bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of postural headache after lumbar puncture requiring epidural blood patch: Effects of needle caliber; 2-year experience
Authors: Chang Warren , Kadribegic Ajla , Denham Kate , Kulzer Matthew , Tragon Tyson , Weis Ty , Spearman Michael , Goldberg Michael
Published: March 2021

Purpose

A common complication of lumbar puncture (LP) is postural headaches. Epidural blood patches are recommended if patients fail conservative management. Owing to a perceived increase in the number of post-lumbar puncture headaches (PLPHs) requiring epidural blood patches at a regional hospital in our network, the decision was made to switch from 20 to 22 gauge needles for routine diagnostic LPs.

Materials and methods

Patients presenting for LP and myelography at one network regional hospital were included in the study. The patients were contacted by nursing staff 3 days post-procedure; those patients who still had postural headaches after conservative management and received epidural blood patches were considered positive cases. In total, 292 patients were included; 134 underwent LP with 20-gauge needles (53 male, 81 female, average age 57.7) and 158 underwent LP with 22-gauge needles (79 male, 79 female, average age 54.6).

Results

Of 134 patients undergoing LP with 20-gauge needles, 15 (11%) had PLPH requiring epidural blood patch (11 female, 3 male, average age 38). Of 158 patients undergoing LP with 22-gauge needles, only 5 (3%) required epidural blood patches (all female, average age 43). The difference was statistically significant ( p < 0.01). Risk factors for PLPH included female gender, younger age, lower body mass index, history of prior PLPH and history of headaches.

Conclusion

Switching from 20-gauge to 22-gauge needles significantly decreased the incidence of PLPH requiring epidural blood patch. Narrower gauge or non-cutting needles should be considered in patients with risk factors for PLPH, allowing for CSF requirements.
Bone-related disorders of the jaw: A clinico-radiological diagnostic algorithm
Authors: Abdel Razek Ahmed Abdel Khalek
Published: March 2021

Bone-related disorders of the jaw (BRDJ) include a spectrum of non-neoplastic and neoplastic lesions of the maxillofacial region that have been recently classified into fibro-osseous lesions, giant cell lesions and osseous tumours. The histopathological features of BRDJ can be similar and overlie each other. Imaging is important in order to reach a specific diagnosis. However, the appearance of BRDJ on imaging is non-specific in some cases. Computed tomography (CT) and magnetic resonance imaging (MRI) are used for accurate localisation, characterisation of the tumour matrix, delineation of the lesion extension and establishment of the relation of BRDJ to the surrounding structures. Imaging is usually done to detect the relationship with the adjacent surrounding vital structures and to diagnose aggressive forms, malignant transformation and associated syndromes. The correlation of the demographic findings, the location and the clinical presentations with the imaging features are important for the diagnosis of BRDJ. The proposed clinico-radiological diagnostic algorithm with CT and MRI helps a specific diagnosis to be reached in some cases.
Feeling otherwise: Ambivalent affects and the politics of critique in geography
Authors: Ruez Derek , Cockayne Daniel
Published: March 2021

Scholars across the social sciences and humanities have increasingly questioned the meaning and purpose of critique. Contributing to those conversations, some geographers have advocated for affirmative or reparative practices such as reading for difference or experimentation that seek to provoke more joyful, hopeful, or enchanting affects, as alternatives to what they perceive as a prevailing forms of ‘negative’ critique. In response, others have re-emphasized the centrality of negativity and revalued negative affects in the context of regimes of racialization, heteronormativity, and coloniality. Rather than taking sides in a debate thus framed, this article develops an ambivalent position that foregrounds multiple senses of difference that exist within affirmative and reparative projects. Drawing on feminist and queer geographic work, the explicitly political and difference-oriented writing of Sedgwick and Deleuze, and queer and postcolonial affect scholars, we argue for critique characterized by an ambivalent and pluralistic attitude toward feeling. Joining those arguing for a pluralization of the moods and modes of critical work, our readings suggest the necessity of a pluralism that refuses any escape from the ‘negativity’ of the social field in favor of an affectively ambivalent engagement with the inherent politics of critique in a plural and uneven world.
Undoing mastery: With ambivalence?
Authors: Linz Jess , Secor Anna J
Published: March 2021

In this commentary, we respond to Derek Ruez and Daniel Cockayne’s article ‘Feeling Otherwise: Ambivalent Affects and the Politics of Critique in Geography’. We do so by picking up ambivalence—or more precisely, ambivalence about ambivalence—as a tool with which Ruez and Cockayne leave us. We find this tool somewhat difficult to grasp, but we understand this as part of its design. Ambivalence undoes the subject’s mastery. In doing so, we find that an airing of ambivalence gives other kinds of entangled, indeterminate, and unknowing relations room to breathe.
Stories we tell
Authors: Kern Leslie
Published: March 2021

