bluuebunny/crossref_metadata_2025 huggingface dataset:
Eptacog Beta for Bleeding Treatment and Prevention in Congenital Hemophilia A and B With Inhibitors: A Review of Clinical Data and Implications for Clinical Practice
Authors: Ciolek Alana M. , Arnall Justin , Moore Donald C. , Palkimas Surabhi , Der-Nigoghossian Julie , Dane Kathryn
Published: October 2021

Objective:

To review the pharmacology, dosing and administration, safety, clinical efficacy, and role of eptacog beta in the treatment of congenital hemophilia with inhibitors.

Data Sources:

A literature search of PubMed (1966 to August 2021) was conducted using the keywords eptacog beta, recombinant FVII, and hemophilia.

Study Selection and Data Extraction:

All relevant published articles and prescribing information on eptacog beta for the treatment of congenital hemophilia with inhibitors were reviewed.

Data Synthesis:

Eptacog beta is a novel recombinant activated factor VII (rVIIa) product that demonstrated efficacy in controlling bleeding and associated pain in patients with hemophilia A or B with inhibitors. Eptacog beta has limited Food and Drug Administration–approved and off-label indications compared with other bypassing agents (BPAs; activated prothrombin complex concentrates [aPCC; eptacog alfa]). Eptacog beta costs less than eptacog alfa, but still more than aPCCs.

Relevance to Patient Care and Clinical Practice:

This review provides insight into the role of eptacog beta for treatment of congenital hemophilia with inhibitors and reviews important health system formulary considerations for available BPAs.

Conclusions:

Eptacog beta is more cost-effective than eptacog alfa and, as such, may become the preferred rVIIa formulary product. However, eptacog alfa availability remains necessary for the treatment of disorders where eptacog beta has limited data. aPCC should remain the first-line BPA for the treatment of bleeding in patients with inhibitors with no contraindications to use because of its equivocal efficacy and safety and in light of the magnitude of cost savings associated with this strategy.
Accelerated Approval of Aducanumab: Where Do We Stand Now?
Authors: Barenholtz Levy Hedva
Published: October 2021

Aducanumab was approved by the Food and Drug Administration (FDA) in June 2021 to treat Alzheimer disease (AD). Its path to approval has been highly scrutinized, with many experts arguing that the FDA’s decision was premature. Accelerated approval was based on a surrogate end point, with evidence to support clinical effectiveness pending a postapproval trial by the drug company sponsor Biogen. As a result, the role of aducanumab in treating AD remains uncertain. A summary of key areas of controversy to guide informed decisions about use of this drug is provided, along with a timeline describing preapproval and postapproval events.
A Comparison of Parent, Teacher, and Youth Ratings on the Inventory of Callous–Unemotional Traits
Authors: Matlasz Tatiana M. , Frick Paul J. , Clark Julia E.
Published: October 2021

The current study compared the validity of self-, parent-, and teacher-report versions of the Inventory of Callous–Unemotional Traits (ICU), a widely used measure of callous–unemotional (CU) traits, at several different ages. Participants ( N = 236, 60.6% girls) were children in Grades 3, 6, and 8 ( Mage = 11.55, SD = 2.23) from a public school system in the southern United States. We tested the association of all three ICU versions with several validators: parent- and teacher-reported conduct problems, peer nominations of characteristics associated with CU traits, and sociometric peer nominations of social preference. Results revealed an interaction between the ICU version and grade in the overall level of CU traits reported, with teacher-report leading to the highest ratings in sixth grade and being higher than parent-report in third grade. Furthermore, the validity of the different versions of the ICU varied somewhat across grades. Specifically, findings support the validity of both teacher- and self-report in third grade, but self-report was the only version to show strong validity in the eighth grade.
A Multiple Streams Framework Approach to Access to Domestic Violence Services in an Indigenous Community
Authors: Hoare Ismael , Agu Ngozichukwuka , Falope Oluyemisi , Wesley Cienna A. , Coulter Martha
Published: October 2021

This article focuses on access to domestic violence services within Belize. Using data from community asset mapping, interviews with key informants, and focus groups with community members, the multiple streams framework was used to identify potential areas for intervention to improve access and ameliorate the effects of family violence in Belize. Identified challenges to accessing limited domestic violence resources were mainly confidentiality concerns and mistrust. Existing laws and regulations, organizational structures, and policies and plans also influenced access. Women's groups, nongovernmental organizations, and the health department can play a crucial role in improving access to domestic violence services.
Representation in American Cities: Who Runs for Mayor and Who Wins?
Authors: Kirkland Patricia A.
Published: October 2021

Business leaders emerge as key players in canonical accounts of urban politics, but data limitations have hampered efforts to quantify their role in city politics. Drawing on an original dataset that includes gender, race, occupational, and political experience for over 3,500 mayoral candidates from 259 cities over fifty years, I document who runs for office and who serves as mayor, with a focus on candidates who are business owners and executives. Overall, the data indicate that mayors tend to be White and male with prior political experience and white-collar careers. Business owners and executives account for nearly one-third of the candidates in the sample, but I find no indication that they win elections at higher rates than other candidates overall. However, my results do suggest that business owners and executives have better electoral prospects in more conservative cities, especially those that hold nonpartisan elections.
Rethinking Older Adult Murder Victims: Looking Back at 25 Years of Homicide Studies to Inform Future Research Needs
Authors: Addington Lynn A.
Published: October 2021

