bluuebunny/crossref_metadata_2025 huggingface dataset:
The Optimal Diversification Strategy in Pharmaceutical Industry: Balance-centred or Hetero-centred?
Authors: Kim Keungoui , Hwang Junseok , Jung Sungdo , Kim Eungdo
Published: May 2021

Due to high uncertainty of product development and business environment, firm-level diversification has been regarded as one of the most effective methods in pharmaceutical firms. In previous study, firm-level diversification was discussed by different value chains of market, product, and technology. However, in most cases, the diversification itself was adopted in a simple manner although its property contains different aspects and the results varies depending on the diversity property of selected index. In addition, the existing approach for measuring firm’s product/market diversification using sales information distinguished by standard industry classification cannot provide direct implication as different strategies are made for market and product diversification. Therefore, this study examines the effects of firm-level diversification on business and innovation performances in pharmaceutical firms by considering (1) three diversification types: market, product, and technology, (2) clear separation between market and product diversification, and (3) two diversification perspectives: balance-centred and hetero-centred. For empirical analysis, an integrated firm-level data set combining from Medtrack, Orange Book, Compustat and Total Patent database is used. From the result, in case of market diversification, less market heterogeneity causes significant influence on business performance. For product and technology, a concentrated and greater heterogeneity of product diversification are turned out to promote business performance, while the more intensive and heterogeneous technology diversification has been shown to improve innovation performance.
Immunohistochemical characterization of mesothelioma in 6 large felids
Authors: Coe Sarah E. , Garner Michael M. , Kiupel Matti
Published: May 2021

Mesothelioma has been reported frequently in large felids. These neoplasms present a diagnostic challenge given their highly variable morphology that mimics carcinomas or sarcomas at different locations. Our goal was to characterize mesotheliomas morphologically and immunohistochemically to determine if a panel of antibodies could be used to more accurately support the diagnosis of these neoplasms in large felids. Mesotheliomas from 6 large felids, including 4 clouded leopards, 1 Bengal tiger, and 1 cheetah, were immunohistochemically labeled for vimentin, E-cadherin, pancytokeratin, Wilms tumor 1 (WT1), MUC-1, and calretinin. The mesotheliomas of the 4 clouded leopards and the tiger were of the epithelial subtype; the mesothelioma from the cheetah was biphasic. All 6 mesotheliomas had strong immunohistochemical labeling for vimentin, E-cadherin, and pancytokeratin. All cases had cytoplasmic labeling for WT1, and 2 also had nuclear labeling. The 3 mesotheliomas with distinct papillary fronds were weakly positive for MUC-1. These and one other epithelial mesothelioma were also positive for calretinin. Our study demonstrates that the morphologic and immunohistochemical phenotypes of mesothelioma that have been identified in humans and domestic species can occur in large felids, and a panel of pancytokeratin, vimentin, WT1, and calretinin can be utilized to support the diagnosis of these neoplasms.
Preventing Harm to Vulnerable Older Adults: A Social Justice Perspective
Authors: Braun Joan
Published: May 2021

This article presents the results from a qualitative study that explored how legislation in British Columbia, intended to protect vulnerable adults from harm, is implemented in practice. The legislation contains guiding principles that require the least restrictive and minimally intrusive form of support or intervention be used and that the adult’s wishes be respected. Sixteen professionals who work as elder abuse responders in British Columba participated in this study through interviews and a focus group. Fifteen of the study participants were social workers. Grounded theory method was used, and themes were identified. The first theme reveals that responders prefer to obtain older adult consent to service provider involvement, rather than forcing compliance by using statutory authority. The second theme reveals that responders may not be able to intervene in a minimally intrusive manner because of resource shortages and organizational structural issues. These findings have human rights and social justice implications.
Trauma-Informed Organizational Dynamics and Client Outcomes in Concurrent Disorder Treatment
Authors: Shier Micheal L. , Turpin Aaron
Published: May 2021

Purpose:

To test an empirical model of the effects of a trauma-informed organizational environment on service user outcomes in the context of concurrent disorder treatment.

Methods:

Service users ( n = 172) were surveyed while in treatment to determine the effects of trauma-informed organizational dynamics (i.e., safety, trust, choice, collaboration, and empowerment) on service user intrapersonal development outcomes (i.e., self-awareness, outlook, coping ability, self-worth, and self-determination) and improvements with concurrent disorder behaviors. After testing for validity and reliability of latent factors, data were analyzed using multivariate analysis.

Results:

As a concise analytical model, the trauma-informed organizational environment was found to significantly positively predict all service user intrapersonal outcomes as well as a reduction in concurrent disorder behaviors.