In this commentary, I respond to Ruez and Cockayne’s ‘Feeling Otherwise’ in a moment of intense ‘otherwise-ness’ as a global pandemic upends daily life in a variety of mundane and profound ways. Provoked by Ruez and Cockayne to take up the idea of the stories we tell, I reflect on ambivalence and writing into a world deeply undecided. Although it is not hard to detect accounts of this crisis at both the ‘paranoid’ and affirmative ends of an affective spectrum, there is also perhaps an unprecedented ambivalence seeping into our stories, one which holds potential for disrupting some of our taken-for-granted ideas about how the world works. As we attempt to use stories to make sense of this changing world and to write into being a world we want to live in, we must, as Ruez and Cockayne insist, remain attentive to difference and resist the pull of a universal, masterful story. I suggest getting comfortable—or staying uncomfortable—in the queasy, sweaty space of undecidability.
Ambivalent methods, geographical difference, and the politics of feeling-knowing
Authors: Ruez Derek , Cockayne Daniel
Published: March 2021

We offer an engagement with the generous responses to our article, ‘Feeling Otherwise’. We think with the authors who responded to our paper to sketch out an affirmative way to understand the concept of ambivalence. We clarify key points, reflect on the responses, and make suggestions for ways to explore this topic further.
Amphiregulin induces interleukin-8 production and cell proliferation in lung epithelial cells through PI3K-Akt/ ERK pathways
Authors: Yang Fangfang , Xu Wei , Pei Yanli
Published: March 2021

Amphiregulin (AR), belongs to the epidermal growth factor (EGF) family, is able to induce a series of pathological and physiological responses by binding and activating epidermal growth factor receptor (EGFR). Interleukin-8 (IL-8) or CXCL8, a pro-inflammatory chemokine, has been suggested to be involved in tumor cell proliferation and inflammatory microenvironment via transactivation of the EGFR. However, whether there is a crosstalk between AR with IL-8 during inflammatory response remain to be fully understood. The current study was designed to investigate the possible mechanism of the interactions between AR and IL-8 production in human lung epithelial cells in vitro. Lung epithelial A549 cells were stimulated with lipopolysaccharide (LPS) to generate ALI model. LPS-induced AR and IL-8 production by A549 cells was measured by real-time PCR, Western Blot, and ELISA. The AR neutralizing antibody, PI3K specific inhibitor LY294002, JNK specific inhibitor SP60012, ERK specific inhibitor PD98089, and p38 inhibitor SB203580 were used to investigate the role of these signal pathways in LPS-induced cell proliferation, AR and IL-8 expression. LPS could induce AR through PI3K/Akt and ERK signal pathways. Furthermore, LPS induced AR promoted the production of IL-8 requires activation of EGFR, PI3K/Akt, and ERK signal pathways. The neutralizing antibody to AR prevented production of IL-8 induced by LPS. Treatment with Erlotinib, PI3K inhibitors, ERK inhibitor significantly inhibited AR-induced IL-8 production and cell proliferation. Our data indicate that a distinct role of EGFR–PI3K–Akt/ERK pathway as a bridge of interaction between AR and IL-8 production, as one of potential mechanisms to regulate inflammation and cell proliferation in human lung epithelial cells.
Dilatable Pulmonary Artery Banding Palliation in Congenital Heart Disease
Authors: Ligon R. Allen , Latson Larry A. , Ruzmetov Mark M. , Chan Kak-Chen , Turner Immanuel I. , Scholl Frank G. , Bibevski Steve
Published: March 2021

Background:

Surgical pulmonary artery banding (PAB) has been limited in practice because of later requirement for surgical removal or adjustment. The aim of this study is to describe our experience creating a dilatable PAB via transcatheter balloon dilation (TCBD) in congenital heart disease (CHD) patients.

Methods:

Retrospective chart review of adjustable PAB—outline anatomical variants palliated and patient outcomes.

Results:

Sixteen patients underwent dilatable PAB—median age 52 days (range 4-215) and weight 3.12 kg (1.65-5.8). Seven (44%) of the patients were premature, 11 (69%) had ventricular septal defect(s) with pulmonary over-circulation, four (25%) atrioventricular septal defects, and four (25%) single ventricle physiology. Subsequent to the index procedure: five patients have undergone intracardiac complete repair, six patients remain well palliated with no additional intervention, and four single ventricles await their next palliation. One patient died from necrotizing enterocolitis (unrelated to PAB) and one patient required a pericardiocentesis postoperatively. Five patients underwent TCBD of the PAB without complication—Two had one TCBD, two had two TCBD, and another had three TCBD. The median change in saturation was 14% (complete range 6-22) and PAB diameter 1.7 mm (complete range 1.1-5.2). Median time from PAB to most recent outpatient follow-up was 868 days (interquartile range 190-1,079).

Conclusions:

Our institution has standardized a PAB technique that allows for transcatheter incremental increases in pulmonary blood flow over time. This methodology has proven safe and effective enough to supplant other institutional techniques of limiting pulmonary blood flow in most patients—allowing for interval growth or even serving as the definitive palliation.
Fate of the Arterial Origin of Major Aortopulmonary Collateral Arteries After Unifocalization
Authors: van de Woestijne P.C. , Cuypers J.A.A.E. , Helbing W.A. , Bogers A.J.J.C.
Published: March 2021

Background:

During unifocalization procedures for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries, collateral arteries are either ligated or detached. Not much is known of the fate of the remaining arterial origins in the long term. Available computed tomography (CT) or magnetic resonance (MR) imaging of the intrathoracic arteries was examined to investigate possible abnormalities at the former position of the collateral arteries as well as ascending aortic diameters.

