bluuebunny/crossref_metadata_2025 huggingface dataset:
Exhaustion of the Executive Control Capacity Eliminates Retrieval Induced Forgetting
Authors: Tumen Ceyda , Ikier Simay
Published: July 2021

Retrieval Induced Forgetting (RIF) demonstrates that retrieval of information can lead to forgetting of related information. The standard RIF paradigm involves studying a certain number of category-exemplar pairs; thereafter, half of the exemplars from half of the categories are retrieved. Finally, all studied pairs are recalled. RIF is revealed when unretrieved exemplars from the retrieved categories are more poorly recalled than exemplars from the unretrieved categories. One explanation for RIF asserts that inhibition prevents interference from the exemplars of the same category during the interpolated retrieval practice phase, which leads to forgetting of these items at final recall. An ongoing debate concerns whether this inhibition requires executive control or whether it is automatic. If inhibition in RIF involves executive control, then a task that will exhaust this limited capacity should reduce or eliminate the RIF effect. The effects of concurrent tasks during the retrieval practice phase have been shown to reduce or eliminate RIF, however, to our knowledge, the effects of prior tasks on RIF has not been investigated. In the present study, in one condition, we conducted an exhaustive inhibition task before the retrieval practice phase and compared this condition to the one in which the prior task was non-exhaustive. Results showed that the RIF effect was eliminated when the prior task was exhaustive. The results supported the executive control view for the inhibition mechanism behind RIF and further showed that exhaustion of the executive control capacity can impair inhibition in subsequent tasks.
Optimization and characterization of flavonoids extracted from Cannabis sativa fibers
Authors: Cui Qilu , Li Jiawei , Yu Chongwen
Published: July 2021

In this paper, the extraction process of flavonoids from hemp fibers was studied. Response surface methodology (RSM) analysis of the extraction parameters indicated that optimized results would be ethanol concentration 76 vol.%, bath ratio 1:50, and reaction time 139 min; therefore, an optimal extraction rate of flavonoids of 0.2275% can be obtained. The chemical structure, surface morphology and element composition of flavonoid extracts were analyzed. The test results indicated that hemp extract contains flavonoids, which can be used to extract flavonoids from hemp fiber, so as to comprehensively develop hemp fiber and reduce the discharge of waste liquid in the traditional degumming process.
Two-dimensional-Wilkins and real-time transesophageal three-dimensional scoring systems: Which one is preferred to mitral valve morphological assessment?
Authors: Toufan Mehrnoush , Jabbary Zahra , aghdam Naser Khezerlou
Published: July 2021

Background

To quantify valvular morphological assessment, some two-dimensional (2D) and three-dimensional (3D) scoring systems have been developed to target the patients for balloon mitral valvuloplasty; however, each scoring system has some potential limitations. To achieve the best scoring system with the most features and the least restrictions, it is necessary to check the degree of overlap of these systems. Also the factors related to the accuracy of these systems should be studied. We aimed to determine the correlation between the 2D Wilkins and real-time transesophageal three-dimensional (RT3D-TEE) scoring systems.

Methods

This cross-sectional study was performed on 156 patients with moderate to severe mitral stenosis who were candidates for percutaneous balloon valvuloplasty. To morphologic assessment of mitral valve, patients were examined by 2D-transthoracic echocardiography and RT3D-TEE techniques on the same day.

Results

A strong association was found between total Wilkins and total RT3D-TEE scores (r = 0.809, p < 0.001). The mean mitral valve area assessed by the 2D and 3D was 1.07 ± 0.25 and 1.03 ± 0.26, respectively, indicating a mean difference of 0.037 cm2 (p = 0.001). We found a strong correlation between the values of mitral valve area assessed by 2D and 3D techniques (r = 0.846, p < 0.001).

Conclusion

There is a high correlation between the two scoring systems in terms of evaluating dominant morphological features. Partially, mitral valve area overestimation in the 2D-transthoracic echocardiography and its inability to assess commissural involvement as well as its dependence on patient age were exceptions in this study.
Capacity in municipalities: Infrastructures, maintenance debts and ways of overcoming a run-to-failure mentality
Authors: Alm Jens , Paulsson Alexander , Jonsson Robert
Published: July 2021

There is a growing maintenance debt of ageing and critical infrastructures in many municipalities in European welfare states. In this article, we use the multidimensional concept of local capacity as a point of departure to analyse how and in what ways Swedish municipalities work with the routine maintenance of infrastructures, including municipal road networks as well as water and sewage systems. For the road networks, maintenance is generally outsourced to contractors and there is also a large degree of tolerance for various standards on different road segments within and between the municipalities. Less used road segments are not as prioritised as those with heavy traffic. For the water and sewage systems, in-house technical capacity is needed as differences in water quality are not tolerated. Economies of scale mean that in-house capacity is translated into the creation of inter-municipal bodies. As different forms of capacities tend to reinforce each other, municipal capacity builds up over time in circular movements. These results add knowledge to current research by pointing to the ways municipalities are overcoming a run-to-failure mentality by building capacity to pay off the infrastructural maintenance debt.
Augmented Inverse Probability Weighting and the Double Robustness Property
Authors: Kurz Christoph F.
Published: July 2021

This article discusses the augmented inverse propensity weighted (AIPW) estimator as an estimator for average treatment effects. The AIPW combines both the properties of the regression-based estimator and the inverse probability weighted (IPW) estimator and is therefore a “doubly robust” method in that it requires only either the propensity or outcome model to be correctly specified but not both. Even though this estimator has been known for years, it is rarely used in practice. After explaining the estimator and proving the double robustness property, I conduct a simulation study to compare the AIPW efficiency with IPW and regression under different scenarios of misspecification. In 2 real-world examples, I provide a step-by-step guide on implementing the AIPW estimator in practice. I show that it is an easily usable method that extends the IPW to reduce variability and improve estimation accuracy.

