bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving efficiency in the stepped-wedge trial design via Bayesian modeling with an informative prior for the time effects
Authors: Zhan Denghuang , Ouyang Yongdong , Xu Liang , Wong Hubert
Published: April 2021

Background

In a cross-sectional stepped-wedge cluster randomized trial comparing usual care to a new intervention, treatment allocation and time are correlated by design because participants enrolled early in the trial predominantly receive usual care while those enrolled late in the trial predominantly receive the new intervention. Current guidelines recommend adjustment for time effects when analyzing stepped-wedge cluster randomized trials to remove the confounding bias induced by this correlation. However, adjustment for time effects impacts study power. Within the Frequentist framework, adopting a sample size calculation that includes time effects would ensure the trial having adequate power regardless of the magnitude of the effect of time on the outcome. But if in fact time effects were negligible, this would overestimate the required sample size and could lead to the trial being deemed infeasible due to cost or unavailability of the required numbers of clusters or participants. In this study, we explore the use of prior information on time effects to potentially reduce the required sample size of the trial.

Methods

We applied a Bayesian approach to incorporate the prior information on the time effects into cluster-level statistical models (for continuous, binary, or count outcomes) for the stepped-wedge cluster randomized trial. We conducted simulations to illustrate how the bias in the intervention effect estimate and the trial power vary as a function of the prior precision and the mis-specification of the prior means of the time effects in an example scenario.

Results

When a nearly flat prior for the time effects was used, the power or sample size calculated using the Bayesian approach matched the result obtained using the Frequentist approach with time effects included. When a highly precise prior for the time effects (with accurately specified prior means) was used, the Bayesian result matched the Frequentist result obtained with time effects excluded. When the prior means of the time effects were nearly correctly specified, including this information improved the efficiency of the trial with little bias introduced into the intervention effect estimate. When the prior means of the time effects were greatly mis-specified and a precise prior was used, this bias was substantial.

Conclusion

Including prior information on time effects using a Bayesian approach may substantially reduce the required sample size. When the prior can be justified, results from applying this approach could support the conduct of a trial, which would be deemed infeasible if based on the larger sample size obtained using a Frequentist calculation. Caution is warranted as biased intervention effect estimates may arise when the prior distribution for the time effects is concentrated far from their true values.
Competition between perceptual grouping cues in an indirect objective task
Authors: Villalba-García Cristina , Jimenez Mikel , Luna Dolores , Hinojosa José A , Montoro Pedro R
Published: April 2021

The integration between Gestalt grouping cues has been a relatively unexplored issue in vision science. The present work introduces an objective indirect method based on the repetition discrimination task to determine the rules that govern the dominance dynamics of the competition between both intrinsic (Experiment 1: proximity vs luminance similarity) and extrinsic grouping cues (Experiment 2: common region vs connectedness) by means of objective measures of grouping (reaction times and accuracy). Prior to the main task, a novel objective equating task was introduced with the aim of equating the grouping strength of the cues for the visuomotor system. The main task included two single conditions with the grouping cues acting alone as well as two competing conditions displaying the grouping factors pitted against one another. Conventional aggregated analyses were combined with individual analysis and both revealed a consistent pattern of processing dominance of: (1) luminance similarity over proximity and (2) common region over connectedness. Interestingly, the individual analyses showed that, despite the heterogeneous responses to the single conditions, the pattern of dominance between cues was robustly homogeneous among the participants in the competing conditions.
Olaparib in hormone receptor-positive, HER2-negative metastatic breast cancer with a somatic BRCA2 mutation
Authors: Schwartzberg Lee S. , Kiedrowski Lesli A.
Published: April 2021

The oral poly(adenosine diphosphate-ribose) polymerase inhibitor olaparib is approved for the treatment of patients with human epidermal growth factor 2-negative (HER2−) metastatic breast cancer (mBC) and a germline breast cancer susceptibility gene (BRCA) mutation who have been treated with chemotherapy. This case report describes a 63-year-old postmenopausal woman with somatic BRCA2-mutated mBC who responded to olaparib treatment following multiple prior lines of therapy. The patient presented in January 2012 with locally advanced, hormone receptor-positive (HR+), HER2− BC which, despite initial response to neoadjuvant chemotherapy, recurred as bone disease in February 2014, and subsequently skin (June 2016) and liver (October 2016) metastases. A comprehensive 592-gene next-generation sequencing panel (Caris Life Sciences), performed on a skin biopsy, detected a pathogenic frameshift mutation in BRCA2 (H3154fs, c.9460delC), which was not identified in a 28-gene hereditary cancer germline analysis (Myriad Genetics, Inc.), and was therefore considered to be a somatic mutation. In January 2017, cell-free DNA (cfDNA) analysis (Guardant Health, Inc.) confirmed the BRCA2 H3154fs mutation in plasma. After several lines of chemotherapy and endocrine therapy, deriving clinical benefit from eribulin and capecitabine, the disease progressed by October 2017, and olaparib (300 mg orally twice daily) was initiated in January 2018. By April 2018, the liver lesions had shrunk by 80% and a >90% response in multiple skin lesions was noted. Clinical response was maintained for 8 months, followed by progression in the skin in September 2018. Biopsy of recurrent lesions revealed a novel BRCA2 mutation, E3152del (c.9455_9457delAGG), predicted to restore the open reading frame and presumably the mechanism of resistance to olaparib. Further likely resistance mutations were noted in subsequent cfDNA analyses. This case demonstrated a clinical response with olaparib as a later-line therapy for HR+, HER2− mBC with a somatic BRCA2 mutation.
Sino-Russian rapprochement and Greater Eurasia: From geopolitical pole to international society?
Authors: Lukin Alexander , Novikov Dmitry
Published: April 2021

