bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation of a Surgical Problem-Based Learning Curriculum: A One-Year Single-Center Experience
Authors: Kronenfeld Joshua P. , Saberi Rebecca A. , Cioci Alessia C. , Urrechaga Eva M. , Ryon Emily L. , Thorson Chad M. , Hui Vanessa W. , Rodgers Steven E. , Sands Laurence R.
Published: March 2022

Background

Problem-Based Learning (PBL) has become an integral part of medical student education for preclinical curricula, but few studies have evaluated the benefits of a PBL curriculum for clinical education. This study aims to assess the 1-year experience after implementing a resident-led PBL program for the third-year (MS3) surgery clerkship and compare students’ self-reported preparedness following PBL sessions to traditional faculty-led lectures.

Methods

Surgical faculty and residents developed a PBL curriculum to address common topics in surgical education. Pandemic requirements necessitated a switch from in-person to virtual sessions during the experience. Students enrolled in the MS3 surgical clerkship were asked to participate in a survey. Demographics and clerkship data were obtained. Quality of PBL and faculty-led lectures were assessed using a ten-point Likert scale, and standard statistical analyses were performed.

Results

During the study period, 165 students rotated through surgery, of which 129 (78%) responded to the survey (53% female, 59% white). PBLs were held in-person (53%), exclusively virtual (32%) or hybrid (15%) platforms. In-person PBLs were preferred to faculty-led lectures for preparing students for NBME examinations (6.9 vs 6.0), oral examinations (7.8 vs 6.3), and surgical cases (6.3 vs 5.8), all P < .001. Virtual PBLs were also preferred to lectures for preparing students for NBME examinations (6.8 vs 5.8, P < .001) and surgical cases (5.6 vs 4.8, P = .05).

Conclusions

PBL is a valuable adjunct for medical student education. Resident-led PBLs were preferred to faculty-led lectures for preparing students for examinations and clerkship experiences and may be useful adjuncts to clinical education.
The Impact of Steroids and Inflammatory Bowel Disease in Colectomies in the Era of Enhanced Recovery
Authors: Dinallo Anthony M. , Tracy Brett M. , Hazen Benjamin J. , Srinivasan Jahnavi K. , Sharma Joe , Shaffer Virginia O.
Published: March 2022

Introduction

Enhanced recovery after surgery protocols are commonly used, but their utility in patients with inflammatory bowel disease and steroid use is poorly studied. We sought to examine influence of inflammatory bowel disease (IBD) and steroid use on hospital length of stay (LOS) and operative duration in patients undergoing colectomies in the era of ERAS.

Methods

We performed retrospective review of our institutional National Surgical Quality Improvement Program (NSQIP) registry (2016-2018) for colectomies. We performed 2 distinct analyses to examine influence of steroids and IBD on LOS and operative duration. Multivariable linear regression was used to predict outcomes after adjusting for relevant perioperative features.

Results

There were 366 patients in the cohort; 17.8% were on steroids and 16.4% had IBD. Patients using steroids had longer LOS (6 vs 4 days, P < .0001). IBD patients had a longer LOS (7 vs 5 days, P < .0001) and longer operative duration (383 min vs 335.5 minute, P = .01) compared to non-IBD patients. On multivariable analysis, steroid use was not associated with increased LOS or operative duration. Inflammatory bowel disease was associated with an increased hospital LOS and operative duration.

Discussion

Patients on steroids had longer LOS when compared to patients not on steroids. Inflammatory bowel disease regardless of steroid use was found to be a significant risk factor for both increased LOS and operative duration. A closer look at preoperative physiology may help to tailor ERAS protocols in patients with inflammatory conditions.
Neurofibromatosis-associated Gastrointestinal Stromal Tumor Causing Small Bowel Obstruction
Authors: Schaeffer H. David , Griffiths Richard L. , Factor Matthew S.
Published: March 2022