[Box: see text]
Study on the effective discharge energy mechanism of vertical ultrasonic vibration assisted EDM processing
Authors: Dong Yinghuai , Li Guangyan , Wang Yan , Song Jianbao , Yang Shuo , Yu Haiyang
Published: July 2021

Compared to traditional EDM processing, UEDM (Ultrasonic Vibration Assisted EDM) have a great improvement in optimizing discharge environment. In this study, ultrasonic vibration is attached to the electrode. According to the relative positional relationship between the movement path of the electrode tip and the discharge gap, four working states of UEDM are defined. The four working states are the path within the discharge gap, the path in contact with the edge of the discharge gap, part of the electrode end path outside the discharge gap, and the path in contact with the workpiece, respectively. States are analyzed from the effective discharge energy and discharge frequency. A mathematical model for effective discharge energy and surface roughness is established for two conventional working states. The correctness of the theoretical research is verified by experiments. As the experiment results shown, the influence of ultrasonic amplitude on the energy of UEDM is primary, while frequency is secondary. A working state with better discharge stability and higher discharge energy when the electrode end path is in contact with the edge of the discharge gap. In the first three conventional machining states, the surface quality of the workpiece increases with the increase of ultrasonic amplitude and frequency. The study can provide scientific guidance for parameter matching of UEDM.
An automated method for detecting atrial fat using convolutional neural network
Authors: Deepa Deepa , Singh Yashbir , Wang Ming Chen , Hu Weichih
Published: July 2021

Atrial Fibrillation (A-fib) is a common cardiac rhythm problem in the population these days in which irregular heartbeat leads to blood clots, heart failure, stroke, and other significant clinical complications. Researchers have found that the atrial fat can lead to AF in most patients. To develop an automated method for detecting the epicardial fat present in the atrium using a Convolutional Neural Network. Cardiac Computed Tomography (CT) images of ten patients were pre-processed to remove the unwanted structure around the heart. An automated pixel value masking was done to locate the epicardial fat in the atrium and a 3D view of the heart was constructed for correct visualization of the location of the fat. A fast and fully automated Convolutional Neural Network (CNN) was applied to detect the atrial epicardial fat through feature selection from the CT images. We achieved 89.22% accuracy, 90.18% sensitivity, and 88.52% specificity in the detection of atrial epicardial fat using our CNN architecture. Our results showed that this CNN-based method can be helpful in atrial epicardial fat detection. Since Deep learning techniques add robustness, rapidness, and reliability, this study provides an unutilized way to detect the atrial fat tissue.
Improving ride comfort of straddle-type monorail vehicle with single-axle bogie by active suspension
Authors: Du Zixue , Xin Liang , Yang Zhen , Xu Zhouzhou
Published: July 2021

This article is concerned with improving the ride comfort of straddle-type monorail vehicles with single-axle bogies by using electro-hydraulic actuator active suspension, which is a new research field. Based on the 15-DOF dynamic model of straddle-type monorail vehicle with single-axle bogie, the model of electro-hydraulic actuator is established, and the adaptive neural fuzzy inference system proportional–integral–differential (adaptive fuzzy inference system proportional–integral–differential) is designed. The simulink results show that the adaptive fuzzy inference system proportional–integral–differential control active suspension can effectively reduce the root mean square value and peak value of the lateral acceleration, vertical acceleration, roll angle acceleration, pitch angle acceleration, and yaw angle acceleration of monorail vehicles compared with the passive suspension. The active suspension of electro-hydraulic actuator can effectively improve ride comfort of the straddle monorail with single-axle bogie.
Kidney transplantation outcomes in lupus nephritis: A 37-year single-center experience from Latin America
Authors: Rodelo Joaquín , González Luis Alonso , Ustáriz José , Matera Silvia , Pérez Keylis , Ramírez Zoraida , Arias Luis Fernando , García Álvaro , Arbeláez Mario , Henao Jorge
Published: July 2021

Objective

We assessed patient and graft outcomes and prognostic factors in kidney transplantation in patients with end-stage kidney disease (ESKD) secondary to lupus nephritis (LN) undergoing kidney transplantation from August 1977 to December 2014 in a Latin American single center.

Methods

The primary endpoint was patient survival, and the secondary endpoints were death-censored graft survival for the first renal transplant and the rate of recurrent LN (RLN). Kaplan–Meier method was used for survival analysis. Factors predicting patient and death-censored graft survivals were examined by Cox proportional-hazards regression analyses.

