bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards Climate Change Mitigation and Adaptation
Authors: Khayyam Umer , Bano Rida , Alvi Shahzad
Published: March 2021

Global climate change is one of the main threats facing humanity and the impacts on natural systems as well as humans are expected to be severe. People can take action against these threats through two approaches: mitigation and adaptation. However, mitigations and adaptations are contingent on the level of motivation and awareness, as well as socio-economic and environmental conditions. This study examined personal perception and motivation to mitigate and adapt to climate change among the university students in the capital city of Pakistan. We divided the respondents into social sciences, applied sciences and natural sciences, using logistic regression analysis. The results indicated that students who perceive severity, benefits from preparation, and have more information about climate change were 1.57, 4.98 and 1.63 times more likely to take mitigation and 1.47, 1.14 and 1.17 times more likely to take adaptation measures, respectively. Students who perceived self-efficacy, obstacles to protect from the negative consequences of climate change and who belonged to affluent families were more likely to take mitigation measures and less likely to take adaptation strategies. However, mitigation and adaptation were unaffected by age, gender and study discipline.
Difference Relates: Allegory, Ideology, and the Anthropocene
Authors: Lesjak Carolyn
Published: March 2021

Fredric Jameson’s recent book, Allegory and Ideology, argues that allegory has become a ‘social symptom’, an attempt during moments of historical crisis to represent reality even as that reality, rife with contradictory levels, eludes representation. Mobilising the fourfold medieval system of allegory he first introduced in The Political Unconscious, Jameson traces a formal history of attempts to come to terms with the ‘multiplicities’ and incommensurable levels that emerge within modernity and postmodernity. This article identifies the complexities of Jameson’s understanding of allegory and draws on the brief moments when Jameson references the Anthropocene to argue for an allegorical reading of our contemporary environmental crisis that would allow us to see the problem the Anthropocene names as truly contradictory: at one and the same time, the world we inhabit appears to us as a world of our own making and as a world that has become truly alien to us.
Justicia cordifolia, a new combination in Brazilian Acanthaceae
Authors: FUNEZ LUÍS ADRIANO , BRAZ DENISE MONTE
Published: March 2021

Sericographis cordifolia is reinstated and a new combination Justicia cordifolia is proposed when transferred to Justicia. Additionally, a detailed morphologic description for this species, field photographs, taxonomic and nomenclatural comments, and species conservation status assessed according to IUCN criteria are provided.
Active disturbance rejection control for a piezoelectric nano-positioning system: A U-model approach
Authors: Wei Wei , Duan Bowen , Zuo Min , Zhang Weicun
Published: March 2021

Both speed and accuracy are key issues in nano-positioning. However, hysteresis existing in piezoelectric actuators severely reduces the positioning speed and accuracy. In order to address the hysteresis, a U-model based active disturbance rejection control is proposed. Based on the linear active disturbance rejection control, a controlled plant is dynamically transformed to be pure integrators. Then, according to the U-model control, a common inversion is obtained and the controlled plant is converted to be “1.” By integrating advantages of both linear active disturbance rejection control and U-model control, the U-model based active disturbance rejection control does promote the reference tracking speed and accuracy. Stability and steady-state error of the close-loop system have been analyzed. Phase lag between the system output and the control input has been effectively eliminated, and the phase-leading advantage of the U-model based active disturbance rejection control has been confirmed. Experimental results show that the U-model based active disturbance rejection control is capable of achieving faster and more accurate positioning. Remarkable improvements and practical realization make the U-model based active disturbance rejection control more promising in nano-positioning.
Affective labour and class distinction in the night-time economy
Authors: Threadgold Steven , Farrugia David , Coffey Julia
Published: March 2021

This article contributes to recent debates about the relationship between affective labour and class by exploring the classed distinctions enacted through affective labour in the urban night-time economy. Bringing theories of affective labour into a dialogue with Bourdieusian feminist analysis, the article explores the affective and symbolic dynamics of hospitality labour in a gentrified inner-urban neighbourhood of Melbourne, Australia. It shows how the practice of hospitality labour enacts classed distinctions and tensions emerging from the gentrification of inner-urban areas, and how the aesthetic and symbolic dimensions of class contribute to the valorisation of affect in hospitality venues. The valorisation of affect are processes in which the value attributed to an atmosphere or consumption experience is based on the forms of distinction practised within the venue, enacted in aesthetics, tastes and modes of embodiment. The article also shows how practices of class distinction – both ‘punching up’ and ‘managing down’ – are connected to the gendered politics of service work in the way that workers manage the threat of violence or sexual harassment in venues. In general, the article shows how the classed dynamics of gentrification are enacted in affective economies, and therefore how Bourdieusian analysis of class can be usefully deployed in theoretical debates about affective labour.
Residential coexistence: Anonymity, etiquette and proximity in high-rise living
Authors: Arviv Tamir , Eizenberg Efrat
Published: March 2021