Conclusions:

This study informs developments in the design and implementation of trauma-informed practice frameworks for concurrent disorder treatment and emphasizes the importance of adapting organizational environments to support improved client outcomes.
A Resource Model of Team Resilience Capacity and Learning
Authors: Brykman Kyle M. , King Danielle D.
Published: May 2021

A team’s capacity to bounce back from adversities or setbacks (i.e., team resilience capacity) is increasingly valuable in today’s complex business environment. To enhance our understanding of the antecedents and consequences of team resilience capacity, we develop and empirically test a resource-based model that delineates critical team inputs and outputs of resilience capacity. Drawing from conservation of resources theory, we propose that voice climate is a critical resource that builds team resilience capacity by encouraging intrateam communication and that leader learning goal orientation (LGO) amplifies this relationship by orienting team discourse toward understanding and growing from challenges. In turn, we propose that team resilience capacity is positively related to team learning behaviors, as teams with a higher resilience capacity are well-positioned to invest their resources into learning activities, and that team information elaboration amplifies this relationship by facilitating resource exchange. Results of a time-lagged, multisource field study involving 48 teams from five Canadian technology start-ups supported this moderated-mediated model. Specifically, voice climate was positively related to team resilience capacity, with leader LGO amplifying this effect. Further, team resilience capacity was positively related to team learning behaviors, with information elaboration amplifying this effect. Altogether, we advance theory and practice on team resilience by offering empirical support on what builds team resilience capacity (voice climate) and what teams with a high resilience capacity do (learning), along with the conditions under which these relationships are enhanced (higher leader LGO and team information elaboration).
Global changes to the chemotherapy service during the covid-19 pandemic
Authors: Chow Man-Chie , Chambers Pinkie , Singleton Georgina , Patel Jignesh , Cooper Silvie , Mythen Charlotte , Bautista-González Elysse , Chisnall Georgia , Djellouli Nehla , Thwaites Benjamin , Wong Ian CK , Vindrola-Padros Cecilia
Published: May 2021

Purpose

In response to the COVID-19 pandemic, changes to chemotherapy services were implemented as a means of managing imposed workload strains within health services and protecting patients from contracting COVID-19. Given the rapidly evolving nature of the pandemic many changes were rapidly adopted and were not substantiated by robust evidence. This study aimed to describe the changes adopted internationally to chemotherapy services, which may be used to guide future changes to treatment delivery.

Methods

A survey was developed to understand the impact of COVID-19 on the delivery of systemic anti-cancer therapies (SACT). It comprised 22 questions and examined the strategies implemented during the pandemic to prioritise and protect patients receiving SACT and the participants’ professional opinion of the strategies employed. The survey was available in English, Spanish and French and was distributed via professional bodies.

Results

129 responses were obtained from healthcare professionals working across 17 different countries. 45% of institutions had to implement treatment prioritisation strategies and all hospitals implemented changes in the delivery of treatment, including: reduction in treatments (69%), using less immunosuppressive agents (50%), allowing treatment breaks (14%) and switching to oral therapies (45%). Virtual clinic visits were perceived by participants as the most effective strategy to protect patients.

Conclusions

The pandemic has forced chemotherapy healthcare professionals to adopt new ways of working by reducing health interactions. Many areas of research are needed following this period, including understanding patients’ perceptions of risks to treatment, utilisation of oral treatments and the impact of treatment breaks on cancer outcomes.
Advanced uterine papillary serous cancer: Could there be a role for newer targeted therapeutic approaches or immune checkpoint inhibitors?
Authors: Dasanu Constantin A , Lerner Jaren , Ocampo Miguel Michel , Iskandar Andrew S , Kaur Jaspreet , Tuler Shahat , Codreanu Ion , Farrell Stephanie , Plaxe Steven C
Published: May 2021

Background

Although now available in oncology clinics, comprehensive germline mutation testing is being performed only in a minority of patients with advanced uterine papillary serous cancer (UPSC). Some of these patients might harbor various targetable mutations, either heritable or acquired. Data sources: We conducted a retrospective cohort study involving all consecutive patients with UPSC treated at our institution from 2009-2019. Data on epidemiology, with an accent on personal and family history of cancer, clinical presentation, disease stage, employed treatment modalities and cancer-specific survival (CSS) was sought.

Findings

Thirteen patients were seventy years of age or younger (≤70) while 15 were older than seventy (>70), and the two arbitrary patient cohorts were well-balanced for the TNM stage. Four UPSC patients >70 had a personal history of metachronous breast cancer. We also identified five cases of breast cancer, two cases of colon cancer, and one of each ovarian and uterine cancer in the first-degree relatives of UPSC patients >70. More than 90% of patients had surgical excision/debulking, and nearly half of the patients in each group received systemic chemotherapy. The most common chemotherapy regimen was carboplatin-paclitaxel every three weeks. Compared to patients ≤70, the UPSC patients >70 were less likely to undergo postoperative radiation therapy (6% vs 61.5%; p = 0.001) and had a worse CSS (21.8 vs. 27.4 months; HR 0.61, p = 0.03).

Conclusions

Personal and family history in a cohort of older UPSC patients identified an excess of second primary cancers, and these patients displayed a shorter CSS. Comprehensive germline and tumor mutation analysis might identify optimal candidates for various targeted agents and immune checkpoint inhibitors, and ultimately improve survival. This may represent an unmet need in the UPSC patients, and further studies are needed to confirm the significance of our findings.
“They Need More Training!” A National Level Analysis of Police Academy Basic Training Priorities
Authors: Sloan John J. , Paoline Eugene A.
Published: May 2021