Results

185 patients were retrospectively evaluated. Patient survival rates were 88% at one year, 82% at three years, 78% at five years, and 67% at ten years. Death-censored graft survival for the first renal transplant was 93% at one year, 89% at three years, 87% at five years, and 80% at ten years. RLN was diagnosed in 2 patients (1.08%), but no graft was lost because of RLN. Thirty-nine (21.1%) patients died, and 65 (35.1%) patients experienced graft loss during the follow-up. By multivariable analyses, older recipient age and 1-month posttransplantation eGFR <45 ml/min/1.73m2 were associated with lower patient survival and an increased risk of graft loss, while induction immunosuppressive therapy exerted a protective effect on patients’ survival. In the subgroup of patients in whom disease activity was measured at the time of transplantation, a higher SLEDAI score was also associated with lower patient survival and an increased risk of graft loss.

Conclusion

In a mostly Mestizo population, kidney transplantation is an excellent therapeutic alternative in LN patients with ESKD. Older recipient age, an eGFR <45 ml/min/1.73m2 at one month posttransplantation, and disease activity at the time of transplantation are predictive of a lower patient and death-censored graft survival, while induction immunosuppressive therapy has a protective effect on patient survival. RLN is rare and does not influence the risk of graft loss.
Improvised music to support Intensive Interaction for children with complex needs: A feasibility study of brief adjunctive music therapy
Authors: Strange John
Published: July 2021

This study investigates Triadic Support of Interaction by Improvisation, an application of music therapy as a brief adjunctive therapy for children with complex needs who are receiving Intensive Interaction. A small randomised controlled trial measured changes in child-support worker interaction between the 4th and the 12th of 12 weekly sessions of Intensive Interaction. In each of two special schools, a control group of four children with complex needs received Intensive Interaction only and an experimental group of four children additionally received improvised music in sessions 5 through 8. Experienced Speech and Language Therapists made blind assessments from video recordings of sessions 4 and 12 using an adaptation of an instrument developed by a National Health Service learning disability service for tracking progress in Intensive Interaction. The experimental group at one research site showed significantly enhanced interaction (p = 0.02). This offers provisional proof of concept, provided environmental factors identified as impacting results at the other site can be resolved in future studies.
Music therapy in the hospital-at-home: A practice for children in palliative care
Authors: Steinhardt Tone Leineboe , Mortvedt Sofie , Trondalen Gro
Published: July 2021

This pilot research study investigated music therapy in a hospital-at-home setting for children in palliative care, focusing on parental and nurses experiences of music therapy. Nine families included in the study were interviewed after receiving a maximum of five individual music therapy sessions at home with a Music Therapist. In addition, a focus group interview with allied health professionals involved in the patients’ care was conducted investigating the multidisciplinary team’s experiences with music therapy. Results revealed that the families drew attention to the feeling of being isolated–yet connected due to music therapy. All the families reported the importance of the relationship to the Music Therapist, while emphasizing flexibility and joint music-making. Music therapy within hospital-at-home treatment was reported as a meaningful and much appreciated form of therapy, while the multidisciplinary teamwork was highly valued by both the health personnel and the families. The results showed the need for a highly skilled Music Therapist to support the families’ complex and dynamic needs within a hospital-at-home setting. The results demonstrated the need for, and the possibilities of, a dynamic music therapy programme adapting not only to the patients’ individual needs but additionally providing family-centred care that considered shifting locations.
Procedural and distributive justice: Effects on attitudes toward body-worn cameras
Authors: Mrozla Thomas
Published: July 2021

The purpose of this study was twofold. First, it examined how procedural and distributive justice influence college students’ perceptions of adoption of body-worn cameras by the police. Second, it explored how procedural and distributive justice influence college students’ perceptions of the ability of body-worn cameras to improve community relations, decrease citizen complaints, increase police officer respect, increase citizen respect, and improve training. Those who perceived distributive injustice were more likely to agree that the police should adopt body-worn cameras. Perceived distributive injustice was also a consistent predictor regarding the varying abilities of body-worn cameras.
Systematic reviews: Structure, form and content
Authors: Phillips Veronica , Barker Eleanor
Published: July 2021

This article aims to provide an overview of the structure, form and content of systematic reviews. It focuses in particular on the literature searching component, and covers systematic database searching techniques, searching for grey literature and the importance of librarian involvement in the search. It also covers systematic review reporting standards such as PRISMA-P and PRISMA, critical appraisal and tools and resources to support the review and ensure it is conducted efficiently and effectively. Finally, it summarizes the requirements when screening search results for inclusion in the review, and the statistical synthesis of included studies’ findings.
Rural–Urban Disparities in Access to Improved Sanitation in Indonesia: A Decomposition Approach
Authors: Irianti Sri , Prasetyoputra Puguh
Published: July 2021

