bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic cerebral hypoperfusion and blood-brain barrier disruption in uninjured brain areas of rhesus monkeys subjected to transient ischemic stroke
Authors: Zhang Yingqian , Zhao Bangcheng , Lai Qi , Li Qinxi , Tang Xun , Zhang Yinbing , Pan Zhixiang , Gao Qiang , Zhong Zhihui
Published: February 2022

Blood-brain barrier (BBB) disruption is a pivotal pathophysiological process in ischemic stroke. Although temporal changes in BBB permeability during the acute phase have been widely studied, little is known about the chronic phase of cerebrovascular changes that may have a large impact on the long-term outcome. Therefore, this study was aimed to measure cerebral vascular abnormalities using CT perfusion in nine rhesus monkeys subjected to transient middle cerebral artery occlusion (tMCAO) for ≥1 year (MCAO-1Y+). The level of cerebral perfusion demonstrated by mean transit time was significantly higher in the ipsilateral caudate nucleus, white matter, thalamus, hippocampus, and contralateral thalamus in MCAO-1Y+ compared with the other nine age-matched control monkeys. The increase in BBB permeability measured through the permeability surface was found in the same ten regions of interest ipsilaterally and contralaterally. We also found decreased levels of Aβ 42/40 ratio in the cerebrospinal fluid (CSF), suggesting a potential link between post-MCAO cognitive decline and Aβ metabolism. Overall, we demonstrated significant cerebral hypoperfusion, BBB disruption, and CSF Aβ decrease during the rehabilitation stage of ischemic stroke in a non-human primate model. Future studies are needed to elucidate the cause-effect relationship between cerebrovascular disruptions and long-term neurological deficits.
Neuropsychological implication in possible antibody-negative limbic encephalitis: a clinical case report
Authors: Lo Buono Viviana , Bonanno Lilla , Palmeri Rosanna , Cammaroto Simona , Morabito Rosa , De Cola Maria Cristina , Sessa Edoardo , Marino Silvia , Bramanti Placido , Corallo Francesco
Published: February 2022

Autoimmune limbic encephalitis is an antibody-mediated brain inflammatory process, which typically involves the medial temporal lobe. Diagnosis requires the presence of antineuronal antibodies, but sometimes patients present clinical features of limbic encephalitis despite negative serology. Thus, the diagnosis of antibody-negative limbic encephalitis is difficult to make, and it must often rely largely on exclusion of other causes. This current case report describes a 28-year-old male that presented 2 months after the acute event with radiological changes typical of limbic encephalitis, but with no identifiable antibody and neuropsychological impairment. Antibody responses to neurotropic viruses and antibody-mediated encephalitis were negative in serum and cerebrospinal fluid. Magnetic resonance imaging showed signs of hyperintensity in the hippocampus bilaterally, amygdala and left pulvinar. The neuropsychological evaluation showed a deficit in emotional face recognition and severe autobiographical amnesia. Bilateral damage to the medial temporal lobe and hippocampus, including the amygdala, is associated with alterations in autobiographical memories. The neuropsychological impairment documented in this current case expands the range of clinical features of antibody-negative encephalitis and provides evidence that the memory deficit in this disorder is more extensive than was previously recognized.
Application of Sieve Analysis to Estimate Recycled Binder Availability
Authors: Pape Sonja , Castorena Cassie
Published: February 2022

One of the challenges of engineering asphalt mixtures containing reclaimed asphalt pavement (RAP) is uncertainty in the proportion of the total recycled asphalt binder that is available to interact and blend with the virgin asphalt, referred to as the recycled binder availability. The industry presently lacks a practical method to quantify RAP binder availability. Research has shown that the primary source of unavailable recycled binder is agglomerations of adhered RAP particles. The binder bound within the agglomerations is unavailable to contact and therefore blend with virgin asphalt. Building on this knowledge, this study establishes a practical method to quantify the extent of RAP agglomeration and, in turn, RAP binder availability by comparing the gradation of recovered RAP aggregates with that of the RAP itself. A size-exclusion method and corresponding predictive equation to estimate RAP binder availability from the high-temperature performance grade of recovered RAP binder and mixing temperature were also assessed. Four RAP sources were evaluated. Each RAP stockpile was paired with virgin aggregates from the same plant that the RAP was sourced at to produce eight mixtures. Tracer-based microscopy measurements within the eight mixtures were generally in good agreement with the estimations of recycled binder availability using sieve analysis. Implementing the size-exclusion method was challenging with local aggregate, and estimates using the predictive equation yielded in some cases good but overall poorer agreement with the measurements of recycled binder availability from tracer-based microscopy compared with the sieve analysis approach.
‘Going her Own Road’: The Tortured Path to Economic Independence in Late Colonial New South Wales
Authors: Lorrison Marian
Published: February 2022

