bluuebunny/crossref_metadata_2025 huggingface dataset:
Adapting the COSP Radar Simulator to Compare GCM Output and GPM Precipitation Radar Observations
Authors: Riley Dellaripa Emily M. , Funk Aaron , Schumacher Courtney , Bai Hedanqiu , Spangehl Thomas
Published: June 2021

Comparisons of precipitation between general circulation models (GCMs) and observations are often confounded by a mismatch between model output and instrument measurements, including variable type and temporal and spatial resolutions. To mitigate these differences, the radar-simulator Quickbeam within the Cloud Feedback Model Intercomparison Project (CFMIP) Observation Simulator Package (COSP) simulates reflectivity from model variables at the subgrid scale. This work adapts Quickbeam to the dual-frequency precipitation radar (DPR) on board the Global Precipitation Measurement (GPM) satellite. The longer wavelength of the DPR is used to evaluate moderate to heavy precipitation in GCMs, which is missed when Quickbeam is used as a cloud radar simulator. Latitudinal and land–ocean comparisons are made between COSP output from the Community Atmospheric Model version 5 (CAM5) and DPR data. Additionally, this work improves the COSP subgrid algorithm by applying a more realistic, nondeterministic approach to assigning GCM gridbox convective cloud cover when convective cloud is not provided as a model output. Instead of assuming a static 5% convective cloud coverage, DPR convective precipitation coverage is used as a proxy for convective cloud coverage. For example, DPR observations show that convective rain typically only covers about 1% of a 2° grid box, but that the median convective rain area increases to over 10% in heavy rain cases. In our CAM5 tests, the updated subgrid algorithm improved the comparison between reflectivity distributions when the convective cloud cover is provided versus the default 5% convective cloud-cover assumption.
Extranodal Head and Neck Mantle Cell Lymphoma: Characteristics, Treatment, and Survival
Authors: Breen Christopher T. , Chao Janet , Mehra Saral , Kohli Nikita
Published: June 2021

Objectives:

To describe disease characteristics and treatment and to analyze survival and mortality for extranodal mantle cell lymphoma (MCL) of the head and neck.

Methods:

Patients with extranodal MCL—excluding primary sites in the salivary glands, eye, and adnexa—were identified from the Surveillance, Epidemiology, and End Results (SEER) 18 Registries (2000-2015). Overall survival (OS) and cumulative incidence of MCL and non-MCL mortality were calculated. Factors associated with MCL and non-MCL mortality were analyzed with cause-specific hazard models.

Results:

Five hundred nine patients met criteria for descriptive analysis and 294 patients met criteria for survival analysis, with a median follow-up of 58 months. The most common sites for MCL were the oropharynx (66.0%), nasopharynx (19.1%), and oral cavity (8.4%). The most common treatment received was chemotherapy alone (48.9%), followed by chemoradiation therapy (16.9%), and radiation therapy alone (10.4%). The proportion of cases diagnosed as early-stage disease ranged from 31% of sinonasal MCLs to 83% of laryngeal MCLs. At 5 years, OS was 63% (95% CI: 57%-69%). There was no significant difference in OS ( P = .79), cumulative incidence of MCL mortality ( P = .76), or cumulative incidence of non-MCL mortality ( P = .98) by anatomic site. Comparing early-stage to late-stage disease, there was no significant difference in OS ( P = .38), cumulative incidence of MCL mortality ( P = .07), or cumulative incidence of non-MCL mortality ( P = .14). Multivariate analysis showed increased hazard of MCL mortality for patients that were older or that presented with stage III or stage IV disease.

Conclusion:

The oropharynx is the most common subsite of head and neck MCLs, followed by the nasopharynx. Primary head and neck MCLs appear to present at an earlier stage than MCLs of other regions. In particular, laryngeal and hypopharyngeal MCLs may present as stage I or II disease.
Critical philology and Dante’s Commedia: A couple of thoughts and a few examples
Authors: Trovato Paolo
Published: June 2021

Not only literary students, but also well-known scholars share the idea that the reconstruction of a text is a routine job which leaves little room for creativity. After some 40 years during which I have edited or prepared the edition of works of Machiavelli ( Discorso intorno alla nostra lingua), Pietro Aretino ( Cortegiana) and Torquato Tasso ( Aminta), and 17 years devoted to the textual transmission and the text of Dante’s  Commedia, I think that, except for the first phases of the job, textual editing requires almost constant critical thought and interpretation. I shall present a little series of examples, mostly from Dante’s Commedia, with cases ranging from decisions in the realm of accidentals to rather complicated choices among competing substantial readings and to the risky enterprise of emendation against all the witnesses of the work. While these examples can give an idea of the novelty of some solutions of my forthcoming edition (the introduction and  Inferno will appear in the summer of 2021), in my view, they seem to confirm the opinion of the great classical philologist Giorgio Pasquali, for whom textual criticism isn’t mechanical; it is methodical.
A Productive Scholar’s Guide to Respectful, Responsible Inquiry During the COVID-19 Pandemic: Moving Forward
Authors: Lane Kathleen Lynne , Cabell Sonia Q. , Drew Sally Valentino
Published: June 2021