One of the targets in the Sustainable Development Goals (SDGs), which is Target 6.2, aims to achieve access to adequate and equitable sanitation. The Government of Indonesia targets universal access to improved sanitation in 2019. However, almost two out of five households in Indonesia are without access to improved sanitation. Moreover, access to improved sanitation is lower in rural areas than that in urban areas. Studies examining the drivers of the disparity in Indonesia are also limited. Therefore, this study was aimed at assessing the characteristics associated with the rural–urban disparity in access to improved sanitation facilities among households in Indonesia. We employed data from the 2016 Indonesian National Socio-Economic Survey (SUSENAS) comprising 290,848 households. The analysis was twofold. First, we fitted multivariate probit regression models using average marginal effects as the measure of association. We then conducted a detailed non-linear decomposition of the rural–urban disparity attributable to all the explanatory variables. The multivariate regression analysis suggested that households living in rural areas were 11.35% (95% confidence interval = [10.97, 11.72]) less likely to have access to improved sanitation facilities than those residing in urban areas. The decomposition analysis suggested that 48.78% are attributable to spatial, demographic, housing, and socio-economic factors, which meant that almost half of the inequalities could be reduced by equalizing these factors. The results provide a decomposition of factors amenable to curtail urban–rural inequalities. Hence, equity-oriented approaches to increasing access to improved sanitation should be prioritized to achieve universal access in 2030 in line with SDG Target 6.2.
The Study of the Relationships of Teacher’s Creative Teaching, Imagination, and Principal’s Visionary Leadership
Authors: Chen Hsin-Hao , Yuan Yu-Hsi
Published: July 2021

This study aims to investigate how a teacher’s creative teaching is affected by the teacher’s imagination and his or her school principal’s visionary leadership, and how the contextual moderating effects are at play among the cross-hierarchical factors. The research framework is divided into two levels: the individual level on how “teacher’s imagination” affects “teacher’s creative teaching” and the group level on the impact of “the principal’s visionary leadership.” From the teachers of 65 primary schools in southern Taiwan invited to participate in the survey study, 861 valid data were returned. The cross-level moderating effects were further examined via hierarchical linear modeling (HLM). The result shows that the “teacher’s imagination” will impact the “creative teaching” positively. The “vision practice” will affect “autonomous learning and challenge-presenting” positively as well. Moreover, the “vision feedback” plays a positive moderator role in how “creative imagination” contributes to “interactive discussion and open-mindedness.” The implication of the study is to discover the predictive model which inspired the students’ creativity potential by cross-hierarchical perspective.
A survey of aerosol exposure systems relative to the analysis of cytotoxicity: A Cooperation Centre for Scientific Research Relative to Tobacco (CORESTA) perspective
Authors: Thorne David , Wieczorek Roman , Fukushima Toshiro , Shin Han-Jae , Leverette Robert , Ballantyne Mark , Li Xiang , Bombick Betsy , Yoshino Kei
Published: July 2021

During a Cooperation Centre for Scientific Research Relative to Tobacco (CORESTA) meeting, the in vitro toxicity testing Sub-Group (IVT SG) met to discuss the evolving field of aerosol exposure research. Given the diversity of exposure parameters and biological endpoints being used, it was considered a high priority to investigate and contextualise the responses obtained. This is particularly driven by the inability to compare between studies on different exposure systems due to user preferences and protocol differences. Twelve global tobacco and contract research companies met to discuss this topic and formulate an aligned approach on how this diverging field of research could be appropriately compared. Something that is becoming increasingly important, especially in the light of more focused regulatory scrutiny. A detailed and comprehensive survey was conducted on over 40 parameters ranging from aerosol generation, dilution and data analysis across eight geographically independent laboratories. The survey results emphasise the diversity of in vitro exposure parameters and methodologies employed across the IVT SG and highlighted pockets of harmonisation. For example, many of the biological protocol parameters are consistent across the Sub-Group. However, variables such as cell type and exposure time remain largely inconsistent. The next steps for this work will be to map parameters and system data against biological findings and investigate whether the observed inconsistencies translate into increased biological variability. The results from the survey provide improved awareness of parameters and nuances, that may be of substantial benefit to scientists in intersecting fields and in the development of harmonised approaches.
‘Thinking with Kaipara’: A decolonising methodological strategy to illuminate social heterogenous nature–culture relations in place
Authors: Makey Leane
Published: July 2021

Decolonising methodologies continue to be critically developed to disrupt the marginalising approaches to knowledge production. By privileging Indigenous ways of knowing, being and doing, relations with nature are a more-than-human entanglement and a relational pursuit. Ecosystems such as estuaries and rivers are connected through kin-based relationships and treated as (or are) ancestors and family members. Such embodiment connects the body–mind–spirit to maintain relations with the mauri of ancestral beings and Deities. Within this ontology, nature is indistinguishable from culture. Our research responds to the call of how method might proceed to de-centre the human and make bodily and material encounters with the nonhuman matter. ‘Thinking with Kaipara’ is a methodological strategy that is a deliberate attempt to pursue embodied ways of producing knowledge. To work with situated knowledges, place and social difference to address the crisis of representation of such in ecosystem-based management, the problematising of ecosystem degradation and restoration practices. Research data produced is founded on human and nonhuman collaboration, an ethic of care, diverse epistemic nature–culture relations, social/nature/gender justice and equality, which makes for empirical evidence not enjoyed by scientific and technocratic methods utilised to inform and shape ecosystem-based management decisions and policy. Geo-creative practices are used by co-researchers/co-participants to recount their lived experiences and knowledges of ecosystem degradation and restoration. Storytelling, poetics, and painting, sculpting, whaikorero, waiata and writing were practices used. We argue that such geo-creative practices challenge the normative spaces and practices of disciplinary knowledge-making and enable the examination of social heterogeneous nature–culture relations in settler-colonial societies.
It’s Practice. But is it Strategy? Reinvigorating strategy-as-practice by rethinking consequentiality
Authors: Jarzabkowski Paula , Kavas Mustafa , Krull Elisabeth
Published: July 2021