Feminist historians have long recognised the symbiotic relationship between personal autonomy and a woman's capacity to earn her own living. This paper draws on legal and press documentation to examine how one woman navigated the difficult path of wage-earning during the 1890s. It argues that Catherine Kirchner saw herself as an autonomous economic entity and conducted herself with equal autonomy within her marriage and an extra-marital love affair. The paper concludes that despite the rhetoric of increasing emancipation and opportunity for women in 1890s New South Wales, the path to economic autonomy remained a difficult one to traverse.
Factors Associated with Screening Positive for Depression among Women Caregivers of Primary Palliative Care Patients in Kerala, India
Authors: Kochuvilayil Arsha , Varma Ravi Prasad
Published: February 2022

Background: The study encompasses findings from a prospective quantitative screening of women family caregivers for depression as part of a larger mixed methods study designed to develop and validate a caregiver burden inventory for the home-based palliative care programme in Kerala, India. Aim: We assessed the proportion of women caregivers screening positive for depression and explored the associated factors. Methods: The Primary care Screening Questionnaire for Depression (PSQ4D) was used to screen participants for depression. Other variables analysed were caregiver and patient related factors, stresses, strains, support received, caregiver burden and quality of life domain variables as per the EuroQol EQ-5D-5L instrument. Results: Forty women (20.0%, 95% Confidence Intervals [CI] 14.46% – 25.54%) screened positive for depression on the PSQ4D. This was more likely if the care recipient was the spouse, if the care recipient had cancer, if the caregiver perceived a moderate or high physical/psychological burden, or a high financial burden. Pain/ discomfort when included had an adjusted odds ratio (AOR) of 8.2 (95% CI 2.6–26.0) and tended to decrease the AOR of all other significantly associated variables, except cancer diagnosis in the care recipient. Conclusion: Depression levels among women caregivers in primary palliative care settings in Kerala seem comparable to prevalence levels among women in the general population. Those caregivers reporting pain/ discomfort should be screened for depression using simple locally validated measures. Depression is associated with higher caregiver burden and poorer quality of life. Screening and treatment of depression may help mitigate these situations.
The Goals of Medicine and Compassion in the Ethical Assessment of Euthanasia and Physician-Assisted Suicide: Relieving Pain and Suffering by Protecting, Promoting, and Maintaining the Person’s Well-Being
Authors: Avci Ercan
Published: February 2022

Arguments regarding the goals of medicine in end-of-life occupy a prominent place in the debate on life-ending medical interventions. The discussions in favor of euthanasia and physician-assisted suicide focus on relieving patients’ intractable pain and suffering to justify the physician's active engagement in killing. Furthermore, the arguments that claim the existence of intractable suffering vindicates euthanasia and physician-assisted suicide are predicated upon compassion in the first instance. The present article concisely studies the goals of medicine and compassion to evaluate their utilization in the ethical justification of life-ending interventions to draw normative conclusions on that basis. The article concludes that relieving a person's unbearable pain and suffering is a crucial goal of medicine, but this goal should be accomplished through morally acceptable means, not euthanasia or physician-assisted suicide. Medicine intends to protect, promote, and maintain the person's physical and psychological wellbeing. Considering euthanasia or physician-assisted suicide an appropriate means to achieve these goals may dramatically impair the therapeutic relationship for patients who regard the physician as a healer. In respect of compassion, the article deduces that even though playing an important role in the patient-physician relationship, compassion does not produce an objective, reliable, and applicable standard to appraise the ethical assessment of euthanasia and physician-assisted suicide because compassion derives from feelings that vary from person to person according to their social, cultural, religious, or political stances and values. The article proposes interpreting the goals of medicine and the concept of compassion in line with giving suffering people adequate and appropriate medical, palliative, spiritual, and emotional care in light of the dedication of medicine to people's health and welfare and the requirement of compassion to help suffering individuals in a constructive course of action.
What can we Learn from Patients who Died from Covid-19 Following Escalation to a Respiratory High Dependency Unit for Trial of Non-Invasive Respiratory Support?
Authors: Evans S. , Elder P. , Shoulder R. , Sundaralingam A. , Kewalramani N. , Porter B. , Flight W. , Hardinge M. , Rahman N.M. , Miller M.
Published: February 2022

Background: Covid-19 infection is associated with significant risk of death, particularly in older, comorbid patients. Emerging evidence supports use of non-invasive respiratory support (CPAP and high-flow nasal oxygen [HFNO]) in this context, but little is known about its use in patients receiving end-of-life care. Methods: This was a retrospective study of 33 patients who died of Covid-19 on the Respiratory High Dependency Unit at the John Radcliffe Hospital, Oxford between 28/03/20 and 20/05/20. Data was sourced via retrospective review of electronic patient records and drug charts. Results: Patients dying from Covid-19 on the Respiratory HDU were comorbid with median Charlson Comorbidity Index 5 (IQR 4-6); median age 78 (IQR 72-85). Respiratory support was trialled in all but one case with CPAP being the most common form of first line respiratory support (84.8%) however, was only tolerated in 44.8% of patients. Median time to death was 10.7 days from symptom onset (IQR 7.5-14.6) and 4.9 days from hospital admission (IQR 3.1-8.3). 48.5% of patients remained on respiratory support at the time of death. Conclusions: End-of-life care for patients with Covid-19 remains a challenge. Patients tend to be frail and comorbid with a rapid disease trajectory. Non-Invasive Respiratory Support may play a key role in symptom management in select patients, however, further work is needed in order to identify patients who will most benefit from Respiratory Support and those for whom withdrawal may prevent unnecessary distress at the end of life or potential prolongation of suffering.
Locked in Glass Classrooms: Black Male Special Education Teachers Socialized as Everything But Educators
Authors: Cormier Christopher J. , Scott LaRon A. , Powell Christine , Hall Kendra
Published: February 2022