This paper offers a new perspective on everyday life in an ethno-nationally mixed vertical urban setting. It focuses on the cultivation of a shared residential identity that, seemingly, can overcome the binational divide. Drawing on interviews with Jewish and Arab residents in a new middle-class high-rise complex (HRC) in Haifa, Israel, we illustrate that Arabs and Jews share many reasons for living in the HRC, reflecting similarities between these populations that are often ignored. Moreover, the physical form of the complex – including its newness and its modern, universal design – makes it a relatively neutral space free from a particular ethno-national or religious identity. Finally, while the relevant literature largely assumes that ‘anonymity’ in high-rises is a negative force, the sense of privacy it affords allows residents to manage social proximity and cultivate a philosophy of ‘live and let live’.
The effectiveness of hope-fostering interventions in palliative care: A systematic review and meta-analysis
Authors: Salamanca-Balen Natalia , Merluzzi Thomas V , Chen Man
Published: March 2021

Background:

The concept of hope is an important theme in chronic illness and palliative care and has been associated with increased psycho-spiritual well-being and quality of life. Psycho-spiritual interventions have been described in this population, but no systematic review of hope-enhancing interventions or hopelessness-reducing interventions has been conducted for persons with palliative care diseases.

Aim:

To describe and assess the effectiveness of interventions in palliative care that measure hope and/or hopelessness as an outcome.

Design:

This systematic review and meta-analysis was pre-registered (Prospero ID: CRD42019119956).

Data sources:

Electronic databases, journals, and references were searched. We used the Cochrane criteria to assess the risk of bias within studies.

Results:

Thirty-five studies (24 randomized controlled trials, 5 quasi-experimental, 6 pre-post studies) involving a total of 3296 palliative care patients were included. Compared with usual/standard cancer care alone, interventions significantly increased hope levels at a medium effect size ( g = 0.61, 95% confidence interval (CI) = 0.28–0.93) but did not significantly reduce hopelessness ( g = −0.08, 95% CI = −0.18 to 0.02). It was found that interventions significantly increase spirituality ( g = 0.70, 95% CI = 0.02–1.37) and decrease depression ( g = −0.29, 95% CI = −0.51 to −0.07), but had no significant effect over anxiety, quality of life, and symptom burden. Overall, quality of evidence across the included studies was rated as low.

Conclusions:

Evidence suggests that interventions can be effective in increasing hope in palliative care patients.
Factors associated with low levels of patient satisfaction following peripheral nerve block
Authors: Hade Anthony D , Okano Satomi , Pelecanos Anita , Chin Adrian
Published: March 2021

Peripheral nerve blocks can provide surgical anaesthesia as well as excellent postoperative analgesia. When questioned postoperatively, however, some patients report low levels of satisfaction with their nerve block experience. At our hospital, patients undergoing regional anaesthesia have their patient characteristics, block characteristics and postoperative feedback routinely recorded in a block registry. We analysed data from 979 consecutive patients undergoing peripheral nerve block for orthopaedic surgery to identify factors associated with low levels of patient satisfaction. The primary outcome was patient satisfaction with their peripheral nerve block (scale 1–5: 4–5 is ‘satisfied’, 1–3 is ‘not satisfied’). Eighty-nine percent (871/979) of patients reported being ‘satisfied’ with their block. Factors negatively associated with patient satisfaction were rebound pain (adjusted odds ratio (aOR) 0.19, 95% confidence interval (CI) 0.04 to 0.85 for moderate rebound pain; aOR 0.11, 95% CI 0.03 to 0.48 for severe rebound pain), discomfort during the block (aOR 0.37, 95% CI 0.16 to 0.82 for moderate discomfort; aOR 0.19, 95% CI 0.05 to 0.76 for severe discomfort) and pain in the post-anaesthesia care unit (aOR 0.30, 95% CI 0.17 to 0.55 for pain ≥8/10). Only 24% (26/108) of patients who reported being ‘not satisfied’ stated that they would be unwilling to undergo a hypothetical future nerve block. Rebound pain of at least moderate intensity, procedural discomfort of at least moderate intensity and severe pain in the post-anaesthesia care unit are all negatively associated with patient satisfaction. Of these factors, rebound pain occurs most frequently, being present in 52% (403/777) of our respondents.
Regional citrate anticoagulation versus low molecular weight heparin for CRRT in hyperlactatemia patients: A retrospective case-control study
Authors: Li Lu , Bai Ming , Zhang Wei , Zhao Lijuan , Yu Yan , Sun Shiren
Published: March 2021

Introduction:

There were controversial opinions on the use of regional citrate anticoagulation (RCA) versus low molecular weight heparin (LMWH) for continuous renal replacement therapy (CRRT) in hyperlactatemia patients, which was considered as one of the contraindications of citrate. The aim of our present study is to evaluate the efficacy and safety of RCA versus LMWH for CRRT in hyperlactatemia patients.

Methods:

Adult patients with hyperlactatemia who underwent RCA or LMWH CRRT in our center between January 2014 and March 2018 were retrospectively recruited. Filter lifespan, ultrafiltration, purification, bleeding, citrate accumulation, filter clot, and the infusion of blood production were evaluated as endpoints.