Multiple gastrointestinal stromal tumors (GISTs) of the small intestine is an uncommon finding but can be a marker for underlying neurofibromatosis type 1 (NF1). We present the case of the 38-year-old male without prior NF1 diagnosis who presented with a small bowel obstruction. His physical exam was notable for cutaneous nodules and café-au-lait spots. He progressed to peritonitis and underwent an exploratory laparotomy, which revealed a 6-cm hemorrhagic mass along the antimesenteric border of the jejunum, causing obstruction and perforation. Pathology was consistent with GISTs. NF1-associated GISTs differ from wild-type GISTs in that they are unlikely to have C-KIT and PDGFRA mutations and therefore do not respond to imatinib. Treatment is largely limited to surgical resection; however, there is evidence that MEK inhibitors may prove an additional treatment strategy.
Health Professionals’ COVID-19 Vaccine Acceptance and Associated Factors in Tertiary Hospitals of South-West Ethiopia: A Multi-Center Cross- Sectional Study
Authors: Boche Bekele , Kebede Oliyad , Damessa Mekonnen , Gudeta Tadesse , Wakjira Diriba
Published: March 2022

Background

Acceptance of the COVID-19 vaccine by health professionals highly influences the communities’ decision to receive the vaccine, because health professionals are perceived to be a reliable source of health information. Hence, this study aimed at assessing COVID-19 vaccine acceptance and associated factors among health professionals in two tertiary hospitals in southwest Ethiopia.

Methods

A cross-sectional study was conducted among 319 health professionals working in Jimma University Medical Center and Mizan-Tepi university teaching hospital, southwest Ethiopia, from June 30, 2021 to July 30, 2021. Data were collected by a structured self-administered questionnaire and analyzed by SPSS version 23. A multivariate logistic regression model was used to identify independent factors associated with health professionals’ covid-19 vaccine acceptance. Variables with P-value < .25 on univariate analysis were candidates for multivariate logistic regression. Then, variables with P-value < .05 at 95% CI in multivariate logistics regression were considered statistically significant.

Results

Of the total participants, 232 (72.73%) received COVID-19 vaccines. Among non-vaccinated health care professionals, 82 (94.3%) of them stated, worries about the safety and side effects of the vaccines, as the reason for non-acceptance. Factors such as, friends or families diagnosed with COVID-19 (AOR = .086; CI: 95%, .041–.18; P = .001), and attitudes and beliefs about COVID-19 and its vaccine (AOR = .129; CI: 95%, .037–.449; P = .001), were significantly associated with the acceptance of COVID-19 vaccine.

Conclusion

More than one-fourth of health professionals who did not accept COVID-19 vaccines require immediate intervention through awareness creation on the safety and adverse effects of the vaccine by the government and other stakeholders. Otherwise, the community may in large reject the vaccine as they trust health professionals.
Proliferation Update. Testing the Science and Technology Studies Mainstream Through Current Science’s Controversies
Authors: Kasavin Ilya , Shipovalova Lada
Published: March 2022

Disputes in the field of science and technology studies (STS) demonstrate its topicality as they elucidate the prospects for a postmodern world, and William Lynch in his book, in search of a constructive solution to current controversies, employs the dialectical approach of Lakatos and Feyerabend. Lynch takes a bold step to present an apparently “degenerated scientific research program” as a competitive alternative to the established and “progressive” mainstream. The book offers not only a theoretical justification for this “minority report,” but also its empirical confirmation, as well as the possibility of practical and socio-political application. We believe that Lynch’s book actualizes the discussion about the nature of sociality as related to scientific cognition, as well as provokes the question of the possibility of specific ontology of scientific knowledge. However, the internal heterogeneity of the sociology of scientific knowledge seems to be slightly underestimated, which sometimes prevents Lynch recognizing his real allies and opponents in modern STS. Lynch’s approach to analyzing scientific alternatives to dominant paradigms and to science communication practices helps problematize current controversies through demonstrating their incommensurability not incomparability. Hopefully this will increase their mutual understanding and collaboration.
Perceived barriers and rewards to sexual consent communication: A qualitative analysis
Authors: Edwards Jessica , Rehman Uzma S , Byers E Sandra
Published: March 2022