Can international anarchy be stabilized, if not globally, then at least regionally? Those scholars who give a positive answer usually refer to the North Atlantic community which can be categorized as an international society from the viewpoint of the English school. The emergence of such a community outside the West is traditionally considered hardly possible. However, this article argues that it may already be emerging in Eurasia, with Russia and China being the key drivers of this trend. In the past few years, these two powers have put forward a number of major initiatives aimed at developing transport networks and logistics, and deepening economic and institutional ties between different parts of the continent. These include but are not limited to Eurasian Economic Union, supported by Russia, and China’s Belt and Road Initiative. Together, Moscow and Beijing began to form a new platform for security and economic cooperation “from Kaliningrad to Shanghai”—the community of Greater Eurasia. Based on the analysis of the geopolitical logic of these initiatives, this article suggests that a new, non-Western international society may be forming in Eurasia among the states with different political systems and cultures, but common geopolitical aims and fears.
Teaching Forensic Science to the American Police and Public: The Scientific Crime Detection Laboratory, 1929-1938
Authors: Wolffram Heather
Published: April 2021

Established in 1929, Northwestern University’s Scientific Crime Detection Laboratory (SCDL), America’s first independent forensic crime laboratory, undertook a wide range of scientific case work during the 1930s, including toxicology, firearms identification, polygraph testing, the analysis of questioned documents and bacteriology; its mission being to provide Chicago with a world-class forensic science service. Alongside this mission, however, a key ambition of the SCDL’s founders was to forensically educate police officers, legal professionals, and the general public. Convinced that American police were largely ignorant of scientific aids to crime detection and that the public’s lack of forensic awareness led to the destruction and contamination of crime scenes, the SCDL attempted to fashion itself as a “school for manhunters.” But, while the laboratory’s ambitious program of public talks, scientific demonstrations, detective schools, expositions, and radio programs were intended to foster the creation of both a scientifically savvy public and policemen on par with those to be found in Europe, the SCDL encountered a number of significant hurdles to achieving these goals, including the hostility of some high-ranking police officials.
Benefit of a pharmacist-led intervention for medication management of renal transplant patients: a controlled before-and-after study
Authors: Chambord Jeremy , Couzi Lionel , Merville Pierre , Moreau Karine , Xuereb Fabien , Djabarouti Sarah
Published: April 2021

Aims:

To assess the effect of a pharmacist-led intervention, using Barrows cards method, during the first year after renal transplantation, on patient knowledge about their treatment, medication adherence and exposure to treatment in a French cohort.

Methods:

We conducted a before-and-after comparative study between two groups of patients: those who benefited from a complementary pharmacist-led intervention [intervention group (IG), n = 44] versus those who did not [control group (CG), n = 48]. The pharmacist-led intervention consisted of a behavioral and educational interview at the first visit (visit 1). The intervention was assessed 4 months later at the second visit (visit 2), using the following endpoints: treatment knowledge, medication adherence [proportion of days covered (PDC) by immunosuppressive therapy] and tacrolimus exposure.

Results:

At visit 2, IG patients achieved a significantly higher knowledge score than CG patients (83.3% versus 72.2%, p = 0.001). We did not find any differences in treatment exposure or medication adherence; however, the intervention tended to reduce the proportion of non-adherent patients with low knowledge scores. Using the PDC by immunosuppressive therapy, we identified 10 non-adherent patients (10.9%) at visit 1 and six at visit 2.

Conclusions:

Our intervention showed a positive effect on patient knowledge about their treatment. However, our results did not show any improvement in overall medication adherence, which was likely to be because of the initially high level of adherence in our study population. Nevertheless, the intervention appears to have improved adherence in non-adherent patients with low knowledge scores.
Effect of transperineal template prostate biopsy on perioperative and functional outcomes following robotic-assisted radical prostatectomy
Authors: Yao Henry H , Ball Kathryn , Bazo Alvaro , Terry Timothy R , Walton Thomas J
Published: April 2021

Objective:

This study aimed to determine the effect of template transperineal (TTP) compared to transrectal (TR) biopsy on surgical and functional outcomes after robotic-assisted radical prostatectomy (RARP).

Methods:

From 2014 to 2018, 280 patients underwent RARP by a single surgeon. Of these, 184 had TR, and 96 had TTP biopsy. Primary outcomes were continence and erectile function recovery (EFR) rates up to 24 months postoperatively. Secondary outcomes comprised positive margin rates and markers of a difficult operation, including operative time, estimated blood loss (EBL), urethral preservation quality and ability to perform planned nerve-sparing surgery.

Results:

The median age was greater in the TTP group (64 vs. 62 years, p=0.028). The proportions of men with preoperative erectile dysfunction and men undergoing nerve-sparing surgery were not different between groups. Operative time, EBL, urethral preservation quality, proportion of men undergoing intended nerve-sparing procedure, positive margin rates and continence recovery rates were not different among the groups. At 24 months, men in the TR group had a higher EFR rate on univariate analysis ( p=0.036), and multivariate analysis ( p=0.03).