Results:

Of the 127 patients included in the original cohort, 81 and 46 accepted RCA and LMWH CRRT, respectively. The filter lifespan was significantly prolonged in the RCA group compared to the LMWH group (44.25 h [2 -83] vs. 24 h [4 -67], p < 0.001). The accumulated filter survival proportions were significantly improved in the RCA group compared to the LMWH group in the original cohort ( p < 0.001) as well as the matched group ( p < 0.001). The filters clotted more frequently in the LMWH group than in the RCA group in both of the original (52.2% vs 26.8%, p = 0.001) and matched cohort (58.6% vs 19.4%, p = 0.001). The bleeding complication was significantly reduced in the RCA group than in the LMWH group in the matched cohort (28.6% vs 4.5%, p = 0.04).

Conclusion:

In critically ill patients with hyperlactatemia requiring CRRT, RCA is superior to LMWH in terms of filter lifespan and bleeding risk without significantly increased risk of citrate accumulation and citrate related metabolic complications. RCA most likely is a safe and effective anticoagulation method for CRRT in patients with hyperlactatemia.
Variable-thickness design of CFRP B-pillar reinforcement considering draping
Authors: Lv Tiantong , Wang Dengfeng
Published: March 2021

An integrated optimization method that comprehensively considers draping factors such as fiber reorientations and cutting of layers is proposed for designing CFRP B-pillar reinforcement with a variable thickness. A laminate parameterization scheme, the local shared layer parameterization scheme (LSL-PS), is developed to parameterize the physical composition of laminates with variable-thickness. Kinematic draping simulations and preform designs are introduced to evaluate fiber reorientations and eliminate manufacturing defects. The optimization design of the B-pillar reinforcement is integrated with a LSL-PS, draping-simulation and preform-design, a RBF surrogate model and GA. At the same time, a comparative optimization without the consideration of draping factors is performed in parallel. The comparison results show that considering draping not only helps designers eliminate manufacturing defects but also helps to obtain a further weight reduction of 13.33% because fiber reorientations are fully utilized to improve the structural performance.
Gaze dynamics with spatiotemporal guided feature descriptor for prediction of driver’s maneuver behavior
Authors: Yan Qiunv , Zhang Weiwei , Hu Wenhao , Cui Guohua , Wei Dan , Xu Jiejie
Published: March 2021

At different levels of driving automation, driver’s gaze maintains great indispensable importance on semantic perception of the surround. In this work, we model gaze dynamics and clarify its relationship with driver’s maneuver behaviors from personalized driving style. Firstly, this paper proposes an Occlusion-immune Face Detector (OFD) for facial landmark detection, which can adaptively solve the facial occlusion introduced by the body and glasses frame in the real-world driving scenarios. Meanwhile, an Eye-head Coordination Model is brought up to bridge the error gap in gaze direction through determining eye pose and head pose fused pattern. Then, a vectorized spatiotemporal guidance feature (STGF) descriptor combining gaze accumulation and gaze transition frequency is proposed to construct gaze dynamics within a time window. Finally, we predict driver’s maneuver behavior through STGF descriptor considering different driving styles to clarify the relationship between gaze dynamics and driving maneuver task. Natural driving data are sampled in a dedicated instrumented vehicle testbed, on which 15 drivers with three kind of driving styles participated. Experimental results show that the prediction model achieves the best performance, estimating driver’s behavior an average of 1 s ahead of actual behavior with 83.6% accuracy considering driving style, compared with other approaches.
Detection and localization of S1 and S2 heart sounds by 3rd order normalized average Shannon energy envelope algorithm
Authors: Nath Madhwendra , Srivastava Subodh , Kulshrestha Niharika , Singh Dilbag
Published: March 2021

Adults born after 1970s are more prone to cardiovascular diseases. Death rate percentage is quite high due to heart related diseases. Therefore, there is necessity to enquire the problem or detection of heart diseases earlier for their proper treatment. As, Valvular heart disease, that is, stenosis and regurgitation of heart valve, are also a major cause of heart failure; which can be diagnosed at early-stage by detection and analysis of heart sound signal, that is, HS signal. In this proposed work, an attempt has been made to detect and localize the major heart sounds, that is, S1 and S2. The work in this article consists of three parts. Firstly, self-acquisition of Phonocardiogram (PCG) and Electrocardiogram (ECG) signal through a self-assembled, data-acquisition set-up. The Phonocardiogram (PCG) signal is acquired from all the four auscultation areas, that is, Aortic, Pulmonic, Tricuspid and Mitral on human chest, using electronic stethoscope. Secondly, the major heart sounds, that is, S1 and S2are detected using 3rd Order Normalized Average Shannon energy Envelope (3rd Order NASE) Algorithm. Further, an auto-thresholding has been used to localize time gates of S1 and S2 and that of R-peaks of simultaneously recorded ECG signal. In third part; the successful detection rate of S1 and S2, from self-acquired PCG signals is computed and compared. A total of 280 samples from same subjects as well as from different subjects (of age group 15–30 years) have been taken in which 70 samples are taken from each auscultation area of human chest. Moreover, simultaneous recording of ECG has also been performed. It was analyzed and observed that detection and localization of S1 and S2 found 74% successful for the self-acquired heart sound signal, if the heart sound data is recorded from pulmonic position of Human chest. The success rate could be much higher, if standard data base of heart sound signal would be used for the same analysis method. The, remaining three auscultations areas, that is, Aortic, Tricuspid, and Mitral have smaller success rate of detection of S1 and S2 from self-acquired PCG signals. So, this work justifies that the Pulmonic position of heart is most suitable auscultation area for acquiring PCG signal for detection and localization of S1 and S2 much accurately and for analysis purpose.
Coronavirus pandemic in Slovakia – The National Library’s experience
Authors: Katarina Kristofova
Published: March 2021