Increasingly, affirmative consent – direct, unambiguous and voluntary agreement to engage in sexual activity ( Craig & McKinley, 2015 ) – is the standard being adopted by educational institutions in North America ( Bennett, 2016 ). Yet, studies show that most individuals continue to communicate consent through nonresistance ( Jozkowski et al., 2014a ). Given this discrepancy, it is critical to understand what factors prevent individuals from engaging in affirmative consent. Furthermore, a better understanding of the perceived rewards of consent communication could incentivize the adoption of affirmative consent. To understand the range of perceived barriers and rewards, we conducted an online, qualitative study where 231 participants answered two open-ended questions. We used inductive content analysis to categorize participants’ perceptions of sexual consent barriers and rewards into four general content areas: (1) Communication Quality, (2) Relational and Emotional Experiences, (3) Sexual Quality and (4) Safety and Coercion. These perceived rewards and barriers were examined through the lens of the Information-Motivation-Behavioural Skills Model. Participants viewed consent communication not only as a means of ensuring safety but also as away to enhance relational and sexual quality. However, they also perceived barriers in all three of these domains as well as barriers to ensuring that sexual consent communication is fluid and easily understood. These findings provide important avenues for future research investigating how individuals reconcile perceived rewards and costs of affirmative consent communication. We also suggest ways to enhance sexual education by discussing potential rewards and validating the normative nature of fears and anxieties around affirmative consent.
Prognostic role of elevated lactate in acute pulmonary embolism: A systematic review and meta-analysis
Authors: Wang Yubin , Feng Yinhe , Yang Xiaoya , Mao Hui
Published: March 2022

Background

Previous studies have shown elevated lactate was a good predictor for the prognosis of pulmonary embolism (PE). However, due to low number of patients and different expression of blood lactate in separate study, these results are inconsistent. Therefore, the aim of this meta-analysis is to evaluate the relationship between increased lactate levels and adverse outcome in acute PE.

Method

The literatures search was conducted in PubMed, Web of Science, and EMBASE until May 29, 2021.

Results

Finally, 6 studies with 1706 patients were included in our meta-analysis. High lactate levels were markedly associated with overall mortality both in unselected PE patients (OR 5.13, 95% CI: 3.36–7.86, p < .00,001) and normotensive PE patients (OR 4.54, 95% CI: 2.64–7.80, p < .00,001), and PE-related short-term mortality in patients with elevated lactate was significantly higher than that in patients with normal levels (OR 9.05, 95% CI :4.08–20.10, p < .00,001). The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of lactate for predicting overall mortality in patients with acute PE were 0.67 (95% CI: 0.43–0.85), 0.73 (95% CI: 0.60–0.83), 2.5 (95% CI: 2.0–3.1), and 0.45 (95% CI: 0.26–0.78), respectively. The area under SROC curve (AUC) was 0.76 (95% CI: 0.73–0.80).

Conclusion

The result of our meta-analysis indicate that elevated blood lactate is a good predictor for overall mortality and short-term mortality in patients with acute PE, and can be routinely measured in risk stratification, but its prognostic role in patients with different risk classes still need to be verified.
Stroke survivors’ perceptions of the factors that influence engagement in activity outside dedicated therapy sessions in a rehabilitation unit: A qualitative study
Authors: Janssen Heidi , Bird Marie-Louise , Luker Julie , McCluskey Annie , Blennerhassett Jannette , Ada Louise , Bernhardt Julie , Spratt Neil J
Published: March 2022

Objective

To investigate stroke survivors’ perceptions of factors influencing their engagement in activity outside of dedicated therapy sessions during inpatient rehabilitation.

Design

Qualitative study.

Setting

Four metropolitan rehabilitation units in Australia.

Participants

People undertaking inpatient rehabilitation after stroke.

Methods

Semi-structured interviews conducted in person by a speech pathologist A stepped iterative process of inductive analysis was employed until data saturation was achieved with themes then applied against the three domains of the Theory of Planned Behaviour (perceived behavioural control, social norms and attitude).

Results

Interviews of 33 stroke survivors (60% female, median age of 73 years) revealed five themes (i) uncertainty about how to navigate and what was available for use in the rehabilitation unit restricts activity and (ii) post-stroke mobility, fatigue and pre- and post-stroke communication impairments restrict activity (perceived behavioural control); (iii) unit set up, rules (perceived and actual) and staff expectations influence activity and (iv) visiting family and friends are strong facilitators of activity (social norms), and (v) personal preferences and mood influence level of activity (attitude).

