bluuebunny/crossref_metadata_2025 huggingface dataset:
Agent-based target evaluation and fire doctrine: an aspect-oriented programming view
Authors: Hocaoğlu Mehmet Fatih
Published: August 2021

Threat evaluation is a vital process for any defense system, and it consists of a series of calculation and evaluation based on the inferred capabilities and intents of the targets that aim to give damage to defended assets. Target evaluation is proceeded in a wargame and the aim is to compare weapon target pairs according to a set of criteria. The target evaluation cycle is repeated anytime a new detection is received and when any change happens in the target currently detected. The whole process consists of a set of tasks that are shared between Command and Control units and the tasks require different responsibilities. Each task is succeeded by a specific behavior that is represented as a reasonably ordered set of actions. The task sharing is organized by taking the C2 architectures into account. In this paper, an agent-based command and control entity, which is in charge of target evaluation and giving engagement decision, is designed and it is situated in an air defense simulation environment. The study aims to propose an agent design in military decision-making domain, bringing analytic methods with the first-order logic together, and combine aspect orientation with agent design. The study also improves dynamic aspect management in agent programming using the relation concept.
MRI as a first-line imaging modality in acute ischemic stroke: a sustainable concept
Authors: Althaus Katharina , Dreyhaupt Jens , Hyrenbach Sonja , Pinkhardt Elmar H. , Kassubek Jan , Ludolph Albert C.
Published: August 2021

Background:

Computed tomography (CT) scans are the first-line imaging technique in acute stroke patients based on the argument of rapid feasibility. Using magnetic resonance imaging (MRI) as the first-line imaging technique is the exception to the rule, although it provides much more diagnostic information and avoids exposure to radiation. We evaluated whether an MRI-based acute stroke concept is fast, suitable, and useful to improve recanalization rates and patient outcomes.

Methods:

We performed a retrospective observational cohort study comparing patients treated at a comprehensive stroke center (Ulm/Germany) applying an MRI-based acute stroke concept with patients recorded in a large comprehensive stroke registry in Baden-Württemberg (Germany). We analyzed the quality indicators of acute stroke treatment, patient’s outcome, and the rate of transient ischemic attack (TIA) at discharge.

Results:

A total of 2182 patients from Ulm and 82,760 patients from the Baden-Württemberg (BW) stroke registry (including 29,575 patients of comprehensive stroke centers (BWc)) were included. Intravenous thrombolysis rate was higher in Ulm than in BW or the BWc stroke centers (Ulm 27.4% versus BW 20.9% versus BWc 26.1; p < 0.01), while a door-to-needle time <30 min could be achieved more frequently (Ulm 73.6% versus BW 44.1% versus BWc 47.1%; p < 0.01). Thrombectomy rate in patients with a proximal vascular occlusion was higher (Ulm 69.2% versus BW 50.7% versus BWc 59.3; p < 0.01). The number of TIA diagnoses was lower (Ulm 16.2% versus BW 24.6% versus BWc 19.9%; p < 0.01). More patients showed a shift to a favorable outcome (Ulm 21.1% versus BW 16.9% versus BWc 15.3; p < 0.01). Complication rates were similar.

Conclusions:

The MRI-based acute stroke concept is suitable, fast and seems to be beneficial. The time-dependent quality indicators were better both in comparison to all stroke units and to the comprehensive stroke units in the area. Based on the MRI concept, high rates of recanalization procedures and fewer TIA diagnoses could be observed. In addition, there was a clear trend towards an improved clinical outcome. A clinical trial comparing the effects of CT and MRI as the primary imaging technique in otherwise identical stroke unit settings is warranted.
Membership has its Privileges: Local TV Effort to Control Data and Destiny
Authors: Wenger Deb
Published: August 2021

Graham Media has developed the Membership for Broadcast Project, which received grant funding last year as part of the Google News Initiative Innovation Challenge. The goal within Graham’s stations is to identify and engage with as many viewers as possible on a scale seldom seen in local TV news. The process involves a new way of thinking about data, who should own it and who should control it. Electronic News explores the initiative to offer a roadmap for other stations that may want to try something similar.
Dilated MMA sign in cDAVF and other arterial feeders on 3D TOF MRA
Authors: Foo Sin Y , Swaminathan Saravana K , Krings Timo
Published: August 2021

Background

Among the varied causes of pulsatile tinnitus, the condition that can cause severe mortality and morbidity is a cranial dural arteriovenous fistula (cDAVF). This study aimed to assess the diagnostic accuracy of the dilated middle meningeal artery on three-dimensional time-of-flight magnetic resonance angiography in cranial dural arteriovenous fistula and to identify other feeders that can aid in the detection of these lesions.

Method

Magnetic resonance angiography and digital subtraction angiography data of all patients with cranial dural arteriovenous fistula treated in a single tertiary referral center between 2007–2020 were included. The middle meningeal artery and other feeders recorded from digital subtraction angiography were assessed on magnetic resonance angiography.