The article summarizes the impacts of the coronavirus pandemic on the operations of the Slovak National Library in 2020 and describes the challenges and oppotunities that it has brought.
The first seven months of the Covid-19 pandemic: Reflections from The National Library of Wales
Authors: Roberts Owain Rhys , Tudur Dafydd
Published: March 2021

This article describes the ways in which Covid-19 pandemic has affected The National Library of Wales during the first 7 months. It describes how the Library responded to the initial UK-wide lockdown which saw the closure of the building in Aberystwyth. The resumption of activities and services during the summer of 2020 is described along with the opportunities that arose due to an accelerated shift towards digital communication. Finally, this article considers how the pandemic is affecting future plans and vision for the future.
Infusion of Kupffer Cells Expanded in Vitro Ameliorated Liver Fibrosis in a Murine Model of Liver Injury
Authors: Li Weina , He Fei
Published: March 2021

Transfer of exogenous macrophages represents an alternative technique to treat liver fibrosis. At present, bone marrow-derived monocytes and stem cells are the main sources for exogenous macrophages. Kupffer cells (KCs) are the resident macrophages in the liver and play a critical role in the liver homeostasis and diseases. It is unclear whether infusion of KCs can treat liver fibrosis. In this study, we observed that granulocyte-macrophage colony stimulating factor (GM-CSF) could improve the purity of cultured KCs and significantly up-regulate the expression of Cluster of Differentiation 11b (CD11b). The most important point is that GM-CSF could significantly promote the proliferation of KCs in vitro. KCs expanded in vitro still had the potential of M1/M2 polarization and phagocytosis. Furthermore, infusion of these KCs could ameliorate liver fibrosis induced by carbon tetrachloride (CCl4) in mice. Together, our results suggest that KCs are likely to be another source for macrophage therapy.
LAMB1 Is Related to the T Stage and Indicates Poor Prognosis in Gastric Cancer
Authors: Ran Tao , Chen ZhiJi , Zhao LiWen , Ran Wei , Fan JinYu , Hong SiYa , Yang ZhaoXia
Published: March 2021

Background and Objective:

Gastric cancer (GC) is a common tumor malignancy with high incidence and poor prognosis. Laminin is an indispensable component of basement membrane and extracellular matrix, which is responsible for bridging the internal and external environment of cells and transmitting signals. This study mainly explored the association of the LAMB1 expression with clinicopathological characteristics and prognosis in gastric cancer.

Methods:

The expression data and clinical information of gastric cancer patients were downloaded from The Cancer Genome Atlas (TCGA) and Asian Cancer Research Group (ACRG). And we analyzed the relationship between LAMB1 expression and clinical characteristics through R. CIBERSORTx was used to calculate the absolute score of immune cells in gastric tumor tissues. Then COX proportional hazard models and Kaplan-Meier curves were performed to evaluate the role of LAMB1 and its influence on prognosis in gastric cancer patients. Finally, GO and KEGG analysis were applied for LAMB1-related genes in gastric cancer, and PPI network was constructed in Cytoscape software.

Results:

In the TCGA cohort, patients with gastric cancer frequently generated LAMB1 gene copy number variation, but had little effect on mRNA expression. Both in the TCGA and ACRG cohorts, the mRNA expression of LAMB1 in gastric cancer tissues was higher than it in normal tissues. All patients were divided into high expression group and low expression group according to the median expression level of LAMB1. The elevated expression group obviously had more advanced cases and higher infiltration levels of M2 macrophages. COX proportional hazard models and Kaplan-Meier curves revealed that patients with enhanced expression of LAMB1 have a worse prognosis. GO/KEGG analysis showed that LAMB1-related genes were enriched in PI3K-Akt signaling pathway, focal adhesion, ECM-receptor interaction, etc.

Conclusions:

The high expression of LAMB1 in gastric cancer is related to the poor prognosis of patients, and it may be related to microenvironmental changes in tumors.
The Deep Breath Before the Plunge: Ictal Apnea and the Amygdala
Authors: Widdess-Walsh Peter
Published: March 2021

[Box: see text]
New Antiproliferative Dibenzo-α-Pyrone From Whole Plants of Centella asiatica
Authors: Liu Yi , Wang Wei , Miao Jian
Published: March 2021

A new compound, 1,3,7,9-tetrahydroxy-6 H-dibenzo[ b, d]pyran-6-one (1), together with 6 known compounds (2-7), was isolated from the extract of whole plants of Centella asiatica. The chemical structure was elucidated on the basis of spectroscopic and mass spectrometric analyses. All the isolates were evaluated for their cytotoxicities against 4 human cancer cell lines (MCF-7, HepG2, Hela, and A549). Among them, compound 1 was found to exhibit significant cytotoxicity on MCF-7 and HepG2 cancer cells with half-maximal inhibitory concentration values of 4.1 and 7.2 µM, respectively.
Alternative Extraction Methods of Essential Oil From the Flowers of Citrus aurantium L. Var Daidai Tanaka: Evaluation of Oil Quality and Sedative-Hypnotic Activity
Authors: Liang Zengenni , Shang Xue-bo , Su Jin , Li Gao-yang , Fu Fu-hua , Guo Jia-jing , Shan Yang
Published: March 2021