Recurring incidents of Black citizens killed or injured during interactions with police has led to calls for “more training” of officers, including new recruits. Prior research on academy-based police recruit training has centered on evaluation and heavily relied on case studies. The current study overcomes these limitations by analyzing the structure and content of academy-based basic training using secondary data collected from the population (N = 591) of U.S. police academies. Although we found significant mean differences across academies in total required contact hours needed to graduate and with how the hours were distributed across training areas, we also found academies adopted the same core curriculum consisting of six major “themes” and topics (n = 39) comprising them. We also found academies prioritized core areas of training in certain areas, while requiring far fewer hours in others. Implications of our results for basic training of recruits and suggestions for future research are then presented.
Enhancing the Marginalized Youth Media Participation Through Formation of a Nation Building Action Plan with Intervention Study Design
Authors: Shiratuddin Norshuhada , Hassan Shahizan , Rahman Zainatul Shuhaida Abdul , Ahmad Mohd. Khairie , Talib Kartini Aboo , Sani Mohd Azizuddin Mohd , Ahmad Noor Sulastry Yurni
Published: May 2021

Malaysian marginalized youth participation in nation building through various media platforms is low. Therefore, an action plan was developed to enhance the social, political and economic participation of youth in marginalized communities through media utilization. The action plan consists of target items and approaches to conduct activities. Eight media-participation-related modules were also tested in an intervention study. The modules were targeted at increasing the level of youth media, social and political participation. Various agencies such as the Malaysian Youth Council, were involved to help realize the plan aims. Results from the stakeholders’ reviews indicated that more efforts have to be carried out to expose these youth to good practices in the use of social media for participation purposes. The findings also concluded that this action plan is well-formed, can serve as a guide, allows integration of cultural harmony and offers empowerment to the youth.
Critical discourse analysis on the influence of media commentary on fatal fetal anomaly in Ireland
Authors: Power Stacey , O’Donoghue Keelin , Meaney Sarah
Published: May 2021

Fatal Fetal Anomaly (FFA) has generated international media attention as termination of pregnancy (TOP) for FFA was legislated for, for the first time in Ireland. Media offers an insight into what health-related information is available to the public and how it is presented to them. The aim of this study was to examine how information related to FFA, TOP for FFA and perinatal palliative care (PPC) were framed in Irish published media. A critical discourse analysis, which examines the relations between discourse and social and cultural phenomena was implemented. Habermasian’s framework facilitated an objective analysis of the text, to facilitate interpretation and understanding of socially produced meanings. A broadsheet and journal were chosen. Dated from 2012 to 2017, 129 articles were identified. Themes of personification of the unborn, human rights and power and politics were embedded in the discourse, creating political influence to sway perceptions and views. Terminology were chosen by different ideological perspectives to create varying contexts and support arguments. PPC was suppressed within the published media. This study highlights misrepresentations in the information delivered to the public and suggests the need for healthcare professionals to expand their media literacy and develop these skills with their patients.
Demographic characteristics, medical needs and utilisation of antenatal care among pregnant undocumented migrants living in Denmark between 2011 and 2017
Authors: Funge Julia kadin , Boye Mathilde Christine , Parellada Clara Barfod , Norredam Marie
Published: May 2021

Introduction: An estimated 22,900–28,900 individuals live undocumented in Denmark, of whom many are women of reproductive age. Undocumented migrants in Denmark who are pregnant only have legal rights to health care in emergencies, which may lead to under-utilisation of antenatal care, despite the possibility of these women seeking antenatal care through informal networks. This study aimed to describe the demographics, general medical needs and prevalence of induced abortions among pregnant undocumented migrant women. Further, we aimed to investigate if the women received antenatal services as recommended, focusing on the timing of their first entry to antenatal care and the number of antenatal visits. Methods: This was a retrospective cross-sectional study. We used data from medical records at a health clinic managed by non-governmental organisations (NGOs) in Denmark from 1 January 2011 to 31 December 2017. Data regarding 679 pregnant women were included in descriptive and regression analyses. Results: The women had a mean age of 28.7 years, originated from 78 different countries and had diverse migration backgrounds. Among the 679 included women, there were 119 pregnancy-related complications. Regarding the utilisation of antenatal services, 52.6% had a late first attendance to antenatal care, and the likelihood of a late first attendance was highest among 35- to 44-year-olds. The majority (92.6%) of the women did not have the recommended number of antenatal care visits, and this was evident across all regions of origin. Logistic regression showed variation in utilisation of antenatal services according to age and region of origin. Conclusions: A quarter of the study population attended the health clinic requesting pregnancy termination. The pregnant undocumented migrants had few medical complications and predominantly attended the health clinic for antenatal care. However, some did attend the clinic with general or pregnancy-related medical conditions. Almost half of the study population had a late first attendance to antenatal care, and the vast majority did not have the recommended number of antenatal care visits. These results call for consideration as to whether health care for pregnant undocumented migrants should be formally available and free of charge.
Smartphone use and academic performance: First evidence from longitudinal data
Authors: Amez Simon , Vujić Sunčica , De Marez Lieven , Baert Stijn
Published: May 2021

To study the causal impact of smartphone use on academic performance, we collected – for the first time worldwide – longitudinal data on students’ smartphone use and educational performance. For three consecutive years, we surveyed all students attending classes in 11 different study programmes at two Belgian universities on general smartphone use and other drivers of academic achievement. These survey data were merged with the exam scores of these students. We analysed the resulting data by means of panel data random-effects estimation controlling for unobserved individual characteristics. A 1 SD increase in overall smartphone use results in a decrease of 0.349 points (out of 20) and a decrease of 2.616 percentage points in the fraction of exams passed.
Fuel consumption and emission reduction of marine lean-burn gas engine employing a hybrid propulsion concept
Authors: Tavakoli Sadi , Bagherabadi Kamyar Maleki , Schramm Jesper , Pedersen Eilif
Published: May 2021

