bluuebunny/crossref_metadata_2025 huggingface dataset:
The urologist’s learning curve of “in-bore” magnetic resonance-guided prostate biopsy
Authors: Rosenzweig Barak , Drori Tomer , Raz Orit , Goldinger Gil , Shlomai Gadi , Zilberman Dorit E. , Shechtman Moshe , Ramon Jacob , Dotan Zohar A. , Portnoy Orith
Published: December 2021

Background

The combination of multi-parametric MRI to locate and define suspected lesions together with their being targeted by an MRI-guided prostate biopsy has succeeded in increasing the detection rate of clinically significant disease and lowering the detection rate of non-significant prostate cancer. In this work we investigate the urologist’s learning curve of in-bore MRI-guided prostate biopsy which is considered to be a superior biopsy technique.

Materials and methods

Following Helsinki approval by The Chaim Sheba Medical Center ethics committee in accordance with The Sheba Medical Center institutional guidelines (5366-28-SMC) we retrospectively reviewed 110 IB-MRGpBs performed from 6/2016 to 1/2019 in a single tertiary center. All patients had a prostate multi-parametric MRI finding of at least 1 target lesion (prostate imaging reporting and data system [PI-RADS] score ≥ 3). We analyzed biopsy duration and clinically significant prostate cancer detection of targeted sampling in 2 groups of 55 patients each, once by a urologist highly trained in IB-MRGpBs and again by a urologist untrained in IB-MRGpBs. These two parameters were compared according to operating urologist and chronologic order.

Results

The patients’ median age was 68 years (interquartile range 62–72). The mean prostate-specific antigen level and prostate size were 8.6 ± 9.1 ng/d and 53 ± 27 cc, respectively. The mean number of target lesions was 1.47 ± 0.6. Baseline parameters did not differ significantly between the 2 urologists’ cohorts. Overall detection rates of clinically significant prostate cancer were 19%, 55%, and 69% for PI-RADS 3, 4 and 5, respectively. Clinically significant cancer detection rates did not differ significantly along the timeline or between the 2 urologists. The average duration of IB-MRGpB targeted sampling was 28 ± 15.8 min, correlating with the number of target lesions (p < 0.0001), and independent of the urologist’s expertise. Eighteen cases defined the cutoff for the procedure duration learning curve (p < 0.05).

Conclusions

Our data suggest a very short learning curve for IB-MRGpB-targeted sampling duration, and that clinically significant cancer detection rates are not influenced by the learning curve of this technique.
Residency training amid the COVID-19 pandemic: exploring the impact on mental health and training, a lesson from Iran
Authors: Moini Ashraf , Maajani Khadije , Omranipour Ramesh , Zafarghandi Mohamad-Reza , Aleyasin Ashraf , Oskoie Roya , Alipour Sadaf
Published: December 2021

Background

COVID-19 has affected the training programs and the clinical schedules of surgical wards in many countries, including Iran. Also, the continuous involvement with COVID-19 patients has caused stress in health care workers; among them, residents are on the frontlines of care delivery. Therefore, we designed a study to assess the mental effects of these circumstances, and the effects on General Surgery and Obstetrics & Gynecology residency training in the busiest surgical departments of our university.

Methods

Participants of this cross-sectional study were residents of General Surgery and Obstetrics & Gynecology of Tehran University of Medical Sciences, and the conventional sampling method was used. We used a questionnaire consisting of 47 questions (mostly using multiple choice questions and answers on the Likert scale) about personal, familial, and demographic characteristics; training activities, and mental effects of COVID-19.

Results

The response rate was 63.5%. (127 filled questionnaires). Around 96% of the residents had emotional problems, 85.9% were highly stressed about contracting COVID-19, 81.3% were worried about transferring it to their families; and 78% believed that their residency training had been impaired.

Conclusion

Overall, our study shows the negative impact of COVID-19 on mental health and the training of residents. We propose that appropriate emotional support and suitable planning for compensation of training deficits is provided for residents.
Using simulation to increase resident comfort discussing social determinants of health
Authors: Morrison John M , Marsicek Sarah M. , Hopkins Akshata M , Dudas Robert A , Collins Kimberly R
Published: December 2021

Background

Social determinants of health (SDoH) play an important role in pediatric health outcomes. Trainees receive little to no training on how to identify, discuss and counsel families in a clinical setting. The aim of this study was to determine if a simulation-based SDoH training activity would improve pediatric resident comfort with these skills.

Methods

We performed a prospective study of a curricular intervention involving simulation cases utilizing standardized patients focused on four social determinants (food insecurity, housing insecurity, barriers to accessing care, and adverse childhood experiences [ACEs]). Residents reported confidence levels with discussing each SDoH and satisfaction with the activity in a retrospective pre-post survey with five-point Likert style questions. Select residents were surveyed again 9–12 months after participation.

Results

85% (33/39) of residents expressed satisfaction with the simulation activity. More residents expressed comfort discussing each SDoH after the activity (Δ% 38–47%; all p < .05), with the greatest effect noted in post-graduate-year-1 (PGY-1) participants. Improvements in comfort were sustained longitudinally during the academic year. More PGY-1 participants reported engaging in ≥ 2 conversations in a clinical setting related to food insecurity (43% vs. 5%; p = .04) and ACEs (71% vs. 20%; p = .02).