In this essay we revisit the radical agenda proposed by strategy-as-practice scholars to study strategy as it emerges within people’s practices. We show that, while much progress has been made, there is still a dominant focus on articulated strategies, which has implications for what is seen as strategic. We anchor our argument in the notion of consequentiality – a guiding yet, ironically, constraining principle of the strategy-as-practice agenda. Our paper proposes a deeper understanding of the notion of strategy as ‘consequential’ in terms of both what is important to a wider range of actors and also following the consequences of these actors’ practices through the patterns of action that they construct. In doing so, we offer a conceptual and an empirical approach to reinvigorating the strategy-as-practice agenda by inviting scholars to take a more active role in field sites, in deciding and explaining what practices are strategic.
Caesarean section defects may affect pregnancy outcomes after in vitro fertilization-embryo transfer: a retrospective study
Authors: Diao Junrong , Gao Ge , Zhang Yunshan , Wang Xinyan , Zhang Yinfeng , Han Ying , Du Aijun , Luo Haining
Published: July 2021

Background

Caesarean section rates are rising worldwide. One adverse effect of caesarean section reported in some studies is an increased risk of subfertility. Only a few studies have assessed the relationship between the previous mode of delivery and in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) reproductive outcomes. In this study, we primarily investigated the impact of a history of caesarean section with or without defects on IVF/ICSI-ET outcomes compared to a vaginal delivery history.

Methods

This retrospective study included 834 women who had a IVF or ICSI treatment at our centre between 2015 and 2019 with a delivery history. In total, 401 women with a previous vaginal delivery (VD) were assigned to the VD group, and 433 women with a history of delivery by caesarean section were included, among whom 359 had a caesarean scar (CS) without a defect and were assigned to the CS group and 74 had a caesarean section defect (CSD) and were assigned to the CSD group. Baseline characteristics of the three groups were compared and analysed. Binary logistic regression analyses were performed to explore the association between clinical outcomes and different delivery modes.

Results

There were no significant differences in the live birth rate, biochemical pregnancy rate, clinical pregnancy rate, mean implantation rate or abnormal pregnancy rate between the CS and VD groups However, the live birth rate and mean implantation rate in the CSD group were significantly lower than those in the VD group (21.6 vs 36.4%, adjusted OR 0.50 [0.27–0.9]; 0.25 ± 0.39 vs 0.35 ± 0.41, adjusted OR 0.90 [0.81–0.99]). Among women aged ≤ 35 years, the subgroup analyses showed that the live birth rate, biochemical pregnancy rate, clinical pregnancy rate, and mean implantation rate in the CSD group were all significantly lower than those in the VD group (21.4 vs 45.8%, adjusted OR 0.35[0.15 ~ 0.85]; 38.1 vs 59.8%, adjusted OR 0.52[0.24–0.82]; 31.0 vs 55.6%, adjusted OR 0.43[0.19–0.92]; 0.27 ± 0.43 vs 0.43 ± 0.43, adjusted OR 0.85[0.43 ± 0.43]). For women older than 35 years, there was no statistically significant difference in any pregnancy outcome among the three groups.

Conclusions

This study suggested that the existence of a CS without a defect does not decrease the live birth rate after IVF or ICSI compared with a previous VD. However, the presence of a CSD in women, especially young women (age ≤ 35 years), significantly impaired the chances of subsequent pregnancy.
Risk factors for venous thromboembolism in patients with diabetes undergoing joint arthroplasty
Authors: Deng Wei , Huo Lili , Yuan Qiang , Huang Deyong , Li Quan , Tian Wei
Published: July 2021

Background

Venous thromboembolism (VTE) is a significant complication after joint arthroplasty. Diabetes is related to a few changes in coagulation and fibrinolysis that may lead to thrombophilia. We aimed to investigate the incidence of postoperative VTE and associated risk factors among patients with diabetes undergoing total hip (THA) or total knee anthroplasty (TKA) in a single centre in China.

Methods

Patients with diabetes who underwent THA or TKA from January 2016 to December 2018 (n = 400) at Beijing Jishuitan Hospital were recruited in this study. Lower limb venous Doppler ultrasound was performed before and after surgery to confirm deep venous thrombosis (DVT). Computer tomography pulmonary angiography was done to confirm pulmonary embolism (PE) for those with new postoperative DVT and typical symptoms of PE. A multivariate logistic regression model was conducted to examine factors associated with the development of postoperative VTE.

