bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical value of IL-13 and ECP in the serum and sputum of eosinophilic AECOPD patients
Authors: Li Ting , Gao Li , Ma Hong-Xia , Wei Yang-Yang , Liu Yue-Hua , Qin Ke-Ru , Wang Wen-Tao , Wang Hai-Long , Pang Min
Published: June 2020

Chronic obstructive pulmonary disease (COPD) is a heterogeneous inflammatory disease and eosinophils (EOS) participate in inflammation process. Acute exacerbation of COPD (AECOPD) is an inevitable trend in the development of the disease and has attracted widespread attention. In the present study, 108 hospitalized patients with AECOPD were collected and the levels of interleukin-13 and eosinophil cationic protein in the serum and sputum were measured to explore their clinical value in eosinophilic AECOPD patients. The patients were divided into an eosinophilic group (52 cases, 48.15%) and a noneosinophilic group (56 cases, 51.85%). The eosinophilic group had fewer acute exacerbations in the past year, shorter average hospitalization days, lower respiratory failure rate, mechanical ventilation utilization rate, and lower CAT and mMRC scores ( P <  0.05). The levels of interleukin-13 and eosinophil cationic protein in sputum in the eosinophilic group were higher than those in the noneosinophilic group ( P <  0.05), and there was no significant difference in the serum between the two groups ( P >  0.05). The receiver operating characteristic (ROC) curves of sputum interleukin-13 and eosinophil cationic protein predicting peripheral blood EOS% ≥2% of AECOPD patients were statistically significant ( P <  0.05). The noneosinophilic group had a higher rate of rehospitalization due to acute exacerbation during the one-year follow-up, and there was no significant difference in mortality between the two groups. The results show that eosinophils in peripheral blood are a simple, convenient, and inexpensive index for assessing the condition and prognosis of AECOPD patients. Interleukin-13 and eosinophil cationic protein are involved in the pathogenesis of eosinophilic AECOPD and may be the new targeted anti-inflammatory therapies in the future.

Impact statement

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is an inevitable trend in the development of the disease and eosinophils (EOS) participate in inflammation process. It is important to explore some relatively simple biomarkers in AECOPD which are useful to recognize the disease. In the present study, 108 hospitalized patients with AECOPD were collected and the levels of IL-13 and ECP in the serum and sputum were measured. The levels of IL-13 and ECP in sputum in the eosinophilic group were higher than those in the noneosinophilic group. Moreover, the noneosinophilic group had a higher rate of rehospitalization due to acute exacerbation during the one-year follow-up. The results show that eosinophils in peripheral blood are a simple, convenient, and inexpensive index for assessing the condition and prognosis of AECOPD patients. IL-13 and ECP are involved in the pathogenesis of eosinophilic AECOPD and may be the new targeted anti-inflammatory therapies.
Embedding Critical Reflection in Training for Spiritual Care Supervision and Practice: The Experience of a Specific Student Group
Authors: Gardner Fiona
Published: June 2020

This article explores student experiences of a subject called Supervision in Spiritual Care Using Critical Reflection in postgraduate study in Australia for spiritual carers and ministers of religion. Their online dialogue identified how students used critical reflection in practice, and what they saw as the benefits and challenges in their learning. This affirms the value of a critically reflective approach to spiritual care and how this can be used in supervision and in practice.
The Warrior’s Journey Intervention: A Chaplain-Led Motivational, Preparatory Exercise for Enhancing Treatment Success
Authors: Fleming Wesley H
Published: June 2020

Outcome literature has shown poor treatment engagement in efficacious, evidence-based post-traumatic stress disorder (PTSD) programs among returning veterans with combat-related psychological symptoms and calls for the development of motivational, preparatory exercises that circumvent stigma-related barriers and are delivered before or during the orientation phase of treatment. The psychological states of hope, meaning, and guilt have been found to impact motivation for treatment and the development and maintenance of post-trauma pathology and symptom severity. Given a chaplain’s less stigmatized role, as compared to mental health providers, and proficiency in assessing these states and providing interventions that mediate change, often before a veteran is enrolled in a PTSD treatment program, this paper introduces a brief, chaplain-led, preparatory exercise called the “Warrior’s Journey Intervention” (WJI). This narrative based, meaning-making exercise is designed to improve motivation for treatment and mitigate post-trauma symptoms by impacting hope, meaning, and guilt through use of a universally shared, metaphoric story of trauma recovery. A case study will demonstrate use of the intervention, observe its effects, and analyze mechanisms of change. Research is recommended at the end of the article to test the hypothesis that the intervention promotes motivation for treatment and reduces symptoms of PTSD and Moral Injury (MI). A standardized manual for the exercise is available from author.
A three-dimensional mapping and virtual reality-based human–robot interaction for collaborative space exploration
Authors: Xiao Junhao , Wang Pan , Lu Huimin , Zhang Hui
Published: June 2020

