bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of long-term corticosteroids in patients treated with CAR T-cell therapy
Authors: Hashmi Hamza , McGann Mary , Greenwell Brian I
Published: May 2022

Introduction

Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are common toxicities associated with chimeric antigen receptor (CAR) T-cell therapy. Severe grade 3 or higher ICANS is less common and requires the use of corticosteroids with or without an Interleukin (IL)-6 receptor antagonist. Although corticosteroids are effective in the management of CRS and ICANS, their impact on CAR T efficacy remains unknown.

Case report

We present the case of a 65-year-old male who received CAR T-cell therapy with brexucabtagene autoleucel for stage I/II Mantle Cell Lymphoma (MCL) and achieved complete remission despite receiving a prolonged course of corticosteroids for severe ICANS.

Management and outcome

The patient received treatment with high-dose corticosteroids, tocilizumab, and anakinra, in addition to multiple antiepileptic agents. Despite a remitting relapsing pattern of ICANS, the patient not only recovered from the life-threatening complication but also achieved a complete remission at three months post CAR T.

Conclusion

This case describes the successful use of corticosteroids for the management of ICANS in a patient treated with CAR T-cell therapy for MCL.
The ‘tears’ score: A tool for grading and monitoring epiphora
Authors: Schulz Christopher B. , Malhotra Raman
Published: May 2022

Purpose

To test the reliability, validity and utility of the TEARS score, a scale of clinical and patient-reported severity in patients with epiphora, comprising 4 subscales: Times wiping (T), clinical Effects (E), Activity limitation (A), and symptoms of Reflex epiphora (R).

Methods

The TEARS score was completed by 136 patients with epiphora (78 treated surgically, and 51 non-surgically). Inter-rater reliability was evaluated using Cohen's Kappa and Bland-Altman analysis. 129 (95%) participants were followed up 2–6 months after baseline (non-surgical patients) or 3–6 months post-operatively (surgical patients). For each TEARS subscale, differences in scores were compared. Convergent validity was evaluated by testing correlation between TEARS and both The Lacrimal Symptom Questionnaire (Lac-Q) and The Watery Eye Quality of Life Score (WEQOL).

Results

Inter-rater reliability (Cohen's K) ranged from 0.5 for ‘A’ and ‘R’ to 0.8 for ‘T’ and ‘E’ subscales. Scores were lower post-operatively in surgical patients (p < 0.001). ‘R’ scores (reflex tearing) were higher in non-surgical cases compared with surgical (p = 0.02) but no difference was observed in other subscales at baseline. TEARS subscale scores were positively correlated with both WEQOL (r = 0.51 to 0.73) and Lac-Q score (r = 0.55 to 0.63).

Conclusion

The TEARS score is quickly and easily implemented in a busy clinical setting. It provides an overview of both subjective and objective clinical severity in patients with epiphora, with appropriate reliability, post-operative responsiveness and convergent validity for this purpose and in this setting. It is a valuable template to be used alongside individualised symptomology.
Treatment of intragraft stenosis in hemodialysis grafts with Supera stents: A retrospective study
Authors: Chua Chai-Hock , Lu Ming-Jen , Chao Hung-Hsing
Published: May 2022

Purpose:

To report the patency rates after implantation of an interwoven nitinol stent to salvage failing arteriovenous grafts (AVGs) caused by intragraft stenoses.

Methods:

Between May 2018 and May 2020, 21 Supera stents were placed in 20 patients (18 women; mean age: 79.9 years) who had a failing AVG due to repeat intragraft stenoses. Recurrent AVG dysfunction with same intragraft stenosis within 3 months after first time angioplasty was a criterion for stenting. Those with concurrent treatment for other lesions were excluded.

Results:

The technical success rate was 100%. Intragraft stenoses were treated at a median of 19.7 (interquartile range: 6–36) months after graft creation. Access circuit primary patency rates after stent placement were 84% and 35% at 6 and 12 months, respectively. Access circuit secondary patency rates were 100% at 6 and 12 months and 89% at 18 months. Only one patient presented with graft failure due to proximal drainage vein occlusion. The target lesion patency rates were 100% at 6 months and 75% at 12 months. The rate of reintervention for intragraft lesion was 0.15 procedures per year. Stent distortion did not occur under regular cannulation.

Conclusion:

The interwoven nitinol stent is a promising treatment for failing AVGs with recurrent intragraft stenoses. The 1-year access circuit primary, secondary, and target lesion patency rates were acceptable, with a low reintervention rate. Stent fracture does not occur in areas of needle puncture.
The effect of clinical guideline education on the knowledge and practice of nurses for peripheral intravenous catheter placement based on short message service: A quasi-experimental study
Authors: Mousavi Hengameh , Ghanbari Atefeh , Karkhah Samad , Alizadeh Javad , Kazemnejad Leyli Ehsan , Jafaraghaee Fateme
Published: May 2022

Background:

Peripheral intravenous catheter (PIVC) placement is the most common invasive clinical procedure, often performed by nurses in hospitals worldwide. This study aimed to assess the effect of clinical guideline education on the knowledge and practice of nurses for PIVC placement based on short message service (SMS).