Conclusion:

TTP biopsy was not associated with markers of a more difficult RARP or worse oncological and continence recovery outcomes but did appear to impact upon long-term rates of EFR.

Level of evidence:

Level 4.
Organisational Citizenship Behaviour: Effect of Gender, Age and Marital Status on Altruistic Behaviour
Authors: Bharthy Harwinder , Sethi Upasna Joshi
Published: April 2021

This article analyses the relationship between altruistic behaviour and gender, age & marital status of employees. Consistent with this analysis, the study indicates that women are more altruistic than men. The age & marital status of employees also impacts their altruistic behaviour. The finding demonstrates opinions of men and women employee opinions about altruistic behaviour of opposite gender and their choice between altruism and job work.
Standardizing the Diagnostic Evaluation of Nonarthritic Hip Pain Through the Delphi Method
Authors: McClincy Michael P. , Wylie James D. , Williams David N. , Novais Eduardo N.
Published: April 2021

Background:

Femoroacetabular impingement and acetabular dysplasia have gained increased attention as nonarthritic sources of pain and dysfunction in young, active patients. To date, no standardized approach to the diagnostic evaluation of nonarthritic hip pain has been identified, as previous work has focused on the diagnostic evaluation and management of patients with femoroacetabular impingement undergoing hip arthroscopy.

Purpose:

To explore the standard diagnostic evaluation practice of experts in the field of hip preservation surgery and combine their expertise through the Delphi method to form a standardized approach to the diagnostic evaluation of patients with nonarthritic hip pain.

Study Design:

Consensus statement.

Methods:

An expert panel made up of 18 orthopaedic surgeons with extensive experience in the treatment of nonarthritic hip disorders participated in this Delphi study. The Delphi panelists were presented with 4 clinical vignettes representing a spectrum of patients with nonarthritic hip pain. Three iterative survey rounds were presented to the panelists based on these clinical vignettes, and a 3-step classic Delphi method was used to establish consensus techniques in the diagnostic evaluation of nonarthritic hip pain.

Results:

Total (100%) participation was gained, with all 18 experts completing all 3 Delphi survey rounds. Consensus (≥75% support) was achieved for some, if not all, vignettes for each of the following diagnostic domains: historical features, physical examination, radiographic sequences, radiographic interpretation, cross-sectional imaging, and ancillary diagnostics.

Conclusion:

In this Delphi study, we identified standardized diagnostic treatment approaches as derived from expert opinion for patients with nonarthritic hip pathomorphologies.
Data Sharing in Education Science
Authors: Logan Jessica A. R. , Hart Sara A. , Schatschneider Christopher
Published: April 2021

Many research agencies are now requiring that data collected as part of funded projects be shared. However, the practice of data sharing in education sciences has lagged these funder requirements. We assert that this is likely because researchers generally have not been made aware of these requirements and of the benefits of data sharing. Furthermore, data sharing is usually not a part of formal training, so many researchers may be unaware of how to properly share their data. Finally, the research culture in education science is often filled with concerns regarding the sharing of data. In this article, we address each of these areas, discussing the wide range of benefits of data sharing, the many ways by which data can be shared; provide a step by step guide to start sharing data; and respond to common concerns.
Indocyanine green fluorescence imaging, sentinel lymph node mapping in patients with vulvar cancer: peritumoral injection dosage and waiting times in our experience
Authors: Scollo P. , Ferrara M. , Pecorino B. , Di Stefano A. B. , Scibilia G.
Published: April 2021

Background

Vulvar cancer is a rare gynecological malignancy that primarily affects women of postmenopausal age. Treatment is mainly surgical, particularly for vulvar squamous cell carcinoma, the most prevalent histotype. In patients with unifocal tumors with a maximum diameter of <4 cm, in the absence of suspected inguinal lymph nodes, sentinel lymph node (SLN) biopsy is recommended. The use of a radioactive tracer is mandatory; the use of the vital blue dye is optional.

Results

Two patients diagnosed with vulvar squamous cell carcinoma (FIGO IB stage) underwent bilateral radical vulvectomy, SLN search and removal, and bilateral inguinal lymphadenectomy at the Cannizzaro Hospital Operative Unit of Obstetrics and Gynecology Department (Catania, Italy). Three milliliters of indocyanine green (ICG) 0.5 mg/mL was administered in 3 peritumoral injections under general anesthesia to screen the SLN. The images were acquired using an intraoperative infrared camera system, which allowed intraoperative visualization of the SLN. An SLN was identified for each patient. The lymph nodes examined by the pathologist were negative for metastatic localization of the disease. However, patients underwent bilateral inguinofemoral lymphadenectomy, as this procedure is not currently codified as a gold standard for the detection of SLN in vulvar cancer. All the lymph nodes removed were negative for the localization of vulvar carcinoma metastases.

