bluuebunny/crossref_metadata_2025 huggingface dataset:
Simplifying prediction of disease progression in pre-symptomatic type 1 diabetes using a single blood sample
Authors: Bediaga Naiara G. , Li-Wai-Suen Connie S. N. , Haller Michael J. , Gitelman Stephen E. , Evans-Molina Carmella , Gottlieb Peter A. , Hippich Markus , Ziegler Anette-Gabriele , Lernmark Ake , DiMeglio Linda A. , Wherrett Diane K. , Colman Peter G. , Harrison Leonard C. , Wentworth John M.
Published: August 2021

Aims/hypothesis

Accurate prediction of disease progression in individuals with pre-symptomatic type 1 diabetes has potential to prevent ketoacidosis and accelerate development of disease-modifying therapies. Current tools for predicting risk require multiple blood samples taken during an OGTT. Our aim was to develop and validate a simpler tool based on a single blood draw.

Methods

Models to predict disease progression using a single OGTT time point (0, 30, 60, 90 or 120 min) were developed using TrialNet data collected from relatives with type 1 diabetes and validated in independent populations at high genetic risk of type 1 diabetes (TrialNet, Diabetes Prevention Trial–Type 1, The Environmental Determinants of Diabetes in the Young [1]) and in a general population of Bavarian children who participated in Fr1da.

Results

Cox proportional hazards models combining plasma glucose, C-peptide, sex, age, BMI, HbA1c and insulinoma antigen-2 autoantibody status predicted disease progression in all populations. In TrialNet, the AUC for receiver operating characteristic curves for models named M60, M90 and M120, based on sampling at 60, 90 and 120 min, was 0.760, 0.761 and 0.745, respectively. These were not significantly different from the AUC of 0.760 for the gold standard Diabetes Prevention Trial Risk Score, which requires five OGTT blood samples. In TEDDY, where only 120 min blood sampling had been performed, the M120 AUC was 0.865. In Fr1da, the M120 AUC of 0.742 was significantly greater than the M60 AUC of 0.615.

Conclusions/interpretation

Prediction models based on a single OGTT blood draw accurately predict disease progression from stage 1 or 2 to stage 3 type 1 diabetes. The operational simplicity of M120, its validity across different at-risk populations and the requirement for 120 min sampling to stage type 1 diabetes suggest M120 could be readily applied to decrease the cost and complexity of risk stratification.

Graphical abstract
Additive manufacturing of AISI 420 stainless steel: process validation, defect analysis and mechanical characterization in different process and post-process conditions
Authors: Liverani Erica , Fortunato Alessandro
Published: August 2021

Stainless steel (SS) alloys produced by laser-based powder bed fusion (LPBF) offers comparable and sometime superior mechanical properties compared to conventionally processed materials. Some of these steels have been extensively studied over the last decade; however additively manufactured martensitic SS, such as AISI 420, need further research in characterizing their post-built quality and mechanical behaviour. This lack of information on martensitic SS is not consistent with their growing demand in the automotive, medical and aerospace industries due to their good corrosion resistance, high hardness and good tensile properties. Selection of the appropriate process parameters and post treatments plays a fundamental role in determining final properties. For this reason, the effect of LPBF process parameters and different heat treatments on density, defect characteristics and locations, roughness and mechanical properties of AISI 420 were investigated in this paper. A first experimental campaign was carried out to establish a set of suitable process parameters for industrial applications. Starting from this result, detected defect properties were investigated by computed tomography (CT) scans. Dimensions, sphericity and distributions of defects inside the volume were analysed and compared between samples manufactured with different parameters. In the second part of the paper, the influence of process and post-process conditions on mechanical properties was investigated. The final presented results establish a correlation between the employed production cycle and the resulting properties of LPBF AISI 420 specimens.
Larson–Penston Self-similar Gravitational Collapse
Authors: Guo Yan , Hadžić Mahir , Jang Juhi
Published: August 2021

Using numerical integration, in 1969 Penston (Mon Not R Astr Soc 144:425–448, 1969) and Larson (Mon Not R Astr Soc 145:271–295, 1969) independently discovered a self-similar solution describing the collapse of a self-gravitating asymptotically flat fluid with the isothermal equation of state$$p=k\varrho $$p=kϱ,$$k>0$$k>0, and subject to Newtonian gravity. We rigorously prove the existence of such a Larson–Penston solution.
Decoding ‘Unnecessary Complexity’: A Law of Complexity and a Concept of Hidden Variation Behind “Missing Heritability” in Precision Medicine
Authors: Singh Rama S.
Published: August 2021

The high hopes for the Human Genome Project and personalized medicine were not met because the relationship between genotypes and phenotypes turned out to be more complex than expected. In a previous study we laid the foundation of a theory of complexity and showed that because of the blind nature of evolution, and molecular and historical contingency, cells have accumulated unnecessary complexity, complexity beyond what is necessary and sufficient to describe an organism. Here we provide empirical evidence and show that unnecessary complexity has become integrated into the genome in the form of redundancy and is relevant to molecular evolution of phenotypic complexity. Unnecessary complexity creates uncertainty between molecular and phenotypic complexity, such that phenotypic complexity (CP) is higher than molecular complexity (CM), which is higher than DNA complexity (CD). The qualitative inequality in complexity is based on the following hierarchy: CP > CM > CD. This law-like relationship holds true for all complex traits, including complex diseases. We present a hypothesis of two types of variation, namely open and closed (hidden) systems, show that hidden variation provides a hitherto undiscovered “third source” of phenotypic variation, beside genotype and environment, and argue that “missing heritability” for some complex diseases is likely to be a case of “diluted heritability”. There is a need for radically new ways of thinking about the principles of genotype–phenotype relationship. Understanding how cells use hidden, pathway variation to respond to stress can shed light on why two individuals who share the same risk factors may not develop the same disease, or how cancer cells escape death.
Effectiveness of Repair of Aortic Coarctation in Neonates: A Long-Term experience
Authors: Minotti Chiara , Scioni Manuela , Castaldi Biagio , Guariento Alvise , Biffanti Roberta , Di Salvo Giovanni , Vida Vladimiro , Padalino Massimo A.
Published: August 2021