Methods:

In a quasi-experimental study with parallel groups, 66 nurses working in two general university hospitals in Iran were enrolled. Data was collected from 2017 to 2018. PIVC placement was assessed before, immediately, and 4 weeks after educational intervention based on SMS (twice a day for 10 days).

Results:

Nurses’ knowledge score immediately after intervention versus before intervention was higher in the intervention group than in the control group (4.48 vs −0.70; p < 0.001). Nurses’ knowledge score in 4 weeks after intervention versus immediately after intervention was lower in the intervention group than in the control group (0.03 vs 0.42; p = 0.014). Nurses’ knowledge scores 4 weeks after intervention versus before intervention was higher in the intervention group than in the control group (4.52 vs −0.27; p < 0.001). Nurses’ practice score immediately after intervention versus before intervention was higher in the intervention group than in the control group (0.57 vs −0.18; p = 0.174). Nurses’ practice score 4 weeks after intervention vs immediately after intervention was higher in the intervention group than in the control group (−0.10 vs −0.38; p = 0.046). Nurses’ practice scores 4 weeks after intervention versus before intervention was higher in the intervention group than in the control group (0.47 vs −0.56; p = 0.001).

Conclusion:

Educational intervention by SMS had a significant effect on increasing the knowledge and practice of nurses toward clinical guidelines for PIVC placement. Therefore, it is suggested that educational intervention by SMS be conducted to improve nurses’ knowledge as an effective educational method.
An advanced particle swarm optimization algorithm and its application to search flutter critical velocity of bridges
Authors: Yu Chuanjin , Li Yongle , Chen Qian , He Jiayong , Zhao Liyang
Published: May 2022

Flutter may lead to collapse of long-span bridges and need to be avoided, which makes the estimation of the onset flutter essential for long-span bridge design. However, the efficiency of traditional solution methods of predicting onset flutter is not high. In this study, it is converted into an optimization model, which is solved by a proposed advanced particle swarm optimization (APSO) with a novel inertia weight strategy and mutation mechanism. Two well-known benchmark functions are firstly employed to validate the performance of APSO. Compared with other existing PSO methods, APSO not only has high accuracy, but also has the fastest convergence speed. Then, APSO is used to find the flutter critical wind speed of bridges. A good agreement is obtained comparing predictions on the onset flutter by the proposed methods and available tests on several study cases. In addition, the value range of APSO variables is discussed in depth. It is confirmed that the proposed APSO algorithm has excellent stability, robustness and fast convergence, which is suitable for searching onset flutter of bridges.
Health information technology adoption and acceptance of Turkish physicians-A model proposal and empirical assessment
Authors: Turan Aykut H , Koç Tuğba
Published: May 2022

Health Information Technology (HIT) systems are receiving increasing attention in recent years. Yet, individual adoption research in health care settings, especially in developing countries are quite limited. Moreover, large body of Information Systems research has focused on user perceptions to form intentions to use a particular technology. However, the antecedents and consequences of perceptions remained largely unanswered in existing research. This study aims to fill this gap by proposing and testing a research model based on a modified Technology Acceptance Model (m - TAM) which incorporates socio psychological and cognitive factors to assess the HIT’s adoption level of Turkish physicians. To do so, two different methods were used to collect data from head physicians, assistant head physicians, and physicians: face to face and online survey. Total 212 useful responses were returned. 174 of them were face-to-face surveys which were administrated to all the first level and some second and third level health organizations. The rest of the surveys were administrated to the second and third level healthcare organizations via online participation. Data were analyzed by Structural Equation Modelling via SmartPLS software program. Results present that commitment is a strong predictor of HIT usage, whereas neither motivation nor resistance has a significant impact on HIT usage.
All-encompassing ethnographies: Strategies for feminist and equity-oriented institutional research
Authors: Winfield Taylor Paige
Published: May 2022

This article addresses the challenges inherent to conducting ethnography in all-encompassing institutions and presents strategies for equity-oriented research in such restrictive settings. All-encompassing institutions are organizations that have no separation between home, work, and play, with forms of surveillance, power imbalances, and control that create logistical and ethical challenges for ethnographers. Building on feminist orientations to qualitative inquiry, the author shares vignettes from her research in a military institution to introduce four strategies for ethnography in these contexts. The strategies are: (a) adopting a participant-centered approach; (b) attending to power dynamics; (c) negotiating consent and confidentiality; and (d) engaging participants in research presentation. These strategies are applicable to ethnographers across contexts looking to meaningfully engage interlocutors in research generation and presentation.
A grid-based approach to exploratory data analysis
Authors: Elliott Steven D
Published: May 2022

A grid-based approach to exploratory data analysis is described wherein the size of a grid’s cells may be altered. The primary tool of exploratory data analysis described here is cluster analysis. Background information is provided regarding the different types of clustering algorithms and their effectiveness. A grid-based approach for exploratory and cluster analysis is then described. Both exploratory and cluster analyses are performed for a series of different sizes of grid cells. Two marketing data sets are utilized to illustrate research questions often faced by market researchers. The first is a cluster analysis of cities used to create strata for selecting a representative probability sample. The second example is a segmentation of customers into groups for the purpose of targeting advertising and product insight. These examples illustrate related issues such as the elimination of “background noise” observations, significance tests for departures from uniform density, and metrics for the shape of a cluster.
Teaching Research in Principle and in Practice: What Do Psychology Instructors Think of Research Projects in Their Courses?
Authors: Wagge Jordan R. , Hurst Michelle A. , Brandt Mark J. , Lazarevic Ljiljana B. , Legate Nicole , Grahe Jon E.
Published: May 2022