Results

The overall incidence of postoperative VTE in patients with diabetes after THA or TKA was 46.8 % (187 out of 400). Among the 187 VTE patients, 7.5 % (14 out of 187) had proximal vein thrombosis and 92.5 % (173 out of 187) had distal vein thrombosis. No PE occurred. Female patients and patients undergoing TKA had higher incidence of postoperative VTE. Patients who developed postoperative VTE were older, and had higher levels of preoperative D-Dimer and Caprini score. A high level of preoperative D-dimer (OR = 2.11, 95 %CI = 1.35–3.30) and the surgery of TKA (OR = 2.29, 95 %CI = 1.29–4.01) significantly increased the risk of developing postoperative VTE. Postoperative initiation of concomitant mechanical prophylaxis and low molecular weight heparin (LMWH) was protective for postoperative VTE (OR = 0.56, 95 %CI = 0.37–0.86).

Conclusions

VTE is common in patients with diabetes undergoing joint arthroplasty. Patients undergoing TKA or with a high level of preoperative D-dimer are at a considerable risk of developing postoperative VTE. There may be a protective role of postoperative initiation of concomitant mechanical prophylaxis and LMWH for VTE.
Clinical and sociodemographic factors associated with late stage cervical cancer diagnosis in Botswana
Authors: Friebel-Klingner Tara M. , Luckett Rebecca , Bazzett-Matabele Lisa , Ralefala Tlotlo B. , Monare Barati , Nassali Mercy Nkuba , Ramogola-Masire Doreen , Bvochora Memory , Mitra Nandita , Wiebe Douglas , Rebbeck Timothy R. , McCarthy Anne Marie , Grover Surbhi
Published: July 2021

Background

Cervical cancer is the leading cause of female cancer mortality in Botswana with the majority of cervical cancer patients presenting with late-stage disease. The identification of factors associated with late-stage disease could reduce the cervical cancer burden. This study aims to identify potential patient level clinical and sociodemographic factors associated with a late-stage diagnosis of cervical cancer in Botswana in order to help inform future interventions at the community and individual levels to decrease cervical cancer morbidity and mortality.

Results

There were 984 women diagnosed with cervical cancer from January 2015 to March 2020 at two tertiary hospitals in Gaborone, Botswana. Four hundred forty women (44.7%) presented with late-stage cervical cancer, and 674 women (69.7%) were living with HIV. The mean age at diagnosis was 50.5 years. The association between late-stage (III/IV) cervical cancer at diagnosis and patient clinical and sociodemographic factors was evaluated using multivariable logistic regression with multiple imputation. Women who reported undergoing cervical cancer screening had lower odds of late-stage disease at diagnosis (OR: 0.63, 95% CI 0.47–0.84) compared to those who did not report screening. Women who had never been married had increased odds of late-stage disease at diagnosis (OR: 1.35, 95% CI 1.02–1.86) compared to women who had been married. Women with abnormal vaginal bleeding had higher odds of late-stage disease at diagnosis (OR: 2.32, 95% CI 1.70–3.16) compared to those without abnormal vaginal bleeding. HIV was not associated with a diagnosis of late-stage cervical cancer. Rural women who consulted a traditional healer had increased odds of late-stage disease at diagnosis compared to rural women who had never consulted a traditional healer (OR: 1.61, 95% CI 1.02–2.55).

Conclusion

Increasing education and awareness among women, regardless of their HIV status, and among providers, including traditional healers, about the benefits of cervical cancer screening and about the importance of seeking prompt medical care for abnormal vaginal bleeding, while also developing support systems for unmarried women, may help reduce cervical cancer morbidity and mortality in Botswana.
Clinical characteristics, gestational weight gain and pregnancy outcomes in women with a history of gestational diabetes mellitus
Authors: Liang Xin , Zheng Wei , Liu Cheng , Zhang Lirui , Zhang Li , Tian Zhihong , Li Guanghui
Published: July 2021

Background

Pregnant women with a history of gestational diabetes mellitus (GDM) are at high risk of GDM. It is unclear whether this population has pregnancy characteristics different from the general population. Whether these features affect the perinatal outcome has not yet been elucidated.

Methods

A retrospective study was conducted, including baseline characteristics, laboratory data, gestational weight gain (GWG), and pregnancy outcomes of 441 pregnant women with prior GDM. Besides, 1637 women without a history of GDM treated in the same period were randomly selected as the control group. The above indicators of the two groups were compared. Multivariable logistic regression analysis was performed to investigate how GWG was associated with perinatal outcomes for previous GDM women.

Results

Among women with GDM history, triglycerides (TG) and fasting plasma glucose (FPG) in the 1st trimester were higher than those without GDM history. GWG was lower in women with prior GDM relative to the control group at various pregnancy stages. However, women with GDM history had a higher risk of developing GDM (OR 3.25, 95% CI 2.26–4.68) and pregnancy-induced hypertension (OR 1.50, 95% CI 1.05–2.45). In women with previous GDM, excessive GWG before OGTT exhibited a positive correlation with pregnancy-induced hypertension (OR 1.47, 95% CI 1.05–3.32), while inadequate GWG was not a protective factor for GDM and pregnancy-induced hypertension.