To evaluate early and long-term results of surgical treatment of aortic coarctation (CoAo) in neonates. This is a retrospective clinical review of neonates with CoAo, who underwent surgery between 1995 and 2019. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by means of relative risk ratio and Cox and logistic multivariate analysis. 218 consecutive neonates (M/F: 129/89, median age 11 days, IQR 7–17 days) were included; 202 (92.7%) had a left thoracotomy; 178 underwent extended end-to-end anastomosis (EEEA, 81.6%). Hypoplastic aortic arch (HAA) was present in 102 patients (46.8%); complex cardiac anomalies in 85 (39%). Significant postoperative complications occurred in 20 (9.2%). Thirty-day mortality was 2.3% (most in complex types). At a median follow-up of 10.4 years (IQR 5.6–15.0 years; FU completeness 95.9%), there were 8 late deaths (3.7%), all associated to complex CoAo. Among 196 survivors, 177 (93.2%) were in NYHA class I; re-interventions on aortic arch occurred in 9.2% (2.0% were surgical). Freedom from mortality and re-intervention on aorta at 10 years were 94.3% and 96.7%, respectively. Surgical repair of CoAo in newborns without CPB in our series was safe and low-risk, with excellent early and late outcomes.
We Asked the Experts: The Role of Rural Hospitals in Achieving Equitable Surgical Access in Low‐Resourced Settings
Authors: Chu Kathryn , Maine Rebecca , Duvenage Riaan
Published: August 2021

Strengthening and defining the role of rural hospitals within a surgical ecosystem is essential to improving quality and timely surgical access for rural people in low and middle‐income countries (LMICs). Regional hospitals are the cornerstone of LMIC rural surgical care but have insufficient human resources and infrastructure that limit the surgical care they can provide. District hospitals are most accessible for many rural patients but also have limited surgical capacity. In order to surgical access for rural people, both regional and district hospital surgical services must be strengthened. A strong relationship between regional and district hospitals through a hub and spoke model is needed. Regional hospital surgeons can support training and supervision for and referrals from district hospitals. Telemedicine can play a key role to leapfrog physical barriers and surgical specialist shortages. The changing demographics of surgical disease will continue to worsen the strain on tertiary hospitals where most subspecialists in LMICs work. The fewer rural patients who need to travel to urban referral and tertiary facilities for problems that can be managed at lower‐level facilities, the better access to timely surgical care for all.
The female mouse is resistant to mild vitamin B3 deficiency
Authors: van der Stelt Inge , Shi Wenbiao , Bekkenkamp-Grovenstein Melissa , Zapata-Pérez Rubén , Houtkooper Riekelt H. , de Boer Vincent C. J. , Hegeman Maria A. , Keijer Jaap
Published: August 2021

Purpose

Vitamin B3 provides nicotinamide adenine dinucleotide (NAD+), an essential coenzyme in oxidoreductase reactions. Severe vitamin B3 deficiency leads to the disease Pellagra, while mild vitamin B3 deficiency has been linked to age-related and metabolic diseases. Mild vitamin B3 deficiency is understudied, especially in females. Therefore, we examined how female mice responded to a diet that induced mild vitamin B3 deficiency in male mice.

Methods

Female C57BL/6RccHsd mice were subjected for 18 weeks to a diet without vitamin B3 and low but sufficient tryptophan (0.115%) (0NR) and were compared to control female mice on the same diet with the reference dose of vitamin B3 (30NR, 30 mg nicotinamide riboside/ kg diet).

Results

In the female mice, no differences between the two dietary groups were found in liver nicotinamide mononucleotide (NMN) levels, body composition, whole body energy and substrate metabolism measured by indirect calorimetry, or liver triacylglycerol metabolism. Expression of seven genes that previously were shown to respond to mild vitamin B3 deficiency in male white adipose tissue were not differentially expressed between the female dietary groups, neither was insulin sensitivity.

Conclusion

We concluded that the female 0NR mice were not vitamin B3 deficient; the role of age, sex and health status is discussed. Demonstrated by clear differences between females and males, the latter showing mild deficiency under the same conditions, this study highlights the importance of studying both sexes.
Lessons learned with the Cobra prosthesis in elderly patients with complex distal radius fractures—a retrospective follow-up study
Authors: Benedikt Stefan , Kaiser Peter , Schmidle Gernot , Kastenberger Tobias , Stock Kerstin , Arora Rohit
Published: August 2021

Introduction

Recently, the Cobra prostheses were introduced in the treatment of distal radius fractures (DRF) of elderly patients. Fracture prostheses provide an alternative treatment option for complex fractures where conservative therapy seems not acceptable and osteosynthesis seems not possible. Data reporting the feasibility of the Cobra prosthesis are sparse. Therefore, this retrospective follow-up study investigated the clinical and radiological mid-term outcome of the Cobra implant in complex DRFs of elderly patients.