The aim of this study was to analyze the content of hypnotic components in the essential oil from Citrus aurantium flowers (EDD), extracted by different methods, and to characterize its sedative-hypnotic effects. The sedative-hypnotic capacity of EDD was evaluated using pentobarbital-induced sleeping assays, locomotor activity tests and GABAA receptor antagonists. The results showed that EDD extracted by steam and water distillation (SWD), hydrodistillation (HD), and ultrasound-assisted hydrodistillation (UHD) had as their main components linalool, linalyl acetate, and limonene, comprising more than 55% of the total peak area. Compared with EDD extracted by HD and UHD, the total content of linalool and linalyl acetate in EDD obtained by SWD was highest, whereas the content of limonene in EDD extracted by the 3 different methods was not different. Oral and intraperitoneal administration of EDD resulted in reduced sleep latency and increased sleep duration of mice, as well as reduced locomotor activity, which was proven by decreases in the total distance travelled, average velocity, number of activities, and central distance. Interestingly, intraperitoneal injection of EDD had better sedative and hypnotic effects than oral ingestion. In vitro assays using SH-SY5Y cells showed that EDD dose-dependently increased Cl− influx, which could be blocked by the GABAA receptor antagonists, picrotoxin, bicuculline, and flumazenil, suggesting that EDD promoted sedative-hypnotic activity by potentiating GABAA receptor-mediated Cl− current responses. Altogether, these results suggest that the important hypnotic-sedative activity of EDD appears to be due to the effects of limonene, and particularly the high contents of linalool and linalyl acetate, which were effectively extracted by SWD.
Impact of Age on Consent in a Geriatric Orthopaedic Trauma Patient Population
Authors: McGovern Madeline M. , McTague Michael F. , Stevens Erin , Medina Juan Carlos Nunez , Franco-Garcia Esteban , Heng Marilyn
Published: March 2021

Introduction:

Persistent misconceptions of frailty and dementia in geriatric patients impact physician-patient communication and leave patients vulnerable to disempowerment. Physicians may inappropriately focus the discussion of treatment options to health care proxies instead of patients. Our study explores the consenting process in a decision-making capable orthogeriatric trauma patient population to determine if there is a relationship between increased patient age and surgical consent by health care proxy.

Methods:

Patients aged 65 and older who underwent operative orthopaedic fracture fixation between 1 of 2 Level 1 Trauma Centers were retrospectively reviewed. Decision-making capable status was defined as an absence of patient history of cognitive impairment and a negative patient pre-surgical Confusion Assessment Method (CAM) and Mini-Cog Assessment screen. Provider of surgical consent was the main outcome and was determined by signature on the consent form.

Results:

510 patients were included, and 276 (54.1%) patients were deemed capable of consent. In 27 (9.8%) of 276 decision-capable patients, physicians obtained consent from health care proxies. 20 of these 27 patients (74.1%) were 80 years of age or older. However, in patients aged 70 to 79, only 7 health care proxies provided consent. (p = 0.07). For every unit increase in age, the log odds of proxy consent increased by .0008 (p < 0.001). Age (p < 0.001), income level (p = 0.03), and physical presence of proxy at consult (p < 0.001) were factors associated with significantly increased utilization of health care proxy provided consent. Language other than English was a significant predictor of proxy-provided consent (p = 0.035). 48 (22%) decision-making incapable patients provided their own surgical consent.

Discussion:

The positive linear association between age and health care proxy provided consent in cognitively intact geriatric orthopaedic patients indicates that increased patient age impacts the consenting process. Increased physician vigilance and adoption of institutional consenting guidelines can reinforce appropriate respect of geriatric patients’ consenting capacity.
Does Venture Capital Investment Spur Innovation? A Cross-Countries Analysis
Authors: Khan Nawab , Qu Haitao , Qu Jing , Wei ChunMiao , Wang Shihao
Published: March 2021

This article examines venture capital composite impact on innovation. For this purpose, we made venture capital index using principal component analysis methodology to test the composite impact of venture capital impact on innovation. We constructed our sample of 41 countries on the basis of venture capital fundraising from 2006 to 2016. First, we empirically tested index individual component, for which we used ordinary least square regression with robust standard error. In the second stage, we made VC index using principal component analysis methodology to analyze the composite effect of VC on patents generation. Empirical results show strong significant venture capital investment impact on patents generations. Overall, our findings suggest that venture capital investment significantly spur innovation, when we analyzed the individual factors of the index as well as compositely. These results encourage governments and policy makers to promote innovation through facilitating venture capital investment which provide an alternative source of finance to startups which find hard to raise fund in conventional fund market. This also suggest that policy maker should consider the composite effect of the venture capital in an economy to robustly encourage innovation.
Interest in Telehealth Among Patients With Chronic Retinal Conditions
Authors: Karthik Naveen , Shields Ryan A. , Brown Meghan M. , Aoun Mariam , Wolfe Jeremy D. , Drenser Kimberly A. , Capone Antonio , Williams George A.
Published: March 2021

Purpose:

This work investigated interest in telehealth services for patients with chronic retinal conditions.