Methods:

From 1989 to 2018, we performed 66 unifocalization procedures in 39 patients. One hundred and twenty-nine collateral arteries were ligated or detached. In 52% (15) of the surviving patients (with a total of 55 ligated or detached collaterals), sufficient imaging of the thoracic aorta from CT (11) and/or MR (9) was available for evaluation.

Results:

The median interval between unifocalization procedure and imaging was 15 years (interquartile range [IQR]: 9-19 years). In 93% (14) of the scanned patients, 18 blunt ends were detected at the location of a former collateral artery. No aneurysm formation of the descending aorta was observed. The median diameter of the ascending aorta was 35 mm (IQR: 31-40 mm). During follow-up, no aortic dissection or rupture occurred.

Conclusions:

Aortic imaging late after unifocalization showed abnormalities in 93% of the scanned patients. Abnormalities consisted mostly of blunt ends of the former collateral artery. We recommend to include routine imaging of the aorta during late follow-up to detect eventual future abnormalities and monitor aortic diameters. Ascending aortic diameters showed slight dilatation with no clinical implications so far.
The Lugones Procedure for Surgical Repair of Scimitar Syndrome: Preserved Growth in a Young Infant
Authors: Fouilloux Virginie , Werner Oscar , Lenoir Marien
Published: March 2021

Surgical repair of Scimitar syndrome is challenging, especially in small patients. Our images demonstrate that the pericardial tunnel technique is feasible even in low-weight patient and that it provides a good growth potential.
Updating an Empirically Based Tool for Analyzing Congenital Heart Surgery Mortality
Authors: Jacobs Marshall L. , Jacobs Jeffrey P. , Thibault Dylan , Hill Kevin D. , Anderson Brett R. , Eghtesady Pirooz , Karamlou Tara , Kumar S. Ram , Mayer John E. , Mery Carlos M. , Nathan Meena , Overman David M. , Pasquali Sara K. , St. Louis James D. , Shahian David , O’Brien Sean M.
Published: March 2021

Objectives:

STAT Mortality Categories (developed 2009) stratify congenital heart surgery procedures into groups of increasing mortality risk to characterize case mix of congenital heart surgery providers. This update of the STAT Mortality Score and Categories is empirically based for all procedures and reflects contemporary outcomes.

Methods:

Cardiovascular surgical operations in the Society of Thoracic Surgeons Congenital Heart Surgery Database (January 1, 2010 – June 30, 2017) were analyzed. In this STAT 2020 Update of the STAT Mortality Score and Categories, the risk associated with a specific combination of procedures was estimated under the assumption that risk is determined by the highest risk individual component procedure. Operations composed of multiple component procedures were eligible for unique STAT Scores when the statistically estimated mortality risk differed from that of the highest risk component procedure. Bayesian modeling accounted for small denominators. Risk estimates were rescaled to STAT 2020 Scores between 0.1 and 5.0. STAT 2020 Category assignment was designed to minimize within-category variation and maximize between-category variation.

Results:

Among 161,351 operations at 110 centers (19,090 distinct procedure combinations), 235 types of single or multiple component operations received unique STAT 2020 Scores. Assignment to Categories resulted in the following distribution: STAT 2020 Category 1 includes 59 procedure codes with model-based estimated mortality 0.2% to 1.3%; Category 2 includes 73 procedure codes with mortality estimates 1.4% to 2.9%; Category 3 includes 46 procedure codes with mortality estimates 3.0% to 6.8%; Category 4 includes 37 procedure codes with mortality estimates 6.9% to 13.0%; and Category 5 includes 17 procedure codes with mortality estimates 13.5% to 38.7%. The number of procedure codes with empirically derived Scores has grown by 58% (235 in STAT 2020 vs 148 in STAT 2009). Of the 148 procedure codes with empirically derived Scores in 2009, approximately one-half have changed STAT Category relative to 2009 metrics. The New STAT 2020 Scores and Categories demonstrated good discrimination for predicting mortality in an independent validation sample (July 1, 2017-June 30, 2019; sample size 46,933 operations at 108 centers) with C-statistic = 0.791 for STAT 2020 Score and 0.779 for STAT 2020 Category.

Conclusions:

The updated STAT metrics reflect contemporary practice and outcomes. New empirically based STAT 2020 Scores and Category designations are assigned to a larger set of procedure codes, while accounting for risk associated with multiple component operations. Updating STAT metrics based on contemporary outcomes facilitates accurate assessment of case mix.
Gendered Body of Turkish Bikini Fitness Athletes on Instagram
Authors: Kavasoğlu İrem , Koca Canan
Published: March 2021

This study sought to understand how Turkish bikini fitness athletes discipline their bodies on Instagram by using Foucault’s theorization of self-surveillance. We examined Instagram photos of 10 bikini fitness athletes and completed interviews with them. We analysed data by conducting quantitative and qualitative content analysis. The findings show that both bikini fitness and Instagram are modern forms of self-surveillance for Turkish female athletes. Bikini fitness dictates (hetero)normative femininity norms such as femininity, sexuality and heterosexual desirability with a feminine glance, silicone breast implants, make-up, long hair, jewelry, and so on. However, Turkish female athletes build a docile body image by confirming that they do not share sexually suggestive poses on Instagram, because of religious and patriarchal norms in Turkey. However, bikini fitness and Instagram are also considered to be potential tools of resistance against religious norms and patriarchal power for these athletes.
Overparenting and Emerging Adults’ Insecure Attachment With Parents and Romantic Partners
Authors: Jiao Jian , Segrin Chris
Published: March 2021