Conclusions

The potential of the administration of indocyanine green (ICG) allows the execution of SLN biopsy, avoiding the multiple administrations of radiocolloid in the pre-operative phase, painful for the patient, elimination, and exposure to radioactivity. Therefore, while requiring standardization of the methodology and a large-scale application, this procedure could open a new surgical management perspective in patients with early-stage vulvar cancer.
Total cholesterol/HDL-C ratio versus non-HDL-C as predictors for ischemic heart disease: a 17-year follow-up study of women in southern Sweden
Authors: Calling Susanna , Johansson Sven-Erik , Wolff Moa , Sundquist Jan , Sundquist Kristina
Published: April 2021

Background

A distorted blood lipid profile is an important risk factor for ischemic heart disease (IHD) but the predictive ability of the different lipid measures has rarely been studied. Our aim was to examine and compare, in a large sample of women, the predictive ability of total cholesterol/HDL cholesterol ratio (TC/HDL-C) and non-HDL-C in relation to IHD, adjusted for age, exercise, smoking, waist-hip ratio, blood pressure, and diabetes mellitus.

Methods

Between 1995 and 2000, a total of 6537 women aged 50–59 years from the Women’s Health in Lund area (WHILA) study in southern Sweden were included and underwent a baseline examination. The women were followed through national registers for incidence of IHD during a mean follow-up of 17 years. The prediction accuracy was estimated through Harrell’s C and Akaike Information Criterion (AIC).

Results

Increasing TC/HDL-C as well as non-HDL-C showed strong associations with IHD, with the highest risk in the 5th quintile, where the HR was 2.30 (95% CI: 1.70–3.11) for TC/HDL-C and 1.67 (95% CI: 1.25–2.24) for non-HDL-C, after adjustments. Comparisons using Harrell’s C and AIC indicated that TC/HDL-C has a slightly higher predictive ability than that of non-HDL-C (Harrell’s C 0.62 and 0.59 respectively, p = 0.003 for difference, age-adjusted model; AIC for TC/HDL-C < AIC for non-HDL-C).

Conclusions

TC/HDL-C ratio and non-HDL-C are both clinical predictors for IHD in middle-aged women. The results indicate that the predictive ability of TC/HDL-C was higher than that of non-HDL-C; however, non-HDL-C was linearly related to IHD (p = 0.58) and may be easier to calculate and interpret in clinical practice, for early identification of future IHD in women.
Cytokine measurements add value to clinical variables in predicting outcomes for Staphylococcus aureus bacteremia
Authors: Tan Karen , Minejima Emi , Lou Mimi , Mack Wendy J. , Nieberg Paul , Wong-Beringer Annie
Published: April 2021

Background

We demonstrated that an early dysregulated cytokine response [high interleukin-10 to tissue necrosis factor (IL-10/TNF) ratio] predicted poor outcomes in patients with Staphylococcus aureus bacteremia (SAB). However, high interpatient variability in cytokine levels were observed. We grouped cytokine measurements in quartiles and assessed their additive value to clinical variables for predicting bacterial persistence and 30-day mortality in patients with SAB.

Methods

A multicenter observational study was conducted in hospitalized patients with SAB. Medical charts were reviewed for relevant information. Blood samples were obtained for cytokine measurements by ELISA: interferon-gamma (IFNγ), interleukin (IL-1β, IL-6, IL-8, IL-10, IL-17) and tissue necrosis factor (TNF). Cytokine measurements were grouped into quartiles. Significant predictors for bacterial persistence and 30-day mortality were determined by multivariable logistic regression analysis. Area under the ROC curve (AUC) analysis was performed and predictive performance was compared between models with and without cytokine quartiles.

Results

Among 606 patients with SAB, a subset of patients (n = 239) had Day 1 cytokine measurements and clinical data collected; of those, 53 (22%) had persistent bacteremia. Accounting for septic shock, the addition of either IL-10 (AUC 0.708) or TNF (AUC 0.714) quartiles measured on Day 1 improved model performance for predicting bacterial persistence. All patients had Day 4 cytokine measurements; 52 patients (8.5%) died within 30-days of SAB onset. Inclusion of either IL-10 (AUC 0.873) or TNF (AUC 0.879) quartiles, but not both, measured on Day 4 to the significant clinical predictors (coronary artery disease, Pitt bacteremia score ≥ 4, and septic shock) improved model performance for mortality.

Conclusions

IL-10 or TNF levels falling within the range in the upper quartiles, when combined with clinical variables, improved model performance for predicting outcomes, and may potentially be used to support aggressive management and biomarker-guided studies to evaluate the benefit of adjunctive immunotherapy for SAB in the future.
Morphine overinfusion of intrathecal drug administration system under magnetic resonance evaluation for the diagnosis of stroke: a case report
Authors: Kim Seoyeon , Kang Min Kyoung
Published: April 2021

Background

Until recently, it is generally considered safe to perform magnetic resonance imaging (MRI) in patients with an intrathecal drug administration system (ITDAS) device. In this study, we presented a case of morphine overdose due to ITDAS malfunction during MRI evaluation for the diagnosis of stroke.

Case presentation

A 58-year-old woman was referred to the emergency department for left-sided hemiparesis and dysarthria. She had undergone ITDAS implantation 4 years ago because of intractable back pain. Her brain MRI examination did not show any abnormalities except an old hemorrhagic infarction in the right basal ganglia. After MRI was performed, her symptoms completely resolved. Approximately 3 h after the MRI scan, the patient showed progressive stuporous consciousness and decreased respiration with decreased peripheral oxygen saturation of 80%. Initial arterial blood gas analysis revealed respiratory acidosis with hypoxia and hypercapnia. We suspected the opioid overdose for her unconciousness, small and sluggish pupils, and slow respiration. The patient regained consciousness within 3 min after the administration of naloxone with severe anxiety and irritability, without any respiratory symptoms or focal neurological deficits. In the pump interrogation and actual reservoir checks performed 6 h after the MRI scan, there was no significant difference between the expected reservoir volume and actual reservoir volume. Follow-up MRI performed to rule out posterior circulation infarction showed no structural lesions. The patient was eventually discharged without further neurologic or functional deterioration, with diagnosis of transient ischemia attack for initial symptoms of focal neurologic deficits.