Results

The overall agreement between readers in identifying the dilated middle meningeal artery was substantial (κ = 0.878, 95% confidence interval: 0.775–0.982). The dilated middle meningeal artery indicated the presence of a cranial dural arteriovenous fistula with a sensitivity of 79.49% (95% confidence interval: 66.81–92.16), specificity of 100% (95% confidence interval: 100.00–100.00), and negative predictive value of 94.56% (95% confidence interval: 90.89–98.02). An area under the curve of 0.8341 was observed for the ipsilateral middle meningeal artery, with a sensitivity of 92.2% and a specificity of 75.0% at a cut-off of 0.30 mm for identifying a cranial dural arteriovenous fistula. Of 73 other feeders, the occipital, meningohypophyseal trunk, ascending pharyngeal, and posterior meningeal arteries contributed to a large proportion visualized on magnetic resonance angiography (83.6% (41/49)).

Conclusion

The dilated middle meningeal artery sign is useful for identifying a cranial dural arteriovenous fistula. Dilatation of the occipital and ascending pharyngeal arteries and meningohypophyseal trunk should be assessed to facilitate the detection of a cranial dural arteriovenous fistula, particularly in the transverse-sigmoid and petrous regions.
Meta-analysis of the association between sclerostin level and adverse clinical outcomes in patients undergoing maintenance haemodialysis
Authors: Li Sha-Sha , Zhang Zhi-Qin , He Da-Wei , He Ao-Lin , Liu Qi-Feng
Published: August 2021

Background:

Studies regarding the relationship of sclerostin (Scl) with clinical outcomes in patients undergoing maintenance haemodialysis have yielded controversial findings. This meta-analysis was performed to investigate the predictive role of Scl in this patient population.

Methods:

Several electronic medical databases (e.g. PubMed, Embase, Web of Science and Cochrane Library) were searched for eligible studies through December 20, 2019. Summary hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated based on Scr level (high or low) using a random or fixed effects model.

Results:

From among 641 initially screened publications, 16 eligible studies were included in this meta-analysis. A high Scl level was not associated with cardiovascular events [HR = 0.8 (95% CI, 0.42–1.35)] or all-cause mortality [HR = 0.93 (95% CI, 0.56–1.54)]. There was high heterogeneity, but no evidence of publication bias. Interestingly, a high Scl level was associated with reduced cardiovascular events [HR = 0.44 (95% CI, 0.29–0.69)] in the subgroup by shorter follow-up period or all-cause mortality [pooled HR = 0.58 (95% CI, 0.36–0.91)] by shorter dialysis vintage.

Conclusion:

This meta-analysis indicated that a high Scl level did not predict total clinical outcomes in patients undergoing maintenance haemodialysis despite survival benefits in the subgroups. The predictive role of Scl in these patients should be further evaluated in large prospective studies.
Impact of preemptive hospitalization on health outcomes at the temporary COVID-19 hospital in Mexico City: a prospective observational study
Authors: Vazquez Rafael Ricardo Valdez , Gallardo-Rincón Héctor , Lomelín-Gascon Julieta , Ville Benavides Rodrigo , Juárez Linda Morales , Bello Héctor Herrera , Castañeda Lidia Moreno , Chavarria Adrian Palacios , Castillo Pablo Escalera , Gonzalez Luis Esteban Ramirez , Avendaño Mónica Arboleya , Berlanga Santiago Treviño , Loza Reyna Albertina Rosas , Wyssmann Renate Victoria Álvarez , Lezama Erika Salinas , Romero Alonso Gutiérrez , Ortega María Dolores Niembro , Acosta Liudmila Villegas , Schotman Ailyn Cendejas , Montoya Jennifer Bertin , Rodriguez Andrea Gonzalez , Ramos Laura María Badel , Martinez-Juarez Luis Alberto , Saucedo-Martínez Rodrigo , Montoya Alejandra , Tapia-Conyer Roberto
Published: August 2021

Introduction:

In response to the evolution of the coronavirus disease 2019 (COVID-19) pandemic, the admission protocol for the temporary COVID-19 hospital in Mexico City has been updated to hospitalize patients preemptively with an oxygen saturation (SpO2) of >90%.

Methods:

This prospective, observational, single-center study compared the progression and outcomes of patients who were preemptively hospitalized versus those who were hospitalized based on an SpO2 ⩽90%. We recorded patient demographics, clinical characteristics, COVID-19 symptoms, and oxygen requirement at admission. We calculated the risk of disease progression and the benefit of preemptive hospitalization, stratified by CALL Score: age, lymphocyte count, and lactate dehydrogenase (<8 and ⩾8) at admission.

Results:

Preemptive hospitalization significantly reduced the requirement for oxygen therapy (odds ratio 0.45, 95% confidence interval 0.31–0.66), admission to the intensive care unit (ICU) (0.37, 0.23–0.60), requirement for invasive mechanical ventilation (IMV) (0.40, 0.25–0.64), and mortality (0.22, 0.10–0.50). Stratification by CALL score at admission showed that the benefit of preemptive hospitalization remained significant for patients requiring oxygen therapy (0.51, 0.31–0.83), admission to the ICU (0.48, 0.27–0.86), and IMV (0.51, 0.28–0.92). Mortality risk remained significantly reduced (0.19, 0.07–0.48).