Discussion

Simulation led to an increased resident comfort with discussing SDoH in a clinical setting. The greatest benefit from such a curriculum is likely realized early in training. Future efforts should investigate if exposure to the simulations and increased comfort level with each topic correlate with increased likelihood to engage in these conversations in the clinical setting.
Characteristics and resource utilization of high-cost users in the intensive care unit: a population-based cohort study
Authors: Dziegielewski Claudia , Talarico Robert , Imsirovic Haris , Qureshi Danial , Choudhri Yasmeen , Tanuseputro Peter , Thompson Laura H. , Kyeremanteng Kwadwo
Published: December 2021

Background

Healthcare expenditure within the intensive care unit (ICU) is costly. A cost reduction strategy may be to target patients accounting for a disproportionate amount of healthcare spending, or high-cost users. This study aims to describe high-cost users in the ICU, including health outcomes and cost patterns.

Methods

We conducted a population-based retrospective cohort study of patients with ICU admissions in Ontario from 2011 to 2018. Patients with total healthcare costs in the year following ICU admission (including the admission itself) in the upper 10th percentile were defined as high-cost users. We compared characteristics and outcomes including length of stay, mortality, disposition, and costs between groups.

Results

Among 370,061 patients included, 37,006 were high-cost users. High-cost users were 64.2 years old, 58.3% male, and had more comorbidities (41.2% had ≥3) when likened to non-high cost users (66.1 years old, 57.2% male, 27.9% had ≥3 comorbidities). ICU length of stay was four times greater for high-cost users compared to non-high cost users (22.4 days, 95% confidence interval [CI] 22.0–22.7 days vs. 5.56 days, 95% CI 5.54–5.57 days). High-cost users had lower in-hospital mortality (10.0% vs.14.2%), but increased dispositioning outside of home (77.4% vs. 42.2%) compared to non-high-cost users. Total healthcare costs were five-fold higher for high-cost users ($238,231, 95% CI $237,020–$239,442) compared to non-high-cost users ($45,155, 95% CI $45,046–$45,264). High-cost users accounted for 37.0% of total healthcare costs.

Conclusion

High-cost users have increased length of stay, lower in-hospital mortality, and higher total healthcare costs when compared to non-high-cost users. Further studies into cost patterns and predictors of high-cost users are necessary to identify methods of decreasing healthcare expenditure.
“We have to learn to cooperate with each other”: a qualitative study to explore integration of traditional healers into the provision of HIV self-testing and tuberculosis screening in Eswatini
Authors: Schausberger Bernadette , Mmema Nqobile , Dlamini Velibanti , Dube Lenhle , Aung Aung , Kerschberger Bernhard , Ciglenecki Iza , Vambe Debrah , Mukooza Esther , Wringe Alison
Published: December 2021

Background

Traditional healing plays an important role in healthcare in Eswatini, and innovative collaborations with traditional healers may enable hard-to-reach men to access HIV and tuberculosis diagnostic services. This study explored attitudes towards integration of traditional healers into the provision of HIV self-testing kits and sputum collection containers.

Methods

A qualitative study was conducted in 2019–2020 in Shiselweni region, Eswatini. Eight male traditional healers were trained on HIV and tuberculosis care including distribution of HIV self-testing kits and sputum collection containers. Attitudes towards the intervention were elicited through in-depth interviews with the eight traditional healers, ten clients, five healthcare workers and seven focus group discussions with community members. Interviews and group discussions were conducted in SiSwati, audio-recorded, translated and transcribed into English. Data were coded inductively and analysed thematically.

Results

81 HIV self-testing kits and 24 sputum collection containers were distributed by the healers to 99 clients, with 14% of participants reporting a reactive HIV self-test result. The distribution of sputum containers did not result in any tuberculosis diagnoses, as samples were refused at health centres.

Traditional healers perceived themselves as important healthcare providers, and after training, were willing and able to distribute HIV self-test kits and sputum containers to clients. Many saw themselves as peers who could address barriers to health-seeking among Swazi men that reflected hegemonic masculinities and patriarchal attitudes. Traditional healers were considered to provide services that were private, flexible, efficient and non-judgemental, although some clients and community members expressed concerns over confidentiality breaches. Attitudes among health workers were mixed, with some calling for greater collaboration with traditional healers and others expressing doubts about their potential role in promoting HIV and tuberculosis services. Specifically, many health workers did not accept sputum samples collected outside health facilities.

Conclusions

Offering HIV self-testing kits and sputum containers through traditional healers led to high HIV yields, but no TB diagnoses. The intervention was appreciated by healers’ clients, due to the cultural literacy of traditional healers and practical considerations. Scaling-up this approach could bridge testing gaps if traditional healers are supported, but procedures for receiving sputum samples at health facilities need further strengthening.
Comparative effectiveness and safety of pharmaceuticals assessed in observational studies compared with randomized controlled trials
Authors: Hong Yoon Duk , Jansen Jeroen P. , Guerino John , Berger Marc L. , Crown William , Goettsch Wim G. , Mullins C. Daniel , Willke Richard J. , Orsini Lucinda S.
Published: December 2021

Background

There have been ongoing efforts to understand when and how data from observational studies can be applied to clinical and regulatory decision making. The objective of this review was to assess the comparability of relative treatment effects of pharmaceuticals from observational studies and randomized controlled trials (RCTs).