As a result of the COVID-19 pandemic of 2020, schools across the country have pivoted to providing a range of instructional opportunities including remote, hybrid, and modified in-person options with a commitment to keeping our society safe and supporting our nations’ youth in continuing their education. One byproduct of this most challenging situation has been the interruption of scientific inquiry in many fields, including educational research. Using a framework of self-leadership, in this feature article, we provide reflections to guide discussion among scholars involved in school-based research during and after the COVID-19 pandemic. Based on lessons learned in our own mentee–mentor relationships and from our collective experiences, the purpose of this article is to offer considerations primarily for early-career scholars, but also to engage dialogue among mid- and late-career scholars to promote school-based inquiry in this defining moment in history, at a time when educators are concerned with mitigating learning loss. We focus on (a) revisiting and refining programmatic lines of inquiry, (b) crafting articles to disseminate lessons learned from research conducted to date—including those with lost time points, (c) retooling in a focused area of inquiry (e.g., methodology), (d) conceptualizing future studies featuring procedures that do—and do not—allow for interpersonal contact, and (e) appreciating and acknowledging individuals who have facilitated inquiry. We conclude with a note of encouragement and call to action for future educational research.
History of contact with the SARS-COV-2 virus and the sense of coherence in the development of psychological distress in the occupational health professionals in Spain
Authors: Gómez-Salgado Juan , Ortega-Moreno Mónica , Soriano Guillermo , Fagundo-Rivera Javier , Allande-Cussó Regina , Ruiz-Frutos Carlos
Published: June 2021

The COVID-19 pandemic has affected the psychological well-being of healthcare professionals, among them, on medical and nursing occupational specialists. This study describes the psychological distress that this group has suffered, analyzing the effect that the sense of coherence related with the history of contact with infected people has generated in their mental health. Cross-sectional descriptive study using online questionnaires. Data were collected on a sample of 499 subjects, representing 42.0% and 38.8% of the associations of specialists in Occupational Medicine and Nursing, respectively. A univariate data analysis, independence test, and the CHAID multivariate method were carried out. The percentage of workers with high psychological distress was higher among women than among men; this was also higher in public sector workers than in the private sector. No differences have been observed regarding psychological distress and educational level, coexistence, having children, working away from home, having a pet, or between being a physician or nurse. The most efficient measure to prevent psychological distress was acting regarding the comprehensibility dimension of the sense of coherence. Sex, contact with any infected person, age, living as a couple, working in public or private centers, the availability of diagnostic tests, and the correlation with the manageability dimension were modulating factors. Sense of coherence is an effective measure to prevent psychological distress due to contact with people affected by COVID-19 in Occupational Health professionals.
Resource-Based Theory and the Value Creation Framework
Authors: Barney Jay B. , Ketchen David J. , Wright Mike
Published: June 2021

This article explains how viewing resource-based theory within Brandenburger and Stuart’s value creation framework adds clarity to the theory as a whole and to its essential elements including the definition of its dependent variables, its approach to value creation, and its approach to the appropriation of economic value. Building on this foundation, the article addresses several questions about resource-based theory: Is it a theory or a view? Is resource-based theory tautological? Is resource-based theory static? How important are stakeholders within resource-based theory? Does resource-based theory constitute a theory of the firm? Does resource-based theory acknowledge industry structure’s role in explaining firm performance? Does resource-based theory incorporate uncertainty? Does resource-based theory have strong managerial implications? In accomplishing these tasks, the article sets the stage for the further evolution and application of resource-based theory.
Living with deafblindness during COVID-19: An international webinar to facilitate global knowledge translation
Authors: Wittich Walter , Nicholas Jude , Damen Saskia
Published: June 2021

Arguably, individuals living with deafblindness are among the hardest hit by the effects of the corona virus disease of 2019 (COVID- 19), given the importance of the sense of touch for their ability to interact with the world. To address this challenge, it is imperative to facilitate the implementation of evidence- and experience-based recommendations, and to improve knowledge translation on a global scale. Deafblind International organized a webinar to provide a platform where participants could exchange experiences and solutions to overcome the challenges created by the arrival of COVID-19, in order to facilitate information exchange among stakeholders in deafblindness during this pandemic. We present an overview of its content here and place the summarized themes in context with existing research literature. Abstract submission was open for 4 weeks in May 2020, resulting in 30 submissions from 13 countries across 5 continents. Of the 26 presenter teams, 9 (35%) had a co-presenter that was living with deafblindness themselves. The number of individual participants across all sessions ranged from 55 to 140 ( M = 98), with a total of 3709 session registrations overall, and the organizers estimate a total attendance of around 400 participants. Based on extensive field notes taken during the webinar, and repeated viewing of the recordings, qualitative description allowed the team to synthesize eight principal themes across the event: access to information, communication, service accessibility, adaptations to service delivery, online safety and security, physical distancing, mental health and research. The first Deafblind International webinar was able to fill an important gap by bringing together a variety of stakeholders in deafblindness across the globe. The event created a sense of group membership and peer support, brought the participants, researchers, the professionals as well as their service agencies closer together and generated a sense of hope and collaboration.
Defining end of life in dementia: A systematic review
Authors: Browne Bria , Kupeli Nuriye , Moore Kirsten J , Sampson Elizabeth L , Davies Nathan
Published: June 2021

Background:

Dementia is a life-limiting condition that affects 50 million people globally. Existing definitions of end of life do not account for the uncertain trajectory of dementia. People living with dementia may live in the advanced stage for several years, or even die before they reach the advanced stage of dementia.