Psychology majors typically conduct at least one research project during their undergraduate studies, yet these projects rarely make a scientific contribution beyond the classroom. In this study, we explored one potential reason for this—that student projects may not be aligned with best practices in the field. In other words, we wondered if there was a mismatch between what instructors teach in principle and what student projects are in practice. To answer this, we asked psychology instructors ( n = 111) who regularly teach courses involving research projects questions about these projects. Instructors endorsed many of the commonly assumed pitfalls of student projects, such as not using rigorous methodology. Notably, the characteristics of these typical student projects did not align with the qualities instructors reported as being important in research practice. We highlight opportunities to align these qualities by employing resources such as crowdsourced projects specifically developed for student researchers.
Enhancing damage localisation in critical areas of storage tanks in floating production storage and offloadings with a guided wave structural health monitoring system
Authors: Dambros Menin Paulo , de Abreu Corrêa Lúcio , Rosauro Clarke Thomas Gabriel , Alvin Liang Denis
Published: May 2022

A guided wave monitoring system for storage tanks of floating production storage and offloading units was tested on a panel which is representative of a critical region of such structures. Initially, baseline signals of the undamaged structure were acquired within a representative temperature range. These signals were then processed with the optimal baseline subtraction, optimal stretch and phase-shift compensation algorithms. Two distinct damage indexes were generated from the residual signals in order to verify the detection capability of the system. A delay-and-sum image algorithm was then applied to the residual signals in order to evaluate the defect localisation capabilities of the system. These images were than post-processed with three different methods, one based on a probabilistic approach, another on singular value decomposition and also with a combination of these two methods. The signal-to-noise ratio (SNR) gain obtained by applying the post-processing strategies was calculated and compared to the original images. Results demonstrate that the system is capable of detecting localised wall loss and indicating its correct position for damage larger than 20% wall thickness loss. Results also show that the post-processing methods helped to improve the SNR, leading to gains of more than 15dB in damage to artefact amplitude ratios.
An MPPCA-based approach for anomaly detection of structures under multiple operational conditions and missing data
Authors: Ma Zhi , Luo Yaozhi , Yun Chung-Bang , Wan Hua-Ping , Shen Yanbin
Published: May 2022

Structural anomaly detection based on the structural health monitoring (SHM) data has attracted significant attention owing to its important role in the early warning of structural damage to existing civil structures. Data-driven approaches, where damage-sensitive features are extracted directly from the SHM data using statistical pattern recognition (SPR) techniques without physical models of structures, have been widely studied. Principal component analysis (PCA) and probabilistic PCA (PPCA) are powerful and efficient SPR methods for linear or weakly nonlinear cases. However, some special structures may be subjected to multiple operational conditions, wherein structural configurations such as geometry and mass distribution may change due to the movement of parts or the whole structure, as in retractable roof structures. These changes may give erroneous results in the SPR of the SHM data and eventually in the anomaly detection by a single PCA or PPCA model. This paper presents an improved approach using a mixture of probabilistic principal component analysis (MPPCA) for the anomaly detection of structures under multiple operational conditions with missing measurement data. First, the baseline MPPCA model was constructed for stress data collected under healthy conditions, where the estimation of the MPPCA parameters was reformulated for the missing data cases. Second, three anomaly statistics were presented for newly monitored incomplete data to detect and localize structural anomalies. The probability distributions of the anomaly statistics were estimated to obtain thresholds for outlier detection. Finally, the effectiveness of the MPPCA-based method was investigated by applying the method to the anomaly detection of a retractable roof structure with numerically simulated and real monitored stress data.
Clinical and Histological Outcomes of Negatively Charged Polystyrene Microspheres Applied Daily Versus Three Times per Week in Hard-to-Heal Diabetic Foot Ulcers: A Randomized Blinded Controlled Trial
Authors: Lázaro-Martínez José Luis , García-Madrid Marta , López-Moral Mateo , Tardáguila-García Aroa , Álvaro-Afonso Francisco Javier , García-Álvarez Yolanda
Published: May 2022