This qualitative study of 10 Black men who teach special education found that they experience their socialization into the profession by school leaders and other system-level influencers as both challenging and conflicting. Although past research demonstrates that Black men who teach special education face pressure to engage in noninstructional roles, especially as disciplinarians and sports coaches, the impact on their school work experiences has not been examined. Study findings show that participants experience a conflict in role that creates a “glass classroom” distinct from the glass ceiling and the glass escalator. The barriers of the glass classroom make school experiences difficult because others do not see Black male teachers’ potential for other meaningful school-based assignments. Thus, their opportunities are constrained. The study uses Wingfield and Chavez’s racial inequity and occupational outcomes and role socialization theory as conceptual frameworks. Implications for practice and research are provided.
Black Special Education Teacher Educators’ Practice of Resistance
Authors: Drame Elizabeth R. , Pierce Nigel P. , Cairo Halle
Published: February 2022

Many special education teacher preparation programs emphasize equity and social justice when preparing future educators who are well equipped to address racial disparities in education. Black special education teacher educators have an impactful role to play in the visioning of racially equitable teacher preparation programs, despite often being one of only a few in their departments, colleges, and institutions. The challenge, however, for these educators is navigating the pernicious, insidious, and deeply rooted barriers associated with Whiteness within predominantly White institutions. Using a DisCrit lens and Whiteness theories, the authors explored how Black teacher educators in special education experienced and disrupted the existence of Whiteness through qualitative interviews with individuals across the United States. These teacher educators presented their definition of quality special educators, as well as their recommendations for increasing racial equity in K-12 settings through preparing racial justice-focused special education teachers.
Study on pressure distribution of pump chamber and axial force in particle-laden flow of centrifugal pump
Authors: Dong Wei , Liu Ze , Dong Yan , Yang Zhenbiao , Lu Qiang , Li Quanwu
Published: February 2022

To explore the pressure distribution characteristics of pump chambers, and the law governing the axial force in a particle-laden flow centrifugal pump, a semi-open impeller centrifugal pump was selected as the research object. The particle model and heterogeneous model were used to develop the numerical calculations of the particle-laden flow field within the centrifugal pump. For the liquid phase we adopted the shear–stress–transport (SST) turbulence model, while for the solid phase we adopted the discrete phase zero equation model. The external characteristics, pressure distribution and axial forces were compared and analyzed (1) for a constant solid particle diameter, d, of 0.1 mm and particle volume fractions, Cv, of 0, 1, 5, and 10%, and (2) for a constant particle volume fraction, Cv, of 10% and solid particle diameters, d, of 0, 0.01, 0.1, and 0.5 mm. The correlations between the particle volume fractions and solid particle diameters with the pump chamber pressure distributions and axial forces were obtained. The results show that when Cv increased from 1–10%, or d from 0.01–0.5 mm, the pump head and efficiency decreased continuously under the same flow rate. At the same time, larger particle volume fractions resulted in larger pressures at the same radius, while for larger solid particle diameters, smaller pressures were obtained at the same radius. Under the same flow rate, when Cv increased from 1–10%, the total axial force of the centrifugal pump increased, but it was smaller than what was achieved under the clean-water condition. When d increased from 0.01 to 0.5 mm, the total axial force of the centrifugal pump decreased. This study provides a reference for the calculation and balance of the total axial force in a particle-laden flow centrifugal pump.
Cogitating the role of Technological Innovation and Institutional Quality in Formulating the Sustainable Development Goal Policies for E7 Countries: Evidence from Quantile Regression
Authors: Anwar Ahsan , Malik Summaira , Ahmad Paiman
Published: February 2022

After the approval of the Sustainable Development Goals (SDGs) by the United Nations, all the countries have tried to achieve these goals. But unfortunately, the emerging economies are still far away from this ideal track. Because, mostly, the prime focus of emerging economies is just to increase the economic growth, while ignoring its environment-related negative externalities. Following this, the present study highlights the importance of designing the SDG framework for seven emerging (E7) economies, which can be used as a benchmark for other developing and emerging economies. For this purpose, this study uses quantile regression to scrutinize the heterogeneous impact of technological innovation, institutional quality, per capita income, trade openness and population on CO2 emission by using the data of E7 countries from 1996 to 2018. The empirical outcomes confirm that technological innovation and institutional quality have performed a major role in reducing CO2 emissions. Results also reveal that the current patterns of economic growth in E7 countries are environmentally unsustainable. Based on the results, this study suggests a comprehensive policy framework for attaining SDG 8, SDG 9, SDG 16 and SDG13.
A machine learning-based model for real-time leak pinpointing in buildings using accelerometers
Authors: El-Zahab Samer , Al-Sakkaf Abobakr , Mohammed Abdelkader Eslam , Zayed Tarek
Published: February 2022