Conclusion:

Preemptive hospitalization reduced the rate of disease progression and may be beneficial for improving COVID-19 patient outcomes.
Religion as a Dominant Logic for Entrepreneurial Activities: Theorizing the Dynamics in and Around ‘We’d Meat Burger, Kazakhstan’
Authors: Amanbayev Yeskender , Aljanova Nurlykhan , Mirzaliyeva Sanam , Ghosh Anjan
Published: August 2021

As religion gains prominence in several countries, research to understand the dynamics between religion and business becomes critical. Extant research paid scant attention to the influence of religion on entrepreneurial activities. To develop insights into this phenomenon, we conduct reflexive field-based case study research on a family business in Kazakhstan that experienced the inclusion of religion as a dominant logic in the management. Kazakhstan provides an interesting context to study the phenomenon as religion gained prominence in post-Soviet Kazakhstan after the collapse of the Soviet Union in 1991. Our study reveals how religion can influence the entrepreneurial mind and activities and transform the family business. Our inductive theorization offers a process model of entrepreneurial journey under the influence of religion and its impact on the organizing of family business. The model consists of influenced disruption, creative combination and pragmatic adaptation through which the entrepreneur with religion as a dominant logic can transform the family business and attain organizational stability. For academia, the study contributes to extend the scholarly understanding of religion as an influencer in entrepreneurship and family business. For practice, our work shows how religious principles as constraints can enact creativity and innovation in organizational transformation.
Enabling Knowledge Management Initiatives through Organizational Communities of Practice
Authors: Aljuwaiber Abobakr
Published: August 2021

Learning the concept of organizational communities of practice (OCoP) is very effective but too complicated when it comes to implementation. Challenges arise when cultivating OCoPs and creating effective communication processes, particularly within an organization that has a traditional hierarchy. Literature on knowledge management (KM) fails to provide an inclusive comprehension of the significance of OCoPs. Thus, the current exploratory research aims to determine how organizational contexts can enable or disable the establishment and development of OCoPs. This article is built on communities of practice (CoP) theory to study the phenomenon of intentionally established OCoPs within large organizations. The case studies conducted for this research involved two companies based in Saudi Arabia, with intentionally created OCoPs. The selected cases assist in providing a holistic understanding of the influential role of organizational context in enabling OCoP activities, using semi-structured interviews, document reviews and field notes. The study findings support an integrated framework to assist organizations in establishing effective OCoPs. Its five phases include establishment, enforcement, recognition, maintenance and sustainability, representing OCoP development phases. The resulting framework organized 16 enabling or disabling factors in OCoP development. This article expands the focus of research beyond traditional CoPs, to investigate the intentional establishment of OCoPs within organizations and understand opportunities and challenges that enable OCoPs. The study argues that organizations implementing OCoPs should offer a comprehensive, long-term strategy for KM initiatives that leads to designing OCoP activities that enable better alignment with the organization’s business plan. A company can shape perceptions and behaviours by establishing the organizational context for social interaction. Thus, this article extends the perspective on developing OCoPs within organizations and argues that the role of middle management requires more thoughtfulness about OCoP research.
Household’s Saving Behaviour in Pakistan: A Micro-Data Analysis
Authors: Akram Naeem
Published: August 2021

Savings play a very crucial role in the economic development of a country by financing investment needs. Household savings are the major and dominant component of national savings in Pakistan. The present study aims to analyse the impact of various socio-economic factors in determining the household savings in Pakistan by using the data of Household Integrated Income and Consumption Survey (HIICS) 2015–2016. It has been found that household’s savings tend to increase with income, living in nucleus family, house ownership, receiving remittances from abroad and being involved in agriculture; and saving tends to decrease with an increase in dependency ratio; and wealth has an insignificant role in determining savings in both urban and rural households. However, education and female labour force participation had a positive relationship with saving among urban households but the relationship is insignificant in rural households. Similarly, age of household head hurts saving in urban households and the relationship is insignificant in rural households.

JEL Classifications: E21, D91, C31
Injuries and Use of Safety Equipment in Stand-up Paddle Boarding
Authors: Balke Maurice , Fischer Marco , Kegler Thorsten , Höher Jürgen , Balke Maryam
Published: August 2021

Background:

Stand-up paddleboarding (SUP) is a water sport that has gained in popularity. Still, very little is known about its injury profile.

Purpose:

To analyze the incidence, mechanisms, and risk factors for SUP-related injuries in mainly calm waters and the use of safety equipment.

Study Design:

Descriptive epidemiology study.

Methods:

The authors distributed an online survey that gathered information on characteristics, injury history over the past 12 months, use of (safety) equipment, and health issues of SUP riders in German-speaking countries.

Results:

A total of 438 participants completed the survey. The mean participant age was 45 years (range, 8-82 years), 48% were female athletes, and 19.6% took part in competitions. Over the past 12 months, 72 (17%) of 431 respondents experienced a SUP-related injury, resulting in an overall incidence rate (IR) of 1.95 injuries per 1000 hours of activity. Male competitive athletes using a hardboard had the highest risk of injury. The IR for competitive riders was higher (3.21 injuries per 1000 hours) than that for recreational riders (1.41 injuries per 1000 hours). Mechanisms of injury were overuse (n = 29) and contact with the board (n = 18) or ground (n = 12). Injuries affected mainly muscles/tendons and joints of the upper arm/shoulder (n = 20), followed by wrist/hand (n = 18), knee (n = 16), elbow/forearm (n = 12), and foot (n = 11). The highest risk of injury occurred when paddling in wild water (33.3%), followed by SUP surfing (29.4%), and the lowest risk occurred while paddling on a lake (16.1%). A life vest was always used by 27, depending on the situation by 201, and never by 202 participants; a leash was always used by 161, depending on the situation by 244, and never by 26 participants. Of the 272 participants who paddled in winter, 253 wore a drysuit or wetsuit, whereas 19 paddled without any special clothing.