Materials and methods

Thirteen patients (mean age 73.5 years, range 65–87 years) were retrospectively evaluated with at least a 1-year follow-up after surgery. Objective and subjective clinical parameters as well as the radiological outcome and complications were analyzed.

Results

The mean follow-up period was 31.2 months. Seven cases required a cemented prosthesis. The mean relative range-of-motion compared to the healthy side was 72.3% and 51.8% for extension and flexion, respectively, and 87.9% and 85.7% for pronation and supination, respectively. The mean grip strength was 78.3% compared to the non-operated side. Eight patients were very satisfied, five patients were partly satisfied with the result. The DASH, PRWE, MHQ and Lyon-Scores averaged 39.1, 36.2, 64.9 and 63.3 points, respectively. The mean VAS-Score for pain was 1.1 at rest and 3.2 during activities. Perioperative complications included one dissection of the extensor pollicis longus tendon, one heterotopic ossification, one radiocarpal dislocation and two cases of an ulnar impaction syndrome due to implant subsidence.

Conclusion

The prosthetic treatment of complex DRFs in elderly patients with the Cobra implant led to clinically and radiologically satisfactory mid-term results. The Cobra prosthesis still does not represent a gold standard but can be regarded as a feasible salvage option for complex DRFs when osteosyntheses may not be possible and non-operative treatment will lead to further functional restrictions and wrist pain during performing activities of daily life in high functional demand patients.
Lateral femoral notch sign and posterolateral tibial plateau fractures and their associated injuries in the setting of an anterior cruciate ligament rupture
Authors: Korthaus Alexander , Warncke Malte , Pagenstert Geert , Krause Matthias , Frosch Karl-Heinz , Kolb Jan Philipp
Published: August 2021

Introduction

ACL injury is one of the most common injuries of the knee joint in sports. As accompanying osseous injuries of the ACL rupture a femoral impression the so-called lateral femoral notch sign and a posterolateral fracture of the tibial plateau are described. However, frequency, concomitant ligament injuries and when and how to treat these combined injuries are not clear. There is still a lack of understanding with which ligamentous concomitant injuries besides the anterior cruciate ligament injury these bony injuries are associated.

Materials and methods

One hundred fifteen MRI scans with proven anterior cruciate ligament rupture performed at our center were retrospectively evaluated for the presence of a meniscus, collateral ligament injury, a femoral impression, or a posterolateral impression fracture. Femoral impressions were described according to their local appearance and posterolateral tibial plateau fractures were described using the classification of Menzdorf et al.

Results

In 29 cases a significant impression in the lateral femoral condyle was detected. There was a significantly increased number of lateral meniscal (41.4% vs. 18.6% p = 0.023) and medial ligament (41.4% vs. 22.1%; p = 0.040) injuries in the group with a lateral femoral notch sign. 104 patients showed a posterolateral bone bruise or fracture of the tibial plateau. Seven of these required an intervention according to Menzdorf et al. In the group of anterior cruciate ligament injuries with posterolateral tibial plateau fracture significantly more lateral meniscus injuries were seen (p = 0.039).

Conclusion

In the preoperative planning of ACL rupture accompanied with a positive femoral notch sign, attention should be paid to possible medial collateral ligament and lateral meniscus injuries. As these are more likely to occur together. A posterolateral impression fracture of the tibial plateau is associated with an increased likelihood of the presence of a lateral meniscal injury. This must be considered in surgical therapy and planning and may be the indication for necessary early surgical treatment.
Outcome measures assisting treatment optimization in multiple sclerosis
Authors: Pardo Gabriel , Coates Samantha , Okuda Darin T.
Published: August 2021

Objective

To review instruments used to assess disease stability or progression in persons with multiple sclerosis (pwMS) that can guide clinicians in optimizing therapy.

Methods

A non-systematic review of scientific literature was undertaken to explore modalities of monitoring symptoms and the disease evolution of MS.

Results

Multiple outcome measures, or tools, have been developed for use in MS research as well as for the clinical management of pwMS. Beginning with the Expanded Disability Status Scale, introduced in 1983, clinicians and researchers have developed monitoring modalities to assess all aspects of MS and the neurological impairment it causes.

Conclusions

Much progress has been made in recent decades for the management of MS and for the evaluation of disease progression. New technology, such as wearable sensors, will provide new opportunities to better understand changes in function, dexterity, and cognition. Essential work over the decades since EDSS was introduced continues to improve our ability to treat this debilitating disease.
One-year outcomes of microhook trabeculotomy versus suture trabeculotomy ab interno
Authors: Yokoyama Hiroshi , Takata Masashi , Gomi Fumi
Published: August 2021

Purpose

To compare clinical success rates and reductions in intraocular pressure (IOP) and IOP-lowering medication use following suture trabeculotomy ab interno (S group) or microhook trabeculotomy (μ group).

Methods

This retrospective review collected data from S (n = 104, 122 eyes) and μ (n = 42, 47 eyes) groups who underwent treatment between June 1, 2016, and October 31, 2019, and had 12-month follow-up data including IOP, glaucoma medications, complications, and additional IOP-lowering procedures. The Kaplan–Meier survival analysis was used to evaluate treatment success rates defined as normal IOP (> 5 to ≤ 18 mm Hg), ≥ 20% reduction of IOP from baseline at two consecutive visits, and no further glaucoma surgery.