Human–robot interaction is a vital part of human–robot collaborative space exploration, which bridges the high-level decision and path planning intelligence of human and the accurate sensing and modelling ability of the robot. However, most conventional human–robot interaction approaches rely on video streams for the operator to understand the robot’s surrounding, which lacks situational awareness and force the operator to be stressed and fatigued. This research aims to improve efficiency and promote the natural level of interaction for human–robot collaboration. We present a human–robot interaction method based on real-time mapping and online virtual reality visualization, which is implemented and verified for rescue robotics. At the robot side, a dense point cloud map is built in real-time by LiDAR-IMU tightly fusion; the resulting map is further transformed into three-dimensional normal distributions transform representation. Wireless communication is employed to transmit the three-dimensional normal distributions transform map to the remote control station in an incremental manner. At the remote control station, the received map is rendered in virtual reality using parameterized ellipsoid cells. The operator controls the robot with three modes. In complex areas, the operator can use interactive devices to give low-level motion commands. In the less unstructured region, the operator can specify a path or even a target point. Afterwards, the robot follows the path or navigates to the target point autonomously. In other words, these two modes rely more on the robot’s autonomy. By virtue of virtual reality visualization, the operator can have a more comprehensive understanding of the space to be explored. In this case, the high-level decision and path planning intelligence of human and the accurate sensing and modelling ability of the robot can be well integrated as a whole. Although the method is proposed for rescue robots, it can also be used in other out-of-sight teleoperation-based human–robot collaboration systems, including but not limited to manufacturing, space, undersea, surgery, agriculture and military operations.
Comparison in thermal stability and catalytic performance of H4PMo11VO40 heteropolyacid supported on mesoporous and macroporous silica materials
Authors: Zhang Heng , Yang Chunhao , Zhao Shengying , Wang Tingting , Zhu Wancheng
Published: June 2020

Ordered mesoporous silica, SBA-15 and MCM-41, and three-dimensionally ordered macroporous SiO2 were used as the supports of H4PMo11VO40 heteropolyacid for methacrolein oxidation. The dispersion and structural evolutions of the heteropolyacid along with thermal treatment were investigated. It was found that the heteropolyacid entered the one-dimensional mesoporous channels of SBA-15 and MCM-41, and the crystallization and growth were limited, leading to high dispersion of the heteropolyacid. However, the thermal stability was decreased under high dispersion. The migration of the heteropolyacid was observed to the end of the one-dimensional channels of SBA-15 and the outer surface of MCM-41 with calcination, accompanied by the decomposition of the heteropolyacid and the formation of MoO3. In comparison, the crystallization and growth of heteropolyacid were not limited in the open macropores of three-dimensionally ordered macroporous SiO2. Dispersed particles on the surface of the macropores with size of about 5 nm exhibited a higher thermal stability. The decomposition of the heteropolyacid in the SBA-15 and MCM-41 supported catalysts resulted in the loss of strong acid sites, causing low selectivity to methacrylic acid in methacrolein oxidation. High thermal stability with high exposure of the active sites in the three-dimensionally ordered macroporous SiO2 supported catalyst contributed to the enhancement in the catalytic performance.
May Holt’s Waiting Consent
Authors: Fotheringham Richard
Published: June 2020

In 1880 the English actor and manager May Holt, following her real-life marriage to a ‘gentleman’ and temporary withdrawal from London and provincial stages, wrote six plays which were staged many times by several managements. The introduction gives some details of her career and examines in detail her most successful work, a short ‘curtain raiser’ comedy, Waiting Consent, which starred several major actors over the next decade, including Violet and Irene Vanbrugh. An unusual early ‘bedroom farce’, it challenged assumptions about women and marriage in the same decade that saw the passing of the Married Women’s Property Act and the first staging of Ibsen’s A Doll's House. The edited script of Waiting Consent follows.
Ecology and Criminology? Applying the tenets of procedural justice to environmental regulations
Authors: Maxwell Sheila R , Maxwell Christopher D
Published: June 2020

Criminologists are increasingly investigating the harmful intersections between humans and the natural environment, largely under the green criminology banner. However, most discourses have largely remained at the macro level and empirical tests are limited. The foci of research had been industry, state/national actors or policy discourses and not individuals responding to mandated environmental regulations. Individual actors are especially important in developing countries where environmental regulations can substantially impact citizens’ livelihood opportunities. This research uses the procedural justice framework to understand citizens’ responses to an environmental regulatory body. A team of local researchers conducted face-to-face interviews with citizens affected by environmental regulations in the Banahaw protected landscape in the north-central Philippines to assess their trust and cooperation with the regulatory body. Results demonstrated high reliability for the key procedural constructs of respect, impartiality, voice, and trustworthiness. Path analysis showed that impartiality and voice were significantly related to perceived trustworthiness of the regulatory body and impartiality is directly related to cooperation. The results provide evidence that criminological perspectives are useful in organizing the complex dynamics of laws, enforcement and behavior change that is inherent in environmental regulations.
Comparative analysis of crystallization behavior induced by different mineral fillers in polypropylene nanocomposites
Authors: Castillo Luciana A. , Barbosa Silvia E.
Published: June 2020