Aim:

To identify how end of life in people with dementia is measured and conceptualised, and to identify the factors that contribute towards identifying end of life in people with dementia.

Design:

Systematic review and narrative synthesis.

Data Sources:

Electronic databases MEDLINE, EMBASE, PsychInfo and CINAHL, were searched in April 2020. Eligible studies included adults with any dementia diagnosis, family carers and healthcare professionals caring for people with dementia and a definition for end of life in dementia.

Results:

Thirty-three studies met the inclusion criteria. Various cut-off scores from validated tools, estimated prognoses and descriptive definitions were used to define end of life. Most studies used single measure tools which focused on cognition or function. There was no pattern across care settings in how end of life was defined. Healthcare professionals and family carers had difficulty recognising when people with dementia were approaching the end of life.

Conclusion:

End-of-life care and research that focuses only on cognitive and functional decline may fail to recognise the complexities and unmet needs relevant to dementia and end of life. Research and clinical practice should adopt a needs-based approach for people with dementia and not define end of life by stage of disease.
Postprandial fasting related headache during Ramadan in Saudi Arabia: A cross-sectional study
Authors: AlAmri Abdullah , AlMuaigel Mohammed , AlSheikh Mona , Zeeshan Mohammad , Suwayyid Wejdan , AlShamrani Foziah
Published: June 2021

Background

Headache disorders are classified as primary or secondary; however, among the secondary headaches, those attributed to food ingestion are not well understood. Therefore, we conducted this study to describe and characterize a new headache entity that occurred during the holy month of Ramadan. This headache occurred within 4 h of breaking the fast.

Methods

This is a nationwide descriptive community-based cross-sectional study conducted during the last 10 days of Ramadan, based on a random sample of adults living in Saudi Arabia. The demographic data, headache symptomatology, nature and distribution of the pain, possible triggering and relieving factors, and patient management programs were analyzed.

Results

Completed questionnaires were obtained from 16,031 participants. Of those, 3147 (19.6%) reported headaches after breaking the fast in Ramadan. In 84.1% of cases, there was no previous diagnosis of headache or migraine. The characteristics of these postprandial fasting-related headaches mostly was episodic in nature (72%). The nature of the headache was variable, mostly heaviness or tightness (53.9%). Triggering factors included ingestion of fried food in (45%) and coffee (26.3%). Lying down and sleeping was found to be an important relieving factor (61%).

Conclusion

A new headache entity is being described. Appears to be quite common, occurs less than 2 h following the first meal, and is mostly of the heaviness and tension type.
The presence of headache at onset in SARS-CoV-2 infection is associated with long-term post-COVID headache and fatigue: A case-control study
Authors: Fernández-de-las-Peñas César , Gómez-Mayordomo Víctor , Cuadrado María L , Palacios-Ceña Domingo , Florencio Lidiane L , Guerrero Angel L , García-Azorín David , Hernández-Barrera Valentín , Arendt-Nielsen Lars
Published: June 2021

Objective

To investigate the association of headache during the acute phase of SARS-CoV-2 infection with long-term post-COVID headache and other post-COVID symptoms in hospitalised survivors.

Methods

A case-control study including patients hospitalised during the first wave of the pandemic in Spain was conducted. Patients reporting headache as a symptom during the acute phase and age- and sex-matched patients without headache during the acute phase participated. Hospitalisation and clinical data were collected from medical records. Patients were scheduled for a telephone interview 7 months after hospital discharge. Participants were asked about a list of post-COVID symptoms and were also invited to report any additional symptom they might have. Anxiety/depressive symptoms and sleep quality were assessed with the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index.

Results

Overall, 205 patients reporting headache and 410 patients without headache at hospitalisation were assessed 7.3 months (Standard Deviation 0.6) after hospital discharge. Patients with headache at onset presented a higher number of post-COVID symptoms (Incident Rate Ratio: 1.16, 95% CI: 1.03–1.30). Headache at onset was associated with a previous history of migraine (Odd Ratio: 2.90, 95% Confidence Interval: 1.41–5.98) and with the development of persistent tension-type like headache as a new post-COVID symptom (Odd Ratio: 2.65, 95% CI: 1.66–4.24). Fatigue as a long-term symptom was also more prevalent in patients with headache at onset (Odd Ratio: 1.55, 95% CI: 1.07–2.24). No between-group differences in the prevalence of anxiety/depressive symptoms or sleep quality were seen.