Attachment theory articulates that social and personal interactions influence individuals’ attachment characteristics. Although research has revealed various negative consequences of overparenting among offspring, very few studies have looked at the attachment features of overparented emerging adults. Relying on cross-sectional data collected from 231 emerging adults ( M age = 24.22 years, 57.1% females) recruited from Amazon’s Mechanical Turk (MTurk), the present study examined the associations between overparenting and emerging adults’ insecure attachment (i.e., attachment anxiety and/or avoidance) in parent-offspring and romantic contexts, and if overparented emerging adults delay marriages. Results showed that overparenting was robustly associated with emerging adults’ insecure attachment with both parents and romantic partners, and overparented emerging adults were less likely to be married. Overall, the findings suggest that overparenting practices, although seemingly well-intentioned, might indeed create barriers for emerging adults to develop and maintain positive and healthy relationships.
Diversity, localization, and (patho)physiology of mature lymphocyte populations in the bone marrow
Authors: Schürch Christian M. , Caraccio Chiara , Nolte Martijn A.
Published: March 2021

The bone marrow (BM) is responsible for generating and maintaining lifelong output of blood and immune cells. In addition to its key hematopoietic function, the BM acts as an important lymphoid organ, hosting a large variety of mature lymphocyte populations, including B cells, T cells, natural killer T cells, and innate lymphoid cells. Many of these cell types are thought to visit the BM only transiently, but for others, like plasma cells and memory T cells, the BM provides supportive niches that promote their long-term survival. Interestingly, accumulating evidence points toward an important role for mature lymphocytes in the regulation of hematopoietic stem cells (HSCs) and hematopoiesis in health and disease. In this review, we describe the diversity, migration, localization, and function of mature lymphocyte populations in murine and human BM, focusing on their role in immunity and hematopoiesis. We also address how various BM lymphocyte subsets contribute to the development of aplastic anemia and immune thrombocytopenia, illustrating the complexity of these BM disorders and the underlying similarities and differences in their disease pathophysiology. Finally, we summarize the interactions between mature lymphocytes and BM resident cells in HSC transplantation and graft-versus-host disease. A better understanding of the mechanisms by which mature lymphocyte populations regulate BM function will likely improve future therapies for patients with benign and malignant hematologic disorders.
Deregulated expression of circular RNAs in acute myeloid leukemia
Authors: Lux Susanne , Blätte Tamara J. , Gillissen Bernhard , Richter Antje , Cocciardi Sibylle , Skambraks Sabrina , Schwarz Klaus , Schrezenmeier Hubert , Döhner Hartmut , Döhner Konstanze , Dolnik Anna , Bullinger Lars
Published: March 2021

Circular RNAs (circRNAs) are dynamically regulated during differentiation and show cell type–specific expression, which is altered in cancer and can have a direct impact on its various hallmarks. We hypothesized that circRNA expression is deregulated in acute myeloid leukemia (AML) and that circRNA candidates might contribute to the pathogenesis of the disease. To identify leukemia-associated and differentiation-independent changes in circRNA expression, we determined the circular RNAome of 61 AML patients and 16 healthy hematopoietic stem and progenitor cell (HSPC) samples using ribosomal RNA–depleted RNA sequencing. We found hundreds of circRNAs that were differentially expressed between AML and healthy HSPCs. Gene set analysis found that many of these circRNAs were transcribed from genes implicated in leukemia biology. We discovered a circRNA derived from the T-cell transcription factor gene B cell CLL/lymphoma 11B, circBCL11B, which was exclusively expressed in AML patients, but not detected in healthy HSPCs, and associated with a T-cell–like gene expression signature. We were able to validate this finding in an independent cohort of 332 AML patients. Knockdown of circBCL11B had a negative effect on leukemic cell proliferation and resulted in increased cell death of leukemic cells, thereby suggesting circBCL11B as a novel functionally relevant candidate in AML pathogenesis. In summary, our study enables comprehensive insights into circRNA expression changes upon leukemic transformation and provides valuable information on the biology of leukemic cells and potential novel pathway dependencies that are relevant for AML therapy.
Gene expression signature predicts relapse in adult patients with cytogenetically normal acute myeloid leukemia
Authors: Walker Christopher J. , Mrózek Krzysztof , Ozer Hatice Gulcin , Nicolet Deedra , Kohlschmidt Jessica , Papaioannou Dimitrios , Genutis Luke K. , Bill Marius , Powell Bayard L. , Uy Geoffrey L. , Kolitz Jonathan E. , Carroll Andrew J. , Stone Richard M. , Garzon Ramiro , Byrd John C. , Eisfeld Ann-Kathrin , de la Chapelle Albert , Bloomfield Clara D.
Published: March 2021