Methods:

A single-center, multi-office study was conducted of patients with chronic retinal conditions who were seen by 1 of 4 physicians during June 2020. Patients whose next appointment was 6 months or later were telephoned. Patients completed a phone interest survey about their interest in a hybrid telehealth evaluation instead of a complete office evaluation with their provider.

Results:

Of 2136 patients reviewed, 453 met eligibility to participate in the survey. A total of 159 patients (35.1%) participated, of whom 91 (57.2%) indicated an interest in telehealth at their next follow-up visit. Of the 68 (42.8%) patients without a current interest in telehealth, 13 (19.1%) expressed interest in pursuing telehealth in the future. Age ( P = .19), sex ( P = .22), race ( P = .79), office location ( P = .19), number of prior visits ( P = .58), and median household income by patient’s zip code ( P = .14) were not predictors of telehealth interest. Among diagnoses, dry age-related macular degeneration was associated ( P = .04) with increased interest in telehealth. An increased number of ocular diagnoses were also found to predict a decreased ( P = .04) interest in telehealth. multivariable analysis revealed healthcare provider as the only significant predictor for interest in telehealth ( P = .03).

Conclusions:

Most patients with chronic retinal conditions may be interested in incorporating telehealth into routine care. Considerations should be made to evaluate interest in telehealth to guide patients to clinical experiences that best suit their needs.
Autoimmune hypoglycemia expands the biological spectrum of HHV8+ multicentric Castleman disease
Authors: Arnautou Pierre , Auclair Martine , Fellahi Soraya , Bouché Clara , Fieschi Claire , Barrak Elias , Queyrel-Moranne Viviane , Chaillous Lucy , Blin Nicolas , Malphettes Marion , Fadlallah Jehane , Bertinchamp Remi , Gérard Laurence , Bengoufa Djaouida , Galicier Lionel , Oksenhendler Eric , Vigouroux Corinne , Boutboul David
Published: March 2021

Key Points

Autoimmune hypoglycemia belongs to the clinical spectrum of HHV8+ MCD and rituximab is an effective treatment of this condition. This rare complication is related to autoantibodies directed toward the insulin receptor and activating the insulin signaling pathway.
Effect of dural inflammatory soup application on activation and sensitization markers in the caudal trigeminal nucleus of the rat and the modulatory effects of sumatriptan and kynurenic acid
Authors: Spekker Eleonóra , Laborc Klaudia Flóra , Bohár Zsuzsanna , Nagy-Grócz Gábor , Fejes-Szabó Annamária , Szűcs Mónika , Vécsei László , Párdutz Árpád
Published: March 2021

Background

The topical inflammatory soup can model the inflammation of the dura mater causing hypersensitivity and activation of the trigeminal system, a phenomenon present in migraineurs. Calcitonin gene-related peptide, transient receptor potential vanilloid-1 receptor, and neuronal nitric oxide synthase are important in the sensitization process there.

5-HT1B/1D receptor agonists, triptans are used as a treatment of migraine. Kynurenic acid an NMDA antagonist can act on structures involved in trigeminal activation.

Aim

We investigated the effect of inflammatory soup induced dural inflammation on the calcitonin gene-related peptide, transient receptor potential vanilloid-1 receptor, and neuronal nitric oxide synthase levels in the caudal trigeminal nucleus. We also tested whether pretreatment with a well-known antimigraine drug, such as sumatriptan and kynurenic acid, a compound with a different mechanism of action, can affect these changes and if their modulatory effects are comparable.

Material and methods

After subcutaneous sumatriptan or intraperitoneal kynurenic acid the dura mater of adult male Sprague-Dawley rats (n = 72) was treated with inflammatory soup or its vehicle (synthetic interstitial fluid). Two and a half or four hours later perfusion was performed and the caudal trigeminal nucleus was removed for immunohistochemistry.

Results and conclusion

Inflammatory soup increased calcitonin gene-related peptide, transient receptor potential vanilloid-1 receptor, and neuronal nitric oxide synthase in the caudal trigeminal nucleus compared to placebo, which was attenuated by sumatriptan and kynurenic acid. This suggests the involvement of 5-HT1B/1D and NMDA receptors in neurogenic inflammation development of the dura and thus in migraine attacks.
Burden of oral anticoagulation in embolic stroke of undetermined source without atrial fibrillation
Authors: Witte Klaus K. , Tsivgoulis Georgios , Reynolds Matthew R. , Tsintzos Stelios I. , Eggington Simon , Ismyrloglou Eleni , Lyon Julie , Huynh Marianne , Egea Marta , de Brouwer Bonnie , Ziegler Paul D. , Franco Noreli , Joglekar Rashmi , Rosemas Sarah C. , Liu Shufeng , Thijs Vincent
Published: March 2021

Objective

Prevention of recurrent stroke in patients with embolic stroke of undetermined source (ESUS) is challenging. The advent of safer anticoagulation in the form of direct oral anticoagulants (DOACs) has prompted exploration of prophylactic anticoagulation for all ESUS patients, rather than anticoagulating just those with documented atrial fibrillation (AF). However, recent trials have failed to demonstrate a clinical benefit, while observing increased bleeding. We modeled the economic impact of anticoagulating ESUS patients without documented AF across multiple geographies.