Over the past 25 years, homicide researchers have largely ignored older adults. This pattern continues even in light of the ongoing demographic shift associated with the aging baby boomer generation. This article reflects on the current state of the literature and discusses areas in need of attention. Future research needs can be categorized into substantive and methodological issues. The insights gained by exploring these topics can generate nuanced explanations for fatal violence against older adults and support future evidence-based prevention policies.
Disrupting the colonial algorithm: Indigenous Australia and social media
Authors: Fredericks Bronwyn , Bradfield Abraham , Nguyen Jenny , Ansell Samar
Published: October 2021

Indigenous voices and outlooks are often overlooked within public discourses in Australia and throughout the world. Settler-colonialism has resulted in centuries of dispossession, manifesting in the denial of Indigenous citizenship, autonomy and sovereignty. Throughout this article we discuss how Indigenous people are increasingly turning to social media to illuminate how colonialism continues to oppress Aboriginal and Torres Strait Islander people and communities. In doing so, Indigenous people are disrupting what we call the ‘colonial algorithms’ that shape misguided perceptions of Indigenous people and identities. Analysing Indigenous use of social media and centring our discussion around several Indigenous-led online campaigns, we demonstrate how online platforms are bringing an array of social issues to light in ways that privilege Indigenous voices and perspectives, ultimately disrupting and shifting oppressive colonial algorithms.
Humoral immune response after COVID-19 in multiple sclerosis: A nation-wide Austrian study
Authors: Bsteh Gabriel , Dürauer Sophie , Assar Hamid , Hegen Harald , Heschl Bettina , Leutmezer Fritz , Pauli Franziska Di , Gradl Christiane , Traxler Gerhard , Zulehner Gudrun , Rommer Paulus , Wipfler Peter , Guger Michael , Höftberger Romana , Enzinger Christian , Berger Thomas
Published: October 2021

Background:

Knowledge on immunity after SARS-CoV-2 infection in patients with multiple sclerosis (pwMS) and the impact of disease-modifying treatment (DMT) is limited.

Objective:

To evaluate degree, duration and potential predictors of specific humoral immune response in pwMS with prior COVID-19.

Methods:

Anti-SARS-CoV-2 antibody testing was performed in pwMS with PCR-confirmed diagnosis of symptomatic COVID-19 from a nation-wide registry. Predictors of seropositivity were identified by multivariate regression models.

Results:

In 125 pwMS (mean age = 42.4 years (SD = 12.3 years), 70% female), anti-SARS-CoV-2 antibodies were detected in 76.0% after a median of 5.2 months from positive PCR. Seropositivity rate was significantly lower in patients on IS-DMT (61.4%, p = 0.001) than without DMT or immunomodulatory DMT (80.6%; 86.0%, respectively). In multivariate analysis, IS-DMT was associated with reduced probability of seropositivity (odds ratio (OR): 0.51; 95% confidence interval (95% CI): 0.17–0.82; p < 0.001). Predefined subgroup analyses showed marked reduction of seropositivity in pwMS on rituximab/ocrelizumab (OR 0.15; 95% CI: 0.05–0.56; p < 0.001). Rate of seropositivity did not change significantly over 6 months.

Conclusions:

Humoral immunity is stable after SARS-CoV-2 infection in MS, but is reduced by immunosuppressive DMT, particularly anti-CD20 monoclonal antibodies. This provides important evidence for advising pwMS as well as for planning and prioritizing vaccination.
Strength index analysis of concrete with large size recycled aggregate based on back propagation neural network
Authors: Li Tan , Xiao Jianzhuang , Singh Amardeep
Published: October 2021

A back propagation (BP) neural network (NN) model was used to analyze the relationship between the cube compressive strength and various strength indicators of concrete with large-sized recycled aggregates (LSRA) (80 mm maximum size). Factors such as strength and replacement rate of recycled aggregates were used as input parameters to establish the neural network model. The BP-NN model was optimized by analyzing the influence and sensitivity of each parameter in the model. Then the mechanical properties of concrete with LSRA were predicted. Results showed that the strength of new concrete had a more significant impact on the strength of recycled concrete with LSRA, followed by the strength of old concrete. While considering all the factors, including the mechanical strength and the replacement ratio regarding the maximum utilization of RA, the 30% incorporation rate was suggested as an ideal incorporation rate.
Hybrid artificial intelligence-based inference models for accurately predicting dam body displacements: A case study of the Fei Tsui dam
Authors: Cheng Min-Yuan , Cao Minh-Tu , Huang I-Feng
Published: October 2021