Methods

We searched PubMed and Embase for systematic literature reviews published between January 1, 1990, and January 31, 2020, that reported relative treatment effects of pharmaceuticals from both observational studies and RCTs. We extracted pooled relative effect estimates from observational studies and RCTs for each outcome, intervention-comparator, or indication assessed in the reviews. We calculated the ratio of the relative effect estimate from observational studies over that from RCTs, along with the corresponding 95% confidence interval (CI) for each pair of pooled RCT and observational study estimates, and we evaluated the consistency in relative treatment effects.

Results

Thirty systematic reviews across 7 therapeutic areas were identified from the literature. We analyzed 74 pairs of pooled relative effect estimates from RCTs and observational studies from 29 reviews. There was no statistically significant difference (based on the 95% CI) in relative effect estimates between RCTs and observational studies in 79.7% of pairs. There was an extreme difference (ratio < 0.7 or > 1.43) in 43.2% of pairs, and, in 17.6% of pairs, there was a significant difference and the estimates pointed in opposite directions.

Conclusions

Overall, our review shows that while there is no significant difference in the relative risk ratios between the majority of RCTs and observational studies compared, there is significant variation in about 20% of comparisons. The source of this variation should be the subject of further inquiry to elucidate how much of the variation is due to differences in patient populations versus biased estimates arising from issues with study design or analytical/statistical methods.
Assessment of foot-and-mouth disease risk areas in mainland China based spatial multi-criteria decision analysis
Authors: Haoran Wang , Jianhua Xiao , Maolin Ouyang , Hongyan Gao , Jia Bie , Li Gao , Xiang Gao , Hongbin Wang
Published: December 2021

Background

Foot-and-mouth disease (FMD) is a highly contagious viral disease of cloven-hoofed animals. As a transboundary animal disease, the prevention and control of FMD are important. This study was based on spatial multi-criteria decision analysis (MCDA) to assess FMD risk areas in mainland China. Ten risk factors were identified for constructing risk maps by scoring, and the analytic hierarchy process (AHP) was used to calculate the criteria weights of all factors. Different risk factors had different units and attributes, and fuzzy membership was used to standardize the risk factors. The weighted linear combination (WLC) and one-at-a-time (OAT) were used to obtain risk and uncertainty maps as well as to perform sensitivity analysis.

Results

Four major risk areas were identified in mainland China, including western (parts of Xinjiang and Tibet), southern (parts of Yunnan, Guizhou, Guangxi, Sichuan and Guangdong), northern (parts of Gansu, Ningxia and Inner Mongolia), and eastern (parts of Hebei, Henan, Anhui, Jiangsu and Shandong). Spring is the main season for FMD outbreaks. Risk areas were associated with the distance to previous outbreak points, grazing areas and cattle density. Receiver operating characteristic (ROC) analysis indicated that the risk map had good predictive power (AUC=0.8634).

Conclusions

These results can be used to delineate FMD risk areas in mainland China, and veterinary services can adopt the targeted preventive measures and control strategies.
Multifunctional exosome-mimetics for targeted anti-glioblastoma therapy by manipulating protein corona
Authors: Wu Jun-Yong , Li Yong-Jiang , Wang Jiemin , Hu Xiong-Bin , Huang Si , Luo Shilin , Xiang Da-Xiong
Published: December 2021

Targeted drug delivery to the glioblastoma (GBM) overcoming blood–brain barrier (BBB) has been challenging. Exosomes are promising vehicles for brain tumor drug delivery, but the production and purification hinder its application for nanomedicine. Besides, the formation of protein corona (PC) may affect the behaviour of nanocarriers. Here, multifunctional exosomes-mimetics (EM) are developed and decorated with angiopep-2 (Ang) for enhancing GBM drug delivery by manipulating PC. Docetaxel (DTX)-loaded EM with Ang modification (DTX@Ang-EM) show less absorption of serum proteins and phagocytosis by macrophages. Ang-EM show enhanced BBB penetration ability and targeting ability to the GBM. Ang-EM-mediated delivery increase the concentration of DTX in the tumor area. The multifunctional DTX@Ang-EM exhibits significant inhibition effects on orthotopic GBM growth with reduced side effects of the chemotherapeutic. Findings from this study indicate that the developed DTX@Ang-EM provide a new strategy for targeted brain drug delivery and GBM therapy.

Graphical abstract
Managed alcohol: one community’s innovative response to risk management during COVID-19
Authors: Brocious Heidi , Trawver Kathi , Demientieff LaVerne Xilegg
Published: December 2021

Background

Harm reduction programs often lack community-based support and can be controversial, despite data demonstrating effectiveness. This article describes one small Alaskan community’s development of a harm reduction managed alcohol program (MAP) in the context of a city-run quarantine site for individuals experiencing homelessness. The MAP was developed to support quarantining by COVID-19-exposed or COVID-positive individuals who also experienced chronic homelessness, a severe alcohol use disorder, and heightened health risks related to potentially unsupported alcohol withdrawal.

Method

Five interviews with key informants involved in planning or implementation of the MAP were conducted using rapid qualitative analysis and narrative analysis techniques.