Although ∼80% of adult patients with cytogenetically normal acute myeloid leukemia (CN-AML) achieve a complete remission (CR), more than half of them relapse. Better identification of patients who are likely to relapse can help to inform clinical decisions. We performed RNA sequencing on pretreatment samples from 268 adults with de novo CN-AML who were younger than 60 years of age and achieved a CR after induction treatment with standard “7+3” chemotherapy. After filtering for genes whose expressions were associated with gene mutations known to impact outcome (ie, CEBPA, NPM1, and FLT3-internal tandem duplication [FLT3-ITD]), we identified a 10-gene signature that was strongly predictive of patient relapse (area under the receiver operating characteristics curve [AUC], 0.81). The signature consisted of 7 coding genes (GAS6, PSD3, PLCB4, DEXI, JMY, NRP1, C10orf55) and 3 long noncoding RNAs. In multivariable analysis, the 10-gene signature was strongly associated with relapse (P < .001), after adjustment for the FLT3-ITD, CEBPA, and NPM1 mutational status. Validation of the expression signature in an independent patient set from The Cancer Genome Atlas showed the signature’s strong predictive value, with AUC = 0.78. Implementation of the 10-gene signature into clinical prognostic stratification could be useful for identifying patients who are likely to relapse.
Heterogeneous NLRP3 inflammasome signature in circulating myeloid cells as a biomarker of COVID-19 severity
Authors: Courjon Johan , Dufies Océane , Robert Alexandre , Bailly Laurent , Torre Cédric , Chirio David , Contenti Julie , Vitale Sébastien , Loubatier Céline , Doye Anne , Pomares-Estran Christelle , Gonfrier Géraldine , Lotte Romain , Munro Patrick , Visvikis Orane , Dellamonica Jean , Giordanengo Valérie , Carles Michel , Yvan-Charvet Laurent , Ivanov Stoyan , Auberger Patrick , Jacquel Arnaud , Boyer Laurent
Published: March 2021

Dysregulated immune response is the key factor leading to unfavorable coronavirus disease 2019 (COVID-19) outcome. Depending on the pathogen-associated molecular pattern, the NLRP3 inflammasome can play a crucial role during innate immunity activation. To date, studies describing the NLRP3 response during severe acute respiratory syndrome coronavirus 2 infection in patients are lacking. We prospectively monitored caspase-1 activation levels in peripheral myeloid cells from healthy donors and patients with mild to critical COVID-19. The caspase-1 activation potential in response to NLRP3 inflammasome stimulation was opposed between nonclassical monocytes and CD66b+CD16dim granulocytes in severe and critical COVID-19 patients. Unexpectedly, the CD66b+CD16dim granulocytes had decreased nigericin-triggered caspase-1 activation potential associated with an increased percentage of NLRP3 inflammasome impaired immature neutrophils and a loss of eosinophils in the blood. In patients who recovered from COVID-19, nigericin-triggered caspase-1 activation potential in CD66b+CD16dim cells was restored and the proportion of immature neutrophils was similar to control. Here, we reveal that NLRP3 inflammasome activation potential differs among myeloid cells and could be used as a biomarker of a COVID-19 patient’s evolution. This assay could be a useful tool to predict patient outcome. This trial was registered at www.clinicaltrials.gov as #NCT04385017.
“You can leave your mask on”: effects on cardiopulmonary parameters of different airway protective masks at rest and during maximal exercise
Authors: Mapelli Massimo , Salvioni Elisabetta , De Martino Fabiana , Mattavelli Irene , Gugliandolo Paola , Vignati Carlo , Farina Stefania , Palermo Pietro , Campodonico Jeness , Maragna Riccardo , Lo Russo Gerardo , Bonomi Alice , Sciomer Susanna , Agostoni Piergiuseppe
Published: March 2021

During the COVID-19 pandemic, the use of protective masks has been essential to reduce contagions. However, public opinion is that there is an associated subjective shortness of breath. We evaluated cardiorespiratory parameters at rest and during maximal exertion to highlight any differences with the use of protective masks.

12 healthy subjects performed three identical cardiopulmonary exercise tests, one without wearing a protective mask, one wearing a surgical mask and one with a filtering face piece particles class 2 (FFP2) mask. Dyspnoea was assessed using the Borg scale. Standard pulmonary function tests were also performed.

All the subjects (40.8±12.4 years; six male) completed the protocol with no adverse events. Spirometry showed a progressive reduction of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) from no mask to surgical to FFP2 (FEV1: 3.94±0.91 L, 3.23±0.81 L, 2.94±0.98 L; FVC: 4.70±1.21 L, 3.77±1.02 L, 3.52±1.21 L; p<0.001). Rest ventilation, O2uptake (V˙O2) and CO2production (V˙CO2) were progressively lower, with a reduction in respiratory rate. At peak exercise, subjects had a progressively higher Borg scale when wearing surgical and FFP2 masks. Accordingly, at peak exercise,V˙O2(31.0±23.4 mL·kg−1·min−1, 27.5±6.9 mL·kg−1·min−1, 28.2±8.8 mL·kg−1·min−1; p=0.001), ventilation (92±26 L, 76±22 L, 72±21 L; p=0.003), respiratory rate (42±8 breaths·min−1, 38±5 breaths·min−1, 37±4 breaths·min−1; p=0.04) and tidal volume (2.28±0.72 L, 2.05±0.60 L, 1.96±0.65 L; p=0.001) were gradually lower. There was no significant difference in oxygen saturation.