A comparative analysis of crystallization behavior induced by several mineral fillers in polypropylene nanocomposites was performed. Morphological changes and thermal properties of nanocomposites were evaluated, considering the influence of shape, crystalline morphology, and concentration of mineral particles. For this study, hydrated magnesium silicates with different particle morphologies, such as platelets (talc) and fibers (sepiolite), were used for nanocomposites. In addition, to analyze the effect of mineral crystallinity on nanocomposites, talc and sepiolite from different origin and genesis were selected. Nanocomposites were compounded and injection molded, using different filler concentration (0, 1, and 3% w/w) for each mineral particle. To evaluate the particle influence on nanocomposite crystallinity, X-ray diffraction was used to determine crystalline phases and crystal orientation, meanwhile differential scanning calorimetry was performed to obtain thermal properties. Main results revealed that talc has a higher nucleating effect on polypropylene matrix than sepiolite fibers, regardless of their origin and genesis. Meanwhile, a transcrystalline layer that surrounds the fiber surface is observed for nanocomposite containing sepiolite. Moreover, Argentinean talc induces different crystalline phases in nanocomposite with respect to Australian one, which partly influences on mechanical properties.
The Appropriateness of Adapting the Australian Environmental Assessment Tool–High Care (EAT-HC) for Persons With Dementia in Singapore
Authors: Sun Joanna
Published: June 2020

Objectives:

This study investigated the level of acceptance in Singapore of the eight principles of design underpinning the Environmental Assessment Tool–High Care (EAT-HC), which is commonly used in Australia to evaluate environments for the care of people living with dementia. A secondary goal was to identify topics particularly relevant to the Singaporean context, which are not included in the Australian EAT-HC.

Background:

This study was undertaken in preparation for the development of a Singaporean version of the Australian EAT-HC.

Methods:

Discussions from 23 focus groups involving 150 family caregivers, aged care staff, administrators, and architects were recorded and thematically analyzed to identify the characteristics of the principles underpinning the EAT-HC that are unlikely to be relevant in a Singaporean version and to identify additional topics required to tailor it to reflect the Singaporean culture. The thematic analysis was supplemented with quantitative data obtained through the use of simple Likert-type scales measuring the appropriateness of each principle in the Singaporean context.

Results:

The principles of design that underpin the EAT-HC were highly accepted by participants and provided a framework for a systematic exploration of Singaporean residential care for people with dementia. Some topics of particular relevance to Singapore were identified. These can be subsumed by the principles without the need for the principles to be changed.

Conclusion:

The results support the use of the design principles underpinning the EAT-HC as the foundation of a tool for the evaluation of Singaporean dementia facilities.
Changes in C-reactive protein in response to anti-inflammatory therapy as a predictor of cardiovascular outcomes: A systematic review and meta-analysis
Authors: Berkley Annie , Ferro Albert
Published: June 2020

Background

Despite the availability of aggressive lipid-lowering strategies, many patients remain at risk of cardiovascular events. C-reactive protein is a marker of inflammation elevated in patients at high risk of cardiovascular events. C-reactive protein has demonstrated value as a predictor of cardiovascular risk; however, it is unclear whether targeting C-reactive protein levels improves outcomes. This systematic review aimed to characterise the relationship between C-reactive protein and cardiovascular outcomes and to assess whether the magnitude of C-reactive protein reduction correlates to the extent of cardiovascular risk reduction.

Methods

A systematic review was conducted to identify randomised controlled trials that measured C-reactive protein before and after administration of therapies for cardiovascular disease and measured incidence of cardiovascular events. A meta-analysis of placebo-controlled studies assessed the relationship between extent of C-reactive protein reduction and cardiovascular risk reduction. Placebo-controlled studies where low-density lipoprotein and triglyceride data were available were also included in a meta-regression to assess the influence of these established risk factors on the efficacy of treatment when compared to C-reactive protein.

Results

Fifteen studies met the criteria for inclusion in this review, of which six were active comparator studies and nine were placebo controlled. Six placebo-controlled studies had data available for meta-regression. Eight studies demonstrated a reduction in events that could be explained by changes in lipid levels, whereas the results of five studies suggested that the association between C-reactive protein reduction and event rates cannot be explained by changes in lipid levels alone. No correlation was found between magnitude of C-reactive protein reduction and cardiovascular risk reduction. A strong correlation was found between C-reactive protein and low-density lipoprotein reduction (adjusted r2 = 0.8).

Conclusions

Targeting C-reactive protein does not offer additional benefit over targeting low-density lipoprotein across the general population in terms of cardiovascular risk reduction. However, there is value in targeting C-reactive protein in patients at high residual inflammatory risk despite non-elevated lipid levels or use of lipid-lowering therapy.
Treatment of pseudobulbar affect in a mixed neurodegenerative disorder with compounded quinidine capsules and dextromethorphan cough syrup
Authors: Villeneuve Yannick , Cruz-Santiago Diana , Masson Helene , Clerc Doris
Published: June 2020

