inflammatory drugs were more commonly used among patients who developed MC (p < 0.01). After controlling for age and gender, these medications remained independent predictors of MC with odds ratio for any non-steroidal anti-inflammatory drug use of 3.04 (95% CI: 1.65–5.69). No association between MC and other previously implicated medications including proton pump inhibitors and selective serotonin reuptake inhibitors was found.

Conclusions

In this cohort of patients with chronic diarrhea, we found use of aspirin and non-steroidal anti-inflammatory drugs, but not other implicated medications to be associated with the development of MC. Whether these drugs trigger colonic inflammation in predisposed hosts or worsen diarrhea in undiagnosed patients is unclear. However, we feel that these findings are sufficient to discuss potential non-steroidal anti-inflammatory drug cessation in patients newly diagnosed with MC.
Subcutaneous administration, higher age and lower renal function are associated with erythrocyte methotrexate accumulation in Crohn’s disease: a cross-sectional study
Authors: van de Meeberg M. M. , Seinen M. L. , Fidder H. H. , Lin M. , Oldenburg B. , de Boer N. K. , Bouma G. , de Jonge R. , Bulatović Ćalasan M. ,   the Dutch Initiative on Crohn and Colitis (ICC)
Published: July 2022

Background

Methotrexate is an immunomodulatory drug for patients with Crohn’s disease. Erythrocyte MTX-polyglutamates (MTX-PG1-5) may be used for therapeutic drug monitoring (TDM) as MTX-PG is thought to mediate MTX’s efficacy. Information on determinants of the concentration of MTX-PG in patients with Crohn’s disease is lacking. We aim to identify clinical and biochemical determinants of the erythrocyte MTX-PG1-5 and MTX-PGtotal concentration in patients with Crohn’s disease.

Methods

Adults with Crohn’s disease on methotrexate treatment who visited the outpatient clinic of Amsterdam UMC were included. Erythrocyte MTX-PGs were measured by tandem mass spectrometry.

Results

Nineteen patients were included, with a median duration of MTX use of 77 months (range 7–202). Twelve patients received MTX monotherapy, whereas 7 patients were on concomitant TNF-α inhibitors. The mean dose of MTX was 15.5 mg (SD ± 2.8) and 12 (63%) patients used subcutaneous MTX. MTX-PG1-5 were successfully measured in 18 patients, showing substantial variability in concentrations of MTX-PGtotal and individual species. The median MTX-PGtotal was 117.1 nmol/L (range 46.4–258.7) with preferential accumulation of MTX-PG3 (43.1 nmol/L, range 15.3–96.1). Patients on subcutaneous compared to oral MTX had higher median MTX-PG(4,5) levels (55 versus 9 nmol/L, p = 0.01). Higher age (β = 0.71) and lower estimated glomerular filtration rate (β = − 0.52) were associated with a significantly higher MTX-PGtotal concentration (R2 = 0.60, p = 0.001).

Conclusion

MTX-PG concentrations display a considerable inter-individual variability. Higher MTX-PG accumulation is associated with subcutaneous administration, higher age, and lower renal function in Crohn’s disease patients.
Metabolism reprogramming signature associated with stromal cells abundance in tumor microenvironment improve prognostic risk classification for gastric cancer
Authors: Huo Junyu , Guan Jing , Li Yankun
Published: July 2022

Background

Stromal cells play an important role in the process of tumor progression, but the relationship between stromal cells and metabolic reprogramming is not very clear in gastric cancer (GC).

Methods

Metabolism-related genes associated with stromal cells were identified in The Cancer Genome Atlas (TCGA) and GSE84437 datasets, and the two datasets with 804 GC patients were integrated into a training cohort to establish the prognostic signature. Univariate Cox regression analysis was used to screen for prognosis-related genes. A risk score was constructed by LASSO regression analysis combined with multivariate Cox regression analysis. The patients were classified into groups with high and low risk according to the median value. Two independent cohorts, GSE62254 (n = 300) and GSE15459 (n = 191), were used to externally verify the risk score performance. The CIBERSORT method was applied to quantify the immune cell infiltration of all included samples.

Results

A risk score consisting of 24 metabolic genes showed good performance in predicting the overall survival (OS) of GC patients in both the training (TCGA and GSE84437) and testing cohorts (GSE62254 and GSE15459). As the risk score increased, the patients’ risk of death increased. The risk score was an independent prognostic indicator in both the training and testing cohorts suggested by the univariate and multivariate Cox regression analyses. The patients were clustered into four subtypes according to the quantification of 22 kinds of immune cell infiltration (ICI). The proportion of ICI Cluster C with the best prognosis in the low-risk group was approximately twice as high as that in the high-risk group, and the risk score of ICI Cluster C was significantly lower than that of the other three subtypes.

Conclusion

Our study proposed the first scheme for prognostic risk classification of GC from the perspective of tumor stromal cells and metabolic reprogramming, which may contribute to the development of therapeutic strategies for GC.
Feasibility of smartphone-supported, combined physical and cognitive activities in the Neighbourhood for stimulating social participation of the elderly
Authors: Thiel Christian , Günther Liane , Osterhoff Anke , Sommer Sascha , Grüneberg Christian
Published: July 2022

Background

Combining smartphone-assisted group activities in the neighbourhood and training in physical and cognitive skills may offer the potential to promote social participation and connectedness of older adults. This non-controlled proof-of-concept, retrospectively registered study aimed to determine the feasibility of such an intervention approach, including its evaluation.

Methods

In two consecutive six-month intervention cycles, 39 community-dwelling adults were provided with weekly smartphone, physical and cognitive training by two tutors. Using a specifically designed app, the participants were also encouraged to join and later self-organise physically and cognitively stimulating activities related to hot spots in their Bochum neighbourhood. Indicators of feasibility were documented.

Results

The recruitment and assessments took 3 hours per participant. Excluding smartphone support, the preparation and the implementation of the intervention amounted to nine person-hours per week.

Six participants dropped out, and 13 did not complete one or more assessments. The participants attended 76 ± 15% of the weekly training sessions. The instructors deemed the programme feasible, but familiarisation with the smartphone and the app was very time-consuming.

Twenty-seven of 29 participants reported high overall satisfaction, and 22 agreed that the programme helped them to establish social contacts. The smartphones attracted substantial interest and were used frequently, despite mixed satisfaction with the project-specific app. From baseline to follow-up, the six-minute walking distance, lower extremity strength and moderate to vigorous physical activity, as well as quality of life, were preserved at a high level, while balance performance was significantly improved. Of the 11 tests related to cognitive functioning, 4 tests (a memory test, the Stroop test and 2 tests of verbal fluency) indicated significant improvement. No moderate or serious adverse events occurred in relation to the assessments or the intervention.

Conclusions

The multimodal approach seems safe and feasible and offers the potential to promote social connectedness, bonds in the residential neighbourhood and smartphone competency, as well as to preserve or improve physical and cognitive functions. Adaptations of the intervention and of the outcome assessments may contribute to better assessment and exploitation of the potential of this approach in a future study involving socially, physically and cognitively less active elderly persons.