Conclusion:

SUP-related injuries predominantly happened in wild water or while SUP surfing, and male competitive athletes using a hardboard had the highest risk of injury. The main mechanisms of injury were overuse and hitting the board or ground. The upper extremity was more prone to injury, followed by the knee and foot. More effort should be made to educate paddlers on the necessity and correct use of the life vest, leash, and specialized outfits.
Immigration Arrests and Educational Impacts: Linking ICE Arrests to Declines in Achievement, Attendance, and School Climate and Safety in California
Authors: Kirksey J. Jacob , Sattin-Bajaj Carolyn
Published: August 2021

With increased tensions and political rhetoric surrounding immigration enforcement in the United States, schools are facing greater challenges in ensuring support for their students of immigrant and Latinx origin. This study examined the associations between county-level immigration arrests and academic achievement, absenteeism, and measures of school climate and safety for students in the California CORE districts. Using ordinary least squares regression analyses with year, grade, school, and student fixed effects, we found that immigration arrests corresponded to declines in academic achievement, attendance, and various measures of school climate and safety for Latinx students and Latinx students who were English learners. We also find small declines in measures of school climate and safety for students who ever received special education services via an Individualized Education Program. Associations were strongest for arrests that occurred during the Trump administration compared with those that occurred during the second term of the Obama administration. Policy implications are discussed.
A Rare Case of Orbital Cellulitis with Progressive Calvarial Osteomyelitis
Authors: Kotwal Tejas , Goh Samantha , Bhargava Eishaan , Touska Philip , Possamai Victoria
Published: August 2021

Orbital cellulitis is a potentially sight and life-threatening complication of acute sinusitis, and the association with osteomyelitis is rare in the era of antibiotic-use. A 13-year-old girl presented with coryzal symptoms and severe headache, with a CT head being consistent with a diagnosis of pansinusitis and orbital cellulitis with abscess formation. She proceeded to have surgical drainage through a combined endoscopic and external approach to intraorbital abscess drainage with frontal trephine. She was also diagnosed with progressive calvarial osteomyelitis involving the right frontal bone, treated with a prolonged course of intravenous antibiotics. Our case highlights the importance of a high index of suspicion for complications of sinusitis. Multimodal imaging is essential to establish the extent of infection, and a multi-disciplinary approach is integral to manage this rare complication.
Association of Mental Health Problems and Socio-Demographic Factors Among Adolescents in Indonesia
Authors: Pandia Veranita , Noviandhari Anindita , Amelia Indah , Hidayat Galih Hafidz , Fadlyana Eddy , Dhamayanti Meita
Published: August 2021

Mental health in adolescents represent a considerable public health issue in developing countries. These problems are considered a source of problem for adolescents’ quality of life. The study objective was to determine the association between mental health problems and sociodemographic variables among adolescents. A cross-sectional study was conducted from October to December 2016 using a school-based survey in 4 districts and 3 cities in West Java Province, Indonesia. Stratified multistage random sampling was used to select junior and senior high school students and self-administered questionnaires were used to collect study data which included: personal data, socioeconomic status scale, and self-reported version of Strengths and Difficulties Questionnaire (SDQ) which divided into 5 subscales. About 3452 adolescents of 32 schools were included in this study, 59% female, 56% junior high school, 56% district residence, most parents’ education were senior high school. The prevalence of mental health problems based on SDQ subscale as total difficulties, conduct problem, emotional symptoms, peer problems, hyperactivity-inattention, were abnormal 31.6, 38.9, 30, 29.3, 15.6, respectively. Mental health problems were more prevalent amongst adolescents in junior high school and residence in district area, with RR and 95% CI were 1.14 (1.04-1.26), and 1.18 (1.08-1.30). As conclusions mental health problems in adolescents were associated with education level and residence area
Empowerment Through Genuine Participation: Giving Voice to the Neglected Majority
Authors: Rwebugisa Liberatus J. , Usinger Janet
Published: August 2021

Empowerment is often a goal of community development projects aimed at poverty reduction; yet, ascertaining whether empowerment occurs can be elusive. This case study research examined the empowerment process. Thirty community partners participated in a three-year community-led initiative to improve public education in a rural northwest Tanzanian village. The initiative included capacity-building activities to enhance personal and collective agency. The findings from the analytic framework of self-determination theory indicated that the initiative simultaneously nurtured and satisfied community partners’ innate basic psychological needs of relatedness, competence and autonomy: hence affirmed their feelings of empowerment. Implications for the theory and practice are presented.
Gram Swaraj: The Sustainable Model for Rural Industrialisation and Employment
Authors: Kakati Bhaskar Kumar
Published: August 2021