Negatively charged polystyrene microspheres (NCMs) have been demonstrated as a novel and effective therapy for managing hard-to-heal diabetic foot ulcers (DFUs). However, one limitation of this therapy is that the protocol is based on daily application, which sometimes does not fit local protocols of wound care. Thus, we aimed to analyze the safety and efficacy of a new dose regimen. We conducted a randomized blinded controlled trial in a specialized diabetic foot unit between May 2019 and February 2021 with a total of 30 patients who had neuropathic or neuroischemic DFUs that had not responded after four weeks of standard treatment. Patients were randomized consecutively into a group that received daily application (control) or one that received applications three times per week (experimental). The clinical outcomes were evaluated using the Wollina score and wound-area reduction (WAR) weekly during a treatment period of 28 days. The histological outcomes were assessed using a soft-tissue punch biopsy (3 mm) at 0, 14, and 28 days to evaluate cellular proliferation. The Wollina scores were higher at the end of treatment by week 4 in both groups, but the differences were not significant between groups. The averages were 6 (5, 7) points in Experimental group (EG) and 6 (6,7) points in Control group (CG) (p = 0.848). Wound area reduction at day 28 was 53.57 [37.43, 79.16] % in the CG and 79.37 [42.74, 93.57] % in the EG, without differences among groups (p = 0.305). Cellular proliferation was similar in both groups at day 28. Application three times per week showed similar clinical and histological outcomes to those of daily application, both dose regimens demonstrated significant improvement of granulation tissue formation and WAR during the treatment.
Effect of Diclofenac and Andrographolide Combination on Carrageenan-Induced Paw Edema and Hyperalgesia in Rats
Authors: Tandoh Augustine , Danquah Cynthia Amaning , Benneh Charles Kwaku , Adongo Donatus Wewura , Boakye-Gyasi Eric , Woode Eric
Published: May 2022

Studies into drug combination at low doses are a promising approach to the management of pain and inflammation. The aim of this study was to evaluate the anti-edema and anti-hyperalgesic effects of a combination of diclofenac and andrographolide. Male Sprague-Dawley rats were first treated with diclofenac or andrographolide alone (3–100 mg/kg), as well as a combination of the 2 drugs. Carrageenan was then injected into the right hind paw of rats, and changes in paw volume and sensitivity to mechanical (von Frey) and thermal (Hargreaves test) stimuli measured. Results showed drug combination produced synergistic effects at reducing paw edema especially at lower doses, with a Loewe synergy score of 13.02 ± 8.75 in SynergyFinder and a combination index of .41 ± .18 after isobolographic analysis. Again synergy scores for decreasing response to 1.0 and 3.6 g force application of von Frey filaments after drug combination were 10.127 ± 5.68 and 8.554 ± 6.53, respectively, in SynergyFinder. Synergistic effects were also seen after drug combination in the Hargreaves test with a synergy score of 5.136 ± 16.38. In conclusion, combination of diclofenac with andrographolide showed better pharmacologic effects after carrageenan injection and was more synergistic at low-dose combinations.
Resolute onyx stent more effective than wingspan stent at preventing procedural complications and long-term restenosis
Authors: Hassan Ameer E. , Khalil Mohammad , Desai Sohum , Tekle Wondwossen G.
Published: May 2022

Background and Purpose

Angioplasty and stenting is a treatment option for patients with medically refractory symptomatic intracranial atherosclerotic disease (sICAD). Currently the Wingspan Stent System (WSS) is the only FDA approved device for this indication. We find the Resolute (R) Onyx Stent, a drug-eluting balloon mounted stent (DES), a better alternative to the WSS for treatment of sICAD. Herein, we present our findings comparing the two stents based on our single center experience.

Methods

A prospectively maintained neuro-endovascular databased was queried for patients between January 2013 to June 2021. Inclusion criteria for patients included sICAD with failed medical management, and intracranial stenting with either R-Onyx DES or WSS, including patients treated within 7 days of their last stroke. Primary outcomes were assessed via the occurrence of ischemic or hemorrhagic stroke or death within 72 h of the procedure. Secondary outcomes consisted of recurrent stroke or significant in-stent restenosis evaluated by a clinical or angiographic follow-up at 6 months.

Results

A total of 184 patients, average age 61.26 (SD = 12.53) (44% women), were eligible for analysis with 58 having R-onyx DES and 126 having WSS. Within 72 h, the primary outcome was observed in 1.7% (n = 1) of patients in the R-onyx DES group and 6.3% (n = 8) of patients in the WSS group (p = 0.089). Among 41 angiographic and clinical follow-ups in the R-onyx DES group, none had a recurrent stroke, while among 101 patients who had follow-up in the WSS group, 8.9% (n = 9) had a stroke (p = 0.024). At a 6-month angiographic follow-up, there was a significantly lower rate of symptomatic in-stent restenosis among the R-onyx DES group with 1.7% (n = 1) compared with 21.4% (n = 27) in the WSS group (p = 0.0003).

Conclusion

R-onyx DES is more effective than WSS in treating sICAD with low rates of periprocedural complications and long-term strokes and symptomatic in-stent restenosis. Future prospective randomized multicenter trials are needed.
Aneurysmal recurrence after successful flow-diversion embolization
Authors: Akbik Feras , Saad Hassan , Grossberg Jonathan A , Tong Frank C , Cawley C Michael , Howard Brian M
Published: May 2022

