bluuebunny/crossref_metadata_2025 huggingface dataset:
Formulating a Meaningful and Comprehensive Placental Phenotypic Classification
Authors: Freedman Alexa A , Keenan-Devlin Lauren S , Borders Ann , Miller Gregory E , Ernst Linda M
Published: April 2021

Introduction

While many placental lesions have been identified and defined, the significance of multiple overlapping lesions has not been addressed. The purpose of our analysis was to evaluate overlapping patterns of placental pathology and determine meaningful phenotypes associated with adverse birth outcomes.

Methods

Placental pathology reports were obtained from a single hospital between 2009 and 2018. Placental lesions were grouped into four major categories: acute inflammation (AI), chronic inflammation (CI), maternal vascular malperfusion (MVM), and fetal vascular malperfusion (FVM). Within each category, lesions were classified as not present, low grade or high grade. Combinations of pathologies were evaluated in relation to preterm birth (<37 weeks) and small for gestational age (SGA) infant (birthweight <10th percentile).

Results

During the study period, 19,027 placentas were reviewed by pathologists. Results from interaction models indicate that MVM and MVM in combination with CI and/or FVM are associated with the greatest odds of SGA infant and PTB. When incorporating grade, we identified 21 phenotype groups, each with characteristic associations with the SGA infant and patterns of PTB.

Discussion

We have developed a comprehensive and meaningful placental phenotype that incorporates severity and multiplicity of placental lesions. We have also developed a web application to facilitate phenotype determination ( https://placentaexpression.shinyapps.io/phenotype ).
Aseptic Meningitis after Recovery from SARS-CoV-2 in an Allogeneic Stem Cell Transplant Recipient
Authors: Basher Fahmin , Camargo Jose F , Diaz-Paez Meilin , Lekakis Lazaros J , Pereira Denise L
Published: April 2021

SARS-CoV-2 emerged as a worldwide pandemic in late 2019 and initially was described as a primary respiratory illness. The clinical manifestations of COVID-19 are now known to encompass nearly all organ systems, including the central nervous system. We present a case of an allogeneic hematopoietic stem cell transplant recipient who recovered from documented SARS-CoV-2 infection and later presented with symptoms of meningitis. While cerebrospinal fluid analysis did not reveal any bacterial or viral etiologies, evidence of an inflammatory state, including ophthalmologic findings of episcleritis, indicate what is likely the first reported case of aseptic meningitis associated with SARS-CoV-2 infection after initial clinical recovery.
Intergenerational music teaching and learning among preservice music teachers and senior adult musicians
Authors: Tsugawa Samuel
Published: April 2021

The purpose of this study was to examine the intergenerational interactions between preservice music teachers and senior adult musicians engaged in music teaching and learning in a New Horizons ensemble within one university’s music teacher preparation program. This intrinsic qualitative case study included written reflections and observational data of 16 current undergraduate music education students and verbatim interview transcripts of 5 current and former students serving as teaching assistants who taught and conducted their university’s New Horizons ensemble. Findings distilled from the data included (a) how younger-aged preservice music teachers responded to generational differences while learning how to interact with senior adult musicians, (b) the pedagogical content knowledge (PCK) learned and developed by participants as a result of teaching in a New Horizons ensemble, and (c) the connections made by participants teaching senior adults to their future careers as professional music educators. Future discussion and directions from this study highlight emerging connections of research between adult and community music settings and music teacher education. Implications include (a) how to create best practices so that the missions and objectives of both music teacher education programs and cooperating community adult ensembles support and enhance each other, (b) fostering outcomes that prepare music education majors for experiences in adult music education, and (c) reimagining New Horizons and music teacher education partnerships that result in more national, racial, cultural, and musical diversity and inclusion.
Pregnancy post autologous stem cell transplant with BEAM conditioning for multiple sclerosis
Authors: Chatterton Sophie , Withers Barbara , Sutton Ian J , Milliken Samuel T , Ma David DF , Moore John J , Massey Jennifer C
Published: April 2021

Background:

Given the increasing numbers of multiple sclerosis (MS) patients undergoing autologous haematopoietic stem cell transplant (AHSCT) worldwide, and with women of childbearing age overrepresented in the target population, it is increasingly important to review fertility and pregnancy outcomes following AHSCT.

Objective:

To evaluate the rate of pregnancy and complications post-AHSCT for MS.

Method:

Retrospective evaluation of the rate of pregnancy and associated complications in a cohort of patients post-AHSCT with BEAM conditioning for MS since 2010 in a tertiary referral centre.

Results:

In our ongoing Phase 2 trial of AHSCT for MS, 55 patients have undergone AHSCT with 30 females being of childbearing age at time of transplantation. Four pregnancies occurred following AHSCT. Two pregnancies were carried to term. No maternal or neonatal complications were reported in either case. Two pregnancies were not carried to term due to elective terminations. Both of these patients became pregnant unexpectedly 2 years following AHSCT. Of the 21 male patients, one patient has fathered three children since his AHSCT. There were no newborn complications.