Outcome

This study documents the planning and implementation of an innovative application of a managed alcohol harm reduction intervention in the context of the COVID-19 pandemic. In this instance, a MAP was used specifically to limit hospital admissions for alcohol withdrawal during a surge of cases in the community, as well as to mitigate spread of the virus. Key informants report no residents enrolled in the MAP program as a part of quarantine required hospitalization for withdrawal or for COVID symptoms, and no shelter resident left the quarantine site while still contagious with COVID-19. Additionally, the level of community support for the program was much higher than originally expected by organizers.

Conclusions

This program highlighted an example of how a community recognized the complexity and potential risk to individuals experiencing structural vulnerability related to homelessness and a severe AUD, and the community at large, and was able to create an alternative path to minimize those risks using a harm reduction strategy.
Postoperative transverse sternal nonunion with a chest wall defect managed by a tibial locking plate and a Gore-Tex dual mesh membrane: a case report
Authors: Malovrh Tomaz , Stupnik Tomaz , Podobnik Boris , Kalisnik Jurij Matija
Published: December 2021

Background

Transverse sternal nonunion is a rare but disabling complication of chest trauma or a transverse sternotomy. Fixation methods, mainly used to manage the more common longitudinal sternal nonunion, often fail, leaving the surgical treatment of transverse nonunion to be a challenge.

Case presentation

We present a case of a highly-disabling, postoperative chest wall defect resulting from transverse sternal nonunion after a transverse thoracosternotomy (clamshell incision) and a concomitant rib resection. Following unsuccessful surgical attempts, the sternal nonunion was fixed with a tibial locking plate and bone grafted, while the post-rib resection chest defect was reconstructed with a Gore-Tex dual mesh membrane. Adequate chest stability was achieved, enabling complete healing of the sternal nonunion and the patient’s complete recovery.

Conclusion

We believe it is important to address both in the rare case of combined postoperative transverse sternal nonunion and the chest wall defect after rib resection. A good outcome was achieved in our patient by fixing the nonunion with an appropriately sized and shaped locking plate with bone grafting and covering the chest defect with a dual mesh membrane.
Immediate effect of manual therapy techniques on the limitation of ankle dorsiflexion: a randomized, controlled, blind clinical trial protocol
Authors: de Castro Silva Matheus , de Marche Baldon Rodrigo , Lins Carolina , de Andrade Gustavo Martins , de Castro Gustavo Barros Braga , Felicio Lilian Ramiro
Published: December 2021

Background

The range of motion (RoM) of dorsiflexion (DF) plays an important role in human mobility, such as absorption of body weight during gait deceleration, jump landings, balance, and eccentric movements. This limitation can generate potentially damaging movements. This way, evaluating techniques for DF RoM increase could help improve immediate performance in such functional activities. This being the case, the objective of this study will be to verify the sum effect of different joint mobilization techniques for DF gain in persons practicing physical activities and its relationship with functional performance and balance.

Methodology

This is a randomized, controlled, and blind clinical trial. Fifty-four (54) volunteers will be recruited, aged between 18 and 40 years, who have DF limitations. After checking eligibility criteria, the participants will be submitted to a physiotherapeutic evaluation. A researcher, blind to evaluation and treatment, will perform the randomization of patients in groups: (A) Joint Mobilization - Mulligan Concept and (B) Joint Mobilization - Maitland Method. All volunteers will be submitted by two blind evaluators for randomization and treatment groups. They will realize the initial evaluation (A0), immediately after techniques (A1) and after 3–4 days of the technique application (A2). A different researcher, blind for evaluation, will perform the treatment, according to the randomization group.

Discussion

It is already known that DF RoM limitation can lead to compensatory and potentially damaging lower limb movements and that joint mobilizations are effective to treatment. However, there is no consensus whether the application of these techniques would also improve aspects of dynamic postural balance and performance in individuals practicing physical activity, and whether the sum of two joint mobilization techniques could enhance this effect.

Trial registration

Brazilian Registry of Clinical Trials (ReBEC) RBR-93xv9t. Registered on 09 April 2020.
A method with inertial extrapolation step for convex constrained monotone equations
Authors: Ibrahim Abdulkarim Hassan , Kumam Poom , Abubakar Auwal Bala , Abubakar Jamilu
Published: December 2021

In recent times, various algorithms have been incorporated with the inertial extrapolation step to speed up the convergence of the sequence generated by these algorithms. As far as we know, very few results exist regarding algorithms of the inertial derivative-free projection method for solving convex constrained monotone nonlinear equations. In this article, the convergence analysis of a derivative-free iterative algorithm (Liu and Feng in Numer. Algorithms 82(1):245–262, 2019) with an inertial extrapolation step for solving large scale convex constrained monotone nonlinear equations is studied. The proposed method generates a sufficient descent direction at each iteration. Under some mild assumptions, the global convergence of the sequence generated by the proposed method is established. Furthermore, some experimental results are presented to support the theoretical analysis of the proposed method.
Implementation and initial evaluation of falls risk reduction resources in a rural Native American Community
Authors: Knight Kyle M.
Published: December 2021

Background

Although falls are common and can cause serious injury to older adults, many health care facilities do not have falls prevention resources available. Falls prevention resources can reduce injury and mortality rates. Using the Centers for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents, Deaths & Injuries (STEADI) model, a falls risk clinic was implemented in a rural Indian Health Service (IHS) facility.