Modern water networks from municipal network to building networks are plagued with the threat of leaks. Leaks create a significant amount of loss of resources. Pressurized water pipelines are more susceptible due to the high pressure at which water travels. Multiple researchers have tried to utilize a variety of static (devices that are left in the network) and dynamic (devices that are mobilized to the suspected location) leak detection techniques to ensure the early detection and pinpointing of leaks in water transportation networks. The main goal is to provide quick and efficient tools that can identify and pinpoint leaks in buildings while being cost-effective. This article proposes a small-scale experimental static real-time monitoring system that can identify leaks and their location with high accuracy by measuring vibration signals via wireless accelerometers. The experiment utilizes one-inch and two-inch Polyvinyl Chloride (PVC) and iron pipelines, which are commonly used in residential buildings. Since the proposed system is static, the wireless accelerometers are placed on the exterior walls of the pipelines. The vibration signals, derived from each accelerometer, were calculated and analyzed. A leak is identified when a spike in the signal is detected. Once a leak was identified, the model would move to determine the source of the signal, that is, the leak location. The developed models proved to be capable of accurately pinpointing leaks within an accuracy of 25 cm. The main techniques that were used in model development were regression analysis and backpropagation of artificial neural networks models.
The Place of Convergent Audiences in the Small Industry Market
Authors: Jansová Iveta , Elavsky Charles Michael
Published: February 2022

In this day and age, it is increasingly important to ask how the cultural industries adapt to the evolution of communication technology. Recent technological changes influencing our understanding of media communication processes are discussed in various fields, with western traditions often predominating. However, the particular impact on industry dynamics is hardly universal. Specifically, the way such changes influence the dynamics of small, distinct peripheral markets remains largely underexamined. To this end, this manuscript focuses on such questions as they relate to the specificities of Central and Eastern Europe and the Czech Republic, a particularly small industry with distinct cultural proclivities. In ascertaining how media representatives/workers comprehend and engage their audiences, this paper presents a fuller understanding of the microsocial processes by which Czech media audiences are framed and conceptualized within Czech media industries and offers insights into the rationales directing the Czech media industry itself, particularly in relation to mediating the dialectic of local dynamics, international competition, and the evolution of digitalization.
“Business Inquiries are Welcome”: Sex Influencers and the Platformization of Non-normative Media on Twitter
Authors: Wang Shuaishuai , Ding Runze
Published: February 2022

By attending to the case of queer men’s sexual use of Twitter in China, this article analyzes how mainstream platforms provide underrepresented groups with unique opportunities in the erotic economy. Drawing on in-depth interviews with fourteen queer male “sex influencers”—people who capitalize on their erotic practices on Twitter and other platforms for economic and social perks—and a three-month digital ethnography, we probe how Twitter shapes sex media production in China and opens up multifarious modes of monetization. We suggest that Chinese queer sex influencers’ monetization practices not only construct vibrant sexual cultures, but also incentivize heightened cross-platform mobility, which serves as a strategy for coping with China’s precarious legal environment. Consequently, there has been a convergence of domestic and transnational platforms, which we argue showcases the vitality and creativity of Chinese non-normative media production and consumption in a globalized and platformized age.
Comparison of Two Illumina Whole Transcriptome RNA Sequencing Library Preparation Methods Using Human Cancer FFPE Specimens
Authors: Wang Danyi , Rolfe P. Alexander , Foernzler Dorothee , O’Rourke Dennis , Zhao Sheng , Scheuenpflug Juergen , Feng Zheng
Published: February 2022

Objective: RNA extraction and library preparation from formalin-fixed, paraffin-embedded (FFPE) samples are crucial pre-analytical steps towards achieving optimal downstream RNA sequencing (RNASeq) results. In this study, we assessed 2 Illumina library preparation methods for RNA-Seq analysis using archived FFPE samples from human cancer indications at 2 independent vendors. Methods: Twenty-five FFPE samples from 5 indications (non-small cell lung cancer, colorectal cancer, renal carcinoma, breast cancer, and hepatocellular carcinoma) were included, covering a wide range of sample storage durations (3-25 years-old), sample qualities, and specimen types (resection vs core needle biopsy). Each sample was processed independently by both vendors. Total RNA was isolated using the Qiagen miRNeasy FFPE kit followed by library construction using either TruSeq Stranded Total RNA library preparation kit with Ribo-Zero Gold, or TruSeq RNA Access library preparation kit. Libraries were normalized to 20 pM and sequenced on an Illumina HiSeq 2500 using V3 chemistry in paired-end mode with a read length of 2 × 50 bp. The data were processed through a standard RNASeq pipeline to produce counts and transcripts per millions for each gene in each sample to compare 2 library kits at 2 different vendors. Results: Our data showed that TruSeq RNA Access libraries yield over 80% exonic reads across different quality samples, indicating higher selectivity of the exome pull down by the capture approach compared to the random priming of the TruSeq Stranded Total kit. The overall QC data for FFPE RNA extraction, library preparation, and sequencing generated by the 2 vendors are comparable, and downstream gene expression quantification results show high concordance as well. With the TruSeq Stranded Total kit, the mean Spearman correlation between vendors was 0.87 and the mean Pearson correlation was 0.76. With the TruSeq RNA Access kit, the mean Spearman correlation between vendors was 0.89 and the mean Pearson correlation was 0.73. Interestingly, examination of the cross-vendor correlations compared to various common QC statistics suggested that library concentration is better correlated with consistency between vendors than is the RNA quantity. Conclusions: Our analyses provide evidence to guide selection of sequencing methods for FFPE samples in which the sample quality may be severely compromised.
Ratio of CA19-9 Level to Total Tumor Volume as a Prognostic Predictor of Pancreatic Carcinoma After Curative Resection
Authors: Xu Junming , Lyu Shaocheng , Zhao Yang , Zhang Xinxue , Liu Zhe , Zhao Xin , He Qiang
Published: February 2022