Conclusions:

This is the first report to our knowledge on fertility outcomes in both sexes post-AHSCT for MS. Patients of both sexes should be counselled prior to treatment on infertility and contraceptive use.
Multiple sclerosis: Is there a risk of worsening after yellow fever vaccination?
Authors: Papeix Caroline , Mazoyer Julie , Maillart Elisabeth , Bensa Caroline , Dubessy Anne-Laure , Goujon Catherine , Launay Odile , Lebrun-Frénay Christine , Louapre Céline , Mrejen Serge , Pourcher Valérie , Rosenheim Michel , Stankoff Bruno , Vidal Jean-Sebastien , Lubetzki Catherine
Published: April 2021

Background:

Yellow fever vaccine (YFV) is not advised for multiple sclerosis (MS) patients because of the potential risk of post-vaccine relapses.

Objective:

To assess the risk of relapsing-remitting multiple sclerosis (RR-MS) worsening after YFV.

Methods:

Non-interventional observational retrospective, exposed/non-exposed cohort study nested in the French national cohort including MS.

Results:

128 RR-MS were included. The 1-year annualized relapse rate (ARR) following YFV did not differ between exposed: 0.219 (0.420) and non-exposed subjects: 0.208 (0.521) ( p = 0.92). Time to first relapse was not different between groups (adjusted hazard ratio (HR) = 1.33; 95% confidence interval (CI) = 0.53–3.30, p = 0.54).

Conclusion:

These results suggest that YFV does not worsen the course of RR-MS.
Male fertility in relapsing-remitting multiple sclerosis patients treated with natalizumab and ocrelizumab: A prospective case-control study
Authors: D’Amico Emanuele , Zanghì Aurora , Calogero Aldo Eugenio , Patti Francesco
Published: April 2021

Scarce data are available about the impact of natalizumab (NTZ) and ocrelizumab (OCR) on male fertility in relapsing-remitting multiple sclerosis (RRMS). In this case–control prospective study, the gonadal steroids and the sperm parameters have been analysed at the time of the RRMS diagnosis and after 12 months from the beginning of the investigated therapies. Sixteen men with RRMS and sixteen matched healthy controls were included. At enrolment and after 12 months on therapy, the gonadal steroids and the sperm parameters of men with RRMS did not differ from the healthy controls. In conclusion, therapy with NTZ and OCR had no impact on fertility status in our cohort of men with RRMS. Further randomized and prospective studies are needed.
Home-based Pilates for symptoms of anxiety, depression and fatigue among persons with multiple sclerosis: An 8-week randomized controlled trial
Authors: Fleming Karl M , Coote Susan B , Herring Matthew P
Published: April 2021

Background:

Symptoms of anxiety, depression and fatigue are common comorbidities among persons with multiple sclerosis (PwMS). A previous pilot study supported Pilates as a feasible exercise modality that may improve these outcomes among PwMS.

Objective:

To quantify the effects of 8 weeks of home-based Pilates on symptoms of anxiety, depression and fatigue among PwMS.

Methods:

A total of 80 PwMS (69 female) were randomized to twice-weekly home-based Pilates guided by a DVD) or wait-list control. Validated questionnaires assessed anxiety, depressive and fatigue symptoms at baseline, weeks 2, 4, 6 and 8. Using intention to treat, repeated measures analysis of covariance (RM-ANCOVA) adjusted for baseline physical activity examined between-group differences across time. Hedges’ d quantified the magnitude of differences in outcome change. Sensitivity analyses examined female-only samples.

Results:

Group × time interactions were statistically significant for all outcomes (all p ⩽ 0.005). Pilates significantly reduced (all p ⩽ 0.03) depressive symptoms (Quick Inventory of Depressive Symptomatology, d = 0.70; Hospital Anxiety and Depression Scale-Depression, d = 0.74), anxiety (State-Trait Anxiety Inventory, d = 0.30; Hospital Anxiety and Depression Scale-Anxiety, d = 0.49), cognitive ( d = 0.44), physical ( d = 0.78), psychosocial ( d = 0.56) and total fatigue ( d = 0.76). Female-only results were materially the same.

Conclusion:

Home-based Pilates significantly improved anxiety, depressive and fatigue symptoms among PwMS with minimal-to-mild mobility disability, including moderate-to-large, clinically meaningful improvements in depressive and fatigue symptoms. Trial Registration: ClinicalTrials.gov (NCT04120207)
Revisiting the crowd: Peaceful assembly in Irish water protests
Authors: Power Séamus A
Published: April 2021

The enactment of the Water Services Bill into Irish law on December 28, 2014, was met with strong opposition from the Irish public, manifesting in local and national demonstrations. This social movement provided an ideal case to examine interactions between protesters and police in different contexts. Ethnographic observations and randomly sampled interviews took place before, and during, seven national demonstrations in Dublin, Ireland. Simultaneously, urban ethnographic research yielded in-depth observational and interview data at local protests in another Irish city. Data from both national and local protests are examined in light of classical and contemporary sociocultural psychological conceptualizations of the crowd. The elaborated social identity model offers most explanatory power to comprehend the observed and reported events between police and protesters in this cultural context during an unprecedented economic recovery following recession. No evidence is found to support classical conceptualizations of the crowd. I describe the consequences of this analysis for conceptualizing police–protester interactions to generate peaceful assembly in liberal democracies.
Trust in social non-pharmaceutical interventions and travel intention during a pandemic
Authors: Chung Jin Young , Lee Choong-Ki , Park Yae-Na
Published: April 2021