This article discusses the relevance of Gram Swaraj or village self-governance and rural industries in the context of pandemic-ravaged countries like India. Drawing mainly from Gandhian Gram Swaraj ideas and secondary sources, it discusses the impact on informal sector workers, their rural–urban–rural migration and precarious livelihood question, the need for rural industries and the adaptation and application of Gram Swaraj ideas. The analysis has implications for considering these ideas for creating sustainable employment and livelihood in rural areas in countries like India.
“I Think Parents Shouldn’t Be Too Pushy”: A Qualitative Exploration of Parent and Youth Perspectives of Youth Decision-Making Involvement in Starting Continuous Glucose Monitoring
Authors: Fremont Ettya R. , Slick Nathalie , Willi Steven M. , Miller Victoria A.
Published: August 2021

Purpose

The purpose of this qualitative study was to explore parent and youth perspectives of the decision-making process to start continuous glucose monitoring (CGM).

Methods

Youth with type 1 diabetes and their parents were assessed with semistructured interviews before adding CGM to their regimen and 2 months after device initiation. Interviews focused on parent, youth, and provider decision-making roles and suggestions for enhancing youth decision-making involvement (DMI). Data were coded and analyzed using thematic analysis.

Results

Youth (N = 41; 13.7 ± 2.9 years) were categorized into decision-making roles: (1) youth primary decision maker (54.8%), (2) youth primary decision maker with parental influence (14.3%), (3) parent primary decision maker with youth agreement (26.2%), and (4) parent primary decision maker without youth agreement (4.8%). Participants described that clinicians provided information, recommended CGM, and gave support. Recommendations to enhance youth DMI included that youth should ask questions, express opinions, and do their own research. Providers should give unbiased information and use visual aids (eg, show the device and videos) to engage youth.

Conclusions

Participants agreed that whereas youth should have a primary role in the decision about CGM, parental and provider support is critical. Parents and providers can facilitate dialogue by directly engaging with youth about their thoughts, feelings, and concerns. Provider use of visual aids may enhance youth engagement and expectations.
The molecular hallmarks of primary and secondary vitreoretinal lymphoma
Authors: Bonzheim Irina , Sander Philip , Salmeron-Villalobos Julia , Süsskind Daniela , Szurman Peter , Gekeler Florian , Spitzer Martin S , Steinhilber Julia , Kohler Esther , Büssgen Melanie , Schittenhelm Jens , Salaverria Itziar , Campo Elias , Coupland Sarah E , Quintanilla-Martinez Leticia , Fend Falko
Published: August 2021

Vitreoretinal lymphoma (VRL) is a rare subtype of diffuse large B-cell lymphoma (DLBCL) considered a variant of primary central nervous system lymphoma (PCNSL). Diagnosis of VRL requires examination of vitreous fluid, but cytologic differentiation from uveitis remains difficult. Due to its rarity and difficulty in obtaining diagnostic material, little is known about the genetic profile of VRL. The aim of our study was to investigate the mutational profile of a large series of primary and secondary VRL. Targeted next generation sequencing using a custom panel containing the most frequent mutations in PCNSL was performed on 34 vitrectomy samples of 31 patients with VRL and negative controls with uveitis. In a subset of cases, genome-wide copy number alterations (CNA) were assessed using the Oncoscan platform. Mutations in MYD88 (74%), PIM1 (71%), CD79B (55%), IGLL5 (52%), TBL1XR1 (48%), ETV6 (45%) and 9p21/CDKN2A deletions (85%) were the most common alterations, with similar frequencies in primary (15), synchronous (3) or secondary (13) VRL. This mutational spectrum is similar to MYD88mut/CD79Bmut (MCD or cluster 5) DLBCL with activation of Toll-like and B-cell receptor pathways and CDKN2A loss, confirming their close relationship. Oncoscan analysis demonstrated a high number of CNAs (mean 18.6/case). Negative controls lacked mutations or CNAs. Using cell free DNA of vitreous fluid supernatant, mutations present in cellular DNA were reliably detected in all examined cases. Mutational analysis is a highly sensitive and specific tool for the diagnosis of VRL and can also be applied successfully to cell free DNA derived from the vitreous.
Splicing factor gene mutations in acute myeloid leukemia offer additive value if incorporated in current risk classification
Authors: van der Werf Inge , Wojtuszkiewicz Anna , Meggendorfer Manja , Hutter Stephan , Baer Constance , Heymans Martijn , Valk Peter J. M. , Kern Wolfgang , Haferlach Claudia , Janssen Jeroen J. W. M. , Ossenkoppele Gert J. , Cloos Jacqueline , Haferlach Torsten
Published: August 2021