Methods

A Fall Risk Questionnaire was created and implemented into the Provider’s Electronic Health Records system interface to streamline provider screening and referral of patients who may be at risk for falls to a group falls risk reduction class.

Results

Participants exhibited average improvements in the Timed Up and Go (6.8 s) (P = 0.0001), Five-Time Sit-to-Stand (5.1 s) (P = 0.0002), and Functional Reach (3.6 inches) (P = 1.0) tests as compared to their own baseline. Results were analyzed via paired t test. 71% of participants advanced out of an “increased risk for falls” category in at least one outcome measure. Of the participants to complete the clinic, all were successfully contacted and three (18%) reported one or more falls at the 90-day mark, of which one (6%) required a visit to the Emergency Department but did not require hospital admission.

Conclusions

In regards to reducing falls in the community, per the CDC STEADI model, an integrated approach is best. All clinicians can play a part in reducing elder falls.
Influence of internal production conditions on the efficiency and competitiveness of enterprises
Authors: Ismayilov Vilayat I. , Almasov Nahid N. , Musayev Nijat S. , Samedova Aygun Q.
Published: December 2021

In the practice of enterprises, there is no clear boundary between the establishment and development of economic and management tools. The purpose of the article is to study the influence of internal production conditions on the efficiency of enterprises. The novelty of the study concerns the development of tools required when new systems for managing business processes are built. The conducted studies of the theoretical and methodological foundations of business process management demonstrated that the economic and managerial tools for ensuring business processes in the enterprise management system constitute a necessary arsenal of management methods. This set of methods primarily includes methods of maintaining the flexibility and adaptability of management systems to ensure the quality of business processes. During the study, it was identified that most often, the expected parameters of development and performance are established for business processes in the management of enterprises. The practical significance of the study is conditioned by the fact that systems for managing business processes and ensuring their quality exist at the studied enterprises in various forms, their functions refer to different departments and sometimes to different levels of management.
Gender-specific psychological and social impact of COVID-19 in Pakistan
Authors: Rabbani Fauziah , Khan Hyder Ali , Piryani Suneel , Khan Areeba Raza , Abid Fahad
Published: December 2021

Background

COVID-19 has rapidly spread across the world. Women may be especially vulnerable to depression and anxiety as a result of the pandemic.

Aims

This study attempted to assess how gender affects risk perceptions, anxiety levels and behavioural responses to the COVID-19 pandemic in Pakistan, to recommend gender-responsive health policies.

Methods

A cross-sectional online survey was conducted. Participants were asked to complete a sociodemographic data form, the Hospital Anxiety and Depression Scale, and questions on their risk perceptions, preventive behaviour and information exposure. Multiple logistic regression analysis was used to assess the effects of factors such as age, gender and household income on anxiety levels.

Results

Of the 1391 respondents, 478 were women and 913 were men. Women considered their chances of survival to be relatively lower than men (59% v. 73%). They were also more anxious (62% v. 50%) and more likely to adopt precautionary behaviour, such as avoiding going to the hospital (78% v. 71%), not going to work (72% v. 57%) and using disinfectants (93% v. 86%). Men were more likely to trust friends, family and social media as reliable sources of COVID-19 information, whereas women were more likely to trust doctors.

Conclusions

Women experience a disproportionate burden of the psychological and social impact of the pandemic compared with men. Involving doctors in healthcare communication targeting women might prove effective. Social media and radio programmes may be effective in disseminating COVID-19-related information to men.
State of the Art of Patient-reported Outcomes in Acromegaly or GH Deficiency: A Systematic Review and Meta-analysis
Authors: van der Meulen Merel , Zamanipoor Najafabadi Amir H , Broersen Leonie H A , Schoones Jan W , Pereira Alberto M , van Furth Wouter R , Claessen Kim M J A , Biermasz Nienke R
Published: December 2021

Context

Insight into the current landscape of patient-reported outcome (PRO) measures (PROM) and differences between PROs and conventional biochemical outcomes is pivotal for future implementation of PROs in research and clinical practice. Therefore, in studies among patients with acromegaly and growth hormone deficiency (GHD), we evaluated (1) used PROMs, (2) their validity, (3) quality of PRO reporting, (4) agreement between PROs and biochemical outcomes, and (5) determinants of discrepancies.

Evidence Acquisition

We searched 8 electronic databases for prospective studies describing both PROs and biochemical outcomes in acromegaly and GHD patients. Quality of PRO reporting was assessed using the International Society for Quality of Life Research (ISOQOL) criteria. Logistic regression analysis was used to evaluate determinants.

Evidence Synthesis

Ninety studies were included (acromegaly: n = 53; GHD: n = 37). Besides nonvalidated symptom lists (used in 37% of studies), 36 formal PROMs were used [predominantly Acromegaly Quality of Life Questionnaire in acromegaly (43%) and Quality of Life-Assessment of Growth Hormone Deficiency in Adults in GHD (43%)]. Reporting of PROs was poor, with a median of 37% to 47% of ISOQOL items being reported per study. Eighteen (34%) acromegaly studies and 12 (32%) GHD studies reported discrepancies between PROs and biochemical outcomes, most often improvement in biochemical outcomes without change in PROs.