Results

Schlemm’s canal opening was longer in the S group than in the μ group (P < 0.0001). The Kaplan–Meier survival analysis of all eyes showed cumulative clinical success rates in S and µ groups were 71.1% and 61.7% (P = 0.230). The Kaplan–Meier survival analysis of eyes with preoperative IOP ≥ 21 mmHg showed cumulative clinical success rates in S and μ groups were 80.4% and 60.0% (P = 0.0192). There were no significant differences in postoperative IOP at 1, 3, and 6 months (S group, 14.9 ± 5.6, 14.6 ± 4.5, 14.6 ± 3.9 mmHg; μ group, 15.8 ± 5.9, 15.2 ± 4.4, 14.7 ± 3.7 mmHg; P = 0.364, 0.443, 0.823), but postoperative IOP was significantly lower in the S group at 12 months (S group, 14.1 ± 3.1 mmHg; μ group, 15.6 ± 4.1 mmHg; P = 0.0361). There were no significant differences in postoperative numbers of glaucoma medications at 1, 3, 6, and 12 months (S group, 1.8 ± 1.6, 1.8 ± 1.5, 2.0 ± 1.6, 1.8 ± 1.5; μ group, 2.0 ± 1.6, 2.0 ± 1.6, 2.1 ± 1.6, 2.2 ± 1.7; P = 0.699, 0.420, 0.737, 0.198).

Conclusion

S and µ group eyes achieved IOP reduction, but μ group eyes had lower clinical success rates among patients with high preoperative IOP at 12 months.
Immune checkpoint inhibitor treatment induces colitis with heavy infiltration of CD8 + T cells and an infiltration pattern that resembles ulcerative colitis
Authors: Hone Lopez Sara , Kats-Ugurlu Gursah , Renken Remco J. , Buikema Henk J. , de Groot Marco R. , Visschedijk Marijn C. , Dijkstra Gerard , Jalving Mathilde , de Haan Jacco J.
Published: August 2021

Colitis is a common, but poorly understood, adverse event of immune checkpoint inhibitors that are standard-of-care for an expanding range of cancer types. This explorative study aimed to describe the immune infiltrates in the colon from individuals developing checkpoint inhibitor colitis and compare them to well-known immunophenotypes of acute graft-versus-host disease, ulcerative colitis, and Crohn’s disease. Colon biopsies (n = 20 per group) of patients with checkpoint inhibitor colitis, acute graft-versus-host disease, ulcerative colitis and Crohn’s disease, all colitis treatment-naïve, and of individuals with a normal colon were analyzed using immunohistochemistry: CD8 for cytotoxic T cells, CD4 for T helper cells, and CD68 to identify cells of macrophage lineage. CD8 + T cell, CD4 + T cell, and CD68 + cell counts were performed. Cell infiltration was scored as scattered/patchy or band-like in the superficial and deep gut mucosa. Checkpoint inhibitor colitis was found to be heavily infiltrated by CD8 + T cells. Comparative analysis between groups showed that both CD8 + T cell counts (P < 0.01) and immune cell infiltration patterns in checkpoint inhibitor colitis were most similar to those observed in ulcerative colitis, with a deep band-like CD4 + T cell infiltration pattern and a superficial band-like CD68 + cell infiltration pattern in both. In conclusion, this is the first immunohistopathological study comparing infiltrate characteristics of checkpoint inhibitor colitis, acute graft-versus-host disease, ulcerative colitis, and Crohn’s disease. Checkpoint inhibitor colitis samples are heterogeneous, heavily infiltrated by CD8 + T cells, and show an immune cell infiltration pattern that is more similar to ulcerative colitis than to colonic acute graft-versus-host disease or colonic Crohn’s disease.
Effectiveness of experimental and commercial pertussis vaccines in the elimination of Bordetella pertussis isolates with different genetic profiles in murine model
Authors: Prygiel Marta , Mosiej Ewa , Wdowiak Karol , Górska Paulina , Polak Maciej , Lis Klaudia , Krysztopa-Grzybowska Katarzyna , Zasada Aleksandra Anna
Published: August 2021

The aim of this study was to compare the elimination of Bordetella pertussis clinical isolates, representing different genotypes in relation to alleles encoding virulence factors (MLST—multi-locus antigen sequence typing), MLVA type (multi-locus variable-number tandem repeat analysis) and PFGE group (pulsed-field gel electrophoresis) from the lungs of naive mice or mice were immunised with the commercial whole-cell pertussis vaccine, the acellular pertussis vaccine and the experimental whole-cell pertussis vaccine. Molecular data indicate that the resurgence of pertussis in populations with high vaccine coverage is associated with genomic adaptation of B. pertussis, to vaccine selection pressure. Pertactin-negative B. pertussis isolates were suspected to contribute to the reduced vaccine effectiveness. It was shown that one of the isolates used is PRN deficient. The mice were intranasally challenged with bacterial suspension containing approximately 5 × 10 7 CFU/ml B. pertussis. The immunogenicity of the tested vaccines against PT (pertussis toxin), PRN (pertactin), FHA (filamentous haemagglutinin) and FIM (fimbriae types 2 and 3) was examined. The commercial whole-cell and acellular pertussis vaccines induced an immunity effective at eliminating the genetically different B. pertussis isolates from the lungs. However, the elimination of the PRN-deficient isolate from the lungs of mice vaccinated with commercial vaccines was delayed as compared to the PRN ( +) isolate, suggesting phenotypic differences with the circulating isolates and vaccine strains. The most effective vaccine was the experimental vaccine with the composition identical to that of the strains used for infection.
Non-mucinous adenocarcinomas and squamous cell carcinomas of the anal region masquerading as abscess or fistula: a retrospective analysis and systematic review of literature
Authors: Tekbaş Aysun , Mothes Henning , Settmacher Utz , Schuele Silke
Published: August 2021