Conclusion

Although both ex vivo and in vivo studies have provided evidence that ITDAS devices are MRI-compatible, the pump is made of titanium and has ferromagnetic components. Since misdiagnosis of overinfusion could lead to mortality, early awareness of overinfusion of the intrathecal drug is needed to all clinicians in case of performing MRI in ITDAS implanted patients.
Effects of positive and negative childhood experiences on adult family health
Authors: Daines Chantel L. , Hansen Dustin , Novilla M. Lelinneth B. , Crandall AliceAnn
Published: April 2021

Background

The objective of the study was to determine the association between adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) with family health in adulthood. Prior research indicates that ACEs and PCEs affect individual physical and mental health in adulthood. However, little is known about how ACEs and PCEs affect family health. Families develop and function through patterns and routines which are often intergenerational. Therefore, a person’s early experiences may influence their family’s health in adulthood.

Method

A survey was administered to 1030 adults through Qualtrics, with participants recruited using quota-sampling to reflect the demographic characteristics of U.S. adults. Participants completed a survey about their childhood experiences, four domains of family health (family social and emotional health processes, family healthy lifestyle, family health resources, and family external social supports), and demographic characteristics. Data were analyzed using structural equation modeling.

Results

After controlling for marriage, education, gender, race and age, ACEs were negatively associated with family social and emotional health processes and family health resources when accounting for PCEs; PCEs were positively associated with all four family health domains irrespective of ACEs.

Conclusion

Childhood experiences affect family health in adulthood in the expected direction. Even in the presence of early adversity, positive experiences in childhood can provide a foundation for creating better family health in adulthood.
Anthropometry at discharge and risk of relapse in children treated for severe acute malnutrition: a prospective cohort study in rural Nepal
Authors: Guesdon Benjamin , Katwal Manisha , Poudyal Amod Kumar , Bhandari Tusli Ram , Counil Emilie , Nepali Sujay
Published: April 2021

Background

There is a dearth of evidence on what should be the optimal criteria for discharging children from severe acute malnutrition (SAM) treatment. Programs discharging children while they are still presenting varying levels of weight-for-height (WHZ) or mid-upper-arm circumference (MUAC) deficits, such as those implemented under the current national protocol in Nepal, are opportunities to fill this evidence gap.

Methods

We followed a cohort of children discharged as cured from SAM treatment in Parasi district, Nepal. Relapse as SAM, defined as the occurrence of WHZ<-3 or MUAC < 115 mm or nutritional edema, was investigated through repeated home visits, during six months after discharge. We assessed the contribution of remaining anthropometric deficits at discharge to relapse risk through Cox regressions.

Results

Relapse as SAM during follow-up was observed in 33 % of the cohort (35/108). Being discharged before reaching the internationally recommended criteria was overall associated with a large increase in the risk of relapse (HR = 3.3; p = 0.006). Among all anthropometric indicators at discharge, WHZ<-2 led to a three-fold increase in relapse risk (HR = 3.2; p = 0.003), while MUAC < 125 mm significantly raised it only in the older children. WHZ<-2 at discharge came up as the only significant predictor of relapse in multivariate analysis (HR = 2.8, p = 0.01), even among children with a MUAC ≥ 125 mm. Of note, more than 80 % of the events of relapse as SAM would have been missed if WHZ had not been monitored and used in the definition of relapse.

Conclusions

Our results suggest that the priority for SAM management programs should be to ensure that children reach a high level of WHZ at discharge, at least above or equal to the WHO recommended cut-off. The validity of using a single MUAC cut-off such as 125 mm as a suitable discharge criterion for all age groups is questioned. Further follow-up studies providing a complete assessment of nutritional status at discharge and not based on a restricted MUAC-only definition of relapse as SAM would be urgently needed to set evidence-based discharge criteria. These studies are also required to assess programs currently discounting or omitting WHZ for identification and management of SAM.
Extreme temperature and out-of-hospital-cardiac-arrest. Nationwide study in a hot climate country
Authors: Kranc Hannan , Novack Victor , Shtein Alexandra , Sherman Rimma , Novack Lena
Published: April 2021

Background

Out-of-hospital-cardiac arrest (OHCA) is frequently linked to environmental exposures. Climate change and global warming phenomenon have been found related to cardiovascular morbidity, however there is no agreement on their impact on OHCA occurrence. In this nationwide analysis, we aimed to assess the incidence of the OHCA events attended by emergency medical services (EMS), in relation to meteorological conditions: temperature, humidity, heat index and solar radiation.

Methods

We analyzed all adult cases of OHCA in Israel attended by EMS during 2016–2017. In the case-crossover design, we compared ambient exposure within 72 h prior to the OHCA event with exposure prior to the four control times using conditional logistic regression in a lag-distributed non-linear model.

Results

There were 12,401 OHCA cases (68.3% were pronounced dead-on-scene). The patients were on average 75.5 ± 16.2 years old and 55.8% of them were males.