Surveillance is a critical activity in monitoring the operation condition and safety of dams. This study reviewed the historical monitoring data of the Fei Tsui dam to determine possible influential factors for the dam body displacement and then evaluated the influencing degree of these factors by using correlation analysis. Thus, the key influential factors were identified objectively and further chosen as the input variables for numerous artificial intelligence (AI)-based inference models, including single machine learning techniques (support vector machine (SVM), artificial neural networks) and hybrid AI models. The models were trained and tested with 4722 real data retrieved in 11 years from the monitoring devices installed on elements of the dam, and then generated their respective inferred dam body displacement values. The results revealed that the adaptive time-dependent evolutionary least squares SVM model had the greatest performance by providing the lowest values of prediction errors in terms of mean absolute percentage error (MAPE = 8.14%), root mean square error (RMSE = 1.08 cm), and coefficient of determination (R = 0.993). The analysis results endorsed that the hybrid AI model could be an efficient tool to early produce accurate warnings of the dam displacements.
Integrating Safety and Health Promotion in Workplaces: A Scoping Review of Facilitators, Barriers, and Recommendations
Authors: Biswas Aviroop , Begum Momtaz , Van Eerd Dwayne , Johnston Heather , Smith Peter M. , Gignac Monique A. M.
Published: October 2021

Background

Growing evidence supports the integration and coordination of occupational health and safety and workplace health promotion activities instead of these coexisting as siloed efforts. Identifying implementation challenges and how these can be overcome is an important step to achieving truly integrated worker health efforts. We conducted a scoping review to identify the barriers and facilitators to integrated worker health approaches and described recommendations for implementing these efforts.

Method

Peer-reviewed articles and gray literature from 2008 to 2019 were searched from the following electronic databases: EMBASE, Ovid Medline, PsycINFO, and ABI/INFORM. References from relevant articles and key informant suggestions also were collected. Data were extracted from documents if they focused on the occupational health and safety and health promotion of workers and described outcomes associated with integrated worker health approaches or outlined considerations relevant to the implementation of these approaches.

Results

Fifty-one documents met the inclusion criteria and were reviewed. Barriers and facilitators to implementing integrated worker health approaches were found at the extraorganizational, organizational, worker, and program levels, with limited resource availability the most reported barrier and support from leadership the most reported facilitator. Ten broad recommendations were identified and highlighted gaining leadership support, demonstrating leadership commitment, developing worker-centric approaches, and building capacity for workers.

Conclusion

In reviewing the literature, we found clear and consistent recommendations relevant for integrated worker health approaches. Further research is needed to better understand how these recommendations apply to diverse workforces and organizations with varied resources.
The Effect of Fibers’ Length Distribution and Concentration on Rheological and Mechanical Properties of Glass Fiber–Reinforced Polypropylene Composite
Authors: Asoodeh Fatemeh , Aghvami-Panah Mohammad , Salimian Saeed , Naeimirad Mohammadreza , khoshnevis Hamed , Zadhoush Ali
Published: October 2021

This article aims to investigate the effect of dispersion and uniformity of fiber length distribution on the rheological and mechanical behavior of polypropylene reinforced with short glass fiber. The composites were prepared through melt compounding with three various glass fiber concentrations using a twin-screw extruder. Multiple extrusion processing was used to alter and manipulate the fibers’ length inside the composites. The fiber length distribution was analyzed via the photomicrograph technique. Rheological measurements indicated that the molten samples were visco-plastic fluids and the Herschel–Bulkley model is the best model for fitting on the rheological behavior diagram. Variables of the fitted model are noticeably altered by the fiber length distribution. Moreover, rheological assessments revealed that the non-Newtonian behavior of the molten composites significantly diminished after the second extrusion processing, while it did not have much effect on the fiber length reduction. In the second phase, tensile and flexural properties were determined to detect the mechanical properties. The results indicated that the tensile strength of the composite has a direct relation with the fiber length distribution factor while the flexural strength is independent of fiber length. Furthermore, the highest tensile and flexural strength attained from the composite containing the highest fiber volume fraction.
DCPS or Sidwell Friends? How Politician Schooling Choices Affect Voter Evaluations
Authors: Finger Leslie K. , Gift Thomas Creigh , Miner Andrew
Published: October 2021

Voters often rely on informational shortcuts, such as the background traits of politicians, to decide which candidates to support at the ballot box. One such background trait is family composition, particularly parental status. Research, however, has mostly overlooked whether the value-laden choices that politicians make regarding their families—like what neighborhoods they live in, where they worship, and what schools they send their children to—affect how constituents view them. We conduct a survey experiment in the U.S. that presents respondents with hypothetical biographies of politicians that randomly vary one of the most important decisions that politicians make regarding their families: whether to send them to public or private school. We find that: (1) voters are more inclined to vote for politicians with children in public school; and (2) this preference may be due to voters perceiving these politicians as both warmer and more committed to public services.
COVID Toes: Concurrent Lower Limb Arterial and Venous Thromboembolism in a Patient with COVID-19 Pneumonitis Presenting with Foot Ischaemia
Authors: Lee Kathryn A. , McBride Richard S. , Narlawar Ranjeet , Myers Rebecca , Antoniou George A.
Published: October 2021

We present a 74-year-old gentleman, who presented with foot ischaemia requiring bilateral amputation in the absence of radiological signs of occlusive peripheral arterial disease. He was found to have COVID-19 pneumonitis and concurrent arterial and venous thromboemboli despite no initial respiratory symptoms or signs, nor pre-existing risk factors for cardiovascular disease. Patients who present with foot ischaemia with or without respiratory symptoms or signs warrant a high index of suspicion for COVID-19 infection, particularly in those with no predisposing risk factors.
Impact of the learning rate and batch size on NOMA system using LSTM-based deep neural network
Authors: Shankar Ravi , Sarojini B K , Mehraj Haider , Kumar A Suresh , Neware Rahul , Singh Bist Ankur
Published: October 2021

