bluuebunny/crossref_metadata_2025 huggingface dataset:
Real-time motion tracking of cognitive Baxter robot based on differential inverse kinematics
Authors: Li Shaobo , Zhang Xingxing , Yang Jing , Bai Qiang , Hu Jianjun , Song Qisong , Li Zhiang
Published: June 2021

The tracking motion of the robot is realized based on a specific robot or relying on an expensive movement acquisition system. It has the problems of complex control procedures, lack of real-time performance, and difficulty in achieving secondary development. We propose a robot real-time tracking control method based on the control principle of differential inverse kinematics, which fuses the position and joint angle information of the robot’s actuators to realize the real-time estimation of the user’s movement during the tracking process. The motion coordinates of each joint of the robot are calculated and the coordinate conversion between man and machine is realized with the combination of the Kinect sensor and the robot operating system. We have demonstrated the robustness and accuracy of the tracking method through the real-time tracking experiment of the Baxter robot. Our research has a wide range of application value, such as automatic target recognition, demonstration teaching, and so on. It provides an important reference for the research in the field of cognitive robots.
Topic modeling for frame analysis: A study of media debates on climate change in India and USA
Authors: Ylä-Anttila Tuukka , Eranti Veikko , Kukkonen Anna
Published: June 2021

We argue that ‘topics’ of topic models can be used as a useful proxy for frames if (1) frames are operationalized as connections between concepts; (2) theme-specific data are used; and (3) topics are validated in terms of frame analysis. Demonstrating this, we analyse 12 climate change frames used by NGOs, governments and experts in Indian and US media, gathered by topic modeling. We contribute methodologically to topic modeling in the social sciences and frame analysis of public debates, and empirically to research on climate change media debates.
Haemolysis, elevated liver enzymes and low platelets: Diagnosis and management in critical care
Authors: Poimenidi Evangelia , Metodiev Yavor , Archer Natasha Nicole , Jackson Richard , Bangash Mansoor Nawaz , Howells Phillip Alexander
Published: June 2021

A thirty-year-old pregnant woman was admitted to hospital with headache and gastrointestinal discomfort. She developed peripheral oedema and had an emergency caesarean section following an episode of tonic-clonic seizures. Her delivery was further complicated by postpartum haemorrhage and she was admitted to the Intensive Care Unit (ICU) for further resuscitation and seizure control which required infusions of magnesium and multiple anticonvulsants. Despite haemodynamic optimisation she developed an acute kidney injury with evidence of liver damage, thrombocytopenia and haemolysis. Haemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome, a multisystem disease of advanced pregnancy which overlaps with pre-eclampsia, was diagnosed. HELLP syndrome is associated with a range of complications which may require critical care support, including placental abruption and foetal loss, acute kidney injury, microangiopathic haemolytic anaemia, acute liver failure and liver capsule rupture. Definitive treatment of HELLP is delivery of the fetus and in its most severe forms requires admission to the ICU for multiorgan support. Therapeutic strategies in ICU are mainly supportive and include blood pressure control, meticulous fluid balance and possibly escalation to renal replacement therapy, mechanical ventilation, neuroprotection, seizure control, and management of liver failure-related complications. Multidisciplinary input is essential for optimal treatment.
Medical and non-medical interventions for post-operative urinary retention prevention: network meta-analysis and risk–benefit analysis
Authors: Sirisreetreerux Pokket , Wattanayingcharoenchai Rujira , Rattanasiri Sasivimol , Pattanaprateep Oraluck , Numthavaj Pawin , Thakkinstian Ammarin
Published: June 2021

Aims:

To assess the efficacy in lowering post-operative urinary retention, urinary tract infection and lower urinary tract symptoms and the incidence of adverse events among 12 interventions and to perform risk–benefit analysis.

Methods:

Previous randomized controlled trials were identified from MEDLINE, Scopus and CENTRAL database up to January 2020. The interventions of interest included early ambulation, fluid adjustment, neuromodulation, acupuncture, cholinergic drugs, benzodiazepine, antispasmodic agents, opioid antagonist agents, alpha-adrenergic antagonists, non-steroidal anti-inflammatory drugs (NSAIDs) and combination of any interventions. The comparators were placebo or standard care or any of these interventions. Network meta-analysis was performed. The probability of being the best intervention was estimated and ranked using rankogram and surface under the cumulative ranking curve. Risk–benefit analysis was done. Incremental risk–benefit ratio (IRBR) was calculated and risk–benefit acceptability curve was constructed.

Results:

A total of 45 randomized controlled trials with 5387 patients was included in the study. Network meta-analysis showed that early ambulation, acupuncture, alpha-blockers and NSAIDs significantly reduced the post-operative urinary retention. Regarding urinary tract infection and lower urinary tract symptoms, no statistical significance was found among interventions. Regarding the side effects, only alpha-adrenergic antagonists significantly increased the adverse events compared with acupuncture and opioid antagonist agents from the indirect comparison. According to the cluster ranking plot, acupuncture and early ambulation were considered high efficacy with low adverse events, corresponding to the IRBR.