Non-pharmaceutical interventions (NPIs) become increasingly one of the most significant practices for preventing the spread of a pandemic through the movement of people (e.g., travel and tourism). Past studies argued that individuals’ acceptance of NPIs is adaptive behavior, which increases travel intention during a pandemic. Yet, firm beliefs about the extent to which others accept NPIs are as important as personal willingness to accept NPIs, due to the social and environmental components of public health measures against infectious disease. Thus, this study examined how one’s trust in social NPIs is related to travel intention during a pandemic. Data were collected in South Korea, one of the few countries where no measures to limit human mobility were taken after the COVID-19 pandemic outbreak. Results showed that the trust in social NPIs meditates the relationship between the efforts to navigate travel constraints and intentions to travel during the pandemic.
What Does it Mean to be a Cultural Omnivore? Conflicting Visions of Omnivorousness in Empirical Research
Authors: de Vries Robert , Reeves Aaron
Published: April 2021

The ‘omnivore’ hypothesis currently dominates the academic literature on the social patterning of taste. It argues that cultural elites no longer resemble the traditional stereotype of an elitist snob. Instead, they are more likely to be ‘omnivores’ with broad tastes encompassing both elite and popular cultural forms. The omnivore hypothesis has inspired more than two decades of research and debate, without a clear resolution. In this article, we argue that progress in the omnivore debate has been impeded in part due to an elision of two distinct interpretations of the omnivore hypothesis: a strong interpretation, which holds that cultural elites are generally averse to class-based exclusivity; and a weak interpretation which holds that, while elites have broad tastes which encompass popular forms, they do not necessarily repudiate class-based exclusion. We demonstrate how drawing this distinction helps to clarify the existing empirical evidence concerning the omnivore hypothesis.
‘I feel the irritation and frustration all over the body’ Affective ambiguities in networked parenting culture
Authors: Lehto Mari , Paasonen Susanna
Published: April 2021

This article investigates the affective power of social media by analysing everyday encounters with parenting content among mothers. Drawing on data composed of diaries of social media use and follow-up interviews with six women, we ask how our study participants make sense of their experiences of parenting content and the affective intensities connected to it. Despite the negativity involved in reading and participating in parenting discussions, the participants find themselves wanting to maintain the very connections that irritate them, or even evoke a sense of failure, as these also yield pleasure, joy and recognition. We suggest that the ambiguities addressed in our research data speak of something broader than the specific experiences of the women in question. We argue that they point to the necessity of focusing on, and working through affective ambiguity in social media research in order to gain fuller understanding the complex appeal of platforms and exchanges.
Racist bullying of BAME (Black and Asian Minority Ethnic) women within police services in England: Race, gender and police culture
Authors: Hasan Marina
Published: April 2021

This article examines the hidden and under-researched area of bullying and harassment of Black and Asian Minority Ethnic (BAME) women in the police service in England. It discusses the impact of a historical policy failure to acknowledge the importance of intersectionality in matters of diversity and the continuing struggle between race and gender. This contributes to the ‘invisibility and sexualization’ of BAME women in policing. In doing so, it makes BAME women susceptible to unique tactics of bullying and harassment that contribute to their impeded progression compared with their White counterparts. These unique tactics are enhanced by the police organization and enforced by police culture. The article concludes that the bullying and harassment of BAME women are underpinned by issues of patriarchy and racism that are difficult to challenge in a bureaucratic and hierarchical organization like the police.
The complexity of professional integration: An investigation of newly arrived teachers’ initial process of establishing themselves as teachers in Sweden
Authors: Bengtsson Anki , Mickwitz Larissa
Published: April 2021

This article investigates the professional integration of a group of newly arrived teachers, mainly from Syria, who participated in the labour market Fast-track programme in Sweden, which aims at facilitating quicker pathways to teaching positions. Drawing on the institutional perspective, our analysis focuses on formal and informal institutional conditions that hinder or enable newly arrived teachers in their striving for legitimacy as professional teachers. Analysis of focus group interviews and observations show that despite their professional experiences there are limits to their prior professional skills and competences being recognized within the Swedish school. The main institutional challenges identified were acquiring Swedish, understanding and managing the pupil-centred curriculum and its associated communication skills and taking on the facilitator teacher role. Handling and negotiating these challenges are important for gaining recognition as professional teachers, which, it seems, influences their opportunities for employment. To afford them opportunities for professional socialization, it is important to enable them to become acquainted with, handle and negotiate institutional conditions within a new school culture. In contrast to the quick-fix view of European integration policy, our study shows that the professional integration process takes time and includes a socialization process.
More Women Candidates: The Effects of Increased Women’s Presence on Political Ambition, Efficacy, and Vote Choice
Authors: Costa Mia , Wallace Isabel
Published: April 2021