In this work, the deep learning (DL)-based fifth-generation (5G) non-orthogonal multiple access (NOMA) detector is investigated over the independent and identically distributed (i.i.d.) Nakagami- m fading channel conditions. The end-to-end system performance comparisons are given between the DL NOMA detector with the existing conventional successive interference cancelation (SIC)-based NOMA detector and from results, it has been proved that the DL NOMA detector performance is better than the convention SIC NOMA detector. In our analysis, the long-short term memory (LSTM) recurrent neural network (RNN) is employed, and the results are compared with the minimum mean square estimation (MMSE) and least square estimation (LS) detector’s performance considering all practical conditions such as multipath fading and nonlinear clipping distortion. It has been shown that with the increase in the relay to destination (RD) channel gain, the bit error rate (BER) improves. Also, with the increase in fading parameter m, the BER performance improves. The simulation curves demonstrate that when the clipping ratio (CR) is unity, the performance of the DL-based detector significantly improves as compared to the MMSE and LS detector for the signal-to-noise ratio (SNR) values greater than 15 dB and it proves that the DL technique is more robust to the nonlinear clipping distortion.
Learning–centred leadership and student achievement: Understanding the mediating effect of the teacher professional community and parental involvement
Authors: Özdemir Nedim , Gün Feyza , Yirmibeş Ahmet
Published: October 2021

This paper examines the links between learning–centred leadership and student achievement through the mediating effect of teacher professional community and parental involvement. Using teacher and student survey data collected from 79 lower secondary Turkish schools in 12 provinces across the country in 2019, this study employs multilevel structural equation modelling. The findings of the current study add to the growing knowledge base in the non-western societies, revealing the impact of principals’ leadership on school processes and outcomes in Turkey. The study suggests that principals have a crucial role in improving student achievement by enhancing situations in which teachers work, namely, organisational and family paths. It suggests that principals’ leadership practices still matter for teacher professional community and parental involvement in non-western countries. Implications for policy, practice and further research are discussed.
“Choose Your Own Adventure”: Web-Based Case Studies of Inclusive Education as a Form of Professional Learning for School Principals
Authors: Sider Steve , Maich Kimberly , Specht Jacqueline , Treadgold Carolyn , Winger Hillary
Published: October 2021

We examine the process of developing web-based case studies, a novel form of professional learning for principals, specifically related to inclusive school leadership. Based on the input from 39 principals, 5 case studies were developed with branching scenarios that provided multiple options for decision-making. These “choose your own adventure” case studies were used in a special education for school administrators course with 109 participants in Ontario, Canada. We consider the authenticity of the cases, the importance of incorporating multiple perspectives, and issues related to function, form, and choice. We incorporate five lessons for developing web-based case studies.
Introduction of 3D Printing in a German Municipal Hospital—Practice Guide for CMF Surgery
Authors: Gleissner H , Castrillon-Oberndorfer G , Gehrlich St
Published: October 2021

Study Design:

This study aimed to introduce 3D printing in a municipal hospital to improve the treatment of craniomaxillofacial patients and optimize costs and operating time. Thus we describe the implementation of low-cost in-house 3D printing to facilitate orbital- and mandible reconstruction in CMF surgery. Moreover, we address legal requirements, safety at work, fire- and data protection. Finally, we want to share our experiences using 3D printing and point out its advantages in providing better patient care.

Methods:

We outline the setup of in-house 3D printing and focus on obeying German health care regulations. We based our approach on a fused deposition modeling 3D printer and free software. As proof of concept, we treated 4 cases of severe orbital trauma and 1 case of mandibular reconstruction. We printed a 3D patient-specific model for each case and adapted a titanium mesh implant, respectively, a titanium reconstruction plate before performing the surgery.

Results:

Our approach reduced costs, duration of anesthesia, operating time, recovery time, and postoperative swelling and increased the revenue. Functional outcome in orbital reconstruction like eye movement and double vision, was improved compared to the conventional technique. No severe complications like loss-of-vision or surgical revision occurred. Likewise, mandibular reconstruction showed no plate loosening or plate fracture.

Conclusion:

The implementation of cost-efficient 3D printing resulted in successful patient treatment with excellent outcomes. Our practice guide offers a 3D printing workflow and could be adapted to fit the needs of other specialties like neurosurgery, orthopedic surgery as well.
Challenges of Singapore’s First Acute Geriatric Isolation Facility During the COVID-19 Pandemic
Authors: Chong Yap Bernard Kok , Del Valle Espeleta Wrenzie , Sinnatamby Savithri , Li Fuyin , Liza Bantilan Anna , Ong Siew Yit , Png Gek Kheng , Koh Jansen Meng Kwang , Koh Lip Hoe , Goh Kiat Sern
Published: October 2021

Aim

The COVID-19 pandemic has seen hospitals isolating suspect cases. Geriatric populations are at a risk of severe COVID-19 disease and often present with concomitant geriatric syndromes requiring holistic interdisciplinary care. However, isolation of older people poses challenges to care delivery. This study shares the experience of Singapore’s first acute geriatric isolation facility geriatric PARI (Pneumonia-Acute Respiratory Infection) ward and describes the geriatric-related outcomes and pitfalls in care delivery.