Conclusions

Prospective studies among patients with acromegaly and GHD use a multitude of PROMs, often poorly reported. Since a substantial proportion of studies report discrepancies between PROs and biochemical outcomes, PROMs are pivotal in the evaluation of disease activity. Therefore, harmonization of PROs in clinical practice and research by development of core outcome sets is an important unmet need.
Mediations of Security, Race, and Violence in the Pulse Nightclub Shooting
Authors: Randell-Moon Holly
Published: December 2021

This article examines news and political mediations of security, race, and violence in the 2016 Pulse Nightclub shooting in an attempt to isolate how dominant institutions reaffirm and preserve the North American state's monopoly on violence and cultural preservation through the calculated balance of security in relation to tolerance of diversity. The event was predominantly mediated through security discourses of the “war on terror,” and this martial framing enabled the production of homonationalist rhetoric (drawing on Jasbir Puar's Terrorist Assemblages) that aimed to include previously excluded queer Latino/a populations within the American body politic. Focusing on news media reporting and political as well as activist responses to the shooting during the months of June–August 2016, the article shows how this process of homonationalist inclusion was not smooth. Memorialization and advocacy for the Pulse victims by dominant institutions is striated by colliding phobias (Islamo-, xeno-, and homo-) that interrupt a clear mode of nationalist address or point of identification in mediations of the shooting. Drawing on a knowledge base attentive to queer-of-color and Indigenous concerns, the article demonstrates how biopolitical and necropolitical value is extracted from communities exposed to intersecting violences with differential dividends distributed to queer Latino/a and Afro-Latino/a communities.
MITOL-mediated DRP1 ubiquitylation and degradation promotes mitochondrial hyperfusion in a CMT2A-linked MFN2 mutant
Authors: Das Rajdeep , Kamal Izaz Monir , Das Subhrangshu , Chakrabarti Saikat , Chakrabarti Oishee
Published: December 2021

Mutations in mitofusin 2 (MFN2) that are associated with the pathology of the debilitating neuropathy Charcot–Marie–Tooth type 2A (CMT2A) are known to alter mitochondrial morphology. One such abundant MFN2 mutation, R364W, results in the generation of elongated, interconnected mitochondria. However, the mechanism leading to this mitochondrial aberration remains poorly understood. Here, we show that mitochondrial hyperfusion in the presence of R364W-MFN2 is due to increased degradation of DRP1 (also known as DNM1L). The E3 ubiquitin ligase MITOL (also known as MARCHF5) is known to ubiquitylate both MFN2 and DRP1. Interaction with and subsequent ubiquitylation by MITOL is stronger in the presence of wild-type MFN2 than with R364W-MFN2. This differential interaction of MITOL with MFN2 in the presence of R364W-MFN2 renders the ligase more available for DRP1 ubiquitylation. Multi-monoubiquitylation and proteasomal degradation of DRP1 in R364W-MFN2 cells in the presence of MITOL eventually leads to mitochondrial hyperfusion. Here, we provide a mechanistic insight into mitochondrial hyperfusion, while also reporting that MFN2 can indirectly modulate DRP1 – an effect not shown previously.

This article has an associated First Person interview with the first author of the paper.
Plantar flexor muscles of kangaroo rats (Dipodomys deserti) shorten at a velocity to produce optimal power during jumping
Authors: Schwaner M. Janneke , Lin David C. , McGowan Craig P.
Published: December 2021

The musculotendon work contributions across all joints during jumping by kangaroo rats are not well understood. Namely, measures of external joint work do not provide information on the contributions from individual muscles or in-series elastic structures. In this study, we examined the functional roles of a major ankle extensor muscle, the lateral gastrocnemius (LG), and a major knee extensor muscle, the vastus lateralis (VL), through in vivo sonomicrometry and electromyography techniques, during vertical jumping by kangaroo rats. Our data showed that both muscles increased shortening and activity with higher jumps. We found that knee angular velocity and VL muscle shortening velocity were coupled in time. In contrast, the ankle angular velocity and LG muscle shortening velocity were decoupled, and rapid joint extension near the end of the jump produced high power outputs at the ankle joint. Further, the decoupling of muscle and joint kinematics allowed the LG muscle to prolong the period of shortening velocity near optimal velocity, which likely enabled the muscle to sustain maximal power generation. These observations were consistent with an LG tendon that is much more compliant than that of the VL.
The impulse response of optic flow-sensitive descending neurons to roll m-sequences
Authors: Leibbrandt Richard , Nicholas Sarah , Nordström Karin
Published: December 2021