The effect of women in politics is vitally important for the study of representation, yet evidence is mixed on the extent to which women’s presence influences individuals’ symbolic attitudes and behaviors. We use a priming survey experiment to examine how information about increased women candidates in the U.S. affects political ambition, efficacy, and future support for women candidates. We present several different patterns across gender and partisanship. Republicans report higher political ambition after hearing about more women candidates, even when those women are running for the opposite party. Men had higher political efficacy in response to more same-party women running, but not opposite-party women. Importantly, our evidence does not support the widespread notion that women’s presence positively influences women’s political efficacy or likelihood to vote for female candidates. The findings highlight the importance of considering the effects of women’s presence not only for the group that is assumed to benefit.
The Underappreciated But Potentially Lethal Role of Brainstem Dysfunction in Epilepsy
Authors: Englot Dario J.
Published: April 2021

[Box: see text]
A Novel Solution to Concomitant Type Ia/Type IIIa Endoleak Using the Cook Zenith Fenestrated Device and Endologix AFX®2
Authors: Smith Andrew H. , Farivar Behzad S.
Published: April 2021

Failing EVAR is typically treated with open explant or conversion to fenestrated endovascular repair. Novel solutions for EVAR salvage may be required in patients unable to tolerate explant or travel to centers with custom-fenestrated capabilities. However, strategies utilizing commercially available devices are often limited by anatomic constraints such as short renal artery to endograft bifurcation length. We present a case of progressive sac expansion due to late, concomitant type Ia and type IIIa endoleaks. The patient was successfully treated by proximal extension into the visceral segment using a Cook Zenith Fenestrated device and graft relining using the Endologix AFX®2.
Minimization of resource utilization data collected within cost-effectiveness analyses conducted alongside Canadian Cancer Trials Group phase III trials
Authors: Cheung Matthew C , Chan Kelvin KW , Golden Shane , Hay Annette , Pater Joseph , Prica Anca , Chen Bingshu E , Leighl Natasha , Mittmann Nicole
Published: April 2021

Background

Cost-effectiveness analyses embedded within randomized trials allow for evaluation of value alongside conventional efficacy outcomes; however, collection of resource utilization data can require considerable trial resources.

Methods

We re-analyzed the results from four phase III Canadian Cancer Trials Group trials that embedded cost-effectiveness analyses to determine the impact of minimizing potential cost categories on the incremental cost-effectiveness ratios. For each trial, we disaggregated total costs into component incremental cost categories and recalculated incremental cost-effectiveness ratios using (1) only the top 3 cost categories, (2) the top 5 cost categories, and (3) all cost components. Using individual trial-level data, confidence intervals for each incremental cost-effectiveness ratio simulation were generated by bootstrapping and descriptively presented with the original confidence intervals (and incremental cost-effectiveness ratios) from the publications.

Results

Drug acquisition costs represented the highest incremental cost category in three trials, while hospitalization costs represented the other consistent cost driver and the top incremental cost category in the fourth trial. Recalculated incremental cost-effectiveness ratios based on fewer cost components (top 3 and top 5) did not differ meaningfully from the original published results. Based on conventional willingness-to-pay thresholds (US$50,000–US$100,000 per quality-adjusted life-year), none of the re-analyses would have changed the original perception of whether the experimental therapies were considered cost-effective.

Conclusions

These results suggest that the collection of resource utilization data within cancer trials could be narrowed. Omission of certain cost categories that have minimal impact on incremental cost-effectiveness ratio, such as routine laboratory investigations, could reduce the costs and undue burden associated with the collection of data required for cancer trial cost-effectiveness analyses.
The relationship between media use, perceptions and regime preference in post-Arab Spring countries
Authors: Altourah Albaraa F , Chen Khin Wee , Al-Kandari Ali A
Published: April 2021

This paper examines the link between attitudes and perceptions and feelings of dissatisfaction predicating the Arab Spring uprisings in Tunisia, Egypt, Libya and Yemen and their correlation to various media use. World Value Survey Report data show choice of media directly predicts governance preference and indirectly predicts governance preference through the creation of certain perceptions. Democratic rule preference is strongly linked to the use of the internet, mobile phones and newspapers. Mobile phones indirectly correlate (negatively) to dictatorial governance but directly correlate to army rule acceptance. Newspapers contribute directly and indirectly to the acceptance of a dictatorial regime and tolerance of army rule.
Gratifications and readership of women’s magazines in South Africa
Authors: Roux Thérèse
Published: April 2021

The purpose of this article is to expand knowledge about the gratification obtained from women’s magazines using the Uses and Gratifications Theory and the Expectation Confirmation Theory. A mobile-administered survey instrument was used to collect data from 520 magazine readers in South Africa. Key findings indicate that women’s magazines – queens of the newsstands – remain effective mechanisms in delivering inspiration for how females explore ways to improve themselves and for their social-oriented gratifications. The perceived gratification for the inspirational self-oriented dimension was higher than for the social-oriented dimension. There is also a significant difference between the satisfaction levels of readership behaviour groups.
Prescribing pathways to triple therapy in patients with chronic obstructive pulmonary disease in the United States
Authors: Schabert Vernon , Shah Surbhi , Holmgren Ulf , Cabrera Claudia
Published: April 2021

Background:

Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend triple therapy (TT) for chronic obstructive pulmonary disease (COPD) patients based on severity. TT utilization by severity is infrequently studied in real-world settings and may deviate significantly from current clinical recommendations. This study describes prescribing pathways to TT among patients with COPD in the United States.