Conclusion:

Early ambulation, acupuncture, opioid antagonist agents, alpha-adrenergic antagonists and NSAIDs significantly reduce the incidence of post-operative urinary retention with no difference in adverse events. Regarding the risk–benefit analysis of the medical treatment, alpha-adrenergic antagonists have the highest probability of net benefit at the acceptable threshold of side effect of 15%, followed by opioid antagonist agents, NSAIDs and cholinergic drugs.
Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes?
Authors: Chalew Stuart , Delamater Alan M. , Washington Sonja , Bhat Jayalakshmi , Franz Diane , Gomez Ricardo , Felipe Dania , Tieh Peter , Finger Laurie
Published: June 2021

Achieving normal or near-normal glycemic control as reflected by HbA1c levels in patients with type 1 diabetes (T1D) is important for preventing the development and progression of chronic complications. Despite delineation and dissemination of HbA1c management targets and advances in insulin pharmacology, insulin delivery systems, and glucose monitoring, the majority of children with T1D do not achieve HbA1c goals. In particular, African Americans are more likely not to reach HbA1c goals and have persistently higher HbA1c than Non-Hispanic Whites. Availability of pumps and other technology has not eliminated the disparity in HbA1c. Multiple factors play a role in the persisting racial disparity in HbA1c outcome. The carefully designed application and deployment of new technology to help the patient/family and facilitate the supportive role of the diabetes management team may be able to overcome racial disparity in glycemic outcome and improve patient quality of life.
Diabetes Technology and Waste: A Complex Story
Authors: Heinemann Lutz , Klonoff David C.
Published: June 2021

Medical products are used increasingly by patients with diabetes as they make diabetes therapy more safe and efficient; subsequently such products are produced and used millions of times each day. This in turn means that the products themselves and the packaging adds up to a huge amount of waste, mainly plastic waste. Not only patients are well aware of this and start to complain about this, in view of the climate change the political pressure to change the situation is high and will increase further. A better balance between performance of the products and their environmental impact has to be found; however, diabetes technology and waste is a complex story with many different aspects.
What to Sell and How to Sell Matters: Focusing on Luxury Hotel Properties’ Business Performance and Efficiency
Authors: Kim Jaewook , Kim Sung In , Lee Minwoo
Published: June 2021

Due to service product characteristics and a mix of complex sales, it is crucial for hotel firms to efficiently design limited physical spaces that serve multiple purposes to optimize revenue and maximize profit. Since luxury hotel properties have different operation strategies than limited-service hotels, their operational efficiency should be a reference during strategic decision-making processes. Primary research purpose is to identify the most efficient operation model for luxury hotel properties. The study computed operation efficiency scores using the data envelopment analysis approach to rank the property efficiency of 37 fully equipped luxury hotels in the United States. Each property can utilize slack analysis to discover a strategic benchmarking company (best efficient frontier) and intuitive strategic recommendations and gain superior input and output productivity. Tobit model analysis provides supplemental understandings regarding the additional operational factors impacting luxury hotel properties’ efficiency score variations. Operating efficiency was found to be achieved by multiple operating inputs and influenced by relative price, fixed costs, and management systems. Theoretical comprehensiveness of luxury service mix has been empirically tested by highlighting efficiency as a key measure. In addition, RevPAR’s ratio on TRevPAR further highlights the importance for luxury hotels to increase non-room sales and revenues to accomplish efficiency.
Autologous Osteochondral Transplantation for Young Patients with Postcollapse Osteonecrosis of the Knee: A Retrospective Cohort Study with an Average 7-Year Follow-Up
Authors: Ma Jinhui , Ren Yansong , Wang Bailiang , Yue Debo , Sun Wei , Wang Weiguo
Published: June 2021

Background

Only a few studies exist that have assessed the efficacy of autologous osteochondral transplantation (AOT) treatment of osteonecrosis (ON) of the knee. The purpose of this study was to clarify the clinical and radiographic results of AOT performed on young patients with postcollapse ON of the knee.

Methods

This retrospective study included 14 young patients (6 men, 8 women, mean age 34.71 ± 5.41 years) with stage III knee ON undergoing AOT surgery. Mean follow-up time was 87 ± 10.23 months. The postoperative clinical and radiological evaluations were based on Hospital for Special Surgery (HSS) scores and plain x-rays. Paired t tests were used for the statistical analysis by SPSS software.

Results

Preoperative HSS (mean 66.86 ± 7.49 points) was significantly improved at mean 7 years to a postoperative HSS (mean 87.36 ± 8.63 points) ( P < 0.001). The postoperative rangeof motion (ROM; 125.71° ± 4.74°) was not significantly different from the preoperative ROM (126.86° ± 7.13°) ( P = 0.626). There was no progression of collapse observed in any knees at the last follow-up. No knees required any reoperations during the follow-up period.