Conclusion

At the individual level, stroke survivors perceived that their ability to be active outside of dedicated therapy sessions was influenced by their impairments, including mood, and their attitude towards and preference for activity. At the ward level, stroke survivors perceived that their ability to be active was influenced by ward set-up, rules and staff expectations. Visitors were perceived to be important facilitators of activity outside of therapy sessions.
The Role of Magnetic Resonance in Evaluating Abdominopelvic Trauma - Part 1: Pancreatic and Hepatobiliary Injuries
Authors: Rajput Mohamed Z. , Mellnick Vincent M.
Published: March 2022

Trauma is an important cause of mortality, particularly in the young. While computed tomography (CT) is the mainstay of body imaging in the setting of trauma, magnetic resonance (MR) imaging can be useful in stable patients. Although more commonly used in spinal and musculoskeletal trauma, MR also has a role in abdominopelvic trauma. Broadly, its uses include clarification of equivocal cases, monitoring complications of trauma, particularly with solid organ injury, or as a primary imaging modality for patients with low suspicion for injury for whom avoiding ionizing radiation is a priority—namely, in pediatric and pregnant patients. In this two-part review article, we will review clinical scenarios where this may be encountered, utilizing case examples. This first installment will focus on pancreatic and hepatobiliary injuries. Pancreatic trauma may be difficult to diagnose on CT, and MR may aid in demonstrating pancreatic duct disruption, allowing for accurate grading according to American Association for the Surgery of Trauma (AAST) criteria. It may also be a useful modality for monitoring evolution of pancreatic injuries and/or pseudocyst development, guiding potential stenting, and/or drainage. Biliary injuries are also optimally evaluated with MR, particularly when aided by the use of hepatobiliary contrast material. This can allow for accurate delineation of biliary ductal anatomy and aid in planning percutaneous or endoscopic treatment of bile leaks.
Dual setting brushite—gelatin cement with increased ductility and sustained drug release
Authors: Rödel Michaela , Teßmar Jörg , Groll Jürgen , Gbureck Uwe
Published: March 2022

A novel dual setting brushite-gelatin cement was achieved by genip ininitiated cross-linking of gelatin during cement setting. Although the combination of an inorganic and organic phase resulted in a decrease of the compressive strength from about 10 MPa without polymeric phase to 3–6–MPa for gelatin modified composites, an increase in elastic properties due to the gelatin hydrogel with a concentration of 10.0 w/v% was achieved. For a powder-to-liquid ratio of 2.5 g*mL−1, a shift of initial maximum stress value during compression testing was observed up to 5% deformation and tested samples showed a pseudo-ductile fracture behavior. The obtained composites of the different formulations were characterized regarding phase composition, porosity as well as drug loading capacity with rifampicin and vancomycin. For the latter, a sustained and prolonged release was realized with a drug release profile according to the Higuchi model and a release exponent of n = 0.5 for the formulation with a PLR of 2.5 g*mL−1 and an incorporation of 10.0 w/v% gelatin.
PMOTO: A Policy Evaluation Model for Moto Usage in Urban Areas
Authors: Minh Chu Cong , Tu Ton That
Published: March 2022

This article introduces PMOTO, a quick strategic and low-cost appraisal tool to identify a short-list of the most promising transport policies to mitigate the adverse impact of motorcycle usage on the city environment. Hanoi and Ho Chi Minh City, Vietnam, were selected as test cases for PMOTO with the same set of policy scenarios built on policy inputs such as tax, charges, fuel efficiency, emission costs, demand management, road-based travel, parking fees and public transport services. The relative merits of different policy options will be analysed and compared in each city and between the two cities.
Trauma-Related Knowledge and Practice Changes among Brokers in a Community-Based Learning Collaborative
Authors: Are Funlola , Saunders Benjamin , Peer Samuel , Ralston Elizabeth , Hanson Rochelle F.
Published: March 2022

Purpose: Broker professionals serve an important intermediary role in improving service access for youth but are often trained separately from clinicians. Community-Based Learning Collaboratives (CBLCs) include specific training/implementation strategies to foster collaboration and build community capacity for EBPs. Methods: The current study examined changes in trauma-related knowledge, practices, organizational culture, and interprofessional collaboration among 63 brokers. Brokers reported significant positive changes in trauma-related knowledge, practices, organizational culture, and interprofessional collaboration following CBLC participation. Results: Hierarchical regression analyses indicated statistically significant improvements in knowledge of treatment planning/case monitoring ( r = .41) and organizational culture ( r = .30) as significant predictors of changes in brokers’ use of child trauma evidence-based practices following CBLC participation. Discussion: Findings emphasize tailoring training to include topics and strategies most relevant to participants’ day-to-day responsibilities.
A study on the conversion relationship of noise perceived annoyance and psychoacoustic annoyance—a case of substation noise
Authors: Guoqing Di , Cong Chen , Yao Yao , Li Dong , Jian Wu
Published: March 2022