Methods:

This study analyzed Geisinger Health System electronic medical records from 1 January 2004 to 30 November 2016. Two retrospective cohorts of COPD patients were included: (1) incident COPD, and (2) incident TT users. COPD treatment patterns, including time to TT, were summarized. Time to TT was estimated using Kaplan–Meier methods. Predictors of the relative hazard for TT among incident COPD patients were estimated using Cox proportional hazards regressions.

Results:

Incident COPD and TT cohorts included 57,141 and 8173 patients, respectively. TT was used by 9.6% of incident COPD patients. In the year before TT, 34.3% of incident TT patients received treatment combinations recommended before TT according to GOLD recommendations, which mainly included: long-acting muscarinic antagonists (LAMAs), long-acting beta agonists (LABAs) + LAMAs, and inhaled corticosteroids  + LABAs. Among incident TT patients, median time from COPD diagnosis to TT exceeded 2 years. The hazard for TT over time was associated with lower forced expiratory volume in 1 s values, more frequent exacerbations, current/previous smoking, and comorbid lung conditions such as pulmonary vascular disease, acute respiratory failure, and lung cancer. About 15–20% of the incident TT patients stepped down to a one- or two-drug regimen. Median time to TT discontinuation or step-down were 2 and 9 months, respectively.

Conclusion:

The study has revealed discrepancies in the treatment of COPD patients between GOLD guidelines and actual clinical practices in the United States. Pathways to TT differed from recommended therapy regimes. Further studies are needed to understand barriers to the use of guideline-recommended TTs by healthcare providers. The reviews of this paper are available via the supplemental material section.
China’s Rural–Urban Transformation: New Forms of Inclusion and Exclusion
Authors: Alpermann Björn
Published: April 2021

China’s urbanisation drive has been unprecedented in scale. It has also produced some paradoxical outcomes and led to multiple interconnections between the rural and the urban spheres. These interconnections are the central focus of this special issue. Thus, preference is given to the term “rural–urban transformation” instead of simply “urbanisation.” The main argument advanced here is that we always need to consider the rural aspects and repercussions alongside the urban side of this dual process. This introduction first highlights some of these antinomies to set the stage for the discussion. Next, it explains how they relate to changing mechanisms of inclusion/exclusion. It is proposed that a theoretical approach of functional differentiation can help us sort out the various ways inclusions and exclusions are being produced and combined. Finally, the introduction presents an overview of the articles collected in this special issue and how they relate to the aforementioned topics.
Survey of physician comfort and attitudes on perioperative opioid prescription in patients with chronic pain
Authors: Tan Pei Yu , Quah Denise Desiree Bi Si , Chan Diana Xin Hui
Published: April 2021

Objective:

This study examines current practices, experiences, beliefs, concerns regarding negative outcomes and confidence of non-pain specialty anaesthetists regarding prescribing opioids to chronic pain patients.

Design:

An electronic cross-sectional survey was conducted by physicians from the Division of Anaesthesiology, excluding pain specialists, at the Singapore General Hospital.

Methods:

An online survey was conducted, investigating: (a) sociodemographic and practice characteristics; (b) current opioid prescribing practices; (c) experiences and beliefs towards prescribing opioid analgesics for chronic non-malignant pain; (d) confidence and comfort when prescribing opioids; and (e) educational and training needs in chronic pain management.

Results:

A total of 123 anaesthetists (80.9%) responded to the survey. It was noted that only 38.2% of respondents were comfortable managing patients with chronic pain. The majority (86.2%) felt that anaesthetists should be the primary doctors in the management of postoperative pain in chronic pain patients, and 61% believed that chronic pain trained specialist anaesthetists should be responsible; 92.7% of respondents agreed that patients who are educated about their pain tend to do better. Most importantly, 96.7% of respondents feel that they will benefit from more education regarding pain management in chronic pain patients.

Conclusions:

The majority of non-pain specialist anaesthetists recognise the importance of education regarding pain management for non-malignant chronic pain patients. Many feel that they are not confident in managing these patients and will benefit from continuing medical education and self-assessment courses to improve their confidence. These results could be used to enrich current pain management courses.
Inverted Meckel’s diverticulitis manifesting as intussusception: unusual case of intestinal obstruction in adults
Authors: Singh Kamaldeep , Tandup Cherring , Bajaj Kapil , Thakur Vipul , Sahu Swapnesh
Published: April 2021

Meckel’s diverticulum can manifest with various complications such as obstruction, intussusception, inflammation or diverticulitis, perforation, haemorrhage and fistula, and commonly manifests in children. Adult intussusception due to inverted Meckel’s diverticulum is an uncommon aetiology of intestinal obstruction but should be suspected in individuals. Imaging such as contrast-enhanced computed tomography aids in the diagnosis but it is not confirmatory to diagnose inverted Meckel’s diverticulum as a leading point. Resection of the intussusception segment is the definitive treatment. We present the case of a young man who presented in emergency with complaints of intestinal obstruction and ileo-ileal intussusception was the aetiology of for the same diagnosed on contrast-enhanced computed tomography of the abdomen. On exploration we discovered an inverted Meckel’s diverticulum to be the leading point for intussusception.
Neutrophil-to-lymphocyte ratio is prognostic factor of prolonged pleural effusion after pediatric cardiac surgery
Authors: Yakuwa Kazuki , Miyaji Kagami , Kitamura Tadashi , Miyamoto Takashi , Ono Minoru , Kaneko Yukihiro
Published: April 2021