Conclusion

Fourteen young patients with local ON of the knee were treated by AOT. No progression of bone collapse was seen and clinical improvement sustained at mean 7 years postsurgery. AOT seems to be a safe technique that can give long-term improvement and durability in young ON patients. However, large-sample and high-quality clinical trials are still needed in the future.
Evaluation of crypt apoptotic bodies and apoptotic indices in pediatric celiac disease by routine staining and H2AX immunostaining
Authors: Hakim Sarah Adel , Abd El-Kareem Dalia
Published: June 2021

Celiac disease (CD) is an immune-mediated disorder with premature apoptosis occurring along the entire crypt-villous axis. H2AX is the end product of the intrinsic apoptotic pathway. This is the first study to assess apoptotic body counts (ABC) by H&E and apoptotic indices (AI) by immunohistochemistry (IHC) in pediatric CD. The aim of the current study was to evaluate ABC in pediatric patients with CD prior to and following institution of a gluten free diet (GFD). Sixty-three pediatric endoscopic duodenal samples were assessed and divided into three groups. A total of 21 samples from treatment naïve CD patients, 21 from the same patients after instituting a GFD, and 21 from non-celiac patients as a control group. Histopathological evaluation of ABC by H&E, and immunohistochemistry assessment of apoptotic indices (AI) by H2AX antibody were performed. The mean maximum ABC and AI were significantly higher in treatment naïve CD than in GFD and control samples. These values were also significantly higher in treatment naïve Marsh 3C (flat) than in Marsh 1, 2, 3A, and 3B (non-flat) CD cases. GFD samples with persistent flat lesions had significantly higher ABC and AI than GFD non-flat cases. ROC analysis of the mean maximum ABC and AI of treatment naïve CD cases had a statistically significant predictive potential for persistent villous atrophy at a cut-off level ⩾6.61 ( P = 0.008) and ⩾105.4 ( P = 0.003), respectively. Histopathological evaluation of crypt apoptotic bodies could provide predictive potential for continued villous atrophy following GFD.
Coronavirus Related Mortality in the Geriatrics Ambulatory Practice
Authors: George Claudene J. , Guo Alice
Published: June 2021

Background

Older adults often have atypical presentations of common diseases and COVID-19 is no exception. Presentations range from asymptomatic to overwhelming symptoms that result in hospitalization, intubation, or death. The number of COVID-19 related deaths among older adults in the outpatient practice during the peak of the pandemic is unclear.

Methods

The objective is to describe the COVID-19 status and clinical characteristics of patients in a Geriatrics Ambulatory Practice who died during the peak of the COVID-19 pandemic. Design: Retrospective chart review Participants: 54 adults age 65 years and older. Methods: COVID-19 status defined by positive test result and presumed COVID-19 status based upon clinical presentation.

Results

Out of 1200 active patients in the Geriatrics Ambulatory Practice, 54 (4.5%) died between January 1st, 2020 and June 30th, 2020. The study sample was 63% female, 33% Hispanic/Latino, 27% Black/African American, and 22% white. The mean (SD) age was 86(8.6) years, range (72-107 years). The most prevalent medical comorbidities in decreasing order of frequency were hypertension (88.9%), diabetes (51.9%), and cognitive impairment (51.9%). Nineteen (35%) were COVID-19 positive and 8 had presumed COVID-19. There were no statistically significant differences in age, gender, race/ethnicity, and medical comorbidities between the COVID-19 or presumed COVID-19 group compared to those with No COVID-19.

Conclusion

Approximately 35% of Geriatric patients who died during the first 6 months of 2020 had confirmed COVID-19 and an additional 15% had presumed COVID-19. The actual number of COVID-19 related deaths among older adults in the ambulatory practice during the peak of the pandemic is difficult to estimate and likely underestimated.
Spatial heterogeneity and major correlates of Unmet Need of family planning among young married women aged 15-24 in India: An Exploratory Study
Authors: Sharma Himani , Singh S. K. , Srivastava Shobhit
Published: June 2021

For young women aged 15 to 24, unintended pregnancies remain very common, reflecting lower contraceptive use. Given the socio-cultural and traditional beliefs and practices, the unmet need for family planning is a crucial indicator for tracking the progress in contraceptive prevalence, ensuring young women’s reproductive and sexual rights. This article aims to analyze spatial heterogeneity in the unmet need for family planning among young women age 15 to 24 and their mesoscale correlates. Using data from the recent round of Indian DHS (2015–2016), commonly known as the National Family Health Survey (NFHS), this study identifies the significant correlates of unmet need of contraception among young married women in India. The statistical methods range from multinomial logistic regression, spatial autocorrelation in terms of Moran’s I statistics, to spatial auto regression, to understand the spatial dependence and clustering in the unmet need across India’s districts. The contraceptive prevalence rate among young married women age 15 to 24 in India was 24%, while almost the same proportion of them (23%) had an unmet need for contraception. Current age, education, religion, poverty, number of children, media exposure, awareness about family planning, and birth occurred in the last 3 years were significant predictors of unmet need. The univariate Moran’s I for unmet need was 0.50, suggesting strong spatial heterogeneity in India. The auto regression models become much more influential after including the spatial weights in the model, where illiteracy, unawareness, poverty, and rural residence were statistically significant predictors of unmet need of family planning among young married women in India. Findings of the study providing complex cultural ecologies of contraceptive use dynamics may give vital inputs in designing gender-sensitive interventions that can create a suitable support system and enabling environment for increasing use of contraception and reducing the unmet need of family planning.
Organizational Innovation in Knowledge Intensive Business Services: The role of Networks, Culture and Resources for Innovation
Authors: Sareen Amit , Pandey Sharadindu
Published: June 2021