An elderly woman admitted in our geriatric inpatient unit suffered from disturbing outbursts of crying and, less frequently, episodes of laughing. The patient was diagnosed with pseudobulbar affect related to a mixed neurodegenerative disorder. This condition is often underdiagnosed and undertreated, despite being relatively frequent in patients with neurodegenerative disorders. This case report describes the treatment of pseudobulbar affect in this patient. The only available treatment in Canada for this condition, antidepressants, was not effective for our patient. Dextromethorphan/quinidine is a good accepted alternative, but the combination is not marketed in Canada. To manage this problem, we used compounded quinidine capsules and dextromethorphan cough syrup. The crying of our patient improved significantly and rapidly after the initiation of this treatment. This case will help professionals to review their central role in treating this complex and disabling condition.
A case of extrapulmonary tuberculosis in a patient with end-stage renal disease with elevated parathyroid hormone–related protein
Authors: Podder Shreya , Fleckenstein Katarina , Gaudiano Zehra
Published: June 2020

The diagnosis of extrapulmonary tuberculosis in patients with end-stage renal disease can be challenging as the signs and symptoms are often non-specific. In this study, we present a case of extrapulmonary tuberculosis in an Ethiopian woman with end-stage renal disease who had subcarinal and right hilar lymphadenopathy, moderate sized right pleural effusion, hypercalcemia, and elevated parathyroid hormone–related protein in the setting of an elevated 1,25-dihydroxyvitamin D. After being started on appropriate tuberculosis treatment, patient’s parathyroid hormone–related protein level decreased and calcium level normalized. Our literature review showed that the elevation of parathyroid hormone–related protein in extrapulmonary tuberculosis has not been well studied, and it is our aim to explore the role of parathyroid hormone–related protein in extrapulmonary tuberculosis.
Dual alternate access sites for the treatment of an ostial left common iliac artery chronic total occlusion
Authors: Satish Mohan , Sethi Sanjum S , Parikh Sahil , Green Philip , Ratcliffe Justin
Published: June 2020

Growing endovascular strategies with TASC D lesions in aortoiliac disease reflect increasing technical success with evidenced safety and efficacy. In cases of failed transfemoral access, revascularization of iliac chronic total occlusions has prompted the utilization of other alternate access sites (e.g. transradial and transbrachial approaches) as important options in aortoiliac TASC D lesions. We describe a case of successful revascularization of an occluded ostial left common iliac artery in an 81-year-old man using a dual ulnar and tibioperoneal approach (absent radial artery). A Controlled Antegrade and Retrograde Tracking technique was performed where a balloon was advanced from the peroneal artery into the distal cap of the chronic total occlusion in the proximal common femoral artery. Balloon inflation was performed and a glidewire from transulnar access was advanced and re-entered into the true lumen in the common femoral artery. The wire was then snared and externalized out the transpedal access site creating a continuous true lumen from the ulnar artery to the peroneal artery. To reconstruct the aortic bifurcation, kissing balloon inflations were performed from the peroneal as well as the ulnar artery approaches. A 10 mm × 59 mm balloon expandable stent was placed in the ostial left common iliac artery and a 8 mm × 60 mm self-expanding stent was placed in the left external iliac artery successfully.
Hierarchical Diagnostic Classification Modeling of Reading Comprehension
Authors: Tabatabaee-Yazdi Mona
Published: June 2020

The Hierarchical Diagnostic Classification Model (HDCM) reflects on the sequences of the presentation of the essential materials and attributes to answer the items of a test correctly. In this study, a foreign language reading comprehension test was analyzed employing HDCM and the generalized deterministic-input, noisy and gate (G-DINA) model to determine and compare respondents’ mastery profiles in the test’s predefined skills and to illustrate the relationships among the attributes involved in the test to capture the influence of sequential teaching of materials on increasing the probability of getting an item a correct answer. Furthermore, Differential Item Functioning (DIF) analysis was applied to detect whether the test functions as a reason for the gender gap in participants’ achievement. Finally, classiﬁcation consistency and accuracy indices are studied. The results showed that the G-DINA and one of the HDCMs fit the data well. However, although the results of HDCM showed the existence of attribute dependencies in the reading comprehension test, the relative fit indices highlight a significant difference between the G-DINA and HDCM, favoring G-DINA. Moreover, results indicate that there is a significant difference between males and females in six items in favor of females. Besides, classiﬁcation consistency and accuracy indices specify that the Iranian University Entrance Examination holds a 71% chance of categorizing a randomly selected test taker consistently on two distinct test settings and a 78% likelihood of accurately classifying any randomly selected student into the true latent classes. As a result, it can be concluded that the Iranian University Entrance Examination can be considered as a valid and reliable test.
The Development of Air Pollution in Mexico City
Authors: Soto-Coloballes Natalia
Published: June 2020