As the emission legislation becomes further constraining, all manufacturers started to fulfill the future regulations about the prime movers in the market. Lean-burn gas engines operating under marine applications are also obligated to enhance the performance with a low emission level. Lean-burn gas engines are expressed as a cleaner source of power in steady loading than diesel engines, while in transient conditions of sea state, the unsteadiness compels the engine to respond differently than in the steady-state. This response leads to higher fuel consumption and an increase in emission formation. In order to improve the stability of the engine in transient conditions, this study presents a concept implementing a hybrid configuration in the propulsion system. An engine model is developed and validated in a range of load and speed by comparing it with the available measured data. The imposed torque into the developed engine model is smoothed out by implementing the hybrid concept, and its influence on emission reduction is discussed. It is shown that with the hybrid propulsion system, the NOX reduces up to 40% because of the maximum load reduction. Moreover, eliminating the low load operation by a Power Take In during incomplete propeller immersion, the methane slip declines significantly due to combustion efficiency enhancement.
Individualized Fraction Regimen of SBRT Patients With Non-Small Cell Lung Cancer Based on Uncomplicated and Cancer-Free Control Probability
Authors: Feng Ai-Hui , Wang Hao , Chen Hua , Gu Heng-Le , Shao Yan , Duan Yan-Hua , Huang Ying , Fu Xiao-Long , Zhou Tao , Xu Zhi-Yong
Published: May 2021

Introduction:

Stereotactic body radiotherapy (SBRT) currently adopts non-discriminative prescription regimen. This study attempts to investigate an individualized fraction regimen (IFR) method for SBRT patients with non-small cell lung cancer (NSCLC) based on Uncomplicated and Cancer-free Control Probability (UCFCP).

Methods:

Twenty patients with NSCLC were retrospectively prescribed with 40 regimens, ranging from 8Gy×5f to 12Gy×5f in step of 0.1 Gy. Taking into consideration of the age and the BMI index of each patient as well, the tumor control probability (TCP), the normal tissue complication probability (NTCP) of the total lung, chest wall and rib, and the secondary cancer probability (SCP) of the total lung were calculated for each plan of the patients. For the 40 regimens, the UCFCP was calculated and the maximum value of UCFCP was the IFR of the specified patient. Besides, IFR of UCP approach which only took account of the TCP and NTCP was also derived and to be compared with the IFR based on the UCFCP method.

Results:

For all the patients, the UCFCP value showed a bell-shaped trend with the change of prescription dose. Among the 20 patients, the IFRs of 16 patients were different from the original fixed regimen. Of the 16 patients, the IFR of 5 patients exhibited slight changes between UCP and UCFCP methods.

Conclusion:

The method based on the maximum value of UCFCP function may be helpful to provide IFR for specific SBRT patients with NSCLC, differentiating the patient specific characteristics such as anatomical structures and locations.
Childhood Health Assets in a Spanish Neighborhood: Children and Families’ Perception
Authors: Vidal-Sánchez Mª Isabel , Laborda-Soriano Ana Alejandra , Cambra-Aliaga Alba , Sanz-Valer Patricia , Gasch Gallén Ángel
Published: May 2021

The health assets (HA; factors or resources that maintain or improves health) approach has hardly been incorporated in occupational therapy, and even less so in research focused on children’s perception. The objective of this study was to provide context-specific empirical evidence regarding children and families’ perception of childhood HA, paying special attention to the occupational dimension. We used a mixed methods design including qualitative research with 130 children using various techniques (brainstorming, focus groups, thematic drawing, and individual interview) and a descriptive study based on a questionnaire answered by 58 families. Most children related well-being to play occupations and belonging. We observed the influence of gender roles, ethnicity, and other socioeconomic factors in the identification and access to HA. We recommend delving into the relationship between the HA approach and occupational therapy, considering the children’s perspective, interculturality, and gender perspectives.
Responding to a Pandemic: COVID-19 Projects in the Malone Center
Authors: Ghobadi Kimia , Hager Greg , Krieger Axel , Levin Scott , Unberath Mathias
Published: May 2021

As the scope and scale of the COVID-19 pandemic became clear in early March of 2020, the faculty of the Malone Center engaged in several projects aimed at addressing both immediate and long-term implications of COVID-19. In this article, we briefly outline the processes that we engaged in to identify areas of need, the projects that emerged, and the results of those projects. As we write, some of these projects have reached a natural termination point, whereas others continue. We identify some of the factors that led to projects that moved to implementation, as well as factors that led projects to fail to progress or to be abandoned.
Tenacissoside H Induces Autophagy and Radiosensitivity of Hepatocellular Carcinoma Cells by PI3K/Akt/mTOR Signaling Pathway
Authors: Lin Jiatian , Ruan Jiyin , Zhu Hao , Chen Zaizhong , Chen Junhui , Yu Hongjian
Published: May 2021