Among the service sector firms, knowledge-intensive business services (KIBS) are highly innovative. Traditionally, innovation has looked from a product or process innovation point of view. However, companies may also innovate in terms of their administrative processes and organizational structures, and this is referred to as Organizational Innovation (OI). Organizations have network relationships with their Customers (NC), Suppliers (NS), Select Competitors (NCOM) and Investors (NI). These networks are important sources of knowledge, technology and resources. Furthermore, the Culture for Innovation (CI) and Resources for Innovation (RI) within a firm needs to be considered. The study evaluates the role of NC, NS, NCOM, NI, CI and RI on OI. A cross-sectional survey of middle- to senior-level executives in KIBS firms in India was carried out, and it was found that CI and NI have a positive effect on OI, while NC has a moderately positive effect on OI. A culture for innovation in KIBS firms stimulates innovation. Strategic investors are able to bring knowledge from the outside world and thus play an important role in OI. Similarly, client relationships may foster OI as administrative processes, and organizational structures need to be aligned to the needs of the clients.
Response to Fuson, Clements, and Sarama Commentary on Litkowski, Duncan, Logan, and Purpura (2020)
Authors: Purpura David J. , Litkowski Ellen C. , Duncan Robert J. , Logan Jessica A. R.
Published: June 2021

In response to Fuson et al.’s commentary on Litkowski et al. (2020), we clarify and expand on three areas: (1) the need for prekindergarten standards, (2) the value in developmental survey work, and (3) the importance of understanding curriculum translation and uptake. Specifically, we note that standards need to be appropriate for grade-level and it is time for more aligned prekindergarten standards. Developmental survey work is critical for ensuring that standards and expectations are accurate and adjusted to meet current needs and can be used address equity issues in instruction. Furthermore, we agree that intervention and curriculum work are needed, but there should be explicit emphasis on enhancing uptake and use of high-quality instruction. Ultimately, we need a system of assessment and instruction that is continually updated and improved, that integrates and modifies new evidence over time to ensure that we are striving for—and attaining—the best results for young children.
Pathways to Critical Literacy Leadership: An Examination of a Cohort Model of Professional Development
Authors: Rogers Rebecca , Elias Martille , Scheetz Melinda
Published: June 2021

As faculty at a land-grant university, we wanted to better understand the complexity of and pathways toward critical literacy leadership among educators. Specifically, we asked: What forms of critical literacy leadership become visible when educators participate in a cohort model of literacy professional development? Thirty educators enrolled across four different literacy cohorts at the university participated in this case study. Participants were diverse in their teaching experiences, racial identity, teaching placement, and literacy expertise. Participants shared similar geo-political-educational realities as they were all a part of the same large, urban district. Survey data, interviews, teaching and learning documents, and categorical data were analyzed in overlapping phases. Descriptive statistics were generated. Four themes related to critical literacy leadership surfaced from interviews using constant comparative methods: brokering equitable literacy practices, negotiating tensions, sharing/strengthening existing literacy practices, and imagining the futurity of literacy leadership. Educators offered complex portraits of critical literacy leadership in various spaces—often leading through learning. Participants’ voices highlighted the impact literacy leaders have on transformative, grassroots efforts toward change.
“VTT”-Domain Proteins VMP1 and TMEM41B Function in Lipid Homeostasis Globally and Locally as ER Scramblases
Authors: Reinisch Karin M. , Chen Xiao-Wei , Melia Thomas J.
Published: June 2021

Recent studies have identified the metazoan ER-resident proteins, TMEM41B and VMP1, and so structurally related VTT-domain proteins, as glycerolipid scramblases.
Lean approach to the management of patients undergoing intravitreal injections during COVID-19 pandemic
Authors: Verolino Marco , Grassi Piergiacomo , Sosto Gennaro , D’Onofrio Gaetano , De Simone Stefania , Costagliola Ciro
Published: June 2021

Background:

To introduce Lean approach principles in the management of patients undergoing intravitreal injections (IVIs) for wet age-related macular degeneration.

Methods:

Retrospective single-centre cohort study. Services location, IVIs scheduling, utilization of staff, data recording methods, ophthalmic examination and surgical procedures were analysed; a new Intravitreal Injection Centre (IVIC) was developed according to Lean principles. Mean number of daily IVIs performed, mean time between registration and discharge, mean turnover time in between patients, percentages of performed IVIs on the monthly scheduled IVIs and of patients rating their experience ⩾8/10 via standardized feedback questionnaires were retrospectively analysed.

Results:

The mean IVIs number per day increased from 20 ± 4.08 to 50 ± 7.07, and the mean time between registration and discharge of a patient decreased from 240 ± 14.14 to 60 ± 8.16 min ( p = 0.00057 and p < 0.00001, respectively). Mean turnover time in between patients decreased from 10 ± 1.41 to 8 ± 2 min ( p = 0.055). The percentage of monthly IVIs performed on the total of scheduled IVIs increased from 60% to 100%, and the percentage of satisfied patients who rated IVIC ⩾8/10 increased from 45% to 95% ( p = 0.0177 and p < 0.00105, respectively).