Exposure to 90th and 10th percentile of temperature adjusted to humidity were positively associated with the OHCA with borderline significance (Odds Ratio (OR) =1.20, 95%CI 0.97; 1.49 and OR 1.16, 95%CI 0.95; 1.41, respectively). Relative humidity below the 10th percentile was a risk factor for OHCA, independent of temperature, with borderline significance (OR = 1.16, 95%CI 0.96; 1.38). Analysis stratified by seasons revealed an adverse effect of exposure to 90th percentile of temperature when estimated in summer (OR = 3.34, 95%CI 1.90; 3.5.86) and exposure to temperatures below 10th percentile in winter (OR = 1.75, 95%CI 1.23; 2.49). Low temperatures during a warm season and high temperatures during a cold season had a protective effect on OHCA. The heat index followed a similar pattern, where an adverse effect was demonstrated for extreme levels of exposure.

Conclusions

Evolving climate conditions characterized by excessive heat and low humidity represent risk factors for OHCA. As these conditions are easily avoided, by air conditioning and behavioral restrictions, necessary prevention measures are warranted.
An Excel program for calculating statistics presented in Marfak et al.’s article ‘Improved RIDIT statistic approach provides more intuitive and informative interpretation of EQ-5D Data’
Authors: Marfak Abdelghafour , Youlyouz-Marfak Ibtissam
Published: April 2021

The objective is to present and share an Excel program that we have developed to perform statistical analyses based on the Improved RIDIT approach of Marfak et al.’s article ‘Improved RIDIT statistic approach provides more intuitive and informative interpretation of EQ-5D Data’.
A clinical study on bone defect reconstruction and functional recovery in benign bone tumors of the lower extremity, treated by bone marrow mesenchymal stem cell rapid screening–enrichment–composite system
Authors: Wang Lei , Luo Dinghao , Wu Junxiang , Xie Kai , Guo Yu , Gan Yaokai , Wu Wen , Hao Yongqiang
Published: April 2021

Background

With the development of medical technology, credible options for defect reconstructions after the resection of benign bone tumors of the lower extremities have become a high priority. As the current reconstructive methods commonly used in clinical practice have some flaws, new methods of reconstruction need to be explored. We aimed to prepare a new kind of bioactive scaffold for the repair of bone defects through a stem cell rapid screening–enrichment–composite technology system developed by our team. Furthermore, we aimed to investigate the curative effects of these bioactive scaffolds.

Methods

Firstly, cell count, trypan blue exclusion rate, and ALP staining were used to evaluate changes in enrichment efficiency, cell activity, and osteogenic ability before and after enrichment. Then, the scaffolds were placed under the skin of nude mice to verify their osteogenic effects in vivo. Finally, the scaffolds were used for the reconstruction of bone defects after operations for benign bone tumors in a patient’s lower limb. The healing status of the defect site at 1 and 3 months was assessed by X-ray, and the Musculoskeletal Tumor Society (MSTS) score was applied to reflect the recovery of patient limb function.

Results

The system effectively enriched stem cells without affecting the activity and osteogenic abilities of the bone marrow mesenchymal stem cells (BMSCs). Meanwhile, the bioactive scaffolds obtained better osteogenic effects. In patients, the active scaffolds showed better bone integration and healing status, and the patients also obtained higher MSTS scores at 1 and 3 months after surgery.

Conclusion

As a new technique, the rapid screening–enrichment–composite technology of stem cells demonstrates a better therapeutic effect in the reconstruction of bone defects after surgery for benign bone tumors of the lower extremities, which will further improve patient prognosis.
Long non‐coding RNA NEAT1 transported by extracellular vesicles contributes to breast cancer development by sponging microRNA-141-3p and regulating KLF12
Authors: Zhou DaoPing , Gu Juan , Wang YuePing , Wu HuaiGuo , Cheng Wei , Wang QingPing , Zheng GuoPei , Wang XueDong
Published: April 2021

Objective

Breast cancer (BC) remains a public-health issue on a global scale. Long non-coding RNAs (lncRNAs) play functional roles in BC. This study focuses on effects of NEAT1 on BC cell invasion, migration and chemotherapy resistance via microRNA (miR)-141-3p and KLF12.

Methods

After extraction and identification of serum extracellular vesicles (EVs), NEAT1 expression in EVs was detected and its association with clinical characteristics of BC patients was analyzed. Besides, the gain-of function was performed to investigate the roles of NEAT1 and miR-141-3p in BC, and levels of NEAT1, miR-141-3p, KLF12 and MDR1 after EV treatment were detected by RT-qPCR and Western blot analysis. Furthermore, the in vitro findings were confirmed via lung metastases in nude mice.

Results

NEAT1 expression in serum EVs was high and related to lymph node metastasis, progesterone receptor, estrogen receptor and Ki-67 in BC patients. After EV treatment, NEAT1 and KLF12 levels were increased, miR-141-3p expression was decreased, the abilities of proliferation, invasion, migration and in vivo metastasis were enhanced, and the sensitivity of cells to cisplatin, paclitaxel and 5-fluorouracil was decreased. After NEAT1 interference, NEAT1 and KLF12 levels in BC cells treated with EVs were decreased, miR-141-3p expression was increased, cell proliferation, invasion, migration and in vivo metastasis were decreased, and drug resistance sensitivity was increased. NEAT1 can bind to miR-141-3p and upregulates KLF12 expression.