Purpose

Abscess or fistula of the anal region is an uncommon presentation of malignancy. Under the assumption of a benign condition, diagnostics is often delayed, resulting in advanced tumour stages at first diagnosis. Due to the case rarity, treatment guidelines for cancers of anorectal region masquerading as abscess or fistula are missing.

Methods

We analysed all patients presenting with an abscess or fistula of the anal region in our department between January 2004 and August 2020. The malignancies were included to our study to acquire data on clinical presentation, treatment and outcome. Furthermore, a systematic review to present adenocarcinomas and squamous cell carcinomas associated to an abscess or fistula was performed.

Results

0.5% of the patients treated for an abscess or fistula of the anal region met the selection criteria. Mean time from the onset of symptoms to diagnosis of malignancy was 100 days. Histology revealed adenocarcinoma and squamous cell carcinoma each in two patients. All patients had locally advanced tumours without distant metastases, in two cases with regional lymph-node metastases. Neoadjuvant chemoradiation was applied in two patients. All patients underwent abdomino-perineal resection of the rectum. The overall outcome reveals a recurrence-free survival of 4.5 and 3 years for two patients. Further two patients died within 5 months after the primary resection.

Conclusion

Advanced carcinomas of the anorectal region may masquerade as abscess or fistula, cause diagnostic problems and delay oncologic treatment. However, even in these very advanced situations, surgical therapy with curative intent should be attempted.
Development and validation of the scoliosis misconception scale (SMS) for assessing level of misconception of patients with adolescent idiopathic scoliosis
Authors: Cheung Amy Ka Po , Lau Charlie Chiu Yi , Chan Meanne Ching Man , Kwan Kenny Yat Hong
Published: August 2021

Background

Little is known about patients’ understanding of adolescent idiopathic scoliosis (AIS). This paper aims to develop and validate the Scoliosis Misconception Scale (SMS) and to explore patients’ level of misconception about AIS.

Methods

A total of 195 patients who were newly referred with newly diagnosed AIS were recruited to assess their levels of misconception and psychological distress before and after their first consultation with a specialist. The 17-item SMS was administered to assess patients’ level of misconception about AIS and the Kessler Psychological Distress Scale (K10) was used to measure their level of distress.

Results

According to the Item Response Theory, all items were within the acceptable range from -3.69 to 2.39 for difficulty parameters, which determined the difficulty of the scale, while most of the items were within the acceptable range from 0.11 to 1.54 for the discrimination parameters, which determined the rate at which the probability of endorsing a correct item changes given ability levels. Internal consistency by marginal reliability was 0.66. One-sample t test revealed that participants on average scored 6.79 (SD = 2.12) before the first clinic session and 6.45 (SD = 2.51) after the first clinic session, both significantly higher than 0 [t(75) = 27.86, p < .001; t(75) = 22.43, p < .001].

Conclusions

Despite a longstanding clinical model that functions well to treat AIS, most patients still have significant misconceptions about the condition. This highlights the necessity to assess patients’ knowledge level of a medical condition and potential generalisability of misconception–distress link to the forefront across other illnesses.
Patient-reported outcomes after incisional hernia repair
Authors: van Veenendaal N. , Poelman M. M. , van den Heuvel B. , Dwars B. J. , Schreurs W. H. , Stoot J. H. M. B. , Bonjer H. J.
Published: August 2021

Purpose

Patient-reported outcomes (PROs) are pivotal to evaluate the efficacy of surgical management. Debate persists on the optimal surgical technique to repair incisional hernias. Assessment of PROs can guide the selection of the best management of patients with incisional hernias. The objective of this cohort study was to present the PROs after incisional hernia repair at long term follow-up.

Methods

Patients with a history of incisional hernia repair were seen at the out-patient clinic to collect PROs. Patients were asked about the preoperative indication for repair and postoperative symptoms, such as pain, feelings of discomfort, and bulging of the abdominal wall. Additionally, degree of satisfaction was asked and Carolina Comfort Scales were completed.

Results

Two hundred and ten patients after incisional hernia repair were included with a median follow-up of 3.2 years. The main indication for incisional hernia repair was the presence of a bulge (60%). Other main reasons for repair were pain (19%) or discomfort (5%). One hundred and thirty-two patients (63%) reported that the overall status of their abdominal wall had improved after the operation. Postoperative symptoms were reported by 133 patients (63%), such as feelings of discomfort, pain and bulging. Twenty percent of patients reported that the overall status of their abdominal wall was the same, and 17% reported a worse status, compared to before the operation. Ten percent of the patients would not opt for operation in hindsight.