Conclusion

Headache in the acute phase of SARS-CoV-2 infection was associated with higher prevalence of headache and fatigue as long-term post-COVID symptoms. Monitoring headache during the acute phase could help to identify patients at risk of developing long-term post-COVID symptoms, including post-COVID headache.
Applicability of modified carbon sorbent for removing potentially toxic biologically active molecules of aromatic structure from blood plasma
Authors: Getsina Maria , P’yanova Lidia , Kornienko Natalia , Lavrenov Alexander , Ershov Anton , Beloborodova Natalia
Published: June 2021

The modification of the mesoporous carbon sorbent with 3-phenylpropanoic acid was carried out in order to create preparations of complex, prolonged action, exhibiting detoxifying, antibacterial, and antifungal properties due to the applied modifier, which is capable of migrating into the solution and exhibiting its own biospecific properties. A technique was developed for fixing 3-phenylpropionic acid (PhPA) on a carbon support by its adsorption from solution. Three types of sorbents with various content of the modifier (PhPA) and the sorbent without modifier were studied. The sorption activity of new sorbents was studied using liquid-liquid extraction and gas chromatography-mass spectrometry methods on model experiments with plasma and aqueous additives of hydroxylated phenyl-containing acids (PhCAs) in various concentrations. The specific surface area was significantly changed for sorbent, modified with 1 × 10−3 mol/L of PhPA solution, and was 25% less than the area of unmodified sorbent. Potentially toxic biologically active hydroxylated PhCAs were used to create model solutions. The degrees of sorption of these compounds were close to 100%, except phenyllactic acid (over 80%). The sorbent without modifier and two sorbents with the lowest content of the modifier are considered to be more effective for the purification of the plasma from the hydroxylated PhCAs than the sorbent with the highest concentration of the modifier. Simultaneous adsorption of toxic metabolites from the bloodstream and desorption of beneficial ones can be used for a more subtle correction of the patient’s condition.
Why are conspiracy theories more successful in some countries than in others? An exploratory study on Internet users from 22 Western and non-Western countries
Authors: Cordonier Laurent , Cafiero Florian , Bronner Gérald
Published: June 2021

This exploratory study aims at identifying macro-social factors associated with the international variance of belief in conspiracy theories. We computed a Conspiracy Index for 22 Western and non-Western countries based on the results of an online survey on conspiratorial beliefs. Stepwise regression analyses show that more than 70% of the international variance of this Conspiracy Index is explained by the following three national variables: the level of democracy, the unemployment rate, and the perceived level of public sector corruption. Conspiracy theories thus appear to be more commonly endorsed in countries where people cannot take an active part in the political life of their country (low level of democracy), where they may feel socially threatened (high unemployment rate), and where institutions and authorities are perceived as untrustworthy (high perception of public sector corruption).
Queers with Guns? Against the LGBT Grain
Authors: Combs Thatcher Phoenix
Published: June 2021

Sociological literature on gun ownership in the United States has primarily centered on white, heterosexual, cisgender men and vulnerability to violence. However, many gun owners do not fit this profile. In this article, I begin to fill this gap by focusing on one group—lesbian, gay, bisexual, transgender, and queer (LGBTQ) people—and answer the question: How does the status of being a vulnerable gender and/or sexual minority shape LGBTQ gun owners’ perspectives on gun ownership? To do so, I focus on gun literature, LGBTQ lives, and questions of vulnerability, and draw on in-depth interviews with 30 LGBTQ gun owners from across the United States. In this study, LGBTQ gun owners highlight two major themes. First, they discuss how their gender expression/sexuality creates possibilities for violence. Second, they relate minority oppression with the violent uprisings that created the LGBT movement. As such, these LGBTQ gun owners go against the LGBT movement’s discourse of pro-gun control and structural change.
Assessing Differential Item Functioning in a Teacher Self-Assessment of Cultural Responsiveness
Authors: Fallon Lindsay M. , Cathcart Sadie C. , Johnson Austin H.
Published: June 2021

The Assessment of Culturally and Contextually Relevant Supports (ACCReS) was developed in response to the need for well-constructed instruments to measure teachers’ cultural responsiveness and guide decision-making related to professional development needs. The current study sought to evaluate the presence of differential item functioning (DIF) in ACCReS items and the magnitude of DIF, if detected. With a national sample of 999 grade K-12 teachers in the United States, we examined measurement invariance of ACCReS items in relation to responses from (a) racially and ethnically minoritized (REM) youth and white teachers (teacher race), (b) teachers in schools with 0–50% and 51–100% REM youth (student race), and (c) teachers with <1–5 years of teaching experience and teachers with >5 years of experience. Findings suggested that ACCReS items exhibited negligible levels of DIF. The lack of DIF found provides additional evidence for the validity of scores from the ACCReS to assess teachers’ cultural responsiveness. Furthermore, descriptive analyses revealed that teachers were more likely to agree with items pertaining to their own classroom practice than items related to access to adequate training and support. Results inform implications for future educational and measurement research.
The Added Value of Supplemental Breast Ultrasound Screening for Women With Dense Breasts: A Single Center Canadian Experience
Authors: Wu Tong , Warren Linda J.
Published: June 2021

Purpose:

We evaluated the contribution to cancer detection of supplemental breast ultrasound screening in women with dense breasts based on a single center experience by comparing our results with similar programs elsewhere.

Methods:

We performed a retrospective review of handheld sonographer-performed screening ultrasound exams at our academic breast imaging center, from January 1st to December 31st, 2019. Breast density, breast cancer risk factors, BI-RADS assessment, and lesion pathology were reviewed and tallied, followed by derivation of the biopsy rate, breast cancer detection rate, PPV3 and average tumor size. These values were compared to published results of breast screening programs elsewhere.