Methods

CRYSTAL-AF trial data were used to assess ischaemic stroke event rates in ESUS patients confirmed AF-free after long-term monitoring. Anticipated bleeding event rates (including both minor and major bleeds) with aspirin, dabigatran 150 mg, and rivaroxaban 20 mg were sourced from published meta-analyses, whilst a 30% ischaemic stroke reduction for both DOACs was assumed. Cost data for clinical events and pharmaceuticals were collected from the local payer perspective.

Results

Compared with aspirin, dabigatran and rivaroxaban resulted in 17.9 and 29.9 additional bleeding events per 100 patients over a patient’s lifetime, respectively. Despite incorporating into our model the proposed 30% reduction in ischaemic stroke risk, both DOACs were cost-additive over patient lifetime, as the costs of bleeding events and pharmaceuticals outweighed cost savings associated with the reduction in ischaemic strokes. DOACs added £5953–£7018 per patient (UK), €6683–€7368 (Netherlands), €4933–€9378 (Spain), AUD$5353–6539 (Australia) and $26,768–$32,259 (US) of payer cost depending on the agent prescribed. Additionally, in the U.S. patient pharmacy co-payments ranged from $2468–$12,844 depending on agent and patient plan. In all settings, cost-savings could not be demonstrated even when the modelling assumed 100% protection from recurrent ischaemic strokes, due to the very low underlying risk of recurrent ischaemic stroke in this population (1.27 per 100 patient-years).

Conclusions

Anticoagulation of non-AF patients may cause excess bleeds and add substantial costs for uncertain benefits, suggesting a personalised approach to anticoagulation in ESUS patients.
Management quality indicators and in-hospital mortality among acute coronary syndrome patients admitted to tertiary hospitals in Ethiopia: prospective observational study
Authors: Fanta Korinan , Daba Fekede Bekele , Tegene Elsah , Melaku Tsegaye , Fekadu Ginenus , Chelkeba Legese
Published: March 2021

Background

Acute coronary syndrome (ACS) remains the leading cause of cardiovascular disease mortality and morbidity worldwide. While the management quality measures and clinical outcomes of patients with ACS have been evaluated widely in developed countries, inadequate data are available from sub-Saharan Africa countries. So, this study aimed to assess the clinical profiles, management quality indicators, and in-hospital outcomes of patients with ACS in Ethiopia.

Methods

A Prospective observational study was conducted at two tertiary hospitals in Ethiopia from March 2018 to November 2018. The primary outcome of the study was in-hospital mortality. Data were analyzed using SPSS version 23.0. Multivariable cox-regression was conducted to identify predictors of time to in-hospital mortality. Variable with p -value < 0.05 was considered statistically significant.

Results

Among 181 ACS patients enrolled, about (61%) were presented with ST-elevation myocardial infarction (STEMI). The mean age of the study participant was 55.8 ± 11.9 years and 62.4% were males. The use of guideline-directed medications within 24 h of hospitalization were sub-optimal (57%) [Dual antiplatelet (73%), statin (74%), beta-blocker (67%) and ACEI (61%)]. Only (7%) ACS patients received the percutaneous coronary intervention (PCI). Discharge aspirin and statin were high (> 90%) while other medications were sub-optimal (< 80%). The all-cause in-hospital mortality rate was 20.4% and the non-fatal MACE rate was 25%. Rural residence (AHR: 3.64, 95% CI: 1.81–7.29), symptom onset to hospital arrival > 12 h (AHR: 4.23, 95% CI: 1.28–13.81), and Cardiogenic shock (AHR: 7.20, 95% CI: 3.55–14.55) were independent predictors of time to in-hospital death among ACS patients.

Conclusion

In the present study, the use of guideline-directed in-hospital medications was sub-optimal. The overall in-hospital mortality rate was unacceptably high and highlights the urgent need for national quality-improvement focusing on timely initiation of evidence-based medications, reperfusion therapy, and strategies to reduce pre-hospital delay.
The prognostic role of functional dependency in older inpatients with COVID-19
Authors: Plotnikov Galina , Waizman Efraim , Tzur Irma , Yusupov Alexander , Shapira Yonatan , Gorelik Oleg
Published: March 2021

Background

Coronavirus disease 2019 (COVID-19) is a pandemic infection with substantial risk of death, especially in elderly persons. Information about the prognostic significance of functional status in older patients with COVID-19 is scarce.

Methods

Demographic, clinical, laboratory and short-term mortality data were collected of 186 consecutive patients aged ≥ 65 years hospitalized with COVID-19. The data were compared between 4 study groups: (1) age 65–79 years without severe functional dependency; (2) age ≥ 80 years without severe functional dependency; (3) age 65–79 years with severe functional dependency; and (4) age ≥ 80 years with severe functional dependency. Multivariate logistic regressions were performed to evaluate the variables that were most significantly associated with mortality in the entire sample.