When animals move through the world, their own movements generate widefield optic flow across their eyes. In insects, such widefield motion is encoded by optic lobe neurons. These lobula plate tangential cells (LPTCs) synapse with optic flow-sensitive descending neurons, which in turn project to areas that control neck, wing and leg movements. As the descending neurons play a role in sensorimotor transformation, it is important to understand their spatio-temporal response properties. Recent work shows that a relatively fast and efficient way to quantify such response properties is to use m-sequences or other white noise techniques. Therefore, here we used m-sequences to quantify the impulse responses of optic flow-sensitive descending neurons in male Eristalis tenax hoverflies. We focused on roll impulse responses as hoverflies perform exquisite head roll stabilizing reflexes, and the descending neurons respond particularly well to roll. We found that the roll impulse responses were fast, peaking after 16.5–18.0 ms. This is similar to the impulse response time to peak (18.3 ms) to widefield horizontal motion recorded in hoverfly LPTCs. We found that the roll impulse response amplitude scaled with the size of the stimulus impulse, and that its shape could be affected by the addition of constant velocity roll or lift. For example, the roll impulse response became faster and stronger with the addition of excitatory stimuli, and vice versa. We also found that the roll impulse response had a long return to baseline, which was significantly and substantially reduced by the addition of either roll or lift.
Thermoresponsive Hydrogels Reinforced with Supramolecular Cellulose Filler
Authors: Sugawara Akihide , Asoh Taka-Aki , Takashima Yoshinori , Harada Akira , Uyama Hiroshi
Published: December 2021

Thermoresponsive poly(N-isopropylacrylamide) hydrogels reinforced with supramolecular cellulose fibers were fabricated. Adamantane was immobilized on the surface of the cellulose fibers, and β-cyclodextrin was introduced into the hydrogel matrix. The interfacial host–guest interaction between the filler and the matrix effectively enhanced the mechanical strength of the hydrogels both in the swelling and deswelling states.
Imaging and pathologic features of non-calcified ductal carcinoma in situ: can sonography predict upgrade?
Authors: Komarla Rohini , Gilliland Lawrence , Piraner Maria , Seidel Rebecca , Clifford Kelly , Kunjummen Jean
Published: December 2021

Objective:

The purpose of this study was to evaluate the imaging and pathologic features and upgrade rate of non-calcified ductal carcinoma in situ (NCDCIS). The study tested the hypothesis that lesions with sonographic findings have higher upgrade rate compared to lesions seen on mammography or MRI only.

Methods:

This retrospective study included patients with ductal carcinoma in situ (DCIS) diagnosed by image-guided core breast biopsy from December 2009 to April 2018. Patients with microcalcifications on mammography or concurrent ipsilateral cancer on core biopsy were excluded. An upgrade was defined as surgical pathology showing microinvasive or invasive cancer.

Results:

A total of 71 lesions constituted the study cohort. 62% of cases (44/71) had a mammographic finding, and 38% (27/71) of mammographically occult lesions had findings on either ultrasound, MRI, or both. Of the 67 cases that underwent sonography, a mass was noted in 56/67 (83.6%) cases and no sonographic correlate was identified in 11/67 (16.4%) cases. 21% (15/71) of lesions were upgraded on final surgical pathology. The upgrade rate of patients with sonographic correlate was 27% (15/56) vs with mammographic findings only was 0% (0/11).

Conclusion:

DCIS should be considered in the differential diagnosis of architectural distortion, asymmetries, focal asymmetries, and masses, even in the absence of microcalcifications. NCDCIS diagnosed by ultrasound may be an independent risk factor for upgrade.

Advances in knowledge:

Radiologists must be aware of imaging features of DCIS and consider increased upgrade rate when NCDCIS is diagnosed by ultrasound.
Both Upper and Lower Limb Movements Contribute to Aesthetics of the Piqué Arabesque in Ballet
Authors: Kawano Yui , Lin Cheng-Feng , Kuno-Mizumura Mayumi
Published: December 2021

This study aimed to identify the factor structures—which are the predominant frameworks for describing the basic dimensions of a concept—that contribute to the aesthetics of body position in ballet. This study was composed of three-dimensional movement analysis and subjective
evaluation. Fourteen ballet dancers participated in the three-dimensional movement analysis. Thirty-six reflective markers were attached to the dancers' bodies, after which the dancers performed a piqué arabesque, a position in which the weight transfers from one leg to the other. This
movement was captured using eight optical cameras and one video camera. Biomechanical parameters, such as the joint angle and velocity of each body part, were calculated from the coordinates of the markers. Twenty-eight videos recorded in the three-dimensional movement analysis were viewed
by 51 observers with ballet experience. The observers subjectively evaluated the videos through four category pairs—"beautiful-ugly," "like-dislike," "interesting-not interesting," and "good-bad"—on a five-point semantic differential scale. Two groups, the top and bottom 30%, were
extracted based on the "beautiful-ugly" rating and compared using an independent t-test. In addition, exploratory factor analysis was performed on the biomechanical parameters that showed significant differences. Five factors were identified: "stability of the right distal upper limb and upper
body," "torso displacement speed," "stability of the left distal upper limb and line of the support leg," "height of the gesture leg," and "stability of the support leg around the hip joint and line of the limbs on the gesture leg side." These results indicate that the movements of both upper
and lower limbs contributed to the aesthetics of the ballet position of piqué arabesque. These findings will be useful for ballet teachers and dancers to understand the intrinsic aesthetics of movements.
Management organization's reporting system
Authors: Zykova T.
Published: December 2021

This article discusses the issues of forming the reporting of housing and communal services organizations. The activities carried out have a significant impact on the content of reporting organizations. The article is devoted to the study of the influence of the peculiarities of the activities of housing and communal services organizations on the composition and content of reports provided to both external and internal users.
Segmental schwannomatosis in the upper extremity: a case report and review of the literature
Authors: Ha Cheungsoo , Kang Yun Kyung , Ha Joong Won , Han Dong Hun , Lee Jun-Ku , Han Soo-Hong
Published: December 2021