Conclusion

Women with prior GDM have glucose and lipid metabolism disorders in the 1st trimester. Limited reduction of GWG before oral glucose tolerance test (OGTT) was insufficient to offset the adverse effects of glucose and lipid metabolism disorders in women with previous GDM. Relevant interventions may be required at early stage or even before pregnancy.
Systemic reactions to subcutaneous allergen immunotherapy: real-world cause and effect modelling
Authors: Aue Adam , Ho Joella , Zhu Rongbo , Kim Harold , Jeimy Samira
Published: July 2021

Background

Subcutaneous immunotherapy (SCIT) is an effective treatment for allergic rhinoconjunctivitis. However, adverse events, including life-threatening systemic reactions, may occur. The purpose of this project is to identify risk factors for systemic reactions to SCIT and to provide practice-based solutions using a quality improvement (QI) framework.

Methods

A QI initiative was performed in a hospital-based, Canadian Allergy clinic administering SCIT in a 12-month period.

Results

A total of 4242 injections of SCIT were performed over a period of 12 months. Of these, 10 injections resulted in a systemic reaction requiring epinephrine administration (i.e., an incidence of 1 in 424 injections, or 0.24%). Eight patients had at least one documented risk factor for a systemic reaction, and six had multiple risk factors. Major risk factors included seasonal exacerbation of allergic rhinitis, uncontrolled asthma, and an error in route of administration. All reactions occurred with the highest allergen extract concentration.

Conclusion

This QI initiative highlights the need for improved patient and health care practitioner education and pre-administration screening. We suggest several considerations for SCIT administration: provide patients with written information on safety; screen patients before injections, including a review of treatment plan adherence and asthma control; adjust dosing to slow down buildup of the most concentrated immunotherapy extract, particularly in high risk patients; and apply additional safety measures in patients with multiple risk factors.
A novel therapeutic approach for inflammatory bowel disease by exosomes derived from human umbilical cord mesenchymal stem cells to repair intestinal barrier via TSG-6
Authors: Yang Shaopeng , Liang Xiaonan , Song Jia , Li Chenyang , Liu Airu , Luo Yuxin , Ma Heran , Tan Yi , Zhang Xiaolan
Published: July 2021

Background

Exosomes as the main therapeutic vectors of mesenchymal stem cells (MSC) for inflammatory bowel disease (IBD) treatment and its mechanism remain unexplored. Tumor necrosis factor-α stimulated gene 6 (TSG-6) is a glycoprotein secreted by MSC with the capacities of tissue repair and immune regulation. This study aimed to explore whether TSG-6 is a potential molecular target of exosomes derived from MSCs (MSCs-Exo) exerting its therapeutic effect against colon inflammation and repairing mucosal tissue.

Methods

Two separate dextran sulfate sodium (DSS) and 2,4,6-trinitrobenzenesulfonic acid (TNBS)-induced IBD mouse models were intraperitoneally administered MSCs-Exo extracted from human umbilical cord MSC (hUC-MSC) culture supernatant. Effects of MSCs-Exo on intestinal inflammation, colon barrier function, and proportion of T cells were investigated. We explored the effects of MSCs-Exo on the intestinal barrier and immune response with TSG-6 knockdown. Moreover, recombinant human TSG-6 (rhTSG-6) was administered exogenously and colon inflammation severity in mice was evaluated.

Results

Intraperitoneal injection of MSCs-Exo significantly ameliorated IBD symptoms and reduced mortality rate. The protective effect of MSCs-Exo on intestinal barrier was demonstrated evidenced by the loss of goblet cells and intestinal mucosa permeability, thereby improving the destruction of tight junctions (TJ) structures and microvilli, as well as increasing the expression of TJ proteins. Microarray analysis revealed that MSCs-Exo administration downregulated the level of pro-inflammatory cytokines and upregulated the anti-inflammatory cytokine in colon tissue. MSCs-Exo also modulated the response of Th2 and Th17 cells in the mesenteric lymph nodes (MLN). Reversely, knockdown of TSG-6 abrogated the therapeutic effect of MSCs-Exo on mucosal barrier maintenance and immune regulation, whereas rhTSG-6 administration showed similar efficacy to that of MSCs-Exo.

Conclusions

Our findings suggested that MSCs-Exo protected against IBD through restoring mucosal barrier repair and intestinal immune homeostasis via TSG-6 in mice.
Intraoperative visualization of nerves using a myelin protein-zero specific fluorescent tracer
Authors: Buckle Tessa , Hensbergen Albertus. W. , van Willigen Danny M. , Bosse Frank , Bauwens Kevin , Pelger Rob C. M. , van Leeuwen Fijs W. B.
Published: July 2021

Background

Surgically induced nerve damage is a common but debilitating side effect in oncological surgery. With the aim to use fluorescence guidance to enable nerve-sparing interventions in future surgery, a fluorescent tracer was developed that specifically targets myelin protein zero (P0).