The level of annoyance is an important basis to determine the acceptable degree of noise and develop noise standards. Psychoacoustic annoyance ( PA) calculated by Zwicker’s model and perceived annoyance (such as mean annoyance, MA and the percentage of highly annoyed population, % HA) obtained through individual self-reports are widely used. PA and MA (or %HA) cannot be directly compared because the ranges of their values are different. Thus, the conversion relationship of PA and MA (or %HA) needs to be developed. As a case study, the model between PA and MA (or %HA) of substations noise was established and the rationality of model was verified. Results showed that the maximum value of the difference of MA (or % HA) between the calculation result of model and experimental result was less than 0.89 (or 15%). In this way, the perceived annoyance of substation noise samples can be determined by calculation without experiments.
Navigating Design Spaces: Finding Designs, Design Collections, and Design Subspaces
Authors: Garcia Sara , Leitão António
Published: March 2022

Generative design systems can generate a wide panoply of solutions, from which designers search for those that best suit their interests. However, without guidance, this search can be highly inefficient, and many interesting solutions may remain unexplored. This problem is mitigated with automated exploration methods. Still, the ones typically provided by generative design tools are mostly based on black-box methods that drastically reduce the role of the designer, while more straightforward white-box mechanisms are dispersedly found in specific applications. This paper proposes the Navigator tool, which gathers a set of white-box mechanisms that automate the generation of default, random, similar and hybrid designs and design subspaces, while also supporting the generation of design collections. The proposed mechanisms were tested with two generative systems that create, respectively, tower and chair designs. We expect that, by providing understandable mechanisms for navigating design spaces, designers can become more engaged in the search process.
Beyond Western and Indigenous Perspectives on Sustainability: Politicizing Sustainability With the Zapatista Rebellious Education
Authors: Maison Léa Marie
Published: March 2022

This article discusses the contributions of different worldviews to the debates on what a transformative sustainability education could be. It focuses on mainstream and alternative strands of thought present in the West, as well as Indigenous worldviews, taking the Zapatistas as an example. The Zapatista social movement of Mexico fights for the autonomy of Mayan communities and the preservation of their culture, social organization and relationship to nature, all of which centers on traditional Mayan cosmovision. To secure the survival of the culture and of the movement itself, these ecological values are included in the education system. The Zapatistas remind us that it is possible to rethink the world and the ideologies underlying the discourses on sustainability and suggest that taking a stand and organize politically should be at the center of an education for sustainability that aims at being transformative.
How Can Video-Reflexive Ethnographers Anticipate Positive Impact on Healthcare Practice?
Authors: Olson Rebecca E. , Dadich Ann
Published: March 2022

Evidence suggests that studies aiming to improve healthcare practice should be flexible and prioritise patient, family and clinician engagement. Video-reflexive ethnography (VRE), a form of qualitative research often employed in healthcare settings, is well-suited to these aims. VRE supplements ethnographic techniques with video-recordings of in situ practices, allowing practitioners to reflect on taken-for-granted practices. Its prioritisation of collaboration, affective entanglement, theory-driven analysis and flexibility – aligned with participatory and post-qualitative inquiry (PQI) – can facilitate reflexivity among researchers and participants for local practice improvement. Yet paradoxically, flexibility can hinder the predictability of impact, and demonstrating likely impact is crucial to securing research funding. This article offers practical advice to qualitative researchers facing this methodological challenge. Using three exemplars, we examine how differing onto-epistemological groundings, conceptualisations of participant engagement and researcher positionings affect the timing, predictability, scalability and transferability of each study’s impact. We show how prioritising affective engagement, flexible goals and collaboration can enable local healthcare practice improvement; prioritising theory generation via consultation can lead to traditional, more transferable, forms of impact. We share insights for researchers seeking to improve healthcare using methods inspired by PQI such as VRE. While predicting impact is fraught, optimising conditions for impactful VRE research can be accomplished by: foregrounding epistemology; prioritising affective engagement; aligning research and stakeholder goals; assessing timing and organisational readiness; and considering researcher and participant positioning.
Volunteering for Research in Prison: Issues of Access, Rapport and Ethics and Emotions During Ethnography
Authors: Martos-Garcia Daniel , Devís-Devís José , Sparkes Andrew C.
Published: March 2022