Tenacissoside H (TEH), which has anti-inflammatory and anti-tumor effects, is a major active ingredient extracted from the stem of Marsdenia tenacissima. However, the effect of TEH on hepatocellular carcinoma (HCC) as well as the underlying mechanisms are still indistinct. Presently, HCC cells (including Huh-7 and HepG2) were dealt with different concentrations of TEH. The proliferation and apoptosis of HCC cells were determined via Cell Counting Kit-8 (CCK8) assay and flow cytometry. In addition, Western blot was conducted to evaluate the expressions of autophagy—and apoptosis-related proteins. Tissue immunofluorescence was carried out to evaluate LC3B expression in the tumor tissues. The data showed that TEH suppressed the growth of HCC cells in a concentration-dependent manner. Besides, TEH enhanced radiosensitivity and promoted the apoptosis of HCC cells. Moreover, the mRNA and protein levels of autophagy-related genes (LC3-II/LC2-I, ATG5, Beclin-1) were significantly promoted by TEH. Mechanistically, TEH attenuated the activation of PI3K/Akt/mTOR signaling pathway. However, inhibition of PI3 K pathway abolished the anti-tumor effects of TEH in HCC cells. Collectively, this study suggested that TEH increases the radiosensitivity of HCC cells via inducing autophagy and apoptosis through downregulating PI3K/Akt/mTOR signaling pathway.
Preparing Neurology Residents and Advanced Practice Providers for the COVID-19 ICU—A Neurocritical Care Led Intervention
Authors: Ch’ang Judy H. , Ford Jenna , Cifrese Laura , Woodward Elliott , Mears Jennifer , Lowrie Rachel , Holland Chloe , Kaplan Aaron , Zhang Cenai , Guterman Elan L.
Published: May 2021

Background and Purpose:

With the surge of critically ill COVID-19 patients, neurology and neurosurgery residents and advanced practice providers (APPs) were deployed to intensive care units (ICU). These providers lacked relevant critical care training. We investigated whether a focused video-based learning curriculum could effectively teach high priority intensive care topics in this unprecedented setting to these neurology providers.

Methods:

Neurocritical care clinicians led a multidisciplinary team in developing a 2.5-hour lecture series covering the critical care management of COVID-19 patients. We examined whether provider confidence, stress, and knowledge base improved after viewing the lectures.

Results:

A total of 88 residents and APPs participated across 2 academic institutions. 64 participants (73%) had not spent time as an ICU provider. After viewing the lecture series, the proportion of providers who felt moderately, quite, or extremely confident increased from 11% to 72% (60% difference, 95% CI 49-72%) and the proportion of providers who felt nervous/stressed, very nervous/stressed, or extremely nervous/stressed decreased from 78% to 48% (38% difference, 95% CI 26-49%). Scores on knowledge base questions increased an average of 2.5 out of 12 points (SD 2.1; p < 0.001).

Conclusion:

A targeted, asynchronous curriculum on critical care COVID-19 management led to significantly increased confidence, decreased stress, and improved knowledge among resident trainees and APPs. This curriculum could serve as an effective didactic resource for neurology providers preparing for the COVID-19 ICU.
Power Increases Perceptions of Others’ Choices, Leading People to Blame Others More
Authors: Yin Yidan , Savani Krishna , Smith Pamela K.
Published: May 2021

Under what circumstances do people adopt a choice mindset? Three studies (two preregistered) tested whether higher power leads people to construe others as having more choice. When power was either measured (Study 1) or manipulated (Studies 2 and 3), high-power perceivers viewed others, even low-power others (Study 3), as having more choice than did low-power perceivers. Consequently, high-power individuals blamed others more for poor performance (Studies 1–3), and were more likely to punish them (Studies 1 and 2). The findings document a direct link between power and choice by showing that the psychological consequences of a choice mindset (i.e., greater blame) can be evoked by power and that effects of power (e.g., on blame) can be mediated by perceptions of choice.
What and whose Confucianism? Sinophone communities and dialogical geopolitics
Authors: Gao Quan , Tse Justin KH , Woods Orlando
Published: May 2021

This commentary responds to An et al.’s (2021) article, ‘Towards a Confucian Geopolitics’, by re-examining ‘the political’ of Confucianism and its contribution to fostering a cosmopolitan form of Confucian geopolitics. By taking note of the differences within and between Sinophone communities, we discuss the variegated forms of Confucianism, and their various geopolitical implications. In doing so, we call for re-theorising Confucian geopolitics as dialogical geopolitics that challenges the cultural and ideological basis of statist and Sino-centric geopolitics.
Towards a Confucian geopolitics: A critical remark
Authors: Liu Xin
Published: May 2021

This commentary reviews An et al.’s (2021) article, ‘Towards Confucian Geopolitics’. It first acknowledges the article’s achievement in highlighting the importance of reading geopolitics by excavating the Chinese traditions and cultural perspectives. However, the commentary also points out that An et al.’s article has failed to understand the complex nature of the Confucian ideology by differentiating between real-world political struggle and cultural idealism. The lack of an evolving political geography has made their reading of Confucianism as either an official ideology or spatialisation unable to correspond with concrete historical realities. Specifically, it has resulted in over-simplification in benchmarking Chinese history and the dichotomous understanding of Hua-Yi division. The commentary further points out that the above problem is a general issue with the culturalist approach to world politics.
Vestibular neuritis caused by severe acute respiratory syndrome coronavirus 2 infection diagnosed by serology: Case report
Authors: Halalau Alexandra , Halalau Madalina , Carpenter Christopher , Abbas Amr E , Sims Matthew
Published: May 2021