Splicing factor (SF) mutations are important contributors to the pathogenesis of hematological malignancies; however, their relevance in risk classification of acute myeloid leukemia (AML) warrants further investigation. To gain more insight into the characteristics of patients with AML carrying SF mutations, we studied their association with clinical features, cytogenetic and molecular abnormalities, and clinical outcome in a large cohort of 1447 patients with AML and high-risk myelodysplastic syndrome. SF mutations were identified in 22% of patients and were associated with multiple unfavorable clinical features, such as older age, antecedent myeloid disorders, and adverse risk factors (mutations in RUNX1 and ASXL1). Furthermore, they had significantly shorter event-free and overall survival. Notably, in European LeukemiaNet (ELN) 2017 favorable- and intermediate-risk groups, SF3B1 mutations were indicative of relatively poor prognosis. In addition, patients carrying concomitant SF mutations and RUNX1 mutations had a particularly adverse prognosis. In patients without any of the 4 most common SF mutations, RUNX1 mutations were associated with relatively good outcome, which was comparable to that of intermediate-risk patients. In this study, we propose that SF mutations be considered for incorporation into prognostic classification systems. First, SF3B1 mutations could be considered an intermediate prognostic factor when co-occurring with favorable risk features and as an adverse prognostic factor for patients currently categorized as having intermediate risk, according to the ELN 2017 classification. Second, the prognostic value of the current adverse factor RUNX1 mutations seems to be limited to its co-occurrence with SF mutations.
Alterations of structural connectivity and structural co-variance network in focal cortical dysplasia
Authors: Lee Dong Ah , Lee Ho-Joon , Kim Hyung Chan , Park Kang Min
Published: August 2021

Background

The aim of this study was to investigate alterations in structural connectivity and structural co-variance network in patients with focal cortical dysplasia (FCD).

Methods

We enrolled 37 patients with FCD and 35 healthy controls. All subjects underwent brain MRI with the same scanner and with the same protocol, which included diffusion tensor imaging (DTI) and T1-weighted imaging. We analyzed the structural connectivity based on DTI, and structural co-variance network based on the structural volume with T1-weighted imaging. We created a connectivity matrix and obtained network measures from the matrix using the graph theory. We tested the difference in network measure between patients with FCD and healthy controls.

Results

In the structural connectivity analysis, we found that the local efficiency in patients with FCD was significantly lower than in healthy controls (2.390 vs. 2.578, p = 0.031). Structural co-variance network analysis revealed that the mean clustering coefficient, global efficiency, local efficiency, and transitivity were significantly decreased in patients with FCD compared to those in healthy controls (0.527 vs. 0.635, p = 0.036; 0.545 vs. 0.648, p = 0.026; 2.699 vs. 3.801, p = 0.019; 0.791 vs. 0.954, p = 0.026, respectively).

Conclusions

We demonstrate that there are significant alterations in structural connectivity, based on DTI, and structural co-variance network, based on the structural volume, in patients with FCD compared to healthy controls. These findings suggest that focal lesions with FCD could affect the whole-brain network and that FCD is a network disease.
Estimating the burden of pediatric HIV in an ‘A’ category district in India: an epidemiological study
Authors: Sinha Anju , Washington Reynold , Sethumadhavan Rajeev , Potty Rajaram Subramanian , Isac Shajy , Thavraj Vasantha , Pandey Ravindra Mohan
Published: August 2021

Background

India lacks epidemiological information on the disease burden of pediatric HIV. The National AIDS Control Program (NACP) estimates the numbers of HIV-positive children as a proportion of adult persons living with HIV. A third of HIV-positive children die before their first birthday and a half before they reach their second birthday. The early detection of HIV is crucial for the prevention of morbidities, growth delays, and death among HIV-positive children.

Methods

The study aimed to estimate the disease burden of pediatric HIV among children in ‘A’ category district of a high HIV prevalence state. An ‘A’ category district is defined by the presence of > 1% HIV prevalence among the general population, as estimated by HIV Sentinel Surveillance. The study used an innovative three-pronged strategy combining cross-sectional and longitudinal methods. The overall burden of pediatric HIV was calculated as a product of cases detected multiplied by a net inflation factor, for each of three strategies.

Results

The existing pool of HIV infection in the district is estimated to be 3266 (95% CI: 2621–4197) HIV positive children < 15 years of age, in a mid-year (2013) projected child population of about 1.4 million, thus giving an HIV prevalence of 0.23% (CI: 0.19–0.30) among children (0–14 years of age). The proportion of children among all people living with HIV in the district works out to 10.4% (CI: 8.6–13.5%).

Conclusions

The study estimate of 0.23% HIV prevalence among children (0–14 years of age) is higher than the NACP estimates (0.02) and is 2.5 higher than the Karnataka state estimate (0.09)22. Similarly, the proportion of children among all persons living with HIV in Belgaum district is 10.4% in this study, as against 6.54% for India. The study methodology is replicable for other settings and other diseases.
Anti-allergic activities of Umbelliferone against histamine- and Picryl chloride-induced ear edema by targeting Nrf2/iNOS signaling in mice
Authors: Younas  , Khan Ashrafullah , Shehzad Omer , Seo Eun Kyoung , Onder Alev , Khan Salman
Published: August 2021

Background

The current study was aimed to investigate the anti-allergic activities of the Umbelliferone (UMB) against the acute Histamine and chronic Picryl chloride (PiCl)-induced allergy in mice. UMB is a coumarin derivative (isolated from Angelica decursiva) found in various parts of the plants such as flowers, roots and, stems isolated from the plants of Umbelliferae family.