Methods

This is a retrospective cross-sectional study performed in 7 negative pressure isolation rooms in an acute care public hospital in Singapore. 100 patients admitted consecutively to the geriatric PARI ward were included. Patient demographics, presenting symptoms and geriatric-related adverse outcomes associated with hospitalisation were collected and analysed.

Results

Patients’ mean age was 86.4 years (standard deviation [SD]: 6.8) with significant comorbidities being hypertension (81%), hyperlipidaemia (74%) and renal disease (70%). 51% of patients had dementia and 24% had behaviour and psychological symptoms of dementia (BPSD). 27% of patients presented atypically with delirium and 15% presented with a fall. Delirium was associated with restraint use (OR: 3.88; p-value 0.01). Falls rate was 1.64 per 1000 occupied bed. 1 patient screened positive for COVID-19.

Conclusions

The geriatric PARI ward is essential for curbing nosocomial transmission of COVID-19. This is important in the older people with comorbidities who are more likely to develop morbidity and mortality. Our study reveals challenges in delivering person-centred care to the older patients in isolation rooms, especially in the management of delirium and falls prevention. Innovative strategies should be developed to minimise isolation-related adverse outcome.
The impact of an education intervention on the approach of hospital staff to patients with dementia in a Danish general hospital setting: An explanatory sequential mixed-methods study
Authors: Toubøl Annemarie , Moestrup Lene , Thomsen Katja , Ryg Jesper , Hansen Dennis Lund , Foldager Mette , Jakobsen Søren , Nielsen Dorthe Susanne
Published: October 2021

The number of patients with dementia admitted to hospitals is increasing. However, the care and treatment of these patients tends to be suboptimal. A response to this is a widespread implementation of educational initiatives. Nevertheless, the effect of such initiatives is questioned. The aim of this study was to investigate the impact of a dementia education intervention by examining the self-reported outcomes of general hospital staff and exploring the staff’s experiences of these outcomes. An explanatory sequential mixed-methods design framed the study method. The quantitative data collection included repeated questionnaires: pre-intervention ( n = 849), one month post-intervention ( n = 618), and five months post-intervention ( n = 468) followed by a qualitative data collection using interviews ( n = 16). The GRAMMS guideline was followed. The integration of the quantitative and qualitative results suggests that the impact of the education intervention can be ascribed to the interdisciplinary focus, which facilitated a comprehensive commitment to creating careful solutions for patients with dementia. A prioritization of person over task seems to be assisted by an improved interdisciplinary cooperation initiated by the inclusion of all employed staff at the hospital in a dementia education intervention.
A Hybrid Strategy for Geometrical Reshaping of the Main Pulmonary Artery and Transcatheter Pulmonary Valve Replacement
Authors: Lugones Ignacio , Barbosa Jesús Damsky , Schvartz Guillermo , Ackerman Judith , Laudani Verónica , Vitorino Adelia Marques , Lucini Victorio , Garay Francisco
Published: October 2021

Transcatheter pulmonary valve replacement has become an attractive alternative to surgical approach in patients with dysfunctional right ventricular outflow tract. However, in certain cases, an unfavorable anatomy might complicate optimal valve deployment and stability. Several techniques have been described to reshape the landing zone and allow proper implantation of the transcatheter valve. Among them, the hybrid approach has gained attention as an interesting method for off-pump pulmonary valve replacement in patients with dilated right ventricular outflow tract. But to date, there is no standardized method to resize and reshape the landing zone for the stented valve. Here, we describe a reproducible method based on simple geometric rules to allow adequate remodeling of the main pulmonary artery to the desired dimensions in a single attempt, followed by perventricular implantation of a Venus P-valve.
Residual Lesion Diagnostics in Pediatric Postcardiotomy Extracorporeal Membrane Oxygenation and Its Outcomes
Authors: Soynov Ilya A. , Kornilov Igor A. , Kulyabin Yuriy Y. , Zubritskiy Alexey V. , Ponomarev Dmitry N. , Nichay Nataliya R. , Murashov Ivan S. , Bogachev-Prokophiev Alexander V.
Published: October 2021

Background:

To assess the impact of diagnostic procedures in identifying residual lesions during extracorporeal membrane oxygenation (ECMO) on survival after pediatric cardiac surgery.

Methods:

Between January 2012 and December 2017, 74 patients required postcardiotomy ECMO. Patients were retrospectively divided into 2 groups: Group I underwent only echocardiography ([echo only] 46 patients, 62.2%) and group II (echo+) underwent additional diagnostic tests (ie, computed tomography [CT] or cardiac catheterization; 28 patients, 37.8%). Propensity score matching was used to balance the 2 groups by baseline characteristics.