Vestibular neuritis is a disorder selectively affecting the vestibular portion of the eighth cranial nerve generally considered to be inflammatory in nature. There have been no reports of severe acute respiratory syndrome coronavirus 2 causing vestibular neuritis. We present the case of a 42-year-old Caucasian male physician, providing care to COVID-19 patients, with no significant past medical history, who developed acute vestibular neuritis, 2 weeks following a mild respiratory illness, later diagnosed as COVID-19. Physicians should keep severe acute respiratory syndrome coronavirus 2 high on the list as a possible etiology when suspecting vestibular neuritis, given the extent and implications of the current pandemic and the high contagiousness potential.
Mechanism of lipopolysaccharide-mediated induction of epithelial-mesenchymal transition of alveolar type II epithelial cells in absence of other inflammatory cells
Authors: Wu Shuai , Ye Huan , Xue TianJiao , Wang Jiali
Published: May 2021

Several studies have shown that gram-negative bacilli infection can cause acute lung injury, and that consequent pulmonary fibrosis is caused when alveolar type-II epithelial cells undergo epithelial-mesenchymal transition (EMT). However, the mechanism underlying this change remains unclear. This study aimed to elucidate whether the main toxin of gram-negative bacteria, lipopolysaccharide (LPS), can induce EMT in human alveolar epithelial cells, and the underlying molecular mechanisms. Human alveolar type-II epithelial cells (A549) were used in EMT induction experiments. Cells were collected after LPS exposure, and changes in the expression levels of epithelial and mesenchymal cell markers were determined. Further, the effect of LPS exposure on the expression of Toll-like Receptor 4 (TLR4), Transforming Growth Factor-beta 1 (TGF-β1) and Smad2/3 was assessed. The expression level of a mesenchymal cell marker was also assessed after pharmacological inhibition of TLR4 and TGF-β1 prior to addition of LPS, to identify downstream pathways involved in EMT induction. Results showed that LPS exposure caused significant downregulation of epithelial marker E-cadherin, and upregulation of mesenchymal marker vimentin, together with increased expression of TGF-β1 and activation of the TGF-β1/Smad2/3 pathway. Furthermore, pretreatment with TGF-β1 and TLR4 inhibitors suppressed EMT, and treatment with the latter also reduced the expression level of TGF-β1. Overall, we conclude that LPS directly induces EMT in A549 cells through upregulation of TLR4 and activation of the TGF-β1/Smad2/3 signalling pathway. Our results suggest that LPS-mediated pulmonary fibrosis may occur in ALI patients even if the LPS-induced inflammatory response is inhibited.
Use of Community Based Participatory Research to Design Interventions for Healthy Lifestyle in an Alternative Learning Environment
Authors: Cristiani Valeria , Kumbamu Ashok , Asiedu Gladys B. , Johnson Shirley K. , Gewirtz O’Brien Janna Rae , Ziebart Gordon , Mogen Melissa R. , Lynch Brian , Kumar Seema
Published: May 2021

Introduction/Objectives

Childhood obesity develops as the result of the interplay between individual and environmental factors. Community based participatory research (CBPR) is an effective tool for improving health of communities. There is limited research on CBPR for facilitating healthy lifestyle in community schools with an alternative learning environment. The objective of the study was to explore student and staff perspectives via focus groups on barriers and facilitators for healthy eating and physical activity in a community school with alternative learning environment and to prioritize, design, and implement suggested interventions to improve healthy lifestyle.

Methods

We conducted qualitative research through 8 focus groups of middle and high school students (n = 40) and 2 focus groups of school staff (n = 8). The school community and research team subsequently identified and implemented interventions for facilitating healthy lifestyle in students within the school environment.

Results

Barriers identified for healthy lifestyle included lack of motivation, lack of healthy food options at school, inadequate knowledge about healthy lifestyle and insufficient opportunities for physical activity. Facilitators for healthy lifestyle were support and motivation from mentors and knowledge about healthy nutrition. Key strategies implemented were addition of healthier food options, educational materials for healthy eating, creation of a walk path, standing desks in classrooms and additional equipment in the school gymnasium.

Conclusions

Formative feedback from students and staff was helpful in the implementation of strategies for facilitating healthy lifestyle among students within a community school with an alternative learning environment.
Crisis Leadership of Covid-19 Fightback: Exploratory Anecdotal Evidence on Selected World Leaders
Authors: Rameshan Pallikara
Published: May 2021