Methods

The UMB (1, 10, 50 mg/kg) was administered intraperitoneally (i.p) half an h before or 2 h after the induction of allergic ear edema. The acute ear edema was induced by histamine (intradermally, i.d), while the chronic ear edema was induced by painting the PiCl (sensitized with the toluene) on the ear. The antioxidants and oxidative stress markers were assessed. The histological changes were assessed using Hematoxylin and eosin (H and E) and giemsa staining. The immunohistochemistry studies were performed to assess the expression of the nuclear factor erythroid 2-related factor 2 (Nrf2) and inducible nitric oxide synthase (iNOS). The data was analyzed using one-way ANOVA tests followed by Tukey’s test with p < 0.05 was chosen as criteria for statistical significance.

Results

UMB treatment markedly reduced the allergic ear edema and ear weight compared to the negative control. Furthermore, the UMB attenuated the oxidative stress markers, while induced the antioxidants enzymes. Similarly, the UMB treatment significantly attenuated the serum immunoglobulin E (IgE) level. The UMB treatment markedly improved the histological parameters using H and E staining and Giemsa staining. The UMB administration induced the Nrf2 expression, while attenuated the iNOS expression. Furthermore, the computational analysis was performed to assess the interaction of the UMB with the various protein targets and to determine the mechanism of interaction with the target proteins.

Conclusion

In conclusion, the UMB treatment significantly alleviated the allergic symptoms, attenuating the oxidative stress, improved the histological features using in vivo and computational approaches.
Developing a hospital accreditation model: a Delphi study
Authors: Mosadeghrad Ali Mohammad , Ghazanfari Fatemeh
Published: August 2021

Background

Hospital accreditation (HA) is an external evaluation of a hospital’s structures, processes and results by an independent professional accreditation body using pre-established optimum standards. The Iranian hospital accreditation system faces several challenges. The overall aim of this study was to develop a model for Iran national hospital accreditation program.

Methods

This research uses the modified Delphi technique to develop and verify a model of hospital accreditation. The first draft of the HA model was introduced through a critical review of 20 pioneer accreditation models and semi-structured interviews with 151 key informants from Public, private, semi-public, charity and military hospitals in Iran. Three rounds of Delphi were conducted with 28 experts of hospital accreditation to verify the proposed model. Panel members were selected from authors of research articles and key speakers in the area of hospital accreditation, senior managers of the country’s health system, university professors in the fields of health policy and management across the country.

Results

A comprehensive model for hospital accreditation was introduced and verified in this study. The HA model has ten constructs of which seven are enablers (“Management and leadership”, “Planning”, “Education and Research”, “employee management”, “patient management”, “resource management”, and “process management”) and three are the results (“employee results”, “patient and society results” and “hospital results”). These constructs were further broken into 43 sub-constructs. The enablers and results scored 65 and 35% of the model’s total scores respectively. Then, about 150 accreditation standards were written and verified.

Conclusions

A comprehensive hospital accreditation model was developed and verified. Proper attention to structures, processes and outcomes and systemic thinking during the development of the model is one of the advantages of the hospital accreditation model developed in this study. Hospital accreditation bodies can use this model to develop or revise their hospital accreditation models.
Molecular and morphological analysis of the developing nemertean brain indicates convergent evolution of complex brains in Spiralia
Authors: Gąsiorowski Ludwik , Børve Aina , Cherneva Irina A. , Orús-Alcalde Andrea , Hejnol Andreas
Published: August 2021

Background

The brain anatomy in the clade Spiralia can vary from simple, commissural brains (e.g., gastrotrichs, rotifers) to rather complex, partitioned structures (e.g., in cephalopods and annelids). How often and in which lineages complex brains evolved still remains unclear. Nemerteans are a clade of worm-like spiralians, which possess a complex central nervous system (CNS) with a prominent brain, and elaborated chemosensory and neuroglandular cerebral organs, which have been previously suggested as homologs to the annelid mushroom bodies. To understand the developmental and evolutionary origins of the complex brain in nemerteans and spiralians in general, we investigated details of the neuroanatomy and gene expression in the brain and cerebral organs of the juveniles of nemerteanLineus ruber.

Results

In the juveniles, the CNS is already composed of all major elements present in the adults, including the brain, paired longitudinal lateral nerve cords, and an unpaired dorsal nerve cord, which suggests that further neural development is mostly related with increase in the size but not in complexity. The ultrastructure of the juvenile cerebral organ revealed that it is composed of several distinct cell types present also in the adults. The 12 transcription factors commonly used as brain cell type markers in bilaterians show region-specific expression in the nemertean brain and divide the entire organ into several molecularly distinct areas, partially overlapping with the morphological compartments. Additionally, several of the mushroom body-specific genes are expressed in the developing cerebral organs.

Conclusions

The dissimilar expression of molecular brain markers betweenL. ruberand the annelidPlatynereis dumeriliiindicates that the complex brains present in those two species evolved convergently by independent expansions of non-homologous regions of a simpler brain present in their last common ancestor. Although the same genes are expressed in mushroom bodies and cerebral organs, their spatial expression within organs shows apparent differences between annelids and nemerteans, indicating convergent recruitment of the same genes into patterning of non-homologous organs or hint toward a more complicated evolutionary process, in which conserved and novel cell types contribute to the non-homologous structures.
Risk of incident fractures in individuals hospitalised due to unexplained syncope and orthostatic hypotension
Authors: Johansson Madeleine , Rogmark Cecilia , Sutton Richard , Fedorowski Artur , Hamrefors Viktor
Published: August 2021

Background

Impaired orthostatic blood pressure response and syncope confer a high risk of falls and trauma. The relationship between a history of unexplained syncope and orthostatic hypotension (OH) with subsequent fractures, however, has not been thoroughly examined. In this study, we aimed to investigate the relationship between previous hospital admissions due to unexplained syncope and OH and incident fractures in a middle-aged population.