Protective masks are associated with significant but modest worsening of spirometry and cardiorespiratory parameters at rest and peak exercise. The effect is driven by a ventilation reduction due to increased airflow resistance. However, because exercise ventilatory limitation is far from being reached, their use is safe even during maximal exercise, with a slight reduction in performance.
A cross-country comparison of user experience of public autonomous transport
Authors: Bellone Mauro , Ismailogullari Azat , Kantala Tommi , Mäkinen Sami , Soe Ralf-Martin , Kyyrö Milla Åman
Published: March 2021

Autonomous solutions for transportation are emerging worldwide, and one of the sectors that will benefit the most from these solutions is the public transport by shifting toward the new paradigm of Mobility as a Service (MaaS). Densely populated areas cannot afford an increase in individual transportation due to space limitation, congestion, and pollution.

Working towards more effective and inclusive mobility in public areas, this paper compares user experiences of autonomous public transport across Baltic countries, with the final goal of gaining an increased insight into public needs. User experience was evaluated through questionnaires gathered along pilot projects implementing a public transportation line, using an automated electric minibus between 2018 and 2019. To have sufficient diversity in the data, the pilot projects were implemented in several cities in the Baltic Sea Area. The data analysed in this paper specifically refer to the cities of Helsinki (Finland), Tallinn (Estonia), Kongsberg (Norway), and Gdańsk (Poland).

Across all cities, passengers provided remarkably positive feedback regarding personal security and safety onboard. The overall feedback, which was very positive in general, showed statistically significant differences across the groups of cities (Kongsberg, Helsinki, Tallinn and Gdansk), partially explicable by the differences in the route design. In addition, across all cities and feedback topics, males gave a lower score compared to females. The overall rating suggests that there is a demand for future last-mile automated services that could be integrated with the MaaS concept, although demand changes according to socio-economic and location-based conditions across different countries.
CT based automatic clinical target volume delineation using a dense-fully connected convolution network for cervical Cancer radiation therapy
Authors: Ju Zhongjian , Guo Wen , Gu Shanshan , Zhou Jin , Yang Wei , Cong Xiaohu , Dai Xiangkun , Quan Hong , Liu Jie , Qu Baolin , Liu Guocai
Published: March 2021

Background

It is very important to accurately delineate the CTV on the patient’s three-dimensional CT image in the radiotherapy process. Limited to the scarcity of clinical samples and the difficulty of automatic delineation, the research of automatic delineation of cervical cancer CTV based on CT images for new patients is slow. This study aimed to assess the value of Dense-Fully Connected Convolution Network (Dense V-Net) in predicting Clinical Target Volume (CTV) pre-delineation in cervical cancer patients for radiotherapy.

Methods

In this study, we used Dense V-Net, a dense and fully connected convolutional network with suitable feature learning in small samples to automatically pre-delineate the CTV of cervical cancer patients based on computed tomography (CT) images and then we assessed the outcome. The CT data of 133 patients with stage IB and IIA postoperative cervical cancer with a comparable delineation scope was enrolled in this study. One hundred and thirteen patients were randomly designated as the training set to adjust the model parameters. Twenty cases were used as the test set to assess the network performance. The 8 most representative parameters were also used to assess the pre-sketching accuracy from 3 aspects: sketching similarity, sketching offset, and sketching volume difference.

Results

The results presented that the DSC, DC/mm, HD/cm, MAD/mm, ∆V, SI, IncI and JD of CTV were 0.82 ± 0.03, 4.28 ± 2.35, 1.86 ± 0.48, 2.52 ± 0.40, 0.09 ± 0.05, 0.84 ± 0.04, 0.80 ± 0.05, and 0.30 ± 0.04, respectively, and the results were greater than those with a single network.

Conclusions

Dense V-Net can correctly predict CTV pre-delineation of cervical cancer patients and can be applied in clinical practice after completing simple modifications.
Life satisfaction in families with a child in an Unresponsive Wakefulness Syndrome
Authors: Chadasch Christiane , Kotchoubey Boris
Published: March 2021

Background

The article examines life conditions in families living together with a child in an Unresponsive Wakefulness Syndrome (UWS). Such families experience severe stress at financial, logistical, and existential level.

Methods

We investigated a large sample of families living with a UWS child (comprising 13% of the total population) and compared these families with families without a chronically ill child. A set of four questionnaires aimed to evaluate life conditions entails a total of 204 items. One of the questionnaires was developed by the corresponding author specifically for this study. The questionnaires were positively accepted by the persons concerned and permitted us to test six specific hypotheses.

Results

Life satisfaction (LS) in families with a UWS child was significantly lower than in control families. LS was significantly affected by external situational factors (everyday support, home visits, support by a doctor, nursing service, health insurance, etc.). Self-management skills were on average lower in families with a UWS child than in controls. These skills strongly and directly correlated with LS. Further, LS was not significantly related to the acceptance of feelings and negatively correlated with the floods of emotions. The relationship with the own child was equally satisfactory in families with and without a UWS child indicating that the families regard their UWS child as a full family member.