The present essay documents changes to both objects of inquiry and the meaning of the epistemological concept of air pollution and it explains the processes that produced them. Smog as a result of production processes and the use of the automobile was not a concern for researchers and government managers in Mexico City, who were used to the dust storms resulting from the desiccation of the great Texcoco Lake during much of the 20th century, until the most industrialized nations of the West and the World Health Organization (WHO), alongside other international bodies such as the Organization for European Economic Cooperation (OEEC), reframed what was understood as air pollution, between the end of the 1960s and the beginning of the 1970s. Concerns about dust storms were displaced by concerns about factory and automotive emissions that contained new dangers—invisible hazards, just then being estimated, which altered what was understood or considered air pollution and gave rise to the quantification of particulate matter (which was then known as suspended dust particles) and new practices such as atmospheric monitoring. This essay concludes that what is understood as air pollution is situated; its meaning is not finite but simply evolves with time and with the rise of new global risks and concerns.
Exploring the Determinants of Digital Content Adoption By Academics: The Moderating Role of Environmental Concerns and Price Value
Authors: Hidayat-ur-Rehman Imdadullah , Akram Muhammad Shakaib , Malik Aneela , Mokhtar Shamsul A. , Bhatti Zeeshan Ahmed , Khan Muhammad Asif
Published: June 2020

The study investigates the underlying motives facilitating users’ continuance intention for digital content in academic settings. Extending the expectation confirmation model of IS continuance (ECM-ISC), the study proposes a conceptual model by incorporating personal and technological antecedents of users’ continuance intention for digital content. In addition, users’ environmental concerns and price value are considered as potential moderators in the relationship between their satisfaction and continuance intention for digital content. An online survey was used to collect data from 311 digital content users of a large public university in Saudi Arabia. Structural equation modeling was used to test the relationships in the conceptual model. The results obtained from SmartPLS 3.2 confirm that compatibility, convenience, self-efficacy, and facilitating conditions are the predictors of confirmation and usefulness of digital content. The confirmation of expectations and perceived usefulness result in greater satisfaction with the digital content, which in turn leads to users’ continuance intention. In addition, the article provides empirical evidence for the impact of environmental concerns on the satisfaction–continuance intention relationship, thus opening a novel research debate. The study is expected to offer new insights both for academicians and managers of digital content.
An Unusual Case (Metastatic-Like Lesion) of Septic Cerebral Embolus Caused by Corynebacterium mucifaciens in a Diabetic Patient
Authors: Senaobar Tahaei Seyed Arad , Mencser Zoltan , Reisz Zita , Barzo Pal
Published: June 2020

Septic cerebral emboli can be a challenging diagnosis to give, especially if atypical bacterial infections are the cause of it. Correct diagnosis of this condition can change the management route of the patient and result in a nonsurgical treatment. To our best knowledge, this is the first case of septic cerebral embolus caused by Corynebacterium mucifaciens reported. In this study, a 65-year-old diabetic patient who have developed ketoacidosis and went into coma was investigated for a case of septic cerebral embolization. The patient developed a sudden right-sided hemiparesis, and the radiological findings showed a tumor-like lesion on the left hemisphere at the level of the internal capsule. At first glance, presence of a metastatic tumor could not be excluded; therefore, further laboratory tests and examinations were done to rule out metastatic lesions. The blood culture of the patient revealed a case of bacteremia caused by Corynebacterium mucifaciens and then a septic cerebral embolus was suspected, but due to the rarity of this pathogen causing such complications as well as the similarity of the lesion to a metastatic brain tumor, a biopsy was performed and the histopathological findings confirmed the diagnosis of a septic cerebral embolus. Corynebacterium mucifaciens should be considered a human pathogen in immunocompromised patients and it can cause cerebral septic embolization. Metastatic brain tumors and tuberculomas should be excluded; if the uncertainty of a metastatic tumor remains, biopsy can be performed and histological findings can amplify the diagnosis of septic cerebral embolus.
Towards Sustainable Supply Chain Management (SSCM): A Case of Leather Industry
Authors: Islam M. Hedaitul , Sarker Md Rayhan , Hossain Md Israil , Ali Kauser , Noor K. M. Asadun
Published: June 2020

At present, sustainable supply chain management (SSCM) has gained a great momentum in this competitive business world for any kind of industry. Leather industry (leather, leather products, and footwear) is the second export earning sector of Bangladesh which is scrambling to implement SSCM in its working cycle. There are lot of challenges that are creating barriers for this industry owners in establishing sustainability practices in their supply chain management. There is lack of enough research in identifying the challenges of SSCM for leather industry of Bangladesh. That’s why, it is very imperative to identify the challenges of SSCM for leather industry in Bangladesh which will guide the industry owners to combat these challenges. In this research, we have not only identified the challenges of SSCM for leather industry but also evaluated the relationship among them. Besides, a priority list of identified challenges is depicted through which the industry owners can easily find out the major and minor challenges. Five industrial experts were selected from export-oriented leather and footwear factories in order to sort out the appropriate challenges. Decision-making trial and evaluation laboratory (DEMATEL) technique was applied to assess the relationship among identified 18 challenges and divided them into two groups such as cause and effect. The casual challenges are lack of knowledge and experience, lack of technical expertise, corruption, social unawareness, lack of acceptance of new technology, lack of training on SSCM, poor organizational culture, market competition and uncertainty, lack of commitment from top management and lack of integration of IT system. On the other hand, lack of eco-literacy among supply chain stakeholders, financial constraints, lack of government rules and regulations, cost of sustainability, limitations of capacity, lack of management initiatives for reverse logistics, demand for lower price and lack of energy and waste management policy were identified as effect group challenges. This study will help the decision-makers of leather industry in formulating strategic policies to address these challenges for in implementing SSCM in leather industry that will drive these sectors toward sustainable development.
Identifying Barriers That Prevent the Usage of Health Information Exchange in Ohio
Authors: Lengel Aaron J. , Carpenter Elise M. L. , Azzi Andrew G. , DiDonato Kristen L.
Published: June 2020