Results:

Two equal groups (28 patients in each group) were formed by propensity score matching. Fourteen (50%) patients in the echo-only group and 20 (71%) patients in the echo+ group were successfully weaned from ECMO ( P = .17). Four (14.3%) patients survived in the echo-only group and 15 (53.5%) patients survived in the echo+ group ( P = .004). Patients in the echo+ group had a lower chance of dying compared to the echo-only group (odds ratio, 0.14.6; 95% CI, 0.039-0.52; P = .003). The residual lesions, which may have served as a mortality factor, were found by autopsy in 8 (40%) patients in the echo-only group, while none were found in the echo+ group ( P = .014).

Conclusions:

The autopsies of patients who died despite postcardiotomy ECMO support showed that in 40% of cases that had been investigated by echo only, residual lesions that had not been detected by echocardiography were present. The cardiac catheterization and CT during ECMO are effective and safe for identifying residual lesions. Early detection and repair of residual lesions may increase the survival rate of pediatric cardiac patients on ECMO.
Examining Linear and Nonlinear Associations Between Negative Emotional Reactivity to Daily Events and Depression Among Adolescents
Authors: Santee Angela C. , Starr Lisa R.
Published: October 2021

Existing research supports competing hypotheses about the link between negative emotional (NE) reactivity to daily events (e.g., hassles and uplifts) and depression. Some have suggested that depression is associated with blunted reactivity, and others have suggested that depression is associated with heightened reactivity. In this study, we tested linear and nonlinear associations, cross-sectionally and longitudinally, between NE reactivity and depression among a sample of 232 adolescents. Participants completed lab-based assessments of depression then rated their experience of emotions, daily hassles, and uplifts three times per day for 7 days. Interviews were readministered 1.5 years later. Results show a significant U-shaped relationship between NE reactivity to hassles and depression symptoms cross-sectionally, which suggests that depression is more severe at the extremes of NE reactivity. NE reactivity to daily uplifts showed significant linear associations, but not quadratic associations, with depression such that heightened reactivity to uplifts was associated with more severe depression symptoms concurrently and predicted worsening of depression longitudinally.
Surgical management of Diffuse Idiopathic Skeletal Hyperostosis (DISH) causing secondary dysphagia (Narrative review)
Authors: Bunmaprasert Torphong , Keeratiruangrong Jakkrit , Sugandhavesa Nantawit , Riew K Daniel , Liawrungrueang Wongthawat
Published: October 2021

Objectives: To summarize the current evidence on surgical treatment for large bridging osteophytes of the anterior cervical spine from Diffuse Idiopathic Skeletal Hyperostosis (DISH). Overview of Literature: In the current review, the surgical treatment of secondary dysphagia from DISH was the most useful treatment. We propose a treatment algorithm for management of this condition because currently there are only case reports and retrospective studies available. Methods: Literature search was performed using the MeSH terms “Anterior Cervical Osteophyte,” “Diffuse Idiopathic Skeletal Hyperostosis (DISH),” and “Dysphagia” and “Treatment” for articles published between January 2000 and February 2020. PubMed search identified 117 articles that met the initial screening criteria. Detailed analysis identified the 40 best matching articles, following which the full inclusion and exclusion criteria left 11 articles for this review. Results: Incidence of secondary dysphagia was associated with DISH in elderly patients (average 65 years). The major clinical findings were dysphagia or respiratory compromise, with the most common level of bridging osteophytes of the cervical spine at C3–C5. There were 10 articles on surgical treatment involving anterior cervical osteophytectomy without fusion, 1 for multilevel cervical oblique corpectomy, 1 for anterior cervical discectomy with fusion plus plate, and 1 for anterior cervical osteophytectomy with stand-alone PEEK cage or plus plate. All the cases resulted in significant improvement without recurrence, with only 1 case having post-operative complications. Follow-up duration was 3–70.3 months. Conclusions: Surgical intervention for anterior cervical osteophytectomy appears to result in improved outcomes. However, there could be disadvantages concerning cervical spine motion if cervical osteophytectomy with cervical discectomy and fusion (ACDF) plus plate system is done.
Suture Tape Augmentation of Screw Fixation Reduces Fragment Migration in Tibial Tubercle Osteotomy: A Biomechanical Study
Authors: Frame Mark , Hauck Oliver , Newman Michael , Cirtautas Anna , Wijdicks Coen
Published: October 2021

Background:

Tibial tubercle osteotomy (TTO) is a complex surgical procedure with a significant risk of complications, which include nonunion and tibial fracture.

Purpose:

To determine whether an additional suture tape augmentation can provide better biomechanical stability compared with standard screw fixation.

Study Design:

Controlled laboratory study.

Methods:

Five matched pairs of human cadaveric knees were divided into 2 groups: the first group underwent standard TTO fixation with 2 parallel screws (standard group). The second group underwent a novel fixation technique, in which a nonabsorbable suture tape (FiberTape) in a figure-of-8 construct was added to the standard screw fixation for extra stabilization in the inferior-superior direction (augmented group). The specimens were biomechanically tested using a multistep cyclic loading protocol from 400 N up to 800 N to simulate the rehabilitation process. Tubercular fragment migration of >50% of the initial distalization length was defined as clinical failure. A pull-to-failure test was applied to the specimens that survived cyclic loading. Tubercular fragment displacement during cyclic loading and pull-to-failure force were recorded and compared between the 2 groups.