Conclusions

The data show that happy life is possible in families living together with a UWS child. They further specify conditions for satisfactory life under multiple highly severe challenges. Personal self-management skills, coping strategies, and resilience, as well as outside social support, appear to be critical factors.
Is set-shifting and central coherence in anorexia nervosa influenced by body mass index, anxiety or depression? A systematic review
Authors: Fuglset Tone Seim
Published: March 2021

Background

Anorexia nervosa (AN) is a severe eating disorder, recognized by a relentless pursuit for thinness and extreme low body weight. The disorder is often accompanied by comorbid disorders such as anxiety and depression, and altered neuropsychological function in terms of poor set-shifting and reduced central coherence. The aim of this review was to evaluate whether neuropsychological impairments in AN are influenced by body mass index, anxiety or depression.

Method

A systematic review approach was used, following the PRISMA guidelines for systematic reviews. Literature was identified via searches in PubMed, PsychInfo and Embase database, by using the search words [anorexia nervosa] AND [central coherence], and [anorexia nervosa] AND [set-shifting]. Studies were included if they were written in English, peer-reviewed, included individuals with AN, included tests measuring set-shifting and/or central coherence, investigated associations between set-shifting/central coherence with anxiety and/or depression and/or BMI. Risk of bias was assessed by using a critical appraisal checklist from the Joanna Briggs Institute. Results were summarized in a narrative synthesis.

Results

Although results are heterogeneous, the majority of studies report that neither body mass index (BMI), anxiety or depression is associated with altered central coherence and set-shifting in individuals with AN.

Conclusions

Findings indicate that BMI, depression and anxiety does not influence neuropsychological function in AN, suggesting that it could be a characteristic of the disorder. A complete understanding of predisposing, precipitating and maintaining factors in AN needs to be addressed in future research. This could contribute to the development of better and more targeted treatment strategies.
Effectiveness and cost effectiveness of a stress management training for leaders of small and medium sized enterprises – study protocol for a randomized controlled-trial
Authors: Lehmann J. A. M. , Schwarz E. , Rahmani Azad Z. , Gritzka S. , Seifried-Dübon T. , Diebig M. , Gast M. , Kilian R. , Nater U. , Jarczok M. , Kessemeier F. , Braun S. , Balint E. , Rothermund E. , Junne F. , Angerer P. , Gündel H.
Published: March 2021

Background

Leaders in small and medium-sized enterprises (SMEs) are exposed to increased stress as a result of a range of challenges. Moreover, they rarely have the opportunity to participate in stress management trainings. Therefore, KMU-GO (ger: Kleine und mittlere Unternehmen – Gesundheitsoffensive; en: small and medium-sized enterprises – health campaign) aims at conducting and evaluating such a stress management training. The focus of evaluation does not only lie on the effects on leaders participating but also on their employees.

Methods

The study is planned as a 2 × 3 mixed design with two groups (intervention and waiting control group) as a between factor and point in time (at baseline, 6 and 12 months later) as a within factor. We aim at collecting data from N = 200 leaders. Based on the results of a preceding assessment, an already successfully implemented stress management training was adapted to SME needs and now serves as the framework of this intervention. The stress management training comprises one and a half days and is followed by two booster sessions (each 180 min) about 3 and 6 months after the training. The main focus of this intervention lies on specifying leaders stress reactivity while at the same time investigating its effects on employees’ mental health. Further dependent variables are leaders´ depression and anxiety scores, effort-reward imbalance, sick days and psychophysiological measures of heart rate variability, hair cortisol, and salivary alpha-amylase. Cost-effectiveness analyses will be conducted from a societal and employers’ point of view.

Discussion

Stress management is a highly relevant issue for leaders in SMEs. By providing an adequate occupational stress management training, we expect to improve leaders´ and also employees` mental health, thereby preventing economic losses for SMEs and the national economy. However, collecting data from employees about the success of a stress management training of their leader is a highly sensitive topic. It requires a carefully planned proceeding ensuring for example a high degree of transparency, anonymity, and providing team incentives.

Trial registration

The KMU-GO trial is registered at the German Clinical Trial Register (DRKS): DRKS00023457 (05.11.2020)
Estimated number of seriously injured road users admitted to hospital in France between 2010 and 2017, based on medico-administrative data
Authors: Zullo Anthony , Large Maxime , Amoros Emmanuelle , Martin Jean-Louis
Published: March 2021

Background

In France, like in most developed countries, the number of road accident fatalities is estimated from police data. These estimates are considered to be good-quality, unlike estimates of road injuries admitted to hospital, and especially serious injuries.

Methods

The present study aimed to supply such data from French hospital medical information data-bases (PMSI). In the PMSI data-bases, road accident victims are identified by external causes of morbidity and mortality, which should be systematically recorded in case of injury, but are often missing. We therefore modeled presence/absence of external cause from the relevant subset of the medicine-surgery-obstetrics PMSI data-base using a logistic regression, and then weighting the results by inverse estimated probability. As ICD-10 coding does not include injury severity, we used the AAAM10 conversion instrument developed by the American Association for Automotive Medicine, originators of the Abbreviated Injury Scale, so as to conform to the European Commission’s definition of serious injury.