Conclusion:

The IVIC improved the quality, efficiency, speed of the overall procedures and clinical capacity of the IVI service through a fast one-way route for patients, limiting time wasted and total distance travelled. This model facilitates the creation of a one-stop clinic through the just-in-time management principle and may be relevant to other ophthalmology services.
Impact of a high emergency lung transplantation programme for cystic fibrosis in France: insight from a comparison with Canada
Authors: Coriati Adèle , Sykes Jenna , Lemonnier Lydie , Ma Xiayi , Stanojevic Sanja , Dehillotte Clémence , Carlier Nicolas , Stephenson Anne L. , Burgel Pierre-Régis
Published: June 2021

Background

France implemented a high emergency lung transplantation (HELT) programme nationally in 2007. A similar programme does not exist in Canada. The objectives of our study were to compare health outcomes within France as well as between Canada and France before and after the HELT programme in a population with cystic fibrosis (CF).

Methods

This population-based cohort study utilised data from the French and Canadian CF registries. A cumulative incidence curve assessed time to transplant with death without transplant as competing risks. The Kaplan–Meier method was used to estimate post-transplant survival.

Results

Between 2002 and 2016, there were 1075 (13.0%) people with CF in France and 555 (10.2%) people with CF in Canada who underwent lung transplantation. The proportion of lung transplants increased in France after the HELT programme was initiated (4.5%versus10.1%), whereas deaths pre-transplant decreased from 85.3% in the pre-HELT period to 57.1% in the post-HELT period. Between 2008 and 2016, people in France were significantly more likely to receive a transplant (hazard ratio (HR) 1.56, 95% CI 1.37–1.77; p<0.001) than die (HR 0.55, 95% CI 0.46–0.66; p<0.001) compared with Canada. Post-transplant survival was similar between the countries, and there was no difference in survival when comparing pre- and post-HELT periods in France.

Conclusions

Following the implementation of the HELT programme, people living with CF in France were more likely to receive a transplant than die. Post-transplant survival in the post-HELT period in France did not change compared with the pre-HELT period, despite potentially sicker patients being transplanted, and was comparable to Canada.
Patients’ perspectives on bronchiectasis: findings from a social media listening study
Authors: Delestre-Levai Irisz , Aliberti Stefano , Almagro Marta , Carnini Chiara , Chalmers James D. , George Sharath C. , Shukla Soumya , Timothy Alan , De Vuono Maria Carmela
Published: June 2021

Although it is of great importance for healthcare professionals to ensure that patients’ needs and concerns are valued and that they feel confident in the quality of the care they receive, there have been few studies specifically addressing the opinions, experiences and needs of patients with bronchiectasis, and more importantly the emotional impact of the disease, diagnosis and treatment.

 Using enterprise grade social listening tools, a comprehensive search around bronchiectasis was performed in five languages, on different social media platforms between January 2018 and December 2019 to obtain the perspectives of patients and caregivers from nine countries on symptoms, treatments and burden of the disease.

 Over 27 000 mentions of bronchiectasis were identified on social media channels, 38.8% of which were posted by patients and caregivers. Approximately 1600 posts were found on bronchiectasis symptoms, out of which persistent cough, shortness of breath and mucus production (22%, 20% and 18%, respectively) were the most commonly discussed. The research revealed that existing diagnostic tests often delay diagnosis or provide inaccurate results, leading to multiple rounds of consults and substantial delays in treatment initiation and management of the disease. Misdiagnosis was common across different age groups, especially among patients without severe symptoms, and this was associated with an emotional burden of anger, confusion, frustration and anxiety.

 Analysis of social media presents a new approach to derive insights on patients’ experiences and emotions with bronchiectasis and has the potential to complement more traditional approaches to drive more patient-focused drug development.
Diagnosis of COVID-19 by exhaled breath analysis using gas chromatography–mass spectrometry
Authors: Ibrahim Wadah , Cordell Rebecca L. , Wilde Michael J. , Richardson Matthew , Carr Liesl , Sundari Devi Dasi Ananga , Hargadon Beverley , Free Robert C. , Monks Paul S. , Brightling Christopher E. , Greening Neil J. , Siddiqui Salman
Published: June 2021

Background

The ongoing coronavirus disease 2019 (COVID-19) pandemic has claimed over two and a half million lives worldwide so far. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is perceived to be seasonally recurrent, and a rapid noninvasive biomarker to accurately diagnose patients early on in their disease course will be necessary to meet the operational demands for COVID-19 control in the coming years.

Objective

The aim of this study was to evaluate the role of exhaled breath volatile biomarkers in identifying patients with suspected or confirmed COVID-19 infection, based on their underlying PCR status and clinical probability.

Methods

A prospective, real-world, observational study was carried out, recruiting adult patients with suspected or confirmed COVID-19 infection. Breath samples were collected using a standard breath collection bag, modified with appropriate filters to comply with local infection control recommendations, and samples were analysed using gas chromatography–mass spectrometry (TD-GC-MS).