Methods

We analysed a large population-based prospective cohort of 30,399 middle-aged individuals (age, 57.5 ± 7.6; women, 60.2%). We included individuals hospitalised due to unexplained syncope or OH as the main diagnosis. Multivariable-adjusted Cox regression analysis was applied to assess the impact of unexplained syncope and OH hospitalisations on subsequent incident fractures.

Results

During a follow-up period of 17.8 + 6.5 years, 8201 (27%) subjects suffered incident fractures. The mean time from baseline and first admission for syncope (n = 493) or OH (n = 406) was 12.6 ± 4.2 years, and the mean age of the first hospitalisation was 74.6 ± 7.4 years. Individuals with incident fractures were older, more likely to be women, and had lower BMI, higher prevalence of prevalent fractures, and family history of fractures. Multivariable-adjusted Cox regression showed an increased risk of incident fractures following hospitalisations due to unexplained syncope (HR 1.20; 95% CI 1.02–1.40; p = 0.025) and OH (HR 1.42; 95% CI 1.21–1.66; p < 0.001) compared with unaffected individuals.

Conclusions

Individuals hospitalised due to unexplained syncope and orthostatic hypotension have an increased risk of subsequent fractures. Our findings suggest that such individuals should be clinically assessed for their syncope aetiology, with preventative measures aimed at fall and fracture risk assessment and management.
A first report of a rare TP53 variant associated with Li-Fraumeni syndrome manifesting as invasive breast cancer and malignant solitary fibrous tumor
Authors: Prejac Juraj , Dedić Plavetić Natalija , Gotovac Jerčić Kristina , Borovečki Fran
Published: August 2021

Background

Li-Fraumeni is a rare autosomal dominant cancer predisposition syndrome. The basis is a germline mutation of TP53 gene which encodes tumor suppressor protein resulting in early onset of tumors, most often breast cancer, soft tissue sarcomas, brain tumors, adrenocortical carcinomas, and leukemia.

Case report

We present a case of a young woman with a positive family history for cancer diagnosed with malignant solitary fibrous tumor and luminal B-like invasive breast cancer. Breast cancer and sarcomas account for the majority of tumors associated with Li-Fraumeni syndrome, yet solitary fibrous tumor is a rare clinical entity with no established guidelines for treatment. Even though both primary tumors were successfully resected, the sarcoma relapsed in the form of lung metastases. The NGS analysis revealed single nucleotide variant (c.1101-1G>A) in TP53 gene, affecting the acceptor splice site at intron 10. Until now, only one case of this genetic variant has been documented with conflicting interpretations of pathogenicity.

Conclusions

The knowledge of TP53 mutation status is essential since the management of these patients requires different approach to avoid excessive toxicity due to the risk of developing secondary malignancy. Using the clinical criteria to screen for affected individuals facilitates appropriate early genetic counseling of patients and their families. Following the American College of Medical Genetics criteria, we believe that the reported single nucleotide variant (c.1101-1G>A) in TP53 gene should be considered pathogenic.
Footprint measurement methods for the assessment and classification of foot types in subjects with Down syndrome: a systematic review
Authors: Gutiérrez-Vilahú Lourdes , Guerra-Balic Myriam
Published: August 2021

Background

Musculoskeletal disorders, especially in the feet, are common in people with Down syndrome (DS). Evaluation of podiatric footprints is important to prevent and manage orthopedic symptoms. The reliability of a wide variety of footprint measurement methods has been evaluated in healthy people, but few studies have considered the specific morphotype features of the feet in subjects with DS. The aim of this systematic review was to identify the podometric measurement tools used to typologically classify the footprints in the population with DS.

Methods

The following electronic databases were searched for studies describing footprint measurement tools to assess and classify the foot types in patients with DS published from inception to December 2020: PubMed, Web of Science, CINAHL, and Scopus. Articles were initially searched by screening titles and abstracts. Potentially relevant studies were then further screened by reviewing full texts. Studies that met the inclusion criteria were included in the review.

Results

Of the 122 articles identified by the search strategy, 14 full texts were retained to assess for eligibility, of which 11 studies met the inclusion criteria and were included. All the studies used footprint measurement methods to classify the foot types in subjects with DS, but only two studies assessed the reliability of those methods for the population with DS. The footprint measurement tools identified were a podoscope, a pressure-sensitive mat, a PressureStatTM carbon paper, and a 3D scanner. The Arch Index was the most common footprint measurement analyzed (seven studies). Two studies used the “gold standard” indexes that include Hernández-Corvo Index, Chippaux-Smirak Index, Staheli Index, and Clarke Angle to measure footprints.

Conclusions

There is a need to determine the reliability and validity of the footprint measurement methods used for clinical classification of the foot types in subjects with DS. This can contribute to an early diagnosis of foot abnormalities that would help to reduce mobility impairments, improving the quality of life of patients with DS.