Conclusion

This study showed that a majority of the patients after incisional hernia repair still report pain or symptoms such as feelings of discomfort, pain, and bulging of the abdominal wall 3 years after surgery. Embedding patients’ expectations and PROs in the preoperative counseling discussion is needed to improve decision-making in incisional hernia surgery.
Insights and decision support for home health care services in times of disasters
Authors: Rest Klaus-Dieter , Hirsch Patrick
Published: August 2021

Home health care (HHC) services are of vital importance for the health care system of many countries. Further increases in their demand must be expected and with it grows the need to sustain these services in times of disasters. Existing risk assessment tools and guides support HHC service providers to secure their services. However, they do not provide insights on interdependencies of complex systems like HHC. Causal-Loop-Diagrams (CLDs) are generated to visualize the impacts of epidemics, blackouts, heatwaves, and floods on the HHC system. CLDs help to understand the system design as well as cascading effects. Additionally, they simplify the process of identifying points of action in order to mitigate the impacts of disasters. In a case study, the course of the COVID-19 pandemic and its effects on HHC in Austria in spring 2020 are shown. A decision support system (DSS) to support the daily scheduling of HHC nurses is presented and applied to numerically analyze the impacts of the COVID-19 pandemic, using real-world data from a HHC service provider in Vienna. The DSS is based on a Tabu Search metaheuristic that specifically aims to deal with the peculiarities of urban regions. Various transport modes are considered, including time-dependent public transport.
Towards a model-driven approach for multiexperience AI-based user interfaces
Authors: Planas Elena , Daniel Gwendal , Brambilla Marco , Cabot Jordi
Published: August 2021

Software systems start to include other types of interfaces beyond the “traditional” Graphical-User Interfaces (GUIs). In particular, Conversational User Interfaces (CUIs) such as chat and voice are becoming more and more popular. These new types of interfaces embed smart natural language processing components to understand user requests and respond to them. To provide an integrated user experience all the user interfaces in the system should be aware of each other and be able to collaborate. This is what is known as a multiexperience User Interface. Despite their many benefits, multiexperience UIs are challenging to build. So far CUIs are created as standalone components using a platform-dependent set of libraries and technologies. This raises significant integration, evolution and maintenance issues. This paper explores the application of model-driven techniques to the development of software applications embedding a multiexperience User Interface. We will discuss how raising the abstraction level at which these interfaces are defined enables a faster development and a better deployment and integration of each interface with the rest of the software system and the other interfaces with whom it may need to collaborate. In particular, we propose a new Domain Specific Language (DSL) for specifying several types of CUIs and show how this DSL can be part of an integrated modeling environment able to describe the interactions between the modeled CUIs and the other models of the system (including the models of the GUI). We will use the standard Interaction Flow Modeling Language (IFML) as an example “host” language.
A method for transforming knowledge discovery metamodel to ArchiMate models
Authors: Pérez-Castillo Ricardo , Delgado Andrea , Ruiz Francisco , Bacigalupe Virginia , Piattini Mario
Published: August 2021

Enterprise architecture has become an important driver to facilitate digital transformation in companies, since it allows to manage IT and business in a holistic and integrated manner by establishing connections among technology concerns and strategical/motivational ones. Enterprise architecture modelling is critical to accurately represent business and their IT assets in combination. This modelling is important when companies start to manage their enterprise architecture, but also when it is remodelled so that the enterprise architecture is realigned in a changing world. Enterprise architecture is commonly modelled by few experts in a manual way, which is error-prone and time-consuming and makes continuous realignment difficult. In contrast, other enterprise architecture modelling proposal automatically analyses some artefacts like source code, databases, services, etc. Previous automated modelling proposals focus on the analysis of individual artefacts with isolated transformations toward ArchiMate or other enterprise architecture notations and/or frameworks. We propose the usage of Knowledge Discovery Metamodel (KDM) to represent all the intermediate information retrieved from information systems’ artefacts, which is then transformed into ArchiMate models. Thus, the core contribution of this paper is the model transformation between KDM and ArchiMate metamodels. The main implication of this proposal is that ArchiMate models are automatically generated from a common knowledge repository. Thereby, the relationships between different-nature artefacts can be exploited to get more complete and accurate enterprise architecture representations.
Stakeholders’ engagement platform to identify sustainable pathways for the development of multi-functional agroforestry in Guadeloupe, French West Indies
Authors: Barlagne Carla , Bézard Marie , Drillet Emilie , Larade Arnaud , Diman Jean-Louis , Alexandre Gisèle , Vinglassalon Arsène , Nijnik Maria
Published: August 2021

Social innovation is critical in shaping human-forest relationships and how farmers and scientists engage with each other to design sustainability transitions. This paper reports on the outputs of a participatory stakeholders’ engagement platform that was designed to draw on local farmers’ knowledge and experience in identifying sustainable pathways for the development of multi-functional agroforestry in Guadeloupe. Two participatory workshops were organised that aimed to gain insights into the reality faced by farmers, in particular: (i) their vision of the future, needs and aspirations; (ii) their understanding of barriers and enablers in relation to the sustainability challenges they are confronted with and; (iii) their framing of human–environment relationships in socio-ecological systems. Outputs of the activities were synthetized by the research team and represented graphically for analysis. Results show that while farmers envision prosperous multifunctional forest farms in the future, they have to face complex challenges that require solutions at multiple scales and suggest different types of innovation: social, institutional, market-based and technical. Farmers saw themselves as being part of the socio-ecological system and as custodians of the natural environment. We discuss the implications of those results in the context of the absence of a system of innovation for agroforestry in Guadeloupe and highlight the opportunity for a innovation ecosystem thinking approach that integrates better the agricultural and forestry sectors, but also between actors and scales of governance. Implementation of aStewardship statuswould enable farmers achieve their vision and embrace a custodian role vis-à-vis the agroforest. Embededment of the stakeholders’ engagement platform and its enabling processes in the innovation ecosystem is key to achieve those objectives.
“I am here for the students”: principals’ perception of accountability amid work intensification
Authors: Wang Fei , Hauseman Cameron , Pollock Katina
Published: August 2021