Conclusions

EVs inhibit the regulation of KLF12 by miR-141-3p by transporting NEAT1 to BC cells, thus promoting BC cell invasion, migration, and chemotherapy resistance.
Successful incorporation of single reviewer assessments during systematic review screening: development and validation of sensitivity and work-saved of an algorithm that considers exclusion criteria and count
Authors: Nama Nassr , Hennawy Mirna , Barrowman Nick , O’Hearn Katie , Sampson Margaret , McNally James Dayre
Published: April 2021

Background

Accepted systematic review (SR) methodology requires citation screening by two reviewers to maximise retrieval of eligible studies. We hypothesized that records could be excluded by a single reviewer without loss of sensitivity in two conditions; the record was ineligible for multiple reasons, or the record was ineligible for one or more specific reasons that could be reliably assessed.

Methods

Twenty-four SRs performed at CHEO, a pediatric health care and research centre in Ottawa, Canada, were divided into derivation and validation sets. Exclusion criteria during abstract screening were sorted into 11 specific categories, with loss in sensitivity determined by individual category and by number of exclusion criteria endorsed. Five single reviewer algorithms that combined individual categories and multiple exclusion criteria were then tested on the derivation and validation sets, with success defined a priori as less than 5% loss of sensitivity.

Results

The 24 SRs included 930 eligible and 27390 ineligible citations. The reviews were mostly focused on pediatrics (70.8%, N=17/24), but covered various specialties. Using a single reviewer to exclude any citation led to an average loss of sensitivity of 8.6% (95%CI, 6.0–12.1%). Excluding citations with ≥2 exclusion criteria led to 1.2% average loss of sensitivity (95%CI, 0.5–3.1%). Five specific exclusion criteria performed with perfect sensitivity: conference abstract, ineligible age group, case report/series, not human research, and review article. In the derivation set, the five algorithms achieved a loss of sensitivity ranging from 0.0 to 1.9% and work-saved ranging from 14.8 to 39.1%. In the validation set, the loss of sensitivity for all 5 algorithms remained below 2.6%, with work-saved between 10.5% and 48.2%.

Conclusions

Findings suggest that targeted application of single-reviewer screening, considering both type and number of exclusion criteria, could retain sensitivity and significantly decrease workload. Further research is required to investigate the potential for combining this approach with crowdsourcing or machine learning methodologies.
Simultaneous determination of 13 mycotoxins in feedstuffs using QuEChERS extraction
Authors: Jo Hyeong-Wook , Park Min-Kyu , Heo Hyo-min , Jeon Hwang-Ju , Choi Sung-Deuk , Lee Sung-Eun , Moon Joon-Kwan
Published: April 2021

Mycotoxins are secondary metabolites produced by various fungi and are known to have a significant negative impact on human and animal health. When feedstuffs are contaminated with mycotoxins, their toxicities may be caused a variety of diseases. In this study, the residual mycotoxins in feedstuffs were analyzed using LC–MS/MS incorporated with QuEChERS extraction. Analytical method validation was performed for LOD, LOQ, linearity, and recoveries with consideration of matrix effects prior to the residual analysis. They were all reached to the accepted range of validation level. Using 39 feedstuff samples (5 g) for mycotoxin analysis, nine samples were contaminated by four major mycotoxins such as fumonisin B1 (FB1), deoxynivalenol, fumonisin B2, and zearalenone. Among them, FB1 was detected at the highest concentration as 18.0943 mg/kg. The total sum of fumonisins in 39 samples did not exceed the maximum residual level (MRL) criterion set by Korean Food and Drug Administration. Altogether, intensive management of mycotoxins in Korean feedstuffs should be implemented with proper and routine monitoring, even their residual concentrations are not exceeded over the MRL levels because of high frequent detection found in this study.
Single tooth restoration in the maxillary esthetic zone using a one-piece ceramic implant with 1 year of follow-up: case series
Authors: Vilor-Fernández Miren , García-De-La-Fuente Ana-María , Marichalar-Mendia Xabier , Estefanía-Fresco Ruth , Aguirre-Zorzano Luis-Antonio
Published: April 2021

Background

Oral implants have helped clinicians to improve the quality of life for many patients. The material of choice for dental implants currently remains titanium type IV, whose mechanical and biological properties have been proven throughout the history of implantology. Yet, this material is not exempt from complications. For these reasons, ceramic alternatives to titanium have emerged. Thus, the purpose of this study is to evaluate peri-implant hard and soft tissue stability with the use of a one-piece ceramic implant (Straumann® PURE Ceramic Implant) during 1 year of follow-up.

Study design

One-piece all-ceramic zirconia (ZrO2) implants were placed to replace single missing teeth in the esthetic zone. Six to 8 weeks after the procedure, the definitive prosthesis was fabricated. At the time of prosthesis, placement (T0) photographs and periapical radiographs were taken, and the following clinical parameters were recorded: probing depth (PD), plaque index (PI), bleeding on probing (BOP), suppuration on probing (SOP), distance from gingival margin to incisal edge (GM-IE), and Jemt papilla index (JPI). Follow-up appointments were scheduled at 4 (T4), 8 (T8), and 12 (T12) months, when the same parameters were recorded. In addition, plaque control was reinforced and prophylaxis was carried out. In this last appointment, a final periapical radiograph was taken to assess marginal bone loss.