Background: Pancreatic ductal adenocarcinoma (PDAC) is known to have a poor prognosis, early local invasion, and distant metastasis. Surgical resection is the most effective treatment, and tumor recurrence can be the key factor affecting the surgical outcome. Serum carbohydrate antigen 19-9 (CA19-9) is a tumor marker with high sensitivity to pancreatic cancer; elevated CA19-9 levels often indicate poor biological behavior. Tumor size is also a crucial factor that affects the prognosis. Therefore, we developed a program to evaluate the effect of the ratio of CA19-9 to total tumor volume (CA19-9/TTV) as a prognostic marker on tumor recurrence and long-term survival in patients with PDAC following pancreaticoduodenectomy (PD). Methods: Data from 200 patients who underwent PD for PDAC were retrospectively analyzed. CA19-9/TTV was calculated according to preoperative CA19-9 and TTV, and patients were divided into two groups according to the optimal cut-off value. Univariate and multivariate analyses were performed on the clinicopathological data to screen the risk factors affecting postoperative recurrence and long-term prognosis of patients with PDAC undergoing PD. Results: The receiver operating characteristic curve showed that the best cut-off value was 5.62 (area under curve [AUC], 0.633; 95% CI: 0.548-0.718). Multivariate analysis showed that tumor differentiation and CA19-9/TTV were independent risk factors for the long-term prognosis of PDAC ( P = 0.004, P = 0.007), as well as for tumor recurrence ( P = 0.008, P = 0.008). Conclusion: CA19-9/TTV is an independent risk factor for the prognosis of PDAC and may be a new marker for lower survival benefits.
Effectiveness of golimumab in patients with ulcerative colitis: results of a real-life study in Switzerland
Authors: Perrig Kathrin , Krupka Niklas , Jordi Sebastian Bruno Ulrich , Rossel Jean-Benoît , Biedermann Luc , Greuter Thomas , Schreiner Philipp , Vavricka Stephan R. , Juillerat Pascal , Burri Emanuel , Zimmermann Dorothee , Maillard Michel H. , Sulz Michael Christian , Brand Stephan , Rogler Gerhard , Misselwitz Benjamin
Published: February 2022

Background:

Tumor necrosis factor (TNF) inhibitors have improved treatment of ulcerative colitis (UC), but loss of response remains a frequent problem. The anti-TNF agent, golimumab, was approved in Switzerland for the treatment of UC in 2014. This study aims to summarize the experience of golimumab in a real-world setting in Switzerland.

Methods:

We analyzed real-world data from 1769 UC patients from the Swiss Inflammatory Bowel Disease Cohort (SIBDC) study and performed a chart review of golimumab-treated patients. We extracted the partial Mayo score at t0 (baseline), t1 (2–16 weeks), t2 (17–35 weeks), and t3 (36–89 weeks). The primary endpoint was clinical response at t1, defined as marked improvement in partial Mayo score and objective parameters. Clinical remission was defined as resolution of symptoms and normalization of objective parameters.

Results:

Our chart review included 103 UC patients with golimumab treatment (5.8% of all SIBDC UC patients); only 16 (15.5%) were anti-TNF naïve. Sixty-three patients remained on golimumab (61.2%) after 180 days, 51 (44.7%) after 365 days, and 34 (33%) after 630 days after the start of treatment. Upon golimumab treatment, the partial Mayo score decreased from 4 [interquartile range (IQR): 2–6] at t0 to 2 (IQR: 0–4) at t1, 1 (IQR: 0–3.5) at t2, and 1 (IQR: 0–3) at t3 ( p < 0.001 for all comparisons with t0). The primary endpoint, clinical response at t1, could be evaluated in 52 patients and was met in 15 individuals (28.8%). Clinical remission at t1 was observed in 8 out of 52 patients (15.4%). Golimumab was generally well tolerated, one patient developed meningitis. The most frequent reasons to stop treatment were primary and secondary non-response.