Increasing job duties and responsibilities associated with the changing role of school principals have prompted even greater accountability. As a result, principals are faced with competing demands and expectations in various forms of accountability from multiple stakeholders. This study examines principals’ perception of accountability in the context of work intensification with a particular focus on the question of “accountable to whom and why.” A total of 1434 practicing principals responded to an online survey that sought to determine the groups and individuals to whom principals feel accountable, and why principals feel accountable to those particular individuals or groups. The survey achieved a response rate of 52.68%. The research results show balancing competing accountabilities concerning students has become a daunting task for school principals. The competing if not conflicting expectations from (federal and state/provincial) educational authorities, teachers, parents, students, and various interest groups often pose significant challenges to principals’ work and add to the complexity of principals’ role. The unrealistic expectations imposed on principals make it imperative to critically examine the changing role of school principals and identify essential and legislatively mandated duties and responsibilities of principalship to better reflect and address their intensified work realities.
Does Counting Different Life Stages Impact Estimates for Extinction Probabilities for Tsetse (Glossina spp)?
Authors: Are Elisha B. , Hargrove John W. , Dushoff Jonathan
Published: August 2021

As insect populations decline, due to climate change and other environmental disruptions, there has been an increased interest in understanding extinction probabilities. Generally, the life cycle of insects occurs in well-defined stages: when counting insects, questions naturally arise about which life stage to count. Using tsetse flies (vectors of trypanosomiasis) as a case study, we develop a model that works when different life stages are counted. Previous branching process models for tsetse populations only explicitly represent newly emerged adult female tsetse and use that subpopulation to keep track of population growth/decline. Here, we directly model other life stages. We analyse reproduction numbers and extinction probabilities and show that several previous models used for estimating extinction probabilities for tsetse populations are special cases of the current model. We confirm that the reproduction number is the same regardless of which life stage is counted, and show how the extinction probability depends on which life stage we start from. We demonstrate, and provide a biological explanation for, a simple relationship between extinction probabilities for the different life stages, based on the probability of recruitment between stages. These results offer insights into insect population dynamics and provide tools that will help with more detailed models of tsetse populations. Population dynamics studies of insects should be clear about life stages and counting points.
Macht Ähnlichkeit den Unterschied? Wenn sozioökonomisch benachteiligte Schülerinnen und Schüler von sozial ähnlichen Lehrkräften unterrichtet werden
Authors: Ostermann Charlotte , Neugebauer Martin
Published: August 2021

Schulen sind Bourdieu zufolge Mittelschichtsinstitutionen, die entsprechende Verhaltensweisen erwarten und prämieren und so zur Benachteiligung von Schülerinnen und Schülern aus niedrigeren Sozialschichten beitragen. Doch welche Rolle spielen dabei Lehrkräfte, die – geprägt von ihrer eigenen Herkunft – als zentrale Akteure die Schulkultur repräsentieren? Der Beitrag untersucht, ob Schüler von Lehrkräften profitieren, die aus ähnlichen sozialen Verhältnissen stammen. Dazu werden PISA-I-Plus-Längsschnittdaten von N = 2539 Schülern und ihren Mathematiklehrkräften im Hinblick auf Unterstützungsverhalten, Mathematikkompetenz und Schulnoten untersucht. Die Ergebnisse aus Propensity-Score-Matching-Analysen zeigen, dass Schüler bei einer sozial ähnlichen Lehrkraft weder besser lernen noch bessere Noten erzielen. Hingegen fühlen sich Schüler unabhängig von ihrer sozialen Herkunft weniger unterstützt von Lehrkräften aus Arbeiter- und Nichtakademikerfamilien. Die Ergebnisse legen nahe, dass Lehrkräfte aus niedrigeren Sozialschichten nur aufgrund ihrer Herkunft kaum zur Eindämmung von sozialen Bildungsungleichheiten beitragen.
Die Ko-Konstruktion von Führung in veränderungsbezogenen Interaktionen zwischen Führungskräften und Mitarbeitenden
Authors: Güntner Amelie Verena , Kauffeld Simone
Published: August 2021