Objectives

Postoperative pleural effusion (PE) is common after pediatric cardiac surgery, and if prolonged can lead to the deterioration of the general condition due to malnutrition and result in death. This study aims at identifying the prognostic factors of prolonged PE after pediatric cardiac surgery. Design and settings: Patients were divided into the effective (with chest tube removal within 10 days after medical therapy) and ineffective (with chest tube in place for more than 10 days) groups. The factors were compared between the two groups retrospectively.

Participants

Participants included patients who had prolonged PE after cardiac surgery in national center for child and health development between October 2014 and October 2017.

Main outcome measures

Baseline characteristics and procedure details were compared between the two groups to determine the predictor of prolonged PE. White blood cell count, platelet count, neutrophil-to-lymphocyte ratio, hemoglobin level, serum total protein level, serum albumin level, blood fibrinogen level, serum creatinine level, etc. were examined.

Results

Twenty patients were included. Between the two groups, no significant differences in baseline characteristics, such as age, weight, and sex were found, and significant differences were observed only in the NLR change ratio (effective group, 5.1 [4.1–8.0] versus ineffective group, 11.9 [9.9–14.1]; P = 0.01).

Conclusions

NLR change ratio is a potential prognostic factor of prolonged PE, including chylothorax, after pediatric cardiac surgery.
Machine Learning Classification of Regional Swiss Yodel Styles Based on Their Melodic Attributes
Authors: Wey Yannick , Metzig Cornelia
Published: April 2021

A classification of wordless yodel melodies from five different regions in Switzerland was made. For our analysis, we used a total of 217 yodel tunes from five regions, which can be grouped into two larger regions, central and north-eastern Switzerland. The results show high accuracy of classification, therefore confirming the existence of regional differences in yodel melodies. The most salient features, such as rhythmic patterns or intervals, demonstrate some of the key differences in pairwise comparisons, which can be confirmed by a postanalysis survey of the relevant scores.
Renewal Retreats for School Counselors: Design, Delivery, and Outcomes
Authors: Sanders Carrie Brill
Published: April 2021

While providing counseling services, school counselors may experience compassion fatigue and need opportunities for support and supervision. To address the ethical imperative of self-care and provide space for school counselors to connect and renew, one district offered a retreat experience designed to renew school counselors who support K–12 students and their school communities. This practitioner research study investigated the design, delivery, and outcomes of the 1-day retreat. With all participants indicating that the retreat was very to extremely useful to them, worth their time, and applicable to their self-care, the findings suggest the value of retreats designed specifically for school counselors.
Evaluating Efficiency Change in Taiwan’s Financial Industry
Authors: Ma Liang-Han , Hsieh Jin-Chi , Li Ying , Chiu Yung-Ho
Published: April 2021

This study evaluates the performance of the financial industry with meta-frontier (MF) dynamic network data envelopment analysis (DN-DEA) from 2009 to 2015. We divide the sample into two groups, Financial Holding group (FHG) and Insurance & Securities group (ISG), for all decision making units (DMUs) of the financial industry. Our goal is to study the effects of operating performance across divisions and across periods and to compare the differences between these two different groups within Taiwan’s bank industry. We find the best business performance was during 2013, where the average value was 0.5485. The best average value of FHG was 0.7192 in 2012, and ISG was 0.7099 in 2010. FHG has best average overall efficiency (OE) value in 2009–2015 periods. However, the average technical efficiency gap ratio (TGR) value of ISG’s (0.7490) is larger than FHG (0.6959), indicating that business performance is affected by group and meta-frontier. FHG has a larger scale than ISG, and so, those firms can input a relatively large proportion of investments and resources to produce better performance. Finally, many DMUs have excess inputs of labor costs and operating expenses, resulting in an average TGR value that is lower than ISG in 2009–2015.
Listening and Speaking for Real-World Communication: What Teachers Do and What Students Learn From Classroom Assessments
Authors: Yu Melissa H. , Reynolds Barry Lee , Ding Chen
Published: April 2021

Even though standardized international communication tests have been frequently studied, very little research has explored how teachers planned listening and speaking classroom assessments or which classroom-based tests were more beneficial for teaching real-world English communication. A qualitative inquiry was undertaken to investigate these assessment issues among five English as foreign language teachers and 24 of their students through the collection and analysis of classroom observation and post assessment interview data. While teachers tended to draw on textbook listening and speaking activities to assess those skills, how they graded students focused heavily on the students’ communicative competence as listeners and speakers of English rather than on their ability to answer comprehension questions correctly in the classroom assessments. Students identified a mismatch between classroom instruction and assessments and also a mismatch between the English used in assessments and the English used in real-world communication.
Open Versus Endoscopic Osteotomy of Posterosuperior Calcaneal Tuberosity for Haglund Syndrome: A Retrospective Cohort Study
Authors: Pi Yanbin , Hu Yuelin , Guo Qinwei , Jiang Dong , Xie Xin , Zhao Feng , Chen Linxin , Ao Yingfang , Jiao Chen
Published: April 2021

Background:

Although endoscopic calcaneoplasty and retrocalcaneal debridement have been extensively applied to treat Haglund syndrome, evidence of the value of the endoscopic procedure remains to be fully established.