This article evaluates the Covid-19 crisis response of top leaders of 20 selected countries from January to May 2020 using anecdotal evidence from media sources and insights from the available crisis management and leadership literature. The main objective of the article is to examine whether the Covid-19 crisis experience and outcome of sample countries are related to their leaders’ behaviour and actions. Based on leaders’ orientation towards certain action motives and action and leadership styles, the article classifies the leaders’ action and leadership styles. The article finds that the leaders with a ‘ missionary’ action style displayed positive leadership styles and generally had the best Covid-19 outcomes, while those with a ‘ gamer’ action style were associated with negative leadership styles and poorer outcomes, with those with ‘political’ and ‘strategist’ action styles falling in between. To validate the impact of evolving leader behaviour on Covid-19 outcomes, the article evaluates the average daily growth of Covid-19 cases in the subsequent (post-analysis) seven weeks and tests the mean differences between different style groups. The tests indicate a significant difference in the outcomes between different style groups except between ‘gamers’ and ‘strategists’. The difference is more pronounced when the BRI[.]S countries (i.e., BRICS minus China) in various combinations are excluded from the test. A similar conclusion arises for the negatively and positively oriented leadership styles. Thus, while finding a relationship of leadership behaviour with Covid-19 outcomes, the article also provides a reason to suspect the role of socio-economic and institutional factors in clouding or confounding the leadership effect in view of the distinctive behaviour of OECD and the large emerging countries.
Non-Hodgkin’s Plasmablastic Lymphoma as Initial Presentation of Human Immunodeficiency Virus
Authors: Jariwal Roopam , Raza Nadia , Bhandohal Janpreet , Cobos Everardo
Published: May 2021

Plasmablastic lymphoma (PBL) is a subtype of non-Hodgkin’s lymphoma that manifests in patients with the diagnosis of human immunodeficiency virus (HIV), more prominently in the head, neck, and oral mucosal region. The diagnosis of this rare lymphoma serves as a concomitant diagnosis of acquired immunodeficiency syndrome. The case is of a 33-year-old previously healthy male, with an unknown diagnosis of HIV with a painful right mandibular mass. He was subsequently diagnosed with PBL and HIV. This case of PBL illustrates the importance of linking a rare and potentially life-threatening diagnosis as a possible first manifestation of HIV.
Bipolar Bone Defects in Shoulders With Primary Instability: Dislocation Versus Subluxation
Authors: Nakagawa Shigeto , Sahara Wataru , Kinugasa Kazutaka , Uchida Ryohei , Mae Tatsuo
Published: May 2021

Background:

In shoulders with traumatic anterior instability, a bipolar bone defect has been recognized as an important indicator of the prognosis.

Purpose:

To investigate bipolar bone defects at primary instability and compare the difference between dislocation and subluxation.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

There were 156 shoulders (156 patients) including 91 shoulders with dislocation and 65 shoulders with subluxation. Glenoid defects and Hill-Sachs lesions were classified into 5 size categories on 3-dimensional computed tomography (CT) scans and were allocated scores ranging from 0 (no defect) to 4 points (very large defect). To assess the combined size of the glenoid defect and Hill-Sachs lesion, the scores for both lesions were summed (range, 0-8 points). Patients in the dislocation and subluxation groups were compared regarding the prevalence of a glenoid defect, a bone fragment of bony Bankart lesion, a Hill-Sachs lesion, a bipolar bone defect, and an off-track Hill-Sachs lesion. Then, the combined size of the bipolar bone defects was compared between the dislocation and subluxation groups and among patients stratified by age at the time of CT scanning (<20, 20-29, and ≥30 years).

Results:

Hill-Sachs lesions were observed more frequently in the dislocation group (75.8%) compared with the subluxation group (27.7%; P < .001), whereas the prevalence of glenoid defects was not significantly different between groups (36.3% vs 29.2%, respectively; P = .393). The combined defect size was significantly larger in the dislocation versus subluxation group (mean ± SD combined defect score, 2.1 ± 1.6 vs 0.8 ± 0.9 points, respectively; P < .001) due to a larger Hill-Sachs lesion at dislocation than subluxation (glenoid defect score, 0.5 ± 0.9 vs 0.3 ± 0.6 points [ P = .112]; Hill-Sachs lesion score, 1.6 ± 1.2 vs 0.4 ± 0.7 points [ P < .001]). Combined defect size was larger in older patients than younger patients in the setting of dislocation (combined defect score, <20 years, 1.6 ± 1.2 points; 20-29 years, 1.9 ± 1.5 points; ≥30 years, 3.4 ± 1.6 points; P < .001) but was not different in the setting of subluxation (0.8 ± 1.0, 0.7 ± 0.9, and 0.8 ± 0.8 points, respectively; P = .885). An off-track Hill-Sachs lesion was observed in 2 older patients with dislocation but was not observed in shoulders with subluxation.

Conclusion:

The bipolar bone defect was significantly more frequent, and the combined size was greater in shoulders with primary dislocation and in older patients (≥30 years).
Clinical Outcomes of Shoulder Stabilization in Females With Glenoid Bone Loss
Authors: Frank Rachel M. , Salem Hytham S. , Richardson Catherine , O’Brien Michael , Newgren Jon M. , Cole Brian J. , Verma Nikhil N. , Nicholson Gregory P. , Romeo Anthony A.
Published: May 2021

Background:

Nearly all studies describing shoulder stabilization focus on male patients. Little is known regarding the clinical outcomes of female patients undergoing shoulder stabilization, and even less is understood about females with glenoid bone loss.

Purpose:

To assess the clinical outcomes of female patients with recurrent anterior shoulder instability treated with the Latarjet procedure.

Study Design:

Case series; Level of evidence, 4.