Results:

695 screening breast ultrasounds for women with dense breasts and negative mammograms were performed in 2019. The biopsy rate was 1.3%, breast cancer detection rate was 7 in 1000, PPV3 was 42%, and the average tumor size was 9.0 ± 1.4 mm.

Conclusions:

The first-year data of the breast screening ultrasound program at our practice are promising, demonstrating comparable cancer detection rate, higher PPV3, and similar biopsy rate in those with dense breasts compared with similar programs elsewhere. Longitudinal analysis and larger sample size are required for validation. Comparison of incidence and prevalence screening data is also warranted to elucidate the true value of this program.
Directional-sum test for nonparametric Behrens-Fisher problem with applications to the dietary intervention trial
Authors: Meng Zhen , Yang Qinglong , Li Qizhai , Zhang Baoxue
Published: June 2021

For a nonparametric Behrens-Fisher problem, a directional-sum test is proposed based on division-combination strategy. A one-layer wild bootstrap procedure is given to calculate its statistical significance. We conduct simulation studies with data generated from lognormal, t and Laplace distributions to show that the proposed test can control the type I error rates properly and is more powerful than the existing rank-sum and maximum-type tests under most of the considered scenarios. Applications to the dietary intervention trial further show the performance of the proposed test.
A multiscale homogenization procedure to predict the elasto-viscoplastic behavior of polymer-based nanocomposites
Authors: Shojaeefard Mohammad Hassan , Khalkhali Abolfazl , Khakshournia Sharif
Published: June 2021

It has been demonstrated that adding a few percent of nanoscale reinforcements, leads to remarkable improvement in mechanical properties of the polymers such as stiffness, damping, and energy absorption. These lightweight materials are attractive substitutes for the heavy metallic structural parts in the automotive, military, aerospace and many other industries. However, due to complexity of these multiphase materials, accurate modeling of their behavior in real loading cases is still ambiguous. The impact simulation is a vital step in design procedure of a vehicle, where a strain rate-dependent model of its components is required. In this paper, an elasto-viscoplastic modeling procedure of the polymer-based nanocomposites, assuming the elastic behavior of the nano-phase is presented; whereas the polymeric matrix deformation is dependent to the loading rate and is characterized by the method of Genetic algorithm optimization-based fitting to the experimental observations. By introducing a modified Halpin-Tsai method, the nanocomposite is then modeled as a homogenized material where the modification algorithm is the main challenge. A combination of approaches including parametric analysis, central composite design of experiments and response surface method is proposed to modify the tangent modulus of the polymeric matrix to be passed as the input to the Halpin-Tsai equations. Finally, the procedure is implemented to a set of epoxy-GNP nanocomposites under unidirectional compressive loads with different rates and the stress-strain curves are predicted with a decent precision.
Impact of changing from a guaiac faecal occult blood test to a faecal immunochemical test in a national screening programme: Results from a pilot study within the national bowel cancer screening programme in England
Authors: Benton Sally C , Piggott Carolyn , Blyuss Oleg , Li Shuping J , Mathews Christopher , Carroll Magdalen , Duffy Stephen
Published: June 2021

Objective

Testing for occult blood in faeces is widely used in bowel cancer screening around the world. In many programmes, the faecal immunochemical test (FIT) is replacing the traditional guiaic faecal occult blood test (gFOBT). There have been a number of reports on the clinical impact of making this change; yet, no-one has considered the pre-analytical and analytical impact of moving from a gFOBT to a FIT bowel cancer screening programme.

Methods

We interrogated data obtained in a FIT pilot carried out in England in 2014 to assess the timeliness of specimen collection device return time and analysis for gFOBT and FIT, the impact of time to analysis on faecal haemoglobin (f-Hb) concentration, and any differences observed between analyses carried out at two different testing laboratories.

Results

FIT kits were returned on average 5.6 days sooner than gFOBT. The time to analysis for FIT leads to an overall rise in f-Hb concentration within the manufacturer’s stated 14-day stability period.

Conclusion

Both these factors are important considerations for laboratories when considering setting up a bowel cancer screening programme, especially if transitioning from gFOBT to FIT. Our data also support previous evidence of males having a higher f-Hb than females and demonstrate that after adjusting for sex, age and screening hub, neither index of multiple deprivation nor screening episode significantly affected f-Hb.
Understanding Public Sentiment in Relation to the African Continental Free Trade Agreement
Authors: Ajala Olubunmi , Ejiogu Amanze , Lawal Adeniyi
Published: June 2021

This study explores public sentiment in relation to the African Continental Free Trade Agreement (ACFTA) by analysing 18,481 tweets mentioning ACFTA over a three-month period. The findings highlight the dominance of actors outside the African continent in the public discourse on ACFTA thus indicating the importance of the African diaspora and foreign interests in framing the debate and influencing public opinion on the continent. They also highlight the salient issues in the public debate on ACFTA to include its potential effects on national economies and jobs as well as the potential for its exploitation by foreign interests. The study also points at a disconnect between governments and politicians promoting ACFTA on the one hand and the average citizen in Africa on the other as it shows a general negative sentiment in all regions and age groups, and more particularly in West Africa and amongst males towards ACFTA.
Neutrophil/lymphocyte, platelet/lymphocyte and monocyte/lymphocyte ratios in schizophrenia
Authors: Zhu Xiaoyu , Zhou Jia , Zhu Yu , Yan Feng , Han Xiaole , Tan Yunlong , Li Ran
Published: June 2021

Objective:

Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) have been used as markers of inflammation in mental illness. However, these indices have not been widely used in schizophrenia research in Chinese participants. Our aim was to use these ratios to explore the relationship between schizophrenia and inflammation.