Results

Statistically significant differences were observed between the groups in the proportions of males (p = 0.007); of patients with diabetes mellitus (p = 0.025), cerebrovascular disease (p < 0.001), renal failure (p = 0.003), dementia (p < 0.001), heart failure (p = 0.005), pressure sores (p < 0.001) and malignant disorders (p = 0.007); and of patients residing in nursing homes (p < 0.001). Compared to groups 1 (n = 69) and 2 (n = 28), patients in groups 3 (n = 32) and 4 (n = 57) presented with lower mean serum albumin levels on admission (p < 0.001), and were less often treated with convalescent plasma (p < 0.001), tocilizumab (p < 0.001) and remdesivir (p < 0.001). The overall mortality rate was 23.1 %. The mortality rate was higher in group 4 than in groups 1 − 3: 45.6 % vs. 8.7 %, 17.9% and 18.3 %, respectively (p < 0.001). On multivariate analysis, both age ≥ 80 years and severe functional dependency were among the variables most significantly associated with mortality in the entire cohort (odds ratio [OR] 4.83, 95 % confidence interval [CI] 1.88 − 12.40, p < 0.001 and OR 2.51, 95 % CI 1.02 − 6.15, p = 0.044, respectively). Age ≥ 80 years with severe functional dependency (group 4) remained one of the variables most significantly associated with mortality (OR 10.42, 95 % CI 3.27–33.24 and p < 0.001).

Conclusions

Among patients with COVID-19, the association of severe functional dependency with mortality is stronger among those aged ≥ 80 years than aged 65–79 years. Assessment of functional status may contribute to decision making for care of older inpatients with COVID-19.
Reference intervals for 26 common biochemical analytes in term neonates in Jilin Province, China
Authors: Wang Kaijin , Zhu Xuetong , Zhou Qi , Xu Jiancheng
Published: March 2021

Background

Biochemical analytes provide information for neonatal disease management and therapy, and population-based reference intervals (RIs) are essential to accurately interpret laboratory test results. This study aimed to establish local RIs for biochemical assays in term neonates.

Methods

A total of 195 healthy term neonates from birth to 3rd day were recruited as reference individuals prospectively. Analytes of 26 common biochemistries were measured using the VITROS 5600 Integrated System. The 3-level nested ANOVA was performed to assess the need for partitioning RIs of each analyte, and RIs were derived by a nonparametric method or robust method. Multiple regression analysis was used to evaluate specific correlations between the analytes and individual characteristics including age, gender, gestational age, birthweight and delivery mode.

Results

There were no between-sex differences in all analytes, whereas there were significant between-day-age differences in 6 analytes. Small between-delivery-mode differences were observed in the results for potassium, phosphorus, and urea. The major related factor of most analytes was postnatal age. During the first 3 days, values of iron, lipids and lipoproteins increased; creatinine, urea, uric acid, creatine kinase and lactate dehydrogenase decreased; other analytes showed slight changes or relatively stable trends. Reference limits of some analytes, particularly lactate dehydrogenase and alkaline phosphatase, were significantly different from adult and pediatric groups.

Conclusions

RIs of 26 common biochemical analytes are established for term neonates aged 0 to 3 days in northeast China. Additionally, it is suggested that age-related changes should be valued in the clinical decision-making process for newborns.
Racially equitable diagnosis of cystic fibrosis using next-generation DNA sequencing: a case report
Authors: Shum Bennett O. V. , Bennett Glenn , Navilebasappa Akash , Kumar R. Kishore
Published: March 2021

Background

Cystic Fibrosis (CF) is one of the most prevalent autosomal recessive inherited disease in Caucasians. Rates of CF were thought to be negligible in non-Caucasians but growing epidemiological evidence shows CF is more common in Indian, African, Hispanic, Asian, and other ethnic groups than previously thought. Almost all second-tier molecular diagnostic tools currently used to confirm the diagnosis of CF consist of panels of the most common CF-causing DNA variants in Caucasians. However non-Caucasian individuals with CF often have a different spectrum of pathogenic variants than Caucasians, limiting the clinical utility of existing molecular diagnostic panels in this group. As a consequence of racially inequitable CF testing frameworks, non-Caucasians with CF encounter greater delays in diagnosis and associated harms than Caucasians. An unbiased approach of detecting CF-causing DNA variants using full gene sequencing could potentially address racial inequality in current CF testing.

Case presentation

We present the case of a female baby from rural India who had a borderline first-tier newborn screening result for CF. Instead of choosing a targeted CF panel for second-tier testing, we used next-generation DNA sequencing to comprehensively analyze the cystic fibrosis transmembrane conductance regulator gene as an unbiased approach for molecular confirmation of CF. Sequencing identified two pathogenic variants that cause CF. One variant (c.1521_1523delCTT) is the most common cause of CF, while the other variant (c.870-1G > C) is absent from all population allele databases and has not been found in the Indian population previously. The rare variant would not have been detected by all currently available targeted CF panels used for second- or third-tier molecular CF testing.

Conclusions

Our use of full gene sequencing as a second-tier CF test in a non-Caucasian patient avoided the problems of missed diagnosis from using Caucasian-biased targeted CF panels currently recommended for second-tier testing. Full gene sequencing should be considered as the standard methodology of second-tier CF testing to enable equal opportunity for CF diagnosis in non-Caucasians.