Results

The number of road-accident related hospital admissions is estimated to be about 100000 per year; serious injuries increased from about 18000 in 2010 to almost 20000 in 2017, with almost 17000 in 2012 and 2013, with a mean of one fatality per 5 serious injury admissions.

Conclusions

These serious injury estimates are close to those obtained by our team from other data and with a different estimation method. The present method has the advantage of using ICD codes for injured people admitted to hospital. This classification and data source (hospital discharge registry) are also used by most european countries reporting serious injury estimates to the Commission. It allows cost estimation of hospital care, and could be applied to other types of accidental injury.
Application of the protection motivation theory for predicting COVID-19 preventive behaviors in Hormozgan, Iran: a cross-sectional study
Authors: Ezati Rad Roghayeh , Mohseni Shokrollah , Kamalzadeh Takhti Hesamaddin , Hassani Azad Mehdi , Shahabi Nahid , Aghamolaei Teamur , Norozian Fatemeh
Published: March 2021

Background

The high prevalence and mortality of coronavirus disease 2019 (COVID-19) have made it the most important health and social challenge around the world. However, this disease can be largely prevented by adherence to hygienic principles and protective behaviors. It seems that identifying the processes involved in protective health behaviors can be effective in planning and implementing suitable interventions to encourage the community toward protective behaviors. Therefore, the present study aimed to predict the preventive behaviors of COVID-19 according to the Protection Motivation Theory (PMT).

Methods

This cross-sectional study was conducted over 2 months in Hormozgan Province, Iran. The study population consisted of all citizens above the age of 15 years. An online questionnaire was used to collect the data. The questionnaire link was available to the participants through social networks. The questionnaire consisted of two sections, including the demographic information and the PMT constructs. All statistical calculations and hypothesis testing were performed in SPSS Version 21 and AMOS Version 21. The significance level was considered to be 0.05 for hypothesis testing.

Results

A total of 2032 subjects, with the mean age of 34.84 ± 9.8 years (r = 15–98), participated in this study. Most of the participants were 31–40 years old, female (60.4%), married (72%), urban residents (87.3%), and employed (58.8%). The majority of them also had a bachelor’s degree or higher (58.8%). Significant positive correlations were observed between the preventive behaviors of COVID-19 and the perceived vulnerability (r = 0.192,P < 0.001), perceived severity (r = 0.092,P < 0.001), response efficacy (r = 0.398,P < 0.001), self-efficacy (r = 0.497,P < 0.001), and protection motivation (r = 0.595,P < 0.001). On the other hand, significant negative correlations were found between the preventive behaviors of COVID-19 and maladaptive behavior rewards (r = − 0.243,P < 0.001) and perceived costs (r = − 0.121,P < 0.001).

Conclusion

The present findings showed that maladaptive behavior reward and fear negatively predicted the protective behaviors. On the other hand, response efficacy and self-efficacy positively predicted the protective behaviors; the impact of self-efficacy was the strongest. Overall, the information provided in this study can contribute to health policymaking in Iran.
Violence and discrimination among Ugandan residents during the COVID-19 lockdown
Authors: Katana Elizabeth , Amodan Bob Omoda , Bulage Lilian , Ario Alex R. , Fodjo Joseph Nelson Siewe , Colebunders Robert , Wanyenze Rhoda K.
Published: March 2021

Background

In March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. Many countries in Sub-Saharan Africa, Uganda inclusive, implemented lockdowns, curfew, banning of both private and public transport systems, and mass gatherings to minimize spread. Social control measures for COVID-19 are reported to increase violence and discrimination globally, including in Uganda as some may be difficult to implement resulting in the heavy deployment of law enforcement. Media reports indicated that cases of violence and discrimination had increased in Uganda’s communities following the lockdown. We estimated the incidence and factors associated with experiencing violence and discrimination among Ugandans during the COVID-19 lockdown to inform control and prevention measures.

Methods

In April 2020, we conducted a secondary analysis of cross-sectional data under the International Citizen Project (ICP) to assess adherence to public health measures and their impact on the COVID-19 outbreak in Uganda. We analyzed data on violence and discrimination from the ICP study. We performed descriptive statistics for all the participants’ characteristics and created a binary outcome variable called experiencing violence and/or discrimination. We performed logistic regression analysis to identify the factors associated with experiencing violence and discrimination.

Results

Of the 1726 ICP study participants, 1051 (58.8%) were males, 841 (48.7%) were currently living with a spouse or partner, and 376 (21.8%) had physically attended work for more than 3 days in the past week. Overall, 145 (8.4%) experienced any form of violence and/or discrimination by any perpetrator, and 46 (31.7%) of the 145 reported that it was perpetrated by a law enforcement officer. Factors associated with experiencing violence or discrimination were: being male (AOR = 1.60 CI:1.10–2.33), having attended work physically for more than 3 days in the past week (AOR = 1.52 CI:1.03–2.23), and inability to access social or essential health services since the epidemic started (AOR = 3.10 CI:2.14–4.50).

Conclusion

A substantial proportion of Ugandan residents experienced violence and/or discrimination during the COVID-19 lockdown, mostly perpetrated by law enforcement officers. We recommend mitigation of the collateral impact of lockdowns with interventions that focus on improving policing quality, ensuring continuity of essential services, and strengthening support systems for vulnerable groups including males.