Results

81 patients were recruited between April 29 and July 10, 2020, of whom 52 out of 81 (64%) tested positive for COVID-19 by reverse transcription–polymerase chain reaction (RT-PCR). A regression analysis identified a set of seven exhaled breath features (benzaldehyde, 1-propanol, 3,6-methylundecane, camphene, beta-cubebene, iodobenzene and an unidentified compound) that separated PCR-positive patients with an area under the curve (AUC): 0.836, sensitivity: 68%, specificity: 85%.

Conclusions

GC-MS-detected exhaled breath biomarkers were able to identify PCR-positive COVID-19 patients. External replication of these compounds is warranted to validate these results.
Patterns of risk exposure in first 1,000 days of life and health, behavior, and education-related problems at age 4.5: evidence from Growing Up in New Zealand, a longitudinal cohort study
Authors: Wallander Jan L. , Berry Sarah , Carr Polly Atatoa , Peterson Elizabeth R. , Waldie Karen E. , Marks Emma , D’Souza Stephanie , Morton Susan M. B.
Published: June 2021

Background

Children who are high priority candidates for early intervention need to be identified to reduce their risk for experiencing problems in development. Those exposed to multiple risk factors are more likely to exhibit problems in development than those exposed to a single or no risk factor. We examined the longitudinal associations between persistence and timing of exposure to cumulative risk (CR) on three occasions by age 2 and problems in development at age 4.5 in health, behavior, and education-related domains.

Methods

Data are fromGrowing Up in New Zealand(NZ), a prospective longitudinal study of a birth cohort first assessed during their last trimester in 2009–10 and followed at ages 9 months and 2 and 4.5 years. All women with an expected delivery date in a 12-month period who resided within a defined region were invited to participate, with no additional eligibility criteria. Exposure was measured for 12 sociodemographic and maternal health risk factors at third trimester and ages 9 months and 2 years, from which developmental trajectories were constructed capturing persistence and timing of CR exposure. Ten developmental outcomes were measured at age 4.5 to classify problems in overall health status, obesity, and injuries; internalizing and externalizing behavior problems; and letter naming, counting forward and backward, and expectations for starting school and completing education.

Results

Analyses of data from 6156 children (49% female, 33% Non-European ethnicity) who participated in the 4.5-age assessment uniformly showed associations between exposure to more than consistently zero CR across early development and higher prevalence of being classified with problems for 9 of 10 outcomes. Persistent exposure to a CR ≥ 4 was generally associated with a higher prevalence of problems for 7 of 10 outcomes, whereas the timing of first exposure to CR ≥ 4 showed a less consistent association with problem outcomes.

Conclusions

These findings are concerning because over 50% of NZ children are exposed to at least one of these risk factors at some point in early development. Routine screening of most of these risk factors during pregnancy is feasible and can identify priority candidates for intervention.
The protection motivation theory for predict intention of COVID-19 vaccination in Iran: a structural equation modeling approach
Authors: Ansari-Moghaddam Alireza , Seraji Maryam , Sharafi Zahra , Mohammadi Mahdi , Okati-Aliabad Hassan
Published: June 2021

Background

Many efforts are being made around the world to discover the vaccine against COVID-19. After discovering the vaccine, its acceptance by individuals is a fundamental issue for disease control. This study aimed to examine COVID-19 vaccination intention determinants based on the protection motivation theory (PMT).

Methods

We conducted a cross-sectional study in the Iranian adult population and surveyed 256 study participants from the first to the 30th of June 2020 with a web-based self-administered questionnaire. We used Structural Equation Modeling (SEM) to investigate the interrelationship between COVID-19 vaccination intention and perceived susceptibility, perceived severity, perceived self-efficacy, and perceived response efficacy.

Results

SEM showed that perceived severity to COVID-19 (β = .17,p < .001), perceived self-efficacy about receiving the COVID-19 vaccine (β = .26,p < .001), and the perceived response efficacy of the COVID-19 vaccine (β = .70,p < .001) were significant predictors of vaccination intention. PMT accounted for 61.5% of the variance in intention to COVID-19 vaccination, and perceived response efficacy was the strongest predictor of COVID-19 vaccination intention.

Conclusions

This study found the PMT constructs are useful in predicting COVID-19 vaccination intention. Programs designed to increase the vaccination rate after discovering the COVID-19 vaccine can include interventions on the severity of the COVID-19, the self-efficacy of individuals receiving the vaccine, and the effectiveness of the vaccine in preventing infection.
Factors associated with birthweight and adverse pregnancy outcomes among children in rural Guinea-Bissau - a prospective observational study
Authors: Stjernholm Alexander Dahl , Thysen Sanne Marie , Borges Igualdino Da Silva , Fisker Ane Bærent
Published: June 2021

Background

Low birthweight (LBW) is associated with higher mortality and morbidity, but there is limited data on the prevalence of LBW in rural Africa, where many births occur at home. The Bacillus Calmette-Guérin (BCG) vaccine has non-specific effects. Studies suggest that maternal BCG-vaccination may affect the health of the child.

Methods

The present study is nested within a randomised trial in rural Guinea-Bissau: Pregnancies were registered at two-monthly village visits, where information on BCG scar status and other background factors were obtained. Children were enrolled in the trial and weighed at home within 72 h after birth. In this prospective observational study, we assessed factors associated with adverse pregnancy outcomes and birthweight in binomial and linear regression models.