Results:

Two specimens of the standard group exhibited clinical failure during cyclic loading to 400 N. All other specimens survived cyclic loading to 800 N. The augmented group showed less cyclic tubercular fragment displacement after every load level compared with the standard group, with statistically significant differences starting from 500 N ( P < .05; power > 0.8). Mean ± standard deviation tubercular fragment displacement at the end of cyclic loading was 2.56 ± 0.82 mm for the augmented group and 5.21 ± 0.51 mm for the standard group. Mean ultimate failure load after the pull-to-failure test was 2475 ± 554 N for the augmented group and 1475 ± 280 N for the standard group.

Conclusion:

The specimens that underwent suture tape augmentation showed less tubercular fragment displacement during cyclic loading and higher ultimate failure forces compared with those that underwent standard screw fixation.

Clinical Relevance:

The augmentation technique could potentially increase the success of a TTO.
Experiences and Motivations of Male Nurses in a Tertiary Hospital in Ghana
Authors: Appiah Stella , Appiah Evans O. , Lamptey Valentina N.L.
Published: October 2021

Introduction

Nurses make up the largest portion of the health care system throughout the world, hence, making the profession the backbone of health care. The nursing workforce is made up of both males and females. However, the majority of nurses are predominately females with the number of male nurses reported to be unappreciable.

Objective

The study therefore aimed to explore the experiences and motivation of male nurses in a tertiary hospital in Ghana.

Methods

A qualitative descriptive research design was employed to explore the lived experiences of male nurses. A total of 20 male nurses were purposively selected, and in-depth interviews were conducted with a semi-structured interview guide. The interviews were tape-recorded, transcribed verbatim, and analyzed using content analysis.

Results

The findings revealed 2 major themes: motivation and experiences of male nurses. The subthemes were individual motivations, external influence, intersecting social reactions and public perceptions, mixed encounters with patients, and satisfaction with the profession.

Conclusion

Male nurses are motivated to a large extent to be part of the nursing profession but will be deeply involved in the profession if some factors affecting them are addressed. Future studies may address the roles of nurse managers in mentoring more males to be involved in the nursing profession.
Beyond trust: Amplifying unheard voices on concerns about harm resulting from health data-sharing
Authors: Mulrine Stephanie , Blell Mwenza , Murtagh Madeleine
Published: October 2021

Background:

The point of care in many health systems is increasingly a point of health data generation, data which may be shared and used in a variety of ways by a range of different actors.

Aim:

We set out to gather data about the perspectives on health data-sharing of people living in North East England who have been underrepresented within other public engagement activities and who are marginalized in society.

Methods:

Multi-site ethnographic fieldwork was carried out in the Teesside region of England over a 6-month period in 2019 as part of a large-scale health data innovation program called Connected Health Cities. Organizations working with marginalized groups were contacted to recruit staff, volunteers, and beneficiaries for participation in qualitative research. The data gathered were analyzed thematically and vignettes constructed to illustrate findings.

Results:

Previous encounters with health and social care professionals and the broader socio-political contexts of people’s lives shape the perspectives of people from marginalized groups about sharing of data from their health records. While many would welcome improved care, the risks to people with socially produced vulnerabilities must be appreciated by those advocating systems that share data for personalized medicine or other forms of data-driven care.

Conclusion:

Forms of innovation in medicine which rely on greater data-sharing may present risks to groups and individuals with existing vulnerabilities, and advocates of these innovations should address the lack of trustworthiness of those receiving data before asking that people trust new systems to provide health benefits.
Avoiding immunogenic drugs is key to preserve renal function in patients receiving immune checkpoint inhibitors: Lessons learned from three illustrative cases
Authors: Martínez Valenzuela Laura , Antón Paula , Tango Ariel , Gómez Francisco , Fulladosa Xavier , De Carvalho Alejandra , Gomà Montserrat , Cruzado Josep Maria , Draibe Juliana , Torras Juan
Published: October 2021

Background:

In the recent years, new immunotherapy agents are showing promising results in the treatment of cancer. Immune checkpoint inhibitors (ICI), which block neoplasm-induced lymphocyte inhibition and enhance cancer immunosurveillance mechanisms, are associated to acute tubulointerstitial nephritis (ATIN). The mechanisms of this adverse effect are debated.

Methods:

We present a three-case series of ATIN in the setting of ICI therapy managed in our Nephrology department. We detail the clinical course of the episodes, emphasizing on the concomitant medications administered. We also conducted a literature review of the altered drug immunogenicity in patients under immunotherapy drugs.

Results:

The three reported ATIN cases illustrate closer temporal association with the concomitant medication rather than the ICI itself. This suggests a scenario where the tolerance to previously accepted drugs seems to be lost. Moreover, one of the patients presented an ATIN flare after ICI discontinuation, suggesting an state of leukocyte hyperactivation.