Conclusion:

Golimumab was used in 5.8% of Swiss UC patients, mainly in biologic-experienced individuals. Golimumab treatment was associated with a sustained reduction of symptoms and clinical response in approximately 30% of patients. [ClinicalTrials.gov identifier: NCT00488631]
Estimation of fracture risk by the FRAX tool in patients with systemic lupus erythematosus: a 10-year longitudinal validation study
Authors: Mok Chi Chiu , Tse Sau Mei , Chan Kar Li , Ho Ling Yin
Published: February 2022

Background:

The fracture risk assessment tool has been widely used to stratify the 10-year fracture risk to guide therapy. Using the actual fracture data of a 10-year longitudinal cohort of older patients with systemic lupus erythematosus, we reported an underestimation of the tool in predicting major symptomatic osteoporotic fractures. Treatment of osteoporosis in systemic lupus erythematosus should not be based on fracture risk estimation alone. Relevant time-dependent risk factors should be taken into account for an individualized decision.

Objective:

To compare the observed fracture incidence in a 10-year longitudinal cohort of patients with systemic lupus erythematosus (SLE) with the fracture risk prediction from the fracture risk assessment (FRAX) tool.

Methods:

Adult patients (⩾40 years) with SLE who had a first DEXA scan performed in 2005–2009 were studied. The 10-year rates of major osteoporotic and hip fractures were estimated by FRAX using clinical data at DEXA with adjustment for prednisolone dosage. The actual incidence of clinical fractures at 10 years was compared with the estimated rates. Factors associated with new fractures were studied by logistic regression.

Results:

A total of 229 SLE patients were studied (age: 50.2 ± 6.6 years, 93% women). Glucocorticoid was used in 148 (65%) patients at baseline (mean dose: 7.3 ± 6.9 mg/day; 34% ⩾ 7.5 mg/day). Osteoporosis (bone mineral density T score ⩽ –2.5) at the hip, femoral neck, or spine was present in 61 (27%) patients. The estimated 10-year risk of major osteoporotic and hip fractures by FRAX was 3.4 ± 4.5% and 0.95 ± 2.3%, respectively. After 10 years, three patients developed hip fracture, 6 patients had limb fractures and 20 patients had symptomatic vertebral fractures (major osteoporotic fracture 12.7%, hip fracture 1.3%). The actual major osteoporotic fracture rate was significantly higher than the FRAX estimation (12.7% vs 3.4%; p < 0.001). Logistic regression revealed that osteoporosis (odds ratio (OR): 4.07 [1.51–10.9]), previous fragility fracture (OR: 3.18 [1.02–9.90]), and a parental history of fracture (OR: 4.44 [1.16–17.0]) were independently associated with new clinical fractures at 10 years.

Conclusion:

The FRAX tool underestimates the major clinical fracture risk at 10 years in patients with SLE.
Determinants of stillbirth among women who gave birth at Hiwot Fana Specialized University Hospital, Eastern Ethiopia: A facility-based cross-sectional study
Authors: Mulatu Teshale , Debella Adera , Feto Tilaye , Dessie Yadeta
Published: February 2022

Introduction/objectives:

Stillbirths are an adverse birth outcome and a significant public health problem in low- and high-income countries. Ethiopia is ranked seventh among ten countries that constitute 66% of the world’s stillbirths. However, there is a dearth of evidence about stillbirths and the determinants in the country, particularly in Eastern Ethiopia. Hence, this study aimed to assess the prevalence and determinants of stillbirths among women who gave birth at Hiwot Fana Specialized University Hospital, Eastern Ethiopia.

Methods:

We conducted a hospital-based cross-sectional study among women who gave birth from October to December 2017. The study participants were selected through a systematic random sampling method. We collected the data using a pretested questionnaire through face-to-face interviews and maternal medical record reviews. The multi-variable logistic regression model was applied to identify the determinants with adjusted odds ratios at a 95% confidence interval. Statistical significance was declared at a p-value less than 0.05.

Results:

Five hundred fifty-five women were included in the study, and 6.7% ((95% confidence interval = 4.7%, 9.2%)) experienced a stillbirth. Previous history of adverse birth outcome (adjusted odds ratio = 9.55; 95% confidence interval = (4.37, 20.85), p = 0.003), multiple pregnancies (adjusted odds ratio = 7.04; 95% confidence interval = (2.12, 23.40), p = 0.000), and spontaneous vaginal delivery (adjusted odds ratio = 0.17; 95% confidence interval = (0.05, 0.51), p = 0.002) were the identified determinants of stillbirth.

Conclusion:

The prevalence of stillbirth in this study was similar to previous reports in the country. Early detection and treatment of complications among mothers with multiple pregnancies and prior history of adverse outcomes are vital to alleviate the problem.
Development and comparison of 1-year survival models in patients with primary bone sarcomas: External validation of a Bayesian belief network model and creation and external validation of a new gradient boosting machine model
Authors: Holm Christina E , Grazal Clare F , Raedkjaer Mathias , Baad-Hansen Thomas , Nandra Rajpal , Grimer Robert , Forsberg Jonathan A , Petersen Michael Moerk , Skovlund Soerensen Michala
Published: February 2022

Background:

Bone sarcomas often present late with advanced stage at diagnosis and an according, varying short-term survival. In 2016, Nandra et al. generated a Bayesian belief network model for 1-year survival in patients with bone sarcomas. The purpose of this study is: (1) to externally validate the prior 1-year Bayesian belief network prediction model for survival in patients with bone sarcomas and (2) to develop a gradient boosting machine model using Nandra et al.’s cohort and evaluate whether the gradient boosting machine model outperforms the Bayesian belief network model when externally validated in an independent Danish population cohort.