Results

Truncated homotypic P0 protein-based peptide sequences were C-terminally functionalized with the far-red cyanine dye Cy5. The lead compound Cy5-P0101–125 was selected after initial solubility, (photo)physical and in vitro evaluation (including P0-blocking experiments). Cy5-P0101–125 (KD = 105 ± 17 nM) allowed in vitro and ex vivo P0-related staining. Furthermore, Cy5-P0101–125  enabled in vivo fluorescence imaging of the Sciatic nerve in mice after local intravenous (i.v.) administration and showed compatibility with a clinical fluorescence laparoscope during evaluation in a porcine model undergoing robot-assisted surgery. Biodistribution data revealed that i.v. administered [111In]In-DTPA-P0101–125 does not enter the central nervous system (CNS).

Conclusion

P0101–125 has proven to be a potent nerve-specific agent that is able to target P0/myelin under in vitro, ex vivo, and in vivo conditions without posing a threat for CNS-related toxicity.
Overcoming COVID-19 in China despite shortcomings of the public health system: what can we learn?
Authors: Wang Mei Mei , Fleßa Steffen
Published: July 2021

Background and objective

The COVID-19 pandemic started in Wuhan, China, in December 2019. Although there are some doubts about the reporting of cases and deaths in China, it seems that this country was able to control the epidemic more effectively than many other countries. In this paper, we would like to analyze the measures taken in China and compare them with other countries in order to find out what they can learn from China.

Methods

We develop a system dynamics model of the COVID-19 pandemic in Wuhan. Based on a number of simulations we analyze the impact of changing parameters, such as contact rates, on the development of a second wave.

Results

Although China’s health care system seems to be poorly financed and inefficient, the epidemic was brought under control in a comparably short period of time and no second wave was experienced in Wuhan until today. The measures to contain the epidemic do not differ from what was implemented in other countries, but China applied them very early and rigorously. For instance, the consequent implementation of health codes and contact-tracking technology contributed to contain the disease and effectively prevented the second and third waves.

Conclusions

China’s success in fighting COVID-19 is based on a very strict implementation of a set of measures, including digital management. While other countries discuss relaxing the lock-down at a rate of 50 per 100,000 inhabitants, China started local lock-downs at a rate of 3 per 100,000. We call for a public debate whether this policy would be feasible for more liberal countries as well.
Impact of the 2014 coinsurance rate revision for the elderly on healthcare resource utilization in Japan
Authors: Nishi Takumi , Maeda Toshiki , Katsuki Susumu , Babazono Akira
Published: July 2021

Background

Cost sharing, including copayment and coinsurance, is often used to contain medical expenditure by decreasing unnecessary or excessive use of healthcare resources. Previous studies in Japan have reported the effects of a coinsurance rate reduction for healthcare from 30 to 10% on the demand for healthcare among 70–74-year-old individuals. However, the coinsurance rate for this age group has recently increased from 10 to 20%. This study aimed to estimate the economic impact of coinsurance rate revision on healthcare resource utilization.

Methods

We collected claims data from beneficiaries of the municipality National Health Insurance and the Japanese Health Insurance Association in Fukuoka Prefecture. We categorized subjects born between March 2, 1944 and April 1, 1944 into the 20% coinsurance rate reduction group and those born between April 2, 1944 and May 1, 1944 into the 10% reduction group. An interrupted time-series analysis for multiple groups was employed to compare healthcare resource utilization trends before and after coinsurance rate reduction at 70 years.

Results

The 10% coinsurance rate reduction led to a significant increase in healthcare expenditure for outpatient care. The 20% reduction group showed a significantly sharper increase in healthcare expenditure for outpatient care than the 10% reduction group. Similarly, the 10% coinsurance group significantly increased in the number of ambulatory visits. The 20% coinsurance rate reduction group had more frequent ambulatory care visits than the 10% reduction group.

Conclusions

These results suggest that increasing the coinsurance rate among the elderly would reduce outpatient healthcare resource utilization; however, it would not necessarily reduce overall healthcare resource utilization.
Using the MEAT VBP Framework to analyse and understand the value of surgical gloves: an explanatory case study
Authors: Stanberry Benedict , Bothma Gerhard , Harrison Katie
Published: July 2021

Background

Value-based healthcare is being extensively piloted, scaled and implemented by healthcare providers and systems around the world. However, the ability of the healthcare supply chain function to strategically contribute to the improvement of value has been held back by a lack of practical tools for turning value-based procurement from concept into action. Two recently developed conceptual models – the American CQO Movement and the European MEAT VBP Framework – have been developed to support the implementation of value-based procurement in healthcare. We demonstrate how the latter of these models can be adapted and applied pragmatically to generate insights into the value of a specific medical device, technology or consumable.

Methods

We undertook an explanatory, qualitative, single-case study focused on a specific consumable – surgical gloves – that provide a critical example of a type of medical device usually procured in high volumes but at risk of commoditisation due to a widespread lack of understanding of their value. Since the global Covid-19 pandemic prevented fieldwork, structured interviews were conducted via Zoom and corroborated by a literature review.

Results

We identified ten cost criteria and eight outcome criteria with which the value of surgical gloves can be analysed and understood. For each of these criteria we propose definitions and value impact metrics that decision-makers can use during a procurement exercise to describe, quantify and compare glove value.

Conclusion

The MEAT VBP Framework provides a highly practical and adaptable means of imposing both structure and rigour on a value analysis process and of qualitatively describing the potential value impact of surgical gloves for patients, professionals, providers and health systems.