Methods:

In this retrospective cross-sectional study, we collected total blood cell counts of 549 patients with schizophrenia and 930 healthy controls at Beijing Huilongguan Hospital in October 2019. We analyzed the subjects’ platelet, lymphocyte, monocyte, and neutrophil counts; compared the calculated NLR, MLR, and PLR between patients and healthy controls; and evaluated the correlations with age and gender.

Results:

Platelet and lymphocyte counts were significantly lower, while NLR and MLR were significantly higher, in patients with schizophrenia compared to healthy controls. Additionally, monocyte count, lymphocyte count, MLR, and NLR were different between male and female subjects.

Conclusion:

This study supports the inflammatory hypothesis of schizophrenia in the Chinese population.
The Experiences of People Living With Chronic Pain During a Pandemic: “Crumbling Dreams With Uncertain Futures”
Authors: Amja Kristina , Vigouroux Marie , Pagé M. Gabrielle , Hovey Richard B.
Published: June 2021

People living with chronic pain experience multiple challenges in their daily activities. Chronic pain is complex and often provokes life circumstances that create increased social isolation. Living with chronic pain during the pandemic may add additional layers of complexity to their daily lives. The researchers endeavored to explore the experiences of people living with chronic pain during the COVID-19 pandemic. Researchers conducted semi-structured, open-ended interviews about how the pandemic influenced participants’ lives. The interviews were recorded and analyzed using an applied philosophical hermeneutics approach. The findings were feeling socially isolated, losing their sense of livinghood, and experiencing augmented stress levels which, in most cases, aggravated their chronic pain. In addition to gaining an in-depth understanding of the needs of people living with chronic pain, these findings may guide policy decisions with the intention of improving health care access and the overall experiences of people living with chronic conditions during a pandemic.
Influence of Gender, Dispositional Optimism, and Coping Strategies on Appearance-Related Distress Among Swedish Adults With Cleft Lip and Palate
Authors: Paganini Anna , Persson Martin , Mark Hans
Published: June 2021

Objective:

To investigate the influence of gender, dispositional optimism, and coping strategies on appearance-related distress among individuals with unilateral cleft lip and palate (UCLP).

Design:

Cross-sectional design with self-report questionnaires analyzed primarily with Spearman correlations ( r s) and multivariate regression analyses.

Setting:

A tertiary cleft center in Sweden.

Participants:

Eighty individuals with UCLP born 1966 to 1986. The mean age for men (n = 50) and women (n = 30) was 38.8 and 37.4 years, respectively.

Main Outcome Measures:

The Derriford Appearance Scale 24 measured appearance-related distress, the Life Orientation Test–Revised, short version measured dispositional optimism and pessimism, and the Coping Orientation to Problems Experienced, short version included 14 coping strategies.

Results:

Women had higher appearance-related distress than men, which was significantly ( P < .05) related to self-blame ( r s = 0.59), pessimism ( r s = 0.59), and low optimism ( r s = −0.56). Men’s appearance-related distress was significantly associated with low active coping ( r s = 0.35), low use of emotional support ( r s = 0.29), denial ( r s = 0.39), behavioral disengagement ( r s = 0.41), and pessimism ( r s = 0.28). The only significant gender interaction reflected greater impact of optimism in reducing appearance-related distress for women (β = −0.06).

Conclusions:

This study showed that high levels of dispositional optimism decrease appearance-related distress, particularly for women. The coping strategies used differed between men and women, and the results suggest that both gender and psychosocial facto r s need to be considered in regard to appearance-related distress among individuals with UCLP in both clinical and research settings. A possible way to decrease distress is to strengthen positive coping strategies and dispositional optimism.
Creep damage model considering unilateral effect based on bimodulus theory
Authors: Guo Yuhao , Liu Gang , Liu Huaqing , Huang Yi
Published: June 2021

Based on the continuous damage mechanics (CDM) theory, Ambartsumyan bimodulus theory and creep damage theory, a bimodulus creep damage constitutive model is proposed in this paper. The model is able to describe the damage-induced unilateral behaviour related to the microdefect closure effect. The unilateral behaviour is considered a special bimodulus property. By judging the tension or compression state in bimodulus theory, different elasticity properties matrixes are selected according to signs of principal stresses. Then, an elasticity properties matrix is linearly converted to a general stress space. The model effectively solves the difficulty of determining tension or compression in complex stress states when the unilateral effect of damage is considered in the analysis of actual structures. The tangent elasticity matrix is used to improve the convergence of the proposed algorithm. In this study, a numerical simulation of the proposed model is achieved by writing subroutines in the FORTRAN language. A numerical example of a hole-in-plate structure under uniaxial stress is analysed. By comparing the results with those obtained by the traditional model, which does not consider the unilateral effect of damage, it is demonstrated that the proposed model is capable of describing the damage-induced unilateral behaviour related to microcracked closure effects. The numerical example validates the effectiveness and realizability of the proposed model.
Potential Dexamethasone–Direct Oral Anticoagulant Drug Interaction: Is This a Concern in COVID?
Authors: Smythe Maureen A. , Burns Carly , Liu Qianyue , Garwood Candice L.
Published: June 2021

Objective

To evaluate the literature on a potential dexamethasone–direct oral anticoagulant (DOAC) drug interaction and provide management considerations with COVID hypercoagulability.