Material and Methods:

The training cohort comprised 3493 patients newly diagnosed with bone sarcoma from the institutional prospectively maintained database at the Royal Orthopaedic Hospital, Birmingham, UK. The validation cohort comprised 771 patients with newly diagnosed bone sarcoma included from the Danish Sarcoma Registry during January 1, 2000–June 22, 2016. We performed area under receiver operator characteristic curve analysis, Brier score and decision curve analysis to evaluate the predictive performance of the models.

Results:

External validation of the Bayesian belief network 1-year prediction model demonstrated an area under receiver operator characteristic curve of 68% (95% confidence interval, 62%-73%). Area under receiver operator characteristic curve of the gradient boosting machine model demonstrated: 75% (95% confidence interval: 70%-80%), overall model performance by the Brier score was 0.09 (95% confidence interval: 0.077–0.11) and decision curve analysis demonstrated a positive net benefit for threshold probabilities above 0.5. External validation of the developed gradient boosting machine model demonstrated an area under receiver operator characteristic curve of 63% (95% confidence interval: 57%-68%), and the Brier score was 0.14 (95% confidence interval: 0.12–0.16).

Conclusion:

External validation of the 1-year Bayesian belief network survival model yielded a poor outcome based on a Danish population cohort validation. We successfully developed a gradient boosting machine 1-year survival model. The gradient boosting machine did not outperform the Bayesian belief network model based on external validation in a Danish population-based cohort.
Ethnographic data in the age of big data: How to compare and combine
Authors: Bjerre-Nielsen Andreas , Glavind Kristoffer Lind
Published: February 2022

Big data enables researchers to closely follow the behavior of large groups of individuals by using high-frequency digital traces. However, these digital traces often lack context, and it is not always clear what is measured. In contrast, data from ethnographic fieldwork follows a limited number of individuals but can provide the context often lacking from big data. Yet, there is an under-explored potential in combining ethnographic data with big data and other digital data sources. This paper presents ways that quantitative research designs can combine big data and ethnographic data and account for the synergies that such combinations can provide. We highlight the differences and similarities between ethnographic data and big data, focusing on the three dimensions: individuals, depth of information, and time. We outline how ethnographic data can validate big data by providing a “ground truth” and complement it by giving a “thick description.” Further, we lay out ways that analysis carried out using big data could benefit from collaboration with ethnographers, and we discuss the potential within the fields of machine learning and causal inference.
The Psychological, Academic, and Economic Impact of COVID-19 on College Students in the Epicenter of the Pandemic
Authors: Reyes-Portillo Jazmin A. , Masia Warner Carrie , Kline Emily A. , Bixter Michael T. , Chu Brian C. , Miranda Regina , Nadeem Erum , Nickerson Amanda , Ortin Peralta Ana , Reigada Laura , Rizvi Shireen L. , Roy Amy K. , Shatkin Jess , Kalver Emily , Rette Danielle , Denton Ellen-ge , Jeglic Elizabeth L.
Published: February 2022

Initial research has indicated that college students have experienced numerous stressors as a result of the pandemic. The current investigation enrolled the largest and most diverse sample of college students to date ( N = 4714) from universities in New York (NY) and New Jersey (NJ), the epicenter of the North American pandemic in Spring 2020. We described the impact on the psychological, academic, and financial health of college students who were initially most affected and examined racial/ethnic group differences. Results indicated that students’ mental health was severely affected and that students of color were disproportionately affected by academic, financial, and COVID-related stressors. Worry about COVID-19 infection, stressful living conditions, lower grades, and loneliness emerged as correlates of deteriorating mental health. COVID-19’s mental health impact on college students is alarming and highlights the need for public health interventions at the university level.
Psychological Readiness to Return to Sport at 6 Months Is Higher After Bridge-Enhanced ACL Restoration Than Autograft ACL Reconstruction: Results of a Prospective Randomized Clinical Trial
Authors: Sanborn Ryan M. , Badger Gary J. ,   The BEAR Trial Team, Proffen Benedikt , Sant Nicholas , Barnett Samuel , Fleming Braden C. , Kramer Dennis E. , Micheli Lyle J. , Yen Yi-Meng , Murray Martha M. , Christino Melissa A.
Published: February 2022

Background:

Previous clinical studies have shown that psychological factors have significant effects on an athlete’s readiness to return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR).

Hypothesis:

We hypothesized that patients who underwent bridge-enhanced ACL restoration (BEAR) would have higher levels of psychological readiness to return to sport compared with patients who underwent ACLR.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

A total of 100 patients (median age, 17 years; median preoperative Marx activity score, 16) with complete midsubstance ACL injuries were randomized to either the BEAR procedure (n = 65) or autograft ACLR (n = 35 [33 hamstring and 2 bone--patellar tendon—bone]) and underwent surgery within 45 days of injury. Objective, functional, and patient-reported outcomes, including the ACL--Return to Sport after Injury (ACL-RSI) scale, were assessed at 6, 12, and 24 months postoperatively.