Results

A total of 32 zirconia implants were placed in 28 patients (16 women and 12 men, aged between 34 and 67 years). The survival and success rate were 93.75%. The increase in probing depth from baseline to 12 months was 0.78 mm. Assessments of plaque index and bleeding on probing showed a slight increase throughout the study.

Conclusions

The results obtained with the Straumann® PURE Ceramic implants show them to exhibit very good clinical behavior. The survival rate of the implants of our pilot study was 93.75%. For these reasons, we can say that zirconia implants could be an alternative to titanium implants in the esthetic zone.
Skin temperature changes after ultrasound-guided supra-inguinal fascia iliaca block: a prospective observational study
Authors: Yoshimura Manabu , Shiramoto Hiroko , Koga Mami , Yoshimatsu Aya , Morimoto Yasuhiro
Published: April 2021

Purpose

Ultrasound-guided supra-inguinal fascia iliaca block (SFIB) is widely used as regional anesthesia of the hip and thigh. It is difficult to judge the blocking effect and the spreading local anesthesia. We hypothesize that the effect and spread of the block could be proven objectively by a rise in the temperature. In this prospective observational study, the broad regional rise in skin temperature of twenty patients who were scheduled for hip surgery was measured using an infrared thermographic camera at multiple intervals following ultrasound-guided SFIB.

Methods

Infrared thermographic imaging of skin temperature at the femoral, obturator, and lateral femoral cutaneous nerve sites was performed before and at 5-min intervals after ultrasound-guided SFIB for up to 15-min post-injection. The primary outcomes are skin surface temperature. Sensory block was assessed immediately after the final infrared thermographic image acquisition using the cold test.

Results

Compared to pre-injection baseline, temperature increased by 1.2 °C [95% confidence interval (CI) 0.4–2.0 °C] after 5 min, 1.2 °C (95% CI 0.4–2.0 °C) after 10 min, and 0.9 °C (95% CI 0.4–2.1°C) after 15 min. The cold test response was reduced in all cases at the femoral and lateral femoral cutaneous nerve sites and in 13 cases at the obturator nerve site. The sensitivity and specificity of the temperature increase to cold loss were 96% and 63%, respectively when we defined >0°C as the clinical threshold.

Conclusions

Successful SFIB significantly enhanced skin temperature at the hip and thigh in all cases, suggesting that infrared surface thermography can be used as an objective assessment tool for adequate analgesia.

Trial registration

University Hospital Medical Information Network Clinical Trials Registry (UMIN 000037866). Registered 31 August 2019.
Stress and psychological impact of the COVID-19 outbreak on the healthcare staff at the fever clinic of a tertiary general hospital in Beijing: a cross-sectional study
Authors: Hong Xia , Cao Jinya , Wei Jing , Duan Yanping , Zhao Xiaohui , Jiang Jing , Jiang Yinan , Geng Wenqi , Zhu Huadong
Published: April 2021

Background

It is important to maintain the psychological well-being of front-line healthcare staff during the coronavirus disease 2019 (COVID-19) pandemic.

Aims

To examine COVID-19-related stress and its immediate psychological impact on healthcare staff.

Method

All healthcare staff working in the fever clinic, from 20 January 2020 to 26 March 2020, of a tertiary general hospital were enrolled. Stress management procedures were in place to alleviate concerns about the respondents’ own health and the health of their families, to help them adjust their work and to provide psychological support via a hotline. Qualitative interviews were undertaken and the Sources of Distress and the Impact of Event Scale-Revised (IES-R) were administered.

Results

Among the 102 participants (25 males; median age 30 years, interquartile range (IQR) = 27–36), the median IES-R total score was 3 (IQR = 0–8), and 6 participants (6.0%) scored above the cut-off on the IES-R (≥20). Safety and security were acceptable or better for 92 (90.2%) participants. The top four sources of distress were worry about the health of one's family/others at 0.88 (IQR = 0.25–1.25), worry about the virus spread at 0.50 (IQR = 0.00–1.00), worry about changes in work at 0.50 (IQR = 0.00–1.00) and worry about one's own health at 0.25 (IQR = 0.25–0.75). There was a moderate correlation between the IES-R score and the Sources of Distress score (rho = 0.501, P = 0.001).

Conclusions

The stress levels of healthcare staff in the fever clinic during the COVID-19 epidemic were not elevated. Physio-psychosocial interventions, including fulfilment of basic needs, activation of self-efficacy and psychological support, are helpful and worth recommending in fighting COVID-19.
Oppositional Identity and Back-Vowel Fronting in a Triethnic Context: The Case of Lumbee English
Authors: Bissell Marie , Wolfram Walt
Published: April 2021

This study considers the dynamic trajectory of fronting of the back vowels boot and boat for 27 speakers in a unique, longstanding context of a substantive, triethnic contact situation involving American Indians, European Americans, and African Americans over three disparate generations in Robeson County, North Carolina. The results indicate that the earlier status of Lumbee English fronting united them with the African American vowel system, particularly for the boot vowel, but that more recent generations have shifted toward alignment with European American speakers. Given that the biracial Southeastern United States historically identified Lumbee Indians as “free persons of color” and the persistent skepticism about the Lumbee Indians as merely a mixed group of European Americans and African Americans, the movement away from the African American pattern toward the European American pattern was interpreted as a case of oppositional identity in which Lumbee Indians disassociate themselves from African American vowel norms in subtle but socially meaningful ways.