Aneurysmal recurrence after successful flow-diversion embolization is exceptionally rare. The rarity of recurrence has called into question the yield of interval surveillance imaging. Here we report the case of a recurrent intracranial aneurysm despite complete angiographic resolution after flow-diversion therapy with a Pipeline embolization device (PED). Given the absence of poor wall apposition, endoleak, and device migration, how this aneurysm recurred remains unclear, particularly given the recurrence was at a timepoint at which complete reendothelialization of the device would be expected. The patient ultimately underwent interval treatment with a second device placed across the neck of the aneurysm. Although rare, reports of aneurysmal recurrences support the use of interval non-invasive imaging surveillance to ensure successful embolization in this patient population.
Vibrodiagnostics as a predictive maintenance tool in the operation of turbo generators of a small hydropower plant
Authors: Baron Petr , Kočiško Marek , Hlavatá Simona , Franas Eduard
Published: May 2022

The most important goal of monitoring and analysis of vibration is to provide information on the operational and technical condition of equipment in order to ensure strategic planning and maintenance management. The article addresses integration of vibrodiagnostics into the system of predictive maintenance in the operation of turbo generators of a small hydropower plant. Small hydropower plants are specific for their ability to provide relatively stable output without unnecessarily burdening the transmission system. Modern turbines are expected to be highly efficient and reliable in operation. By including these devices into the predictive maintenance system, it is possible to identify their possibly unusual behavior, estimate the remaining service life, and draw attention to incorrect setting of operating parameters. The task of research in this area was to evaluate the applicability of data obtained from vibrodiagnostics to identifying turbo generator failures and key parameters that may have a potential impact on the behavior of this type of equipment.
Absence of the celiac trunk: Definition, classification, multidetector computed tomography angiographic findings, and their probable embryological mechanisms
Authors: Mao Yi , Yao Yun , Li Xiaoguang , Zhang Chunlai , Chen Xiao , Wang Yi
Published: May 2022

Objective

This study aims to identify the types and prevalence of absence of the celiac trunk by using multidetector computed tomography (MDCT) angiography, and analyze their probable embryological mechanisms.

Methods

A retrospective study was carried out on 2500 abdominal MDCT angiography images. The absence of the celiac trunk was defined as that the celiac trunk is not exist, more specifically, there is not such an arterial trunk containing at least two major branches of the celiac trunk. Various types of the absence of the celiac trunk were investigated.

Results

Of the 2500 patients, 19 (0.76%) patients were identified as an absence of the celiac trunk. According to its definition and classification, the absence of the celiac trunk could be divided into five types: type I (LGA + CHA + SA + SMA), type II (HM trunk + LGA + SA), type III (SM trunk + LGA + CHA), type IV (GM trunk + CHA + SA), and type V (other type); and these types were observed in 5 patients (0.20%), 9 patients (0.36%), 3 patients (0.12%), 0 patients (0.00%), and 2 (0.08%) patients, respectively. There were more examples of the types I and II than of the types III–V ( p = 0.004).

Conclusion

We systematically classified the absence of the celiac trunk based on its MDCT angiography findings. Abnormal interruptions and persistence of the longitudinal anastomosis, regression of vascular root, and emergence of replaced artery could all be the embryological mechanisms of various types of the absence of the celiac trunk.
A single-center experience of 30-day perioperative and one year clinical outcomes of transcarotid artery revascularization in 100 consecutive patients
Authors: AbuRahma Ali F , AbuRahma Zachary T , Santini Adrian , Beasley Matthew , Davis Meghan , Lee Andrew , Veith Christina , Roshdy Mazen , Dean L Scott , Davis Elaine
Published: May 2022

Background

Transcarotid Artery Revascularization (TCAR) using the ENROUTE system (Silk Road) has been proposed as a safe and effective alternative to both carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TF-CAS). Two large registries (ROADSTER 1 and ROADSTER 2) have shown that TCAR has acceptable/low rates of perioperative stroke/death. This study will analyze the 30-day perioperative and 1-year clinical outcomes from a single-center.

Patient population and methods

This is a retrospective analysis of prospectively collected data from SVS/VQI TCAR surveillance project (TSP) of 100 consecutive patients (102 TCAR procedures) done in our institution. These procedures were done for high-risk patients for CEA, which included anatomical (previous CEA, high cervical lesion, neck radiation, stoma, arch type, etc.), physiological (CHF, severe coronary artery disease, COPD on O2 therapy, etc.) and combined anatomical/physiological reasons. These procedures were done by vascular surgeons after receiving the appropriate training. The perioperative stroke, death, and MI rates were analyzed. Kaplan Meyer analysis was used to estimate rate of freedom from stroke/death and the incidence of ≥50% and ≥80% in-stent restenosis at 1 year.

Results

100 consecutive high-risk patients for CEA included: 38% anatomical, 44% physiological, and 18% combined anatomical and physiological reasons. The mean age was 72.5 years (range 52–90 years). Indications for TCAR were 34% for symptomatic lesions (TIA/stroke) and 66% for asymptomatic lesions. Mean ipsilateral treated stenosis was 80.4%. Contralateral ≥50% stenosis/occlusion was present in 31% of patients. Technical success rate was 100%. 92% had pre-stenting PTA and 26% had post-stenting PTA. The mean flow reversal time was 8.5 min (range 3–26 min). The 30-day perioperative stroke rate was 2.9% (1/67, 1.5% for asymptomatic patients), the stroke/death rate was 2.9%, and stroke/death and MI rate was 3.9% (4/102). Other perioperative complications included cranial nerve injury 3/102 (2.9%), carotid artery dissection (2%), and major hematoma (necessitated operation evacuation) (5.9%). Freedom from stroke rates and stroke/death rates at 1 year were: 90% and 89%. Freedom from ≥50% and ≥80% in-stent restenosis rates at 1 year were 82% and 90%, respectively. None of these restenosis were symptomatic except two (2/13). Freedom from reintervention rate at 1 year was 98%.