Background: As clinical services expand in community pharmacies, access to patient information through a health information exchange (HIE) may be of increased benefit to patient care. Objectives: To identify perceptions and barriers to the use of HIE by high-performing clinical pharmacists within a grocery store chain and collect other health care provider perceptions of using HIE. Methods: Two web-based surveys consisting of multiple choice, select all that apply, and 5-point Likert-type scale questions were administered via email to Ohio pharmacists working in high clinical performing pharmacies and Ohio health care providers utilizing CliniSync, an Ohio-based HIE program. Outcomes measured included pharmacist perceptions of preparedness to participate in HIE, their relationship with patients and health care providers, and barriers to utilizing HIE. Provider outcomes included perceptions of relationships with patients, awareness of community pharmacy services, referral habits, and perceived benefit of a HIE. Results: Pharmacists tend to believe they have the skill (median 5, interquartile range [IQR] 1) and desire (median 5, IQR 1) to be a part of the HIE network. Pharmacists appear confident in their abilities to provide patient care as a part of HIE networks (median 4, IQR 1). While 66% of providers surveyed are aware of services provided by community pharmacists, 75% state that they do not refer patients to a pharmacy for those services. Conclusion: Implementing HIE into clinical pharmacy workflow and encouraging providers to use it to make patient health information available to pharmacists would provide additional information for pharmacists to review when providing clinical services in the community pharmacy setting, ultimately benefiting patient care.
Diagnosis of asthma in children: findings from the Swiss Paediatric Airway Cohort
Authors: de Jong Carmen C.M. , Pedersen Eva S.L. , Mozun Rebeca , Müller-Suter Dominik , Jochmann Anja , Singer Florian , Casaulta Carmen , Regamey Nicolas , Moeller Alexander , Ardura-Garcia Cristina , Kuehni Claudia E.
Published: June 2020

Introduction

Diagnosing asthma in children remains a challenge because respiratory symptoms are not specific and vary over time.

Aim

In a real-life observational study, we assessed the diagnostic accuracy of respiratory symptoms, objective tests and two paediatric diagnostic algorithms (proposed by the Global Initiative for Asthma (GINA) and the National Institute for Health and Care Excellence (NICE)) in the diagnosis of asthma in school-aged children.

Methods

We studied children aged 5–17 years who were referred consecutively to pulmonary outpatient clinics for evaluation of suspected asthma. Symptoms were assessed by parental questionnaire. The investigations included specific IgE measurement or skin prick tests, measurement of exhaled nitric oxide fraction (FeNO), spirometry, body plethysmography and bronchodilator reversibility (BDR). Asthma was diagnosed by paediatric pulmonologists based on all available data. We assessed diagnostic accuracy of symptoms, tests and diagnostic algorithms by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC).

Results

Among 514 participants, 357 (70%) were diagnosed with asthma. The combined sensitivity and specificity was highest for any wheeze (sensitivity=75%, specificity=65%), dyspnoea (sensitivity=56%, specificity=76%) and wheeze triggered by colds (sensitivity=58%, specificity=78%) or by exercise (sensitivity=55%, specificity=74%). Of the diagnostic tests, the AUC was highest for specific total airway resistance (sRtot; AUC=0.73) and lowest for the residual volume (RV)/total lung capacity (TLC) ratio (AUC=0.56). The NICE algorithm had sensitivity=69% and specificity=67%, whereas the GINA algorithm had sensitivity=42% and specificity=90%.

Conclusion

This study confirms the limited usefulness of single tests and existing algorithms for the diagnosis of asthma. It highlights the need for new and more appropriate evidence-based guidance.
Complications following symptom-limited thoracentesis using suction
Authors: Sagar Ala Eddin S. , Landaeta Maria F. , Adrianza Andres M. , Aldana Grecia L. , Pozo Leonardo , Armas-Villalba Aristides , Toquica Christian C. , Larson Andrew J. , Vial Macarena R. , Grosu Horiana B. , Ost David E. , Eapen George A. , Sheshadri Ajay , Morice Rodolfo C. , Shannon Vickie R. , Bashoura Lara , Balachandran Diwakar D. , Almeida Francisco A. , Uzbeck Mateen H. , Casal Roberto F. , Faiz Saadia A. , Jimenez Carlos A.
Published: June 2020

Background

Thoracentesis using suction is perceived to have increased risk of complications, including pneumothorax and re-expansion pulmonary oedema (REPO). Current guidelines recommend limiting drainage to 1.5 L to avoid REPO. Our purpose was to examine the incidence of complications with symptom-limited drainage of pleural fluid using suction and identify risk factors for REPO.

Methods

A retrospective cohort study of all adult patients who underwent symptom-limited thoracentesis using suction at our institution between January 1, 2004 and August 31, 2018 was performed, and a total of 10 344 thoracenteses were included.