Purpose/Hypothesis:

The purpose of this study was to compare the postoperative outcomes and the amount of osteotomy between open and endoscopic surgery for the treatment of Haglund syndrome. It was hypothesized that endoscopic calcaneoplasty would lead to higher patient satisfaction and lower complication rates compared with open surgical techniques.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The following postoperative outcomes were compared between the open surgery group (n = 20) and the endoscopic surgery group (n = 27): visual analog scale for pain, American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, Foot Function Index, Tegner score, Ankle Activity Score, and 36-Item Short Form Health Survey; postoperative complications; and duration of surgery. To determine the extent of resection, the authors compared the calcaneal height ratio, calcaneal resection ratio, calcaneal resection angle, pitch line, and Haglund deformity height between groups. The learning curve for endoscopic calcaneoplasty was also calculated.

Results:

There were no significant differences between the open and endoscopic groups on any outcome score. Two patients in the open group reported temporary paresthesia around the incisional site, indicating sural nerve injuries; no complication was reported in the endoscopy group. None of the parameters for extent of resection were statistically significant between the groups. The duration of surgery was 44.90 ± 10.52 and 65.39 ± 11.12 minutes in the open and endoscopy groups, respectively ( P = .001). Regarding the learning curve for endoscopic calcaneoplasty (6 surgeons; 27 follow-up patients; 9 patients lost to follow-up), the duration of surgery reached a steady point of 55.68 ± 4.19 minutes after the fourth operation.

Conclusion:

The results of this study indicated that the endoscopy procedure was as effective as the open procedure. The endoscopic procedure required significantly more time than the open procedure, and the duration of the endoscopic procedure was shortened only after the fourth operation, suggesting that it requires high technical skills and familiarity with the anatomic relationships.
Repair Integrity and Functional Outcomes Between Knot-Tying and Knotless Suture-Bridge Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Trial
Authors: Şahin Koray , Şentürk Fatih , Ersin Mehmet , Arzu Ufuk , Chodza Mechmet , Erşen Ali
Published: April 2021

Background:

Knot-tying suture-bridge (SB) rotator cuff repair may compromise the vascularity of the repaired tendon, causing tendon strangulation and medial repair failure. The knotless SB repair technique has been proposed to overcome this possibility and decrease retear rates.

Purpose:

To compare clinical and structural outcomes and retear patterns between the knot-tying and knotless SB techniques. We hypothesized that the knotless technique would result in lower retear rates owing to the preservation of intratendinous vascularity.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

A total of 104 patients with full-thickness rotator cuff tears were randomly and prospectively allocated to undergo knot-tying (group 1) or knotless (group 2) SB repair. Clinical outcome measures included range of motion, the visual analog scale (VAS) for pain, and the Constant score for function. Repair integrity was evaluated on magnetic resonance imaging scans using the Sugaya classification. Retears were also classified according to their pattern as type 1 (lateral) or type 2 (medial).

Results:

Overall, 88 patients (group 1: n = 42 [mean ± SD age, 54.3 ± 9.8 years]; group 2: n = 46 [mean ± SD age, 55.8 ± 8.2 years]) were included in the final analysis. The mean ± SD follow-up period was 25.4 ± 8.3 and 23.3 ± 7.2 months for groups 1 and 2, respectively. From preoperatively to postoperatively, the mean VAS pain score improved significantly in both groups (group 1: from 7.4 ± 1.7 to 1.0 ± 1.7; group 2: from 7.1 ± 1.9 to 1.3 ± 2.0; P < .0001 for both), as did the mean ± SD Constant score (group 1: from 51.7 ± 13.4 to 86.0 ± 11.5; group 2: from 49.4 ± 18.4 to 87.2 ± 14.8; P < .0001 for both). There was no significant difference between the groups for the postoperative VAS or Constant score. The retear rate was not significantly different between the groups (19.0% [8/42] in group 1 and 28.3% [13/46] in group 2; P > .05). There was a significant difference in the type 2 failure rate (75.0% [6/8] in group 1 and 23.1% [3/13] in group 2; P = .03).

Conclusion:

Both techniques showed excellent improvement and comparable clinical outcomes, and there was no significant difference in retear rates. Consistent with previously published data, the type 2 failure rate was significantly higher with the knot-tying technique.