Data Sources

A search of EMBASE, PubMed, and Google Scholar (January 1990 to May 2021), limited to the English language, using applicable search terms resulted in 137 articles, with 21 relevant articles included. Regulatory agency and clinical guidance documents were also reviewed.

Study Selection and Data Extraction

Included articles describe in vitro or in vivo animal or human data for dexamethasone induction of cytochrome P450 (CYP) 3A4 or P-glycoprotein (P-gp).

Data Synthesis

Dexamethasone has the potential to interact with the DOACs via CYP3A4 and/or P-gp induction. Only apixaban and rivaroxaban have CYP3A4 metabolism. Dexamethasone can increase CYP3A4 activity by up to 70% and reduce the area under the concentration-time curve (AUC) of CYP3A4 substrates by >40%, which is consistent with criteria for a weak CYP inducer. In rodents, dexamethasone P-gp induction is associated with AUC reductions of 20% to 50%. Human data are lacking.

Relevance to Patient Care and Clinical Practice

Severe COVID-19 infection is associated with hypercoagulability. Although heparins are the preferred anticoagulants for hospitalized COVID-19 patients, DOACs are being utilized. Dexamethasone is recommended for hospitalized COVID-19 patients requiring supplemental oxygen. The concurrent use of dexamethasone and apixaban or rivaroxaban in such patients carries the potential for reduced anticoagulant effect during a state of heightened thrombotic risk.

Conclusions

Concurrent use of dexamethasone and apixaban or rivaroxaban in hospitalized COVID-19 patients with laboratory evidence of COVID coagulopathy should be avoided until higher-quality data are available.
Efficacy of Metformin in Patients With Breast Cancer Receiving Chemotherapy or Endocrine Therapy: Systematic Review and Meta-analysis
Authors: Morio Kayoko , Kurata Yasuko , Kawaguchi-Sakita Nobuko , Shiroshita Akihiro , Kataoka Yuki
Published: June 2021

Background

Previous studies have suggested that metformin might improve survival outcomes in patients with breast cancer. However, findings on the efficacy of metformin with chemotherapy or endocrine therapy are inconsistent.

Objective

To clarify the efficacy of metformin with chemotherapy or endocrine therapy in breast cancer patients according to the treatment setting, including neoadjuvant, adjuvant, and metastasis/recurrence.

Methods

We systematically searched for randomized controlled trials (RCTs) in MEDLINE, CENTRAL, and EMBASE from inception through July 2020. Overall survival (OS), progression-free survival (PFS), and hypoglycemia rate were the primary outcomes. Secondary outcomes included severe adverse events (SAEs) and relapse-free survival. We used the Grading of Recommendations Assessment, Development, and Evaluation approach and performed a meta-analysis to evaluate the efficacy and safety of metformin with chemotherapy and endocrine therapy in patients with breast cancer.

Results

Our systematic review included 412 participants from 5 trials. Metformin showed little to no difference in OS (hazard ratio [HR] = 1.13; 95% CI = 0.71-1.81; certainty of evidence [COE], moderate) and PFS (HR = 1.14; 95% CI = 0.86-1.50; COE, moderate) in patients with metastasis/recurrence. The evidence was very uncertain about the effect of metformin on survival outcomes in patients who received metformin with neoadjuvant or adjuvant treatment. Metformin showed little to no difference in hypoglycemia and SAEs.

Conclusion and Relevance

Metformin should be discouraged routinely in nondiabetic patients with metastatic/recurrent breast cancer. Further RCTs are needed to verify whether metformin with chemotherapy or endocrine therapy results in significant clinical benefits in the neoadjuvant or adjuvant setting.
Trends in the Utilization of Ankle Replacements: Data From Worldwide National Joint Registries
Authors: Perry Thomas A. , Silman Alan , Culliford David , Gates Lucy , Arden Nigel , Bowen Catherine ,   and the International Ankle Arthroplasty Registry Consortium
Published: June 2021

Background:

Over the past decade, there has been a growth in the use of ankle replacements. Data from national joint registries have shown between-country differences in the utilization of ankle replacement. The reasons for these differences are, however, not well understood. Our aims were to describe and compare the annual incidence of primary ankle replacement between countries and, to examine potential reasons for variation over time.

Methods:

We used aggregate data and summary statistics on ankle replacements for the period 1993 to 2019 from national joint replacement registries in Australia, Finland, New Zealand, Norway, Sweden and the United Kingdom. From the annual recorded counts of procedures, demographic data were extracted on age, sex distribution, and indication(s) for primary ankle replacement. Registry-level summary results were also obtained on data completeness, counts of hospitals/units, and health care providers performing ankle replacements annually and data collection processes (mandatory vs voluntary). Annual ankle replacement incidence for all diagnoses and, by indication categories (osteoarthritis [OA] and rheumatoid arthritis [RA]), were calculated per 100 000 residential population aged ≥18 years.