Results

Among 1320 women who had their BCG scar status assessed, 848 (64%) had a scar, 472 (36%) had no scar. The risk of adverse pregnancy outcomes (miscarriages, stillbirths, early neonatal deaths) tended to be higher among BCG scar-negative women (13%) than among women with a BCG scar (10%), adjusted prevalence ratio = 1.29 (0.99–1.68). Birthweight was assessed for 628 (50%) of the 1232 live born children. The mean birthweight was 2.89 kg (SD 0.43) and the proportion of LBW children was 17% (104/628). Sex, twinning, region of birth, maternal age, maternal mid-upper arm circumference (MUAC), antenatal consultations, parity and possession of a mobile phone were associated with birthweight, while maternal BCG scar status was not.

Conclusions

This study provides the first birthweight data for home-born children in rural Guinea-Bissau, with a mean birthweight of 2.89 kg (SD 0.43) and a LBW prevalence of 17%. We found a tendency for higher risk of adverse pregnancy outcomes among BCG scar-negative women. Birthweight was similar in children of mothers with and without BCG scar.
Moral distress and ethical climate in intensive care medicine during COVID-19: a nationwide study
Authors: Donkers Moniek A. , Gilissen Vincent J. H. S. , Candel Math J. J. M. , van Dijk Nathalie M. , Kling Hans , Heijnen-Panis Ruth , Pragt Elien , van der Horst Iwan , Pronk Sebastiaan A. , van Mook Walther N. K. A.
Published: June 2021

Background

The COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.

Methods

An extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19.

Results

Three hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect,  ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior.

Conclusion

Levels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care.
Do remote dialysis services really cost more? An economic analysis of hospital and dialysis modality costs associated with dialysis services in urban, rural and remote settings
Authors: Gorham Gillian , Howard Kirsten , Cunningham Joan , Barzi Federica , Lawton Paul , Cass Alan
Published: June 2021

Background

Rates of end-stage kidney disease in Australia are highest in the Northern Territory (NT), with the burden of disease heaviest in remote areas. However, the high cost of delivering dialysis services in remote areas has resulted in centralisation, requiring many people to relocate for treatment. Patients argue that treatment closer to home improves health outcomes and reduces downstream healthcare use. Existing dialysis cost studies have not compared total health care costs associated with treatment in different locations.

Objective

To estimate and compare, from a payer perspective, the observed health service costs (all cause hospital admissions, emergency department presentations and maintenance dialysis) associated with different dialysis models in urban, rural and remote locations.

Methods

Using cost weights attributed to diagnostic codes in the NT Department of Health’s hospital admission data set (2008–2014), we calculated the mean (SD) total annual health service costs by dialysis model for 995 dialysis patients. Generalized linear modeling with bootstrapping tested the marginal cost differences between different explanatory variables to estimate ‘best casemix’/‘worst casemix’ cost scenarios.

Results

The mean annual patient hospital expenditure was highest for urban models at $97 928 (SD $21 261) and $43 440 (SD $5 048) and lowest for remote at $19 584 (SD $4 394). When combined with the observed maintenance dialysis costs, expenditure was the highest for urban models at $148 510 (SD $19 774). The incremental cost increase of dialysing in an urban area, compared with a rural area, for a relocated person from a remote area, was $5 648 more and increased further for those from remote and very remote areas to $10 785 and $15 118 respectively.

Conclusions

This study demonstrates that dialysis treatment in urban areas for relocated people has health and cost implications that maybe greater than the cost of remote service delivery. The study emphasises the importance of considering all health service costs and cost consequences of service delivery models.

Key points for decision makers

Relocation for dialysis treatment has serious health and economic consequences. Relocated people have low dialysis attendance and high hospital costs in urban areas. While remote dialysis service models are more expensive than urban models, the comparative cost differences are significantly reduced when all health service costs are included. The delivery of equitable and accessible dialysis service models requires a holistic approach that incorporates the needs of the patient; hence dialysis cost studies must consider the full range of cost impacts beyond the dialysis treatments alone.
The biomechanical effect on the adjacent L4/L5 segment of S1 superior facet arthroplasty: a finite element analysis for the male spine
Authors: Shi Zewen , Shi Lin , Chen Xianjun , Liu Jiangtao , Wu Haihao , Wang Chenghao , Chen Zeming , Yang Fang , Yu Sheng , Pang Qingjiang
Published: June 2021

Background

The superior facet arthroplasty is important for intervertebral foramen microscopy. To our knowledge, there is no study about the postoperative biomechanics of adjacent L4/L5 segments after different methods of S1 superior facet arthroplasty. To evaluate the effect of S1 superior facet arthroplasty on lumbar range of motion and disc stress of adjacent segment (L4/L5) under the intervertebral foraminoplasty.

Methods

Eight finite element models (FEMs) of lumbosacral vertebrae (L4/S) had been established and validated. The S1 superior facet arthroplasty was simulated with different methods. Then, the models were imported into Nastran software after optimization; 500 N preload was imposed on the L4 superior endplate, and 10 N⋅m was given to simulate flexion, extension, lateral flexion and rotation. The range of motion (ROM) and intervertebral disc stress of the L4-L5 spine were recorded.