Conclusion

Although the perioperative events were somewhat higher than what has been reported in previous registries, TCAR for patients who are high-risk for CEA has a low perioperative stroke and stroke/death rates with satisfactory outcome at 1 year. Further long-term data is probably needed to verify long-term outcome.
Instructional Boundary Management during COVID-19
Authors: Shaked Haim , Benoliel Pascale Sarah
Published: May 2022

Instructional Boundary Management is an area of school leadership comprising activities that simultaneously involve instructional leadership and boundary management. This study explores principals’ Instructional Boundary Management during COVID-19. Data collection consisted of semi-structured interviews with a diverse sample of 33 Israeli elementary school principals. Data analysis indicated that principals felt an increasing need to carry out most Instructional Boundary Management activities during COVID-19. The findings suggest that COVID-19 influenced principals’ needs through the following three factors: the challenges that COVID-19 posed to teachers, the challenges that COVID-19 posed to students and parents, and the transition from face-to-face instruction to distance learning. These findings reveal the mechanisms through which COVID-19 affected Instructional Boundary Management activities, explaining how and why COVID-19 has led to a greater need for principals’ Instructional Boundary Management.
Facebook Comments Influence Perceptions of Journalistic Bias: Testing Hostile Media Bias in the COVID-19 Social Media Environment
Authors: Gearhart Sherice , Coman Ioana A. , Moe Alexander , Brammer Sydney
Published: May 2022

News organizations increasingly use Facebook to expand their reach and foster audience engagement. However, this free platform exposes news audiences to user comments before accessing and reading news articles. This exposure shapes the visible opinion climate and has the potential to influence readers. Through the application of the hostile media bias hypothesis, the influence of Facebook comments on COVID-19 related news articles and a knowledge-based assessment on perceptions of news bias and credibility are tested using a nationwide sample of Facebook users ( N = 450). Findings show that user comments enhance negative perceptions of bias and diminish perceptions of favorability. The ability for knowledge-based assessments to alleviate this negative influence may induce reactance and needs further investigation.
Elevated baseline expression of seven virulence factor RNA transcripts in visceralizing species of Leishmania: a preliminary quantitative PCR study
Authors: Mukkala Avinash Naraiah , Kariyawasam Ruwandi , Lau Rachel , Valencia Braulio M. , Llanos-Cuentas Alejandro , Boggild Andrea K.
Published: May 2022

Introduction:

Leishmaniasis is a neglected tropical disease that manifests as three major disease phenotypes: cutaneous, mucocutaneous, and visceral. In this preliminary study, we quantified virulence factor (VF) RNA transcript expression in Leishmania species, stratified by geographic origin and propensity for specific disease phenotypes.

Methods:

Cultured promastigotes of 19 Leishmania clinical and ATCC isolates were extracted for total cellular RNA, cDNA was reverse transcribed, and qPCR assays were performed to quantify VF RNA transcript expression for hsp23, hsp70, hsp83, hsp100, mpi, cpb, and gp63.

Results:

Comparison of visceralizing species (Leishmania donovani, Leishmania chagasi, and Leishmania infantum) versus non-visceralizing species [Leishmania (Viannia) spp., Leishmania tropica, Leishmania major, Leishmania mexicana, and Leishmania amazonensis] revealed a significantly greater pooled transcript expression for visceralizing species (p = 0.0032). Similarly, Old World species demonstrated significantly higher VF RNA transcript expression than New World species (p = 0.0015). On a per-gene basis, species with a propensity to visceralize ubiquitously expressed higher levels of gp63 (p = 0.005), cpb (p = 0.0032), mpi (p = 0.0032), hsp23 (p = 0.0039), hsp70 (p = 0.0032), hsp83 (p = 0.0032), and hsp100 (p = 0.0032).

Conclusion:

Here, we provide quantitative, preliminary evidence of elevated VF RNA transcript expression driven largely by the visceralizing causative species of Leishmania. This work highlights the extensive heterogeneity in pathogenicity mechanisms between Leishmania species, which may partly underpin the fatal progression of visceral leishmaniasis.
Tradeoffs all the way down: Ethical abduction as a decision-making process for data-intensive technology development
Authors: Tanweer Anissa
Published: May 2022

Ample scholarship demonstrates that data-intensive technologies have the capacity to cause serious harm and that their developers are obliged to address ethics in their work. This ethnographic paper tells the story of data scientists attempting to instantiate a carefully considered ethical vision into a data infrastructure while balancing competing priorities, negotiating divergent interests, and wrestling with contrasting values. I use their story to develop the concept of “ethical abduction,” which I characterize as an exemplary process by which actors can intentionally and systematically address ethical issues that arise during their day-to-day actions by making decisions with consideration for a foundational ethical worldview. It entails tacking back and forth between divergent but complementary ways of thinking: between establishing ideals and making decisions given practical constraints; between understanding historical context and anticipating future consequences; between acknowledging structural dependencies and accepting responsibility for moral agency.
Telemedicine options to address identified health needs in Botswana
Authors: Ncube Benson , Mars Maurice , Scott Richard E
Published: May 2022