Dieser Beitrag in der ZeitschriftGruppe. Interaktion. Organisation. Zeitschrift für Angewandte Organsationspsychologie (GIO)befasst sich damit, wie Führung in Veränderungsprozessen als dynamischer, wechselseitiger Einflussprozess zwischen Führungskräften und Mitarbeitenden verstanden werden kann und welches Potenzial diese Perspektive für die Effektivität von Führung bietet. Die Hauptaufgabe von Führungskräften wird häufig in der Leitung und Beeinflussung ihrer Mitarbeitenden gesehen. Diese Aufgabe stellt insbesondere im Kontext organisationaler Veränderungen eine Herausforderung dar, wenn es darum geht, Mitarbeitende für eine Verhaltensänderung zu motivieren. Vor dem Hintergrund kontinuierlich stattfindender Veränderungen in der heutigen Zeit gilt es daher, ein Verständnis für die Entwicklung positiver und negativer Interaktionsdynamiken in Gesprächen zwischen Führungskräften und Mitarbeitenden zu entwickeln. In der Führungsforschung bestehen dazu unterschiedliche theoretische Perspektiven, die verschiedene Betrachtungsweisen zu Entstehung und Verlauf von Führung und den Einflussprozessen zwischen Führungskräften und Mitarbeitenden bieten. Der vorliegende Artikel beleuchtet die unterschiedlichen Führungsperspektiven vor dem Hintergrund der Herausforderungen organisationaler Veränderungen und leitet praktische Implikationen ab. Sowohl auf der Ebene von Mitarbeitenden, Führungskräften als auch auf der organisationalen Ebene werden Wege aufgezeigt, wie mit Hilfe des Verständnisses von Führung als dynamischer, wechselseitiger Prozess positive Führungs- und Veränderungsprozesse gestaltet werden können.
Early health technology assessment using the MAFEIP tool. A case study on a wearable device for fall prediction in elderly patients
Authors: Federici Carlo , Pecchia Leandro
Published: August 2021

By using a case-study on a fall-prediction device for elderly patients with orthostatic hypotension we aim to demonstrate how the MAFEIP tool, developed as part of the European Innovation Programme on Active and Healthy Ageing (EIP on AHA), can be used to inform manufacturers on their product development based on a cost-effectiveness criterion. Secondly, we critically appraise the tool and suggest further improvements that may be needed for a larger-scale adoption of MAFEIP within and beside the EIP on AHA initiative. The model was implemented using the MAFEIP tool. Within the tool one way sensitivity analyses were performed to assess the robustness of the model against the relative effectiveness of the fall-prevention device at different price levels. The MAFEIP tool was applied to a novel fall-prediction device and used to estimate the expected cost-effectiveness and perform threshold analysis. In our case study, the device produced estimated gains of 0.035 QALYs per patient and incremental costs of £ 518 (incremental cost-effectiveness ratio £14,719). Based on the one-way sensitivity analysis, the maximum achievable price at a willingness to pay threshold of £20,000 per QALY is estimated close to £900. The MAFEIP allows to quickly create early economic models, and to explore model uncertainty by performing deterministic sensitivity analysis for single parameters. However, the integration within the MAFEIP of common analytical tools such as probabilistic sensitivity analysis and Value of information would greatly contribute to its relevance for evaluating innovative technologies within and beside the EIP on AHA initiative.
The AI Methods, Capabilities and Criticality Grid
Authors: Schmid Thomas , Hildesheim Wolfgang , Holoyad Taras , Schumacher Kinga
Published: August 2021

Many artificial intelligence (AI) technologies developed over the past decades have reached market maturity and are now being commercially distributed in digital products and services. Therefore, national and international AI standards are currently being developed in order to achieve technical interoperability as well as reliability and transparency. To this end, we propose to classify AI applications in terms of the algorithmic methods used, the capabilities to be achieved and the level of criticality. The resulting three-dimensional classification scheme, termed the AI Methods, Capabilities and Criticality (AI-$$\hbox {MC}^2$$MC2) Grid, combines current recommendations of the EU Commission with an ethical dimension proposed by the Data Ethics Commission of the German Federal Government (Datenethikkommission der Bundesregierung: Gutachten. Berlin, 2019). As a whole, the AI-$$\hbox {MC}^2$$MC2Grid allows not only to gain an overview of the implications of a given AI application as well as to compare efficiently different AI applications within a given market or implemented by different AI technologies. It is designed as a core tool to define and manage norms, standards and compliance of AI applications, but helps to manage AI solutions in general as well.
The importance of thinking about Guillain-Barré syndrome during the COVID-19 pandemic: a case with pure dysautonomic presentation
Authors: Biassoni Erica , Assini Andrea , Gandoglia Ilaria , Benedetti Luana , Boni Silvia , Pontali Emanuele , Feasi Marcello , Gandolfo Federica , Del Sette Massimo
Published: August 2021

Guillain-Barré syndrome (GBS) is a peripheral nervous system disease caused by an immune-mediated inflammatory mechanism, usually triggered by a previous infectious process or vaccine; its typical presentation is a rapid and progressive bilateral limb hyposthenia, associated with sensory deficits and reduction or absence of osteotendinous reflexes. However, also autonomic nervous system can be involved with heart rate fluctuations, blood pressure instability, pupillary dysfunction, and urinary retention. Since the beginning of COVID-19 pandemic, GBS has been reported among neurological complications of SARS-CoV-2 infection, although etiopathological mechanisms still have to be clearly defined. We report the case of a 79-year-old man with multiple comorbidities, including diabetes, who was affected by SARS-CoV-2 interstitial pneumonia and developed dysautonomic symptoms after 10 days of hospitalization. A neurological evaluation was performed, and GBS was considered as a possible cause of the clinical manifestations. This hypothesis was confirmed by electrophysiological study and further supported, ex-juvantibus, by the satisfactory response to immunoglobulin treatment. In our opinion, this case of pure dysautonomic presentation of GBS in a SARS-CoV-2 positive patient is relevant because it suggests to consider GBS upon SARS-CoV-2 infection even if the symptoms have uncommon characteristics (e.g., pure vegetative manifestations) and if there are confounding factors which could lead to a misdiagnosis (e.g., old age, SARS-CoV-2 infection consequences and diabetes).