Schwannomas, the most frequently occurring benign tumors of the peripheral nerve sheath, generally remain as painless swellings for several years before diagnosis. Multiple schwannomas involving different nerves within the same extremity are rare. We report a rare case of a 61-year-old female patient who presented with multiple schwannomas in the palmar common and proper digital nerves, 15 years after the resection of a median nerve schwannoma within the same upper extremity. Using pre-established diagnostic criteria, she was diagnosed with segmental schwannomatosis. After careful surgical resection, biopsy confirmed the diagnosis, and she recovered without neurological symptoms or limitations in the range of motion. A literature review revealed only four case series on segmental schwannomatosis, indicating its rarity. Postoperative sensory deficits are more likely in cases with multiple schwannomas in the common and proper digital nerves. We demonstrate that such complications can be avoided by meticulous dissection and separation of the tumors from the nerve fibers.
Stan zachowania wybranych starych druków przechowywanych w Bibliotece Jagiellońskiej: Kolekcje oo. kamedułów z Bieniszewa książąt Sanguszków oo. reformatów z Biecza
Authors: Baumann Ekaterina
Published: December 2021

PRESERVATION STATE OF A SELECTED OLD PRINTS KEPT IN THE JAGIELLONIAN LIBRARY – COLLECTIONS OF THE OLD PRINTS OF THE CAMALDOLESE HERMITS FROM BIENISZEW, PRINCES OF THE SANGUSZKO FAMILY, AND FRANCISCAN REFORMATES FROM BIECZ The work presents results of research on preservation state of three chosen book collections kept in the Jagiellonian Library in Krakow, i.e. The book collections of the Camaldolese Hermits from Bieniszew, princes of the Sanguszko family, and Franciscan Reformates from Biecz. The studies were made with instruments of the methodology of mixed research on the basis of quantitative data obtained by the scoring system method according to a scale. The results were used as a basis for creating the generall ibrarianship model of the evaluation of preservation state of old prints kept in different institutions (public and cloister libraries, private collections). For this model, the following components were defined: structure, list of parameters of book destructions for the assessment in two modes (extended and simplified), as well as significance of the whole list. Furthermore, an optimal scheme of the processing of data, their interpretation and visualisation was proposed. The librarianship model of the evaluation of preservation state of old prints may be used for the determination of conservation work priorities in libraries, assessment of expenditures and obtaining funds for conservation. In this way, it can be used for preservation of the future of cultural property.
The Perils of Personalized Pricing with Network Effects
Authors: Hajihashemi Bita , Sayedi Amin , Shulman Jeffrey D.
Published: December 2021

This research shows when, why, and how network effects can make it such that price personalization reduces profit, demand, and consumer surplus.
A Branch-Price-and-Cut Algorithm for the Two-Echelon Vehicle Routing Problem with Time Windows
Authors: Mhamedi Tayeb , Andersson Henrik , Cherkesly Marilène , Desaulniers Guy
Published: December 2021

In this paper, we propose an exact branch-price-and-cut (BPC) algorithm for the two-echelon vehicle routing problem with time windows. This problem arises in city logistics when high-capacity and low-capacity vehicles are used to transport items from depots to satellites (first echelon) and from satellites to customers (second echelon), respectively. The aim is to determine a set of least-cost first- and second-echelon routes such that the load on the routes respect the capacity of the vehicles, each second-echelon route is supplied by exactly one first-echelon route, and each customer is visited by exactly one second-echelon route within its time window. We model the problem with a route-based formulation where first-echelon routes are enumerated a priori, and second-echelon routes are generated using column generation. The problem is solved using BPC. To generate second-echelon routes, one pricing problem per satellite is solved using a labeling algorithm which keeps track of the first-echelon route associated with each (partial) second-echelon route considered. Furthermore, to speed up the solution process, we introduce effective deep dual-optimal inequalities and apply known valid inequalities. We perform extensive computational experiments on benchmark instances and show that our method outperforms a state-of-the-art algorithm. We also conduct sensitivity analyses on the different components of our algorithm and derive managerial insights related to the structure of the first-echelon routes.
The dental nurse's role in orthodontics
Authors: Jabbal Raj
Published: December 2021

Raj Jabbal gives an insight into the importance of orthodontic nurses in practice
Adapting to change
Authors: Butler Louise
Published: December 2021

Dental Nursing talks to Louise Butler about how her practice's team handled the pandemic
SCREEN NOW: a new educational resource for diabetes and eye health
Authors: Phillips Anne
Published: December 2021

Diabetes retinopathy is a feared complication of diabetes. Anne Phillips describes a new educational resource to explain the need for retinal screening to people living with diabetes and health professionals
Mandatory vaccination: is it ethical?
Authors: Winter George
Published: December 2021

Mandatory – or compulsory – vaccinations are controversial, with some arguing that individuals should have the right to assert their personal decisions without state interference. The recent decision to make COVID-19 vaccination mandatory for frontline NHS workers in England, as well as those working in social care, has thrown the idea into the spotlight.