Objective

Global efforts to implement national ehealth strategies have occurred, yet specific telemedicine implementations have fallen behind. A weakness inherent within many, perhaps most, national ehealth strategies, including Botswana's – is a lack of telemedicine focus. This is despite its potential to address many current healthcare system needs. The development of a telemedicine-specific strategy, to complement the existing ehealth strategy, has been proposed. This paper reports on an emulated process to determine prioritised health needs, identify broad solutions, consider ehealth and then telemedicine solutions, and prioritise these as insight for telemedicine-specific strategy development.

Methods

The eHealth Strategy Development Framework (eHSDF) was adopted and steps 5–7 were emulated. Key informants participated in telephone-based semi-structured interviews in November 2020, using a key informant interview guide. Participants were asked specific questions related to national health needs, proposed solutions, and prioritisation. The interviews were recorded and transcribed for analysis.

Results

Eleven key informants identified the top five perceived health issues as human resource shortages, congestion and overcrowding, prevalence of diseases, poor referral system, and lack of diagnostic and case management skills. Solutions were proposed, some of which included: Telehealth (including telemedicine), health informatics, and elearning. Telemedicine solutions included: a health professional help desk, teleconsultations, and apps for specialist referral. eLearning solutions were training, mentoring, and continuing professional development.

Conclusion

A telemedicine-specific strategy, addressing the identified health issues and aligned to the existing national ehealth strategy, would provide the required focus to enable the development and deployment of telemedicine activities in the country.
Using self-monitoring technology for nutritional counseling and weight management
Authors: Carpenter Chelsea A , Ugwoaba Umelo A , Cardel Michelle I , Ross Kathryn M
Published: May 2022

Self-monitoring of weight, dietary intake, and physical activity is a key strategy for weight management in adults with obesity. Despite research suggesting consistent associations between more frequent self-monitoring and greater success with weight regulation, adherence is often suboptimal and tends to decrease over time. New technologies such as smartphone applications, e-scales, and wearable devices can help eliminate some of the barriers individuals experience with traditional self-monitoring tools, and research has demonstrated that these tools may improve self-monitoring adherence. To improve the integration of these tools in clinical practice, the current narrative review introduces the various types of self-monitoring technologies, presents current evidence regarding their use for nutrition support and weight management, and provides guidance for optimal implementation. The review ends with a discussion of barriers to the implementation of these technologies and the role that they should optimally play in nutritional counseling and weight management. Although newer self-monitoring technologies may help improve adherence to self-monitoring, these tools should not be viewed as an intervention in and of themselves and are most efficacious when implemented with ongoing clinical support.
What criteria are young people using to select mobile mental health applications? A nominal group study
Authors: Kabacińska Katarzyna , McLeod Kaleigh , MacKenzie Annika , Vu Kim , Cianfrone Michelle , Tugwell Andrew , Robillard Julie M
Published: May 2022

Objective

The popularity of smartphone technology provides a unique opportunity to make mental health support widely accessible, especially among young people. Despite the promising results of some mobile mental health support applications, the overwhelming number of available applications (apps) on the market makes it difficult to make a choice that will be safe and effective. Currently, widely available tools are either developed by experts, without end user input or are solely based on usability rankings. Thus, it remains unclear what aspects of mental health apps are important for young people. The purpose of this study was to determine what criteria young adults use when they select mental health applications and what is the relative importance of these criteria to inform the development of a user-driven app-rating platform.

Methods

We conducted 4 group sessions with 47 youth and young adults aged 15–25 in British Columbia, Canada using a modified nominal group technique. This method allows for establishing the relative importance of criteria in a structured group discussion. We recorded, transcribed and analysed the resulting data using qualitative content analysis and quantitative methods.

Results

Criteria that are the most important to young adults when selecting mental health apps include accessibility, security and grounding in scientific evidence. We identified specific aspects of the discussed criteria which were ranked in the order of importance.

Conclusion

Consulting end users about their priorities when evaluating mental health apps ensures that their values and priorities are incorporated into future app-rating platforms, alongside expert opinions. The present study also outlines the common contexts in which apps are used as well as their desirable features to inform mental health app development.
Understanding the user: Patients’ perception, needs, and concerns of health apps for chronic constipation
Authors: Lee V Vien , Vijayakumar Smrithi , Lau Ni Yin , Blasiak Agata , Siah Kewin Tien Ho , Ho Dean
Published: May 2022

Objective

Chronic constipation is a prevalent gastrointestinal disorder that requires long-term management and treatment adherence. With increasing smartphone usage, health app adoption represents an opportunity to incorporate personalized, patient-led care into chronic constipation management. Despite the number of apps available targeting patients with constipation, studies have not yet examined user needs and barriers towards successful app adoption and sustained usage. Accordingly, the current study explored user perception, needs, and concerns of health apps in patients with chronic constipation.