Results:

For the period with data from all 6 countries (2010-2015), New Zealand had the largest annual incidence (mean ± SD) of 3.3 ± 0.2 ankle replacement procedures per 100 000 population whereas Finland had the lowest incidence (0.92 replacements). There were no common temporal trends in the utilization of ankle replacements. Over the years studied, OA was the predominant diagnosis in the United Kingdom, Australia, and New Zealand, whereas RA was the most common indication in Scandinavia.

Conclusion:

In these 6 countries, we found marked differences in the utilization of ankle replacements. Registry-related factors including data completeness and the number of hospitals/surgeons performing ankle replacements are likely to contribute to the observed between-country differences and need to be carefully considered when interpreting comparisons for this less common site for joint replacement surgery.

Level of Evidence:

Level III, retrospective study.
Impact of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Renal Function in Type 1 Cardiorenal Syndrome
Authors: Ilges Daniel T. , Dermody Morgan L. , Blankenship Caitlyn , Mansfield Valerie , Van Tuyl Joseph S.
Published: June 2021

Introduction:

Angiotensin-converting enzyme inhibitor (ACE-I) and angiotensin receptor blocker (ARB) discontinuation during acute heart failure (AHF) is associated with increased mortality following hospitalization. Although the etiology of acute kidney injury (AKI) in type 1 cardiorenal syndrome (CRS) has been linked to renal venous congestion, ACE-I/ARB withdrawal (AW) theoretically promotes renal function recovery. ACE-I/ARBs are dose-reduced or withheld in approximately half of patients with CRS, but the subsequent impact on renal function remains largely uninvestigated. This study compared AW to ACE-I/ARB continuation (AC) during CRS.

Methods:

This was a retrospective, single-center chart review. Patients aged 18-89 years admitted from April 2018 to August 2019 with AHF and AKI were identified using discharge ICD-10 codes. All patients were treated with an ACE-I/ARB before admission. Key exclusion criteria included shock, pregnancy, and end-stage renal disease. The primary endpoint was change in serum creatinine (SCr) from admission through 72 hours. Data were analyzed utilizing chi-square and Mann-Whitney U tests with SPSS software.

Results:

A total of 111 admissions were included. AW occurred in 68 patients upon admission. AW patients presented with a higher blood urea nitrogen ( P = 0.034), higher SCr ( P = 0.021), and lower ejection fraction ( P = 0.04). Median SCr change from admission to 72 hours did not differ between groups (AW −0.1 mg/dL vs AC 0.0 mg/dL, P = 0.05). There was no difference in SCr reduction ≥0.3 mg/dL at 72 hours, 30-day readmissions, or ACE-I/ARB prescription at discharge.

Conclusions:

In patients with type 1 CRS, AW was not associated with improved renal function at 72 hours. A larger sample size is necessary to confirm these results.
Targeting the Cholesterol Paradigm in the Risk Reduction for Atherosclerotic Cardiovascular Disease: Does the Mechanism of Action of Pharmacotherapy Matter for Clinical Outcomes?
Authors: Zhou Ruihai , Stouffer George A. , Smith Sidney C.
Published: June 2021

Hypercholesterolemia is a well-established risk factor for atherosclerotic cardiovascular disease (ASCVD). Low-density lipoprotein cholesterol (LDL-C) has been labeled as “bad” cholesterol and high-density lipoprotein cholesterol (HDL-C) as “good” cholesterol. The prevailing hypothesis is that lowering blood cholesterol levels, especially LDL-C, reduces vascular deposition and retention of cholesterol or apolipoprotein B (apoB)-containing lipoproteins which are atherogenic. We review herein the clinical trial data on different pharmacological approaches to lowering blood cholesterol and propose that the mechanism of action of cholesterol lowering, as well as the amplitude of cholesterol reduction, are critically important in leading to improved clinical outcomes in ASCVD. The effects of bile acid sequestrants, fibrates, niacin, cholesteryl ester transfer protein (CETP) inhibitors, apolipoprotein A-I and HDL mimetics, apoB regulators, acyl coenzyme A: cholesterol acyltransferase (ACAT) inhibitors, cholesterol absorption inhibitors, statins, and proprotein convertase subtilisin kexin 9 (PCSK9) inhibitors, among other strategies are reviewed. Clinical evidence supports that different classes of cholesterol lowering or lipoprotein regulating approaches yielded variable effects on ASCVD outcomes, especially in cardiovascular and all-cause mortality. Statins are the most widely used cholesterol lowering agents and have the best proven cardiovascular event and survival benefits. Manipulating cholesterol levels by specific targeting of apoproteins or lipoproteins has not yielded clinical benefit. Understanding why lowering LDL-C by different approaches varies in clinical outcomes of ASCVD, especially in survival benefit, may shed further light on our evolving understanding of how cholesterol and its carrier lipoproteins are involved in ASCVD and aid in developing effective pharmacological strategies to improve the clinical outcomes of ASCVD.