Methods:

All cases of female patients who had recurrent anterior shoulder instability with ≥15% anterior glenoid bone loss and underwent the Latarjet procedure were analyzed. Patients were evaluated after a minimum 2-year postoperative period with scores of the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale.

Results:

Of the 22 patients who met our criteria, 5 (22.7%) were lost to follow-up, leaving 17 (77.2%) available for follow-up with a mean ± SD age of 31.7 ± 12.9 years. Among these patients, 16 (94.1%) underwent 1.6 ± 0.73 ipsilateral shoulder operations (range, 1-3) before undergoing the Latarjet procedure. Preoperative indications for surgery included recurrent instability with bone loss in all cases. After a mean follow-up of 40.2 ± 22.9 months, patients experienced significant score improvements in the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale ( P < .05 for all). There were 2 reoperations (11.8%). There were no cases of neurovascular injuries or other complications.

Conclusion:

Female patients with recurrent shoulder instability with glenoid bone loss can be successfully treated with the Latarjet procedure, with outcomes similar to those of male patients in the previously published literature. This information can be used to counsel female patients with recurrent instability with significant anterior glenoid bone loss.
Factors Associated With Lateral Epicondylitis of the Elbow
Authors: Park Hyung Bin , Gwark Ji-Yong , Im Jin-Hyung , Na Jae-Boem
Published: May 2021

Background:

Metabolic factors have been linked to tendinopathies, yet few studies have investigated the association between metabolic factors and lateral epicondylitis.

Purpose:

To evaluate risk factors for lateral epicondylitis, including several metabolic factors.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

We evaluated 1 elbow in each of 937 volunteers from a rural region that employs many agricultural laborers. Each participant received a questionnaire, physical examinations, blood tests, simple radiographic evaluations of both elbows, magnetic resonance imaging of bilateral shoulders, and an electrophysiological study of bilateral upper extremities. Lateral epicondylitis was diagnosed using 3 criteria: (1) pain at the lateral aspect of the elbow, (2) point tenderness over the lateral epicondyle, and (3) pain during resistive wrist dorsiflexion with the elbow in full extension. Multivariable logistic regression analysis was used to calculate the odds ratios (ORs) and 95% CIs for various demographic, physical, and social factors, including age, sex, waist circumference, dominant-side involvement, smoking habit, alcohol intake, and participation in manual labor; the comorbidities of diabetes, hypertension, thyroid dysfunction, metabolic syndrome, ipsilateral biceps tendon injury, ipsilateral rotator cuff tear, and ipsilateral carpal tunnel syndrome; and the serologic parameters of serum lipid profile, glycosylated hemoglobin A1c, level of thyroid hormone, and high-sensitivity C-reactive protein.

Results:

The prevalence of lateral epicondylitis was 26.1% (245/937 participants). According to the multivariable logistic regression analysis, female sex (OR, 2.47; 95% CI, 1.78-3.43), dominant-side involvement (OR, 3.21; 95% CI, 2.24-4.60), manual labor (OR, 2.25; 95% CI, 1.48-3.43), and ipsilateral rotator cuff tear (OR, 2.77; 95% CI, 1.96-3.91) were significantly associated with lateral epicondylitis ( P < .001 for all). No metabolic factors were significantly associated with lateral epicondylitis.

Conclusion:

Female sex, dominant-side involvement, manual labor, and ipsilateral rotator cuff tear were found to be risk factors for lateral epicondylitis. The study results suggest that overuse activity is more strongly associated with lateral epicondylitis than are metabolic factors.
Silent Hypertensive Crisis in an Adolescent: First Case Report of Pediatric Pheochromocytoma from Indonesia
Authors: Ambarsari Cahyani Gita , Hidayati Eka Laksmi , Tridjaja Bambang , Mochtar Chaidir Arif , Wulandari Haryanti Fauzia , Harahap Agnes Stephanie , Grace Angela
Published: May 2021

Secondary hypertension in children, to the rare extent, can be caused by endocrine factors such as pheochromocytoma, an adrenal tumor that secretes catecholamine. Only a few cases have been reported in the past 3 decades. To the best of our knowledge, this is the first case report of pediatric pheochromocytoma from Indonesia. We reviewed a case of a 16-year-old Indonesian boy with history of silent hypertensive crisis who was referred from a remote area in an island to the pediatric nephrology clinic at Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Despite medications, his symptoms persisted for 14 months. At the pediatric nephrology clinic, pheochromocytoma was suspected due to symptoms of catecholamine secretion presented, which was palpitation, diaphoresis, and weight loss. However, as the urine catecholamine test was unavailable in Indonesia, the urine sample was sent to a laboratory outside the country. The elevated level of urine metanephrine, focal pathological uptake in the right adrenal mass seen on 131I-MIBG, and histopathology examination confirmed the suspicion of pheochromocytoma. Following the tumor resection, he has been living with normal blood pressure without antihypertensive medications. This case highlights that pheochromocytoma should always be included in the differential diagnoses of any atypical presentation of hypertension. In limited resources setting, high clinical awareness of pheochromocytoma is required to facilitate prompt referral. Suspicion of pheochromocytoma should be followed by measurement of urine metanephrine levels. Early diagnosis of pheochromocytoma would fasten the optimal cure, alleviate the symptoms of catecholamine release, and reverse hypertension.