Results

The ROM and disc stress of L4/L5 increased with the increasing of the proportions of S1 superior facet arthroplasty. Compared with the normal model, the ROM of L4/L5 significantly increased in most directions of motion when S1 superior facet formed greater than 3/5 from the ventral to the dorsal or 2/5 from the apex to the base. The disc stress of L4/L5 significantly increased in most directions of motion when S1 superior facet formed greater than 3/5 from the ventral to the dorsal or 1/5 from the apex to the base.

Conclusion

In this study, the ROM and disc stress of L4/L5 were affected by the unilateral S1 superior facet arthroplasty. It is suggested that the forming range from the ventral to the dorsal should be less than 3/5 of the S1 upper facet joint. It is not recommended to form from apex to base.

Level of evidence

Level IV
Weight and mid-upper arm circumference gain velocities during treatment of young children with severe acute malnutrition, a prospective study in Uganda
Authors: Kamugisha Jolly G. K. , Lanyero Betty , Nabukeera-Barungi Nicolette , Nambuya-Lakor Harriet , Ritz Christian , Mølgaard Christian , Michaelsen Kim F. , Briend André , Mupere Ezekiel , Friis Henrik , Grenov Benedikte
Published: June 2021

Background

Weight gain is routinely monitored to assess hydration and growth during treatment of children with complicated severe acute malnutrition (SAM). However, changes in weight and mid-upper arm circumference (MUAC) gain velocities over time are scarcely described. We assessed weight and MUAC gain velocities in 6–59 mo-old children with complicated SAM by treatment phase and edema status.

Methods

This was a prospective study, nested in a randomized/probiotic trial (ISRCTN16454889). Weight and MUAC gain velocities were assessed by treatment phase and edema at admission using linear mixed-effects models.

Results

Among 400 children enrolled, the median (IQR) age was 15.0 (11.2;19.2) months, 58% were males, and 65% presented with edema. During inpatient therapeutic care (ITC), children with edema vs no edema at admission had negative weight gain velocity in the stabilization phase [differences at day 3 and 4 were − 11.26 (95% CI: − 20.73; − 1.79) g/kg/d and − 13.09 (95% CI: − 23.15; − 3.02) g/kg/d, respectively]. This gradually changed into positive weight gain velocity in transition and eventually peaked at 12 g/kg/d early in the rehabilitation phase, with no difference by edema status (P > 0.9). During outpatient therapeutic care (OTC), overall, weight gain velocity showed a decreasing trend over time (from 5 to 2 g/kg/d), [difference between edema and non-edema groups at week 2 was 2.1 (95% CI: 1.0;3.2) g/kg/d]. MUAC gain velocity results mirrored those of weight gain velocity [differences were − 2.30 (95% CI: − 3.6; − 0.97) mm/week at week 1 in ITC and 0.65 (95% CI: − 0.07;1.37) mm/week at week 2 in OTC].

Conclusions

Weight and MUAC gain velocities among Ugandan children with complicated SAM showed an increasing trend during transition and early in the rehabilitation phase, and a decreasing trend thereafter, but, overall, catch-up growth was prolonged. Further research to establish specific cut-offs to assess weight and MUAC gain velocities during different periods of rehabilitation is needed.
Lymphangioma of popliteal fossa masquerading as Baker’s cyst
Authors: Padmanaban Elamparidhi , Suryawanshi Sanika , Amirthalingam Umamageswari , Keloth Thara , George Rintu
Published: June 2021

Background

Lymphatic malformations are the second most common vascular malformations after venous malformations. These slow-flow lesions occur most often in the paediatric population and seldom in the extremities. We report a case of lymphangioma at the popliteal fossa in an adult who underwent complete surgical resection.

Case presentation

A 30-year-old male presented to the department of orthopaedics with a swelling in the right calf region. Clinically, it was suspected to be a Baker’s cyst. Ultrasound showed a multiloculated anechoic cystic lesion in the inferior aspect of popliteal fossa along the intermuscular plane with multiple internal septations. Infected Baker’s cyst was considered, and MRI was suggested for further evaluation. On MRI, the lesion measured 7.2 × 4.6 × 5.8 cm, appeared as a low signal on T1 and high signal on STIR and T2, with multiple internal septations and was situated in the inferior aspect of the right popliteal fossa along the intermuscular plane between the lateral head of gastrocnemius and soleus muscles. No obvious synovial extension. A post-contrast study showed minimal peripheral and septal enhancement. Neither internal enhancing solid components nor significant internal derangement of the knee was observed. Diagnosis of lymphangioma was considered based on the imaging features and ruling out the common differentials for cystic lesions around the knee. Wide local excision was performed. Histopathological evaluation showed multiple irregularly dilated lymphatic channels lined by flatted epithelium. The lymphatic channels were seen to be surrounded by thick fibro collagenous cyst wall with scattered congested blood vessels, skeletal muscle fibre and chronic inflammatory cells.

Conclusion

Lymphangioma must be included in the differential diagnosis of any cystic lesion if the lesion appears multiseptated and/or infiltrative. At the popliteal fossa, it presents as a multiseptated cyst with no synovial continuity or internal derangement of the knee.