Conclusions:

Unraveling the exact patho-mechanisms by which ICI-related ATIN occurs will allow the prevention of the development of this side effect and determine whether ICI re-challenge in patients previously affected by ICI-ATIN is safe.
Bleeding assessment tools in the diagnosis of VWD in adults and children: a systematic review and meta-analysis of test accuracy
Authors: Kalot Mohamad A. , Husainat Nedaa , Tayiem Sammy , El Alayli Abdallah , Dimassi Ahmad B. , Diab Osama , Abughanimeh Omar , Madoukh Bader , Qureini Aref , Ameer Barbara , Di Paola Jorge , Eikenboom Jeroen C.J. , Jacobs-Pratt Vicky , McLintock Claire , Montgomery Robert , O’Donnell James S. , Sidonio Robert , Brignardello-Petersen Romina , Flood Veronica , Connell Nathan T. , James Paula D. , Mustafa Reem A.
Published: October 2021

Von Willebrand disease (VWD) can be associated with significant morbidity. Patients with VWD can experience bruising, mucocutaneous bleeding, and bleeding after dental and surgical procedures. Early diagnosis and treatment are important to minimize the risk of these complications. Several bleeding assessment tools (BATs) have been used to quantify bleeding symptoms as a screening tool for VWD. We systematically reviewed diagnostic test accuracy results of BATs to screen patients for VWD. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. Two investigators screened and abstracted data. Risk of bias was assessed using the revised tool for the quality assessment of diagnostic accuracy studies and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 7 cohort studies that evaluated the use of BATs to screen adult and pediatric patients for VWD. The pooled estimates for sensitivity and specificity were 75% (95% confidence interval, 66-83) and 54% (29-77), respectively. Certainty of evidence varied from moderate to high. This systematic review provides accuracy estimates for validated BATs as a screening modality for VWD. A BAT is a useful initial screening test to determine who needs specific blood testing. The pretest probability of VWD (often determined by the clinical setting/patient population), along with sensitivity and specificity estimates, will influence patient management.
Transcription factor MEF2D is required for the maintenance of MLL-rearranged acute myeloid leukemia
Authors: Zhao Lianzhong , Zhang Pengcheng , Galbo Phillip M. , Zhou Xinyue , Aryal Sajesan , Qiu Shaowei , Zhang Hao , Zhou Yang , Li Chunliang , Zheng Deyou , Bhatia Ravi , Lu Rui
Published: October 2021

Acute myeloid leukemia (AML) with MLL-rearrangement (MLL-r) comprises ∼10% of all AML cases and portends poor outcomes. Much remains uncovered on how MLL-r AML drives leukemia development while preventing cells from normal myeloid differentiation. Here, we identified that transcription factor MEF2D is a super-enhancer-associated, highly expressed gene in MLL-r AML. Knockout of MEF2D profoundly impaired leukemia growth, induced myeloid differentiation, and delayed oncogenic progression in vivo. Mechanistically, MEF2D loss led to robust activation of a CEBPE-centered myeloid differentiation program in AML cells. Chromatin profiling revealed that MEF2D binds to and suppresses the chromatin accessibility of CEBPE cis-regulatory regions. In human acute leukemia samples, MEF2D expression showed a strong negative correlation with the expression of CEBPE. Depletion of CEBPE partially rescued the cell growth defect and myeloid cell differentiation induced by the loss of MEF2D. Lastly, we show that MEF2D is positively regulated by HOXA9, and downregulation of MEF2D is an important mechanism for DOT1L inhibitor-induced antileukemia effects. Collectively, our findings suggest that MEF2D plays a critical role in human MLL-r AML and uncover the MEF2D-CEBPE axis as a crucial transcriptional mechanism regulating leukemia cell self-renewal and differentiation block.
CNS involvement in AML at diagnosis is rare and does not affect response or survival: data from 11 ECOG-ACRIN trials
Authors: Ganzel Chezi , Lee Ju-Whei , Fernandez Hugo F. , Paietta Elisabeth M. , Luger Selina M. , Lazarus Hillard M. , Cripe Larry D. , Douer Dan , Wiernik Peter H. , Rowe Jacob M. , Tallman Martin S. , Litzow Mark R.
Published: October 2021

Central nervous system (CNS) involvement in patients with newly diagnosed acute myeloid leukemia (AML) is rare, and systematic data regarding outcome are scarce. This retrospective study summarized data from 11 consecutive Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) clinical trials for patients with newly diagnosed AML. In all, 3240 patients with AML were analyzed, and 36 (1.11%) were found to have CNS involvement at diagnosis. The incidence of CNS disease among the 5 studies with per protocol mandatory lumbar puncture (LP) was similar to the incidence among studies in which LP was performed at the discretion of the investigator (0.86% vs 1.41%; P = .18). There was no significant difference in the rate of complete remission (CR) among patients with CNS involvement and those with other extramedullary disease (EMD) sites or those with no EMD (52.8% vs 59.3%-60%). The median overall survival (OS) for patients who were CNS positive, who had other EMD, or who had no EMD was 11.4, 11.3, and 12.7 months, respectively. There was no difference in OS among patients with CNS involvement, those with other EMD (hazard ratio [HR], 0.96; adjusted P = .84), and those with no EMD (HR, 1.19; adjusted P = .44). In conclusion, the reported incidence of CNS involvement in patients with newly diagnosed AML is low (1.1%), irrespective of whether an LP is mandatory or not. The presence of CNS disease at diagnosis in and of itself does not seem to portend a poor prognosis for achieving an initial CR or for OS.