Results

Pleural fluid ≥1.5 L was removed in 19% of the procedures. Thoracentesis was stopped due to chest discomfort (39%), complete drainage of fluid (37%) and persistent cough (13%). Pneumothorax based on chest radiography was detected in 3.98%, but only 0.28% required intervention. The incidence of REPO was 0.08%. The incidence of REPO increased with Eastern Cooperative Oncology Group performance status (ECOG PS) ≥3 compounded with ≥1.5 L (0.04–0.54%; 95% CI 0.13–2.06 L). Thoracentesis in those with ipsilateral mediastinal shift did not increase complications, but less fluid was removed (p<0.01).

Conclusions

Symptom-limited thoracentesis using suction is safe even with large volumes. Pneumothorax requiring intervention and REPO are both rare. There were no increased procedural complications in those with ipsilateral mediastinal shift. REPO increased with poor ECOG PS and drainage ≥1.5 L. Symptom-limited drainage using suction without pleural manometry is safe.
Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis
Authors: Alqahtani Jaber S. , Njoku Chidiamara M. , Bereznicki Bonnie , Wimmer Barbara C. , Peterson Gregory M. , Kinsman Leigh , Aldabayan Yousef S. , Alrajeh Ahmed M. , Aldhahir Abdulelah M. , Mandal Swapna , Hurst John R.
Published: June 2020

Background

Readmission rates following hospitalisation for COPD exacerbations are unacceptably high, and the contributing factors are poorly understood. Our objective was to summarise and evaluate the factors associated with 30- and 90-day all-cause readmission following hospitalisation for an exacerbation of COPD.

Methods

We systematically searched electronic databases from inception to 5 November 2019. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality was assessed using a modified version of the Newcastle–Ottawa Scale. We synthesised a narrative from eligible studies and conducted a meta-analysis where this was possible using a random-effects model.

Results

In total, 3533 abstracts were screened and 208 full-text manuscripts were reviewed. A total of 32 papers met the inclusion criteria, and 14 studies were included in the meta-analysis. The readmission rate ranged from 8.8–26.0% at 30 days and from 17.5–39.0% at 90 days. Our narrative synthesis showed that comorbidities, previous exacerbations and hospitalisations, and increased length of initial hospital stay were the major risk factors for readmission at 30 and 90 days. Pooled adjusted odds ratios (95% confidence intervals) revealed that heart failure (1.29 (1.22–1.37)), renal failure (1.26 (1.19–1.33)), depression (1.19 (1.05–1.34)) and alcohol use (1.11 (1.07–1.16)) were all associated with an increased risk of 30-day all-cause readmission, whereas being female was a protective factor (0.91 (0.88–0.94)).

Conclusions

Comorbidities, previous exacerbations and hospitalisation, and increased length of stay were significant risk factors for 30- and 90-day all-cause readmission after an index hospitalisation with an exacerbation of COPD.
Effect of smoking on treatment outcome among tuberculosis patients in Malaysia; a multicenter study
Authors: Khan Amer Hayat , Sulaiman Syed Azhar Syed , Hassali Mohamed Azmi , Khan Kashif Ullah , Ming Long Chiau , Mateen Omer , Ullah Malik Obaid
Published: June 2020

Background

Smoking plays a key role in the development of tuberculosis (TB) infection and is also a predictor of poor TB treatment prognosis and outcomes. The current study was conducted to determine the prevalence of smoking and to assess the effects of smoking on treatment outcomes among TB patients.

Methods

A multi-center retrospective study design was used to collect data from TB patients in four different states of Malaysia, namely Penang, Sabah, Sarawak, and Selangor. The study included medical records of TB patients admitted to the selected hospitals in the period from January 2006 to March 2009. Medical records with incomplete data were not included. Patient demographics and clinical data were collected using a validated data collection form.

Results

Of all patients with TB (9337), the prevalence of smokers was 4313 (46.2%). Among smokers, 3584 (83.1%) were associated with pulmonary TB, while 729 (16.9%) were associated with extrapulmonary TB. Male gender (OR = 1.43, 95% CI 1.30–1.58), Chinese ethnicity (OR = 1.23, 95% CI 1.02–1.49), Sarawak indigenous ethnicity (OR = 0.74, 95% CI 0.58–0.95), urban residents (OR = 1.46, 95% CI 1.33–1.61), employed individuals (OR = 1.21, 95% CI 1.09–1.34), alcoholics (OR = 4.91, 95% CI 4.04–5.96), drug abusers (OR = 7.43, 95% CI 5.70–9.60) and presence of co-morbid condition (OR = 1.27, 95% CI 1.16–1.40) all showed significant association with smoking habits. This study found that 3236 (75.0%) patients were successfully treated in the smokers’ group, while 4004 (79.7%) patients were non-smokers. The proportion of deaths (6.6%,n = 283), defaulters (6.6%,n = 284) and treatment interruptions (4.7%,n = 204) was higher in the smokers’ group.