Results:

Patients who underwent the BEAR procedure had significantly higher ACL-RSI scores at 6 months compared with those who underwent ACLR (71.1 vs 58.2; P = .008); scores were similar at 12 and 24 months. Baseline factors independently predictive of higher ACL-RSI scores at 6 months were having a BEAR procedure and participating in level 1 sports prior to injury, explaining 15% of the variability in the scores. Regression analysis of baseline and 6-month outcomes as predictors indicated that the International Knee Documentation Committee (IKDC) score at 6 months explained 45% of the 6-month ACL-RSI variance. Subsequent analysis with IKDC excluded from the model indicated that decreased pain, increased hamstring and quadriceps strength in the surgical limb, and decreased side-to-side difference in anteroposterior knee laxity were significant predictors of a higher ACL-RSI score at 6 months, explaining 34% of the variability in scores. Higher ACL-RSI score at 6 months was associated with earlier clearance to return to sports.

Conclusion:

Patients who underwent the BEAR procedure had higher ACL-RSI scores at 6 months postoperatively. Better ACL-RSI scores at 6 months were related most strongly to higher IKDC scores at 6 months and were also associated with lower pain levels, better muscle recovery, and less knee laxity at 6 months.

Registration:

NCT02664545 ( ClinicalTrials.gov identifier).
Acute Intestinal Intussusception: Beware of Burkitt’s Lymphoma
Authors: Sahli Hind , El Mandour Jihane , Boularab Jihad , Allali Nazik , Chat Latifa , El Haddad Siham
Published: February 2022

Burkitt’s lymphoma can show in a variety of ways, and it’s frequently identified in children owing to the development of an abdominal tumor. This aggressive, fast growing tumor can induce either indirect symptoms due to pressure phenomena or direct involvement of the intestine lumen, resulting in intestinal obstruction or intussusception. We are reporting a case of intestinal intussusception in a patient with Burkitt’s lymphoma.
Utilization of EHR to Improve Support Person Engagement in Health Care for Patients With Chronic Conditions
Authors: Hodgson Jennifer , Welch Melissa , Tucker Emily , Forbes Thompson , Pye Joseph
Published: February 2022

Innovations in electronic health record (EHR) systems invite new patient and family engagement methods and create opportunities to reduce healthcare disparities. However, many patients and their identified support persons (ie, proxies) are unsure how to interface with the technology. This phenomenological qualitative study served as a pilot study to investigate the patient, proxy, and provider lived experiences utilizing patient-facing EHR portals. Individual interviews and focus groups were utilized to collect qualitative data from 21 patient, proxy, and healthcare provider participants across 3 time points. Colaizzi's phenomenological data analysis method was utilized to interpret the data. Four themes emerged highlighting critical benefits and obstacles for patients and support persons interfacing with a patient portal: (a) agency, (b) connection, (c) support, and (d) technology literacy. Results help highlight strategies and dispel myths essential to advancing patient and family engagement using EHR patient portal systems. The study's outcomes reflect recommendations for onboarding proxies and improving patient/family engagement and family-centered care models.
Treating the Unvaccinated COVID-19 Patient with Compassion
Authors: Jacob Enemona , Meah Sunzidha
Published: February 2022

Delivering high-quality care services is essential in the support and treatment of the unvaccinated coronavirus disease (COVID-19) patient. The need to show compassion to the patient has been preserved within the codes of conduct for health and social care professionals and a fundamental value in the National Health Service (NHS) constitution. This article highlights the place and necessity of compassion when health and social care workers are caring for the unvaccinated COVID-19 patient.
WASOG statement on the diagnosis and management of sarcoidosis-associated pulmonary hypertension
Authors: Savale Laurent , Huitema Marloes , Shlobin Oksana , Kouranos Vasilis , Nathan Steven D. , Nunes Hiliaro , Gupta Rohit , Grutters Jan C. , Culver Daniel A. , Post Marco C. , Ouellette Daniel , Lower Elyse E. , Al-Hakim Tamara , Wells Athol U , Humbert Marc , Baughman Robert P.
Published: February 2022

Sarcoidosis-associated pulmonary hypertension (SAPH) is an important complication of advanced sarcoidosis. Over the past few years, there have been several studies dealing with screening, diagnosis and treatment of SAPH. This includes the results of two large SAPH-specific registries. A task force was established by the World Association of Sarcoidosis and Other Granulomatous disease (WASOG) to summarise the current level of knowledge in the area and provide guidance for the management of patients. A group of sarcoidosis and pulmonary hypertension experts participated in this task force. The committee developed a consensus regarding initial screening including who should undergo more specific testing with echocardiogram. Based on the results, the committee agreed upon who should undergo right-heart catheterisation and how to interpret the results. The committee felt there was no specific phenotype of a SAPH patient in whom pulmonary hypertension-specific therapy could be definitively recommended. They recommended that treatment decisions be made jointly with a sarcoidosis and pulmonary hypertension expert. The committee recognised that there were significant defects in the current knowledge regarding SAPH, but felt the statement would be useful in directing future studies.