Methods

Fifteen participants with chronic constipation (age range = 28–79 years, 10 females) in Singapore completed a 60 min semi-structured qualitative interview exploring participant's experiences with and attitudes towards chronic constipation and health apps. Participants also completed two questionnaires regarding their constipation symptoms and general technology usage. Interviews were audio-recorded, transcribed verbatim, and coded using NVivo.

Results

Four themes and 10 sub-themes were identified using inductive thematic analysis. Themes and sub-themes cover importance of patient identity, disease-based expectations of health apps, barriers towards adoption and sustained usage of health apps, necessary conditions when adopting health apps (including perception of supportive benefits, clear understanding of app intention, personalized technology, and trusted sources), and push factor expectations which includes creative engagement and incentivization embedded within the app.

Conclusion

The findings captured barriers and key elements necessary for successful health app adoption and continued usage by patients with chronic constipation. Identified elements that matter to patients can provide app developers with user-focused insights and recommendations to develop effective health apps that sustain user engagement.
Long-term Outcomes Following Temperature-Controlled Radiofrequency Neurolysis for the Treatment of Chronic Rhinitis
Authors: Ehmer Dale , McDuffie Chad M. , McIntyre J. Bradley , Davis Bryan M. , Mehendale Neelesh H. , Willis John H. , Watkins Jeremy P. , Kakarlapudi V. Vasu
Published: May 2022

Background

Temperature-controlled radiofrequency neurolysis of the posterior nasal nerve has been shown to reduce the symptom burden of patients with chronic rhinitis.

Objectives

To evaluate the long-term safety and effectiveness of temperature-controlled radiofrequency neurolysis of the posterior nasal nerve for the treatment of chronic rhinitis.

Methods

A prospective extension of a 12-month single-arm study, where reflective total nasal symptom score (rTNSS) and the responses to a study-specific quality of life questionnaire and patient satisfaction survey were collected at 24 months.

Results

Forty-seven patients completed initial 12-month follow-up after treatment with the study device, of which 34 patients were reconsented and completed 24-month follow-up. The mean rTNSS of the long-term follow-up patients improved from 8.4 (95% confidence interval (CI), 7.7 to 9.0) at baseline to 2.9 (95% CI, 2.1 to 3.6), P < .001 at 24 months, a 65.5% improvement. On a 6-point scale (0-5), postnasal drip improved from a mean of 4.1 (95% CI, 3.6 to 4.6) to 2.1 (95% CI, 1.7 to 2.5) and chronic cough improved from 3.2 (95% CI, 2.7 to 3.6) to 0.9 (95% CI, 0.5 to 1.3) from baseline through 24 months; P < .001 for both measures. The proportion of patients achieving a minimal clinically important difference of 30% improvement from baseline at 24 months was 88.2% (95% CI, 73.4%-95.3%). At 24 months, 24% of patients were taking overall fewer and 15% taking overall more rhinitis medication classes than at baseline. Patients reported a higher quality of life in terms of sleep, well-being, and lower oral medication/nasal spray use at 24 months. There were no serious adverse events considered related to the procedure in the 12-24-month period.

Conclusion

Temperature-controlled radiofrequency neurolysis results in a significant and durable reduction in the symptom burden of chronic rhinitis and patients reported improved quality of life through 24 months postprocedure.
Vasoplegia Following Complex Spine Surgery: Incidence and Risk
Authors: Ishak Basem , Pulido Juan N. , von Glinski Alexander , Ansari Darius , Oskouian Rod J. , Chapman Jens R.
Published: May 2022

Study design

Retrospective cohort study

Objectives

Vasoplegia is a life-threatening form of distributive or vasodilatory shock that is characterized by reduced systemic vascular resistance with resultant hypotension and normal to elevated cardiac output affecting morbidity and mortality. Vasoplegia in the context of Spine Surgery has not been described previously. The purpose of this case series is to determine incidence, risk factors, complications and postoperative outcome in patients with vasoplegia after complex multi-level thoraco-lumbar spine surgery.

Methods

A retrospective review of the electronic medical records at our institution was conducted between January 2014 and June 2018. All patients undergoing multi-level spine surgery (>6 levels) were screened for intraoperative hypotension. Patient demographics, surgical characteristics, neurological status, blood loss, risk factors, medical treatment, complications, hospital course and mortality were collected. All patients included in this study had a minimum follow-up period of 3 months.

Results

Out of 8521 surgically treated patients, 994 patients with multi-level thoraco-lumbar spine surgery were identified. A total of 41 patients had intraoperative hypotensive events. Of those, 5 patients with vasoplegia could be identified after elimination of all other potential contributing factors. Vasoplegia did not influence the neurological outcome. One major and three minor complications occurred. All patients showed full recovery. The risk factors identified for vasoplegia include prolonged surgery with osteotomies.

Conclusions

Vasoplegia is a rare condition with an incidence of .6%. Patients experiencing vasoplegia did not appear to experience worse surgical outcomes. The use of special intraoperative hemodynamic monitoring should be considered in selected cases.