Conclusions

Smoking has a strong influence on TB and is a major barrier towards treatment success (OR = 0.76, 95% CI 0.69–0.84,p < 0.001). Therefore, the findings indicate that smoking cessations are an effective way to decrease treatment failure and drug resistance.
Immunologic aspects of characteristics, diagnosis, and treatment of coronavirus disease 2019 (COVID-19)
Authors: Chang Feng-Yee , Chen Hsiang-Cheng , Chen Pei-Jer , Ho Mei-Shang , Hsieh Shie-Liang , Lin Jung-Chung , Liu Fu-Tong , Sytwu Huey-Kang
Published: June 2020

On March 11, 2020, the World Health Organization declared the worldwide spread of the infectious disease COVID-19, caused by a new strain of coronavirus, SARS-CoV-2, as a pandemic. Like in all other infectious diseases, the host immune system plays a key role in our defense against SARS-CoV-2 infection. However, viruses are able to evade the immune attack and proliferate and, in susceptible individuals, cause severe inflammatory response known as cytokine storm, particularly in the lungs. The advancement in our understanding of the mechanisms underlying the host immune responses promises to facilitate the development of approaches for prevention or treatment of diseases. Components of immune system, such as antibodies, can also be used to develop sensitive and specific diagnostic methods as well as novel therapeutic agents. In this review, we summarize our knowledge about how the host mounts immune responses to infection by SARS-CoV-2. We also describe the diagnostic methods being used for COVID-19 identification and summarize the current status of various therapeutic strategies, including vaccination, being considered for treatment of the disease.
Quality of life up to 10 years after traumatic brain injury: a cross-sectional analysis
Authors: Rauen Katrin , Reichelt Lara , Probst Philipp , Schäpers Barbara , Müller Friedemann , Jahn Klaus , Plesnila Nikolaus
Published: June 2020

Background

Traumatic brain injury (TBI) is the leading cause of death and disability among children and young adults in industrialized countries, but strikingly little is known how patients cope with the long-term consequences of TBI. Thus, the aim of the current study was to elucidate health-related quality of life (HRQoL) and outcome predictors in chronic TBI adults.

Methods

In this cross-sectional study, 439 former patients were invited to report HRQoL up to 10 years after mild, moderate or severe TBI using the QOLIBRI (Quality of Life after Brain Injury) questionnaire. The QOLIBRI total score has a maximum score of 100. A score below 60 indicates an unfavorable outcome with an increased risk of an affective and/or anxiety disorder. Results were correlated with demographics and basic characteristics received from medical records (TBI severity, etiology, age at TBI, age at survey, time elapsed since TBI, and sex) using regression models. Differences were considered significant at p <  0.05.

Results

From the 439 invited patients, 135 out of 150 in principle eligible patients (90%) completed the questionnaire; 76% were male, and most patients experienced severe TBI due to a traffic-related accident (49%) or a fall (44%). The mean QOLIBRI total score was 65.5 (± 22.6), indicating good HRQoL. Factors for higher level of satisfaction (p = 0.03; adjusted R2 = 0.1) were autonomy in daily life (p = 0.03; adjusted R2 = 0.09) and cognition (p = 0.05; adjusted R2 = 0.05). HRQoL was weakly correlated with initial TBI severity (p = 0.04; adjusted R2 = 0.02). 36% of patients reported unfavorable HRQoL with increased risk of one (20%) or two (16%) psychiatric disorders.

Conclusions

The majority of chronic TBI patients reported good HRQoL and the initial TBI severity is a slight contributor but not a strong predictor of HRQoL. Autonomy and cognition are decisive factors for satisfied outcome and should be clearly addressed in neurorehabilitation. One third of patients, however, suffer from unsatisfactory outcome with psychiatric sequelae. Thus, an early neuropsychiatric assessment after TBI is necessary and need to be installed in future TBI guidelines.
Rheumatic valvular heart disease combined with woven coronary artery: a case report
Authors: Liu Zhengjiang , Li Yueliang
Published: June 2020

Background

Woven coronary artery (WCA) is an extremely rare congenital anomaly in which a part of epicardial coronary artery is divided into thin channels, that twist along the axis of the coronary arteries and then merge again as the main coronary lumen. This anomaly is regarded as a benign condition because the blood flow is normal. Very few cases of WCA have been reported.

Case presentation

Herein we report a case of a 44-year-old man who was admitted to our hospital due to 20 years of repeated episodes of heart palpitations, 2 years of shortness of breath after activity, and the symptoms were aggravated for 1 month. He had history of inferior myocardial infarction and atrial fibrillation. Color Doppler echocardiography revealed rheumatic heart disease, severe mitral regurgitation, mild-moderate tricuspid regurgitation, moderate pulmonary hypertension. Coronary angiography revealed 60–85% diffuse stenosis in the middle of left anterior descending artery, 60–90% diffuse stenosis in the middle of left circumflex artery, 30–40% diffuse stenosis in the proximal segment of right coronary artery, and WCA anomaly in the middle, and distal segments of right coronary artery.

Conclusion

The patient successfully underwent prosthetic valve replacement and left anterior descending coronary artery bypass grafting, and had a good recovery after surgery. Further studies are needed to fully understand the disease and determine appropriate treatment options.