Registration:

NCT03982108 ( ClinicalTrials.gov identifier).
Patient Satisfaction With Chronic Pain Management: Patient Perspectives of Improvement
Authors: Li Yuelin (Cindy) , Hapidou Eleni G
Published: April 2021

Integrating satisfaction measures with pain-related variables can highlight global change and improvement from the patients’ perspective. This study examined patient satisfaction in an interdisciplinary chronic pain management program. Nine hundred and twenty-seven (n = 927) participants completed pre- and post-treatment measures of pain, depression, catastrophizing, anxiety, stages of change, and pain acceptance. Multiple regression was used to examine these variables at admission and discharge as predictors of patient satisfaction. Pain-related variables explained 50.6% of the variance (R2 = .506, F 22,639 = 29.79, P < .001) for general satisfaction, and 38.9% of the variance (R2 = 0.389, F 22,639 = 18.49, P < .001) for goal accomplishment. Significant predictors of general satisfaction included depression (β = −0.188, P < .001) and the maintenance stage of change (β = 0.272, P < .001). The latter was also a significant predictor of goal accomplishment (β = 0.300, P < .001). Discharge pain-related measures are more influential than admission measures for predicting patient satisfaction. Patient satisfaction is significantly related to establishing a self-management approach to pain.
Outcomes of patients with decreased arterial oxyhaemoglobin saturation on pulmonary arterial hypertension drugs
Authors: Valentin Simon , Maurac Arnaud , Sitbon Olivier , Beurnier Antoine , Gomez Emmanuel , Guillaumot Anne , Textoris Laura , Fay Renaud , Savale Laurent , Jaïs Xavier , Montani David , Picard François , Mornex Jean-François , Prevot Grégoire , Chabot François , Humbert Marc , Chaouat Ari
Published: April 2021

Background

Drugs approved for the treatment of pulmonary arterial hypertension (PAH) improve long-term outcomes. These drugs have pulmonary vasodilator properties which may potentially cause a decrease in arterial oxyhaemoglobin saturation (SaO2) in some patients. The present retrospective study of the French Pulmonary Hypertension Registry aimed to describe the clinical characteristics and outcomes of patients showing a ≥3% decrease inSaO2while treated with PAH drugs.

Methods

We reviewed 719 PAH patients. The exclusion criteria were PAH associated with congenital heart disease and PAH with overt features of venous/capillaries involvement.

Results

173 (24%) patients had a ≥3% decrease inSaO2. At diagnosis, they were older with a lower diffusing capacity of the lung for carbon monoxide and a shorter 6-min walk distance compared with those who did not display a ≥3% decrease inSaO2. The percentage of patients meeting the European Society of Cardiology/European Respiratory Society (ESC/ERS) low-risk criteria at re-evaluation was significantly lower in those with a ≥3% decrease inSaO2and more patients started long-term oxygen therapy in this group (16%versus5%; p<0.001). A ≥3% decrease inSaO2was associated with a poorer survival (hazard ratio 1.81, 95% CI 1.43–2.34; p<0.0001). In a multivariate Cox analysis, a ≥3% decrease inSaO2was a prognostic factor independent of age at diagnosis and ESC/ERS risk stratification at follow-up.

Conclusions

When treated with PAH drugs, a large subset of patients experience a ≥3% decrease inSaO2, which is associated with worse long-term outcomes and reduced survival.
Impact of erenumab on acute medication usage and health care resource utilization among migraine patients: a US claims database study
Authors: Tepper Stewart J. , Fang Juanzhi , Vo Pamela , Shen Ying , Zhou Lujia , Abdrabboh Ahmad , Glassberg Mrudula , Ferraris Matias
Published: April 2021

Background

Migraine is one of the leading causes of disability worldwide. Erenumab is a fully human monoclonal antibody that targets the calcitonin gene-related peptide (CGRP) receptor. This study aimed to evaluate real-world evidence on the impact of erenumab on acute medication usage and health care resource utilization (HCRU) among migraine patients.

Methods

This retrospective effectiveness study utilized the US Optum’s de-identified Clinformatics® Data Mart database to identify migraine patients initiating erenumab between May 1, 2018 and September 30, 2019. Patients had to be at least 18 years old, with a minimum of three doses for erenumab in the 6-month post-index period and continuous medical/pharmacy coverage in the 12-month pre- and 6-month post-index period. The date of the first claim for erenumab served as the index date. Use of acute medications overall and at different drug class level, and HCRU were compared during the 6-month pre- vs. post-index period. Impact of erenumab on acomposite endpoint of three possible events: 1) outpatient visit with a diagnosis of migraine and an associated acute medication claim within 7 days of the visit, 2) hospital admission with a primary diagnosis for migraine, or 3) emergency room visit with a primary diagnosis for migraine (any events that occurred ≤3 days apart were counted only once) was also evaluated.

Results

The analysis included 3171 identified patients. At 6 months, following initiation of erenumab, acute medication use including the number of types of acute medication, number of claims of each medication and % of patients who received acute medication, and HCRU were significantly decreased. For the composite outcome, the mean number of events decreased from 1.03 to 0.77 (rate ratio: 0.75; 95% CI: 0.71 to 0.79;P < 0.0001). A decrease in the proportion of patients with any of the three events was also observed (52.7% vs. 39.5%,P < 0.0001).

Conclusion

In this retrospective analysis, erenumab was associated with significantly reduced acute medication use and HCRU in a real-world setting, hence significantly reducing the burden of the disease. A composite endpoint could be used as a proxy to evaluate the burden of migraine attacks; however, further research is needed.