Gaining access to formal institutions can be problematic for ethnographers. This is especially so when it comes to prisons where people are incarcerated by the state against their will for various crimes committed by them. Here, in such highly controlled environments, some authors have pointed out the lack of openness of correctional facilities to inquiry and the limited cooperation forthcoming from the various authorities that oversee them. Accordingly, this article examines the difficult processes undertaken to negotiate access to a high-security prison in Spain, and then maintain his role there for a 2-year period as a volunteer sports educator in order to explore the multiple meanings given to sport and physical activity in the prison setting by the prisoners, educational staff and the guards. The emotional costs and ethical dilemmas of sustaining working relationships with these different groups over time in order to achieve specific research goals are highlighted and reflections for future studies of prison life are offered.
Nanomaterials effects on induced magnetic field and double-diffusivity convection on peristaltic transport of Prandtl nanofluids in inclined asymmetric channel
Authors: Akram Safia , Athar Maria , Khalid Saeed  , Umair Mir Yasir
Published: March 2022

The effects of induced magnetic field, thermal and concentration convection on the peristaltic flow of Prandtl nanofluids are explored in this study in an inclined asymmetric channel. A detailed mathematical explanation is given for Prandtl nanofluids with double-diffusivity convection and induced magnetic field. To simplify non-linear partial differential equations, the long wavelength and low approximation of the Reynolds number are used. Using numerical technique, the non-linear differential equations are solved. Exact solutions of thermal and concentration are calculated. The impact of the various physical parameters of flow quantities is shown in graphical results.
Partisan news versus party cues: The effect of cross-cutting party and partisan network cues on polarization and persuasion
Authors: Ozer Adam L. , Wright Jamie M.
Published: March 2022

The pervasiveness of partisan media and the 24/7 news cycle allow ample opportunity for partisan-motivated reasoning and selective exposure. Nonetheless, individuals still frequently encounter out-party media outlets and expert pundits through mainstream news and social media. We seek to examine the effects of cross-cutting partisan outlet cues (e.g. Fox News, MSNBC) and direct party cues (e.g. Republican, Democrat) on citizens’ perceptions of ideology, source credibility, and news consumption. Using an experiment that pits outlet cues against direct party cues, we find that cross-cutting outlet and direct party cues lead citizens to perceive pundits as more ideologically moderate. As a result, respondents find out-party pundits on in-party outlets to be less biased, increasing interest in the pundits’ perspectives. However, while cross-cutting pundits gain among the out-party, they lose among the in-party. This trade-off holds important normative implications for individual news consumption and the ability of outlets and pundits to appear unbiased while garnering the largest possible audience.
Socioeconomic Effects on Psychosocial Factors Among Low-Income Older Adults
Authors: Sargent Lana , Zanjani Faika , Winship Jodi , Gendron Tracey , Mackiewicz Marissa , Diallo Ana , Waters Leland , Battle Kimberly , Ford Gregory , Falls Katherine , Chung Jane , Price Elvin T. , Cisewski Melissa , Parsons Pamela , Health VCU iCubed ,   Wellness in Aging Transdisciplinary Core
Published: March 2022

Objectives: Older adults have been disproportionately affected by COVID-19. The primary goal of this study is to determine the socioeconomic effects on psychosocial factors among low-income independent-living older adults, in an urban setting, during the COVID-pandemic. Methods: Participants were recruited through Virginia Commonwealth University’s Richmond Health and Wellness Program. Telephone surveys ( n=100) were conducted using the Epidemic – Pandemic Impacts Inventory Geriatric with the Racial/Ethnic Discrimination addendum. Responses were analyzed for income and education effects across seven domains: home life, social activities/isolation, economic, emotional health-wellbeing, physical health, COVID-infection history, and positive change behaviors/experiences. Results: The sample population was between 51 and 87 years of age, 88% were Black, 57% reported incomes of $10,000/year or less, and 60% reported a high-school education or less. There were income effects for social activities/isolation (f = 3.69, p<.05) and positive change (f = 8.40, p<.01), and education effects for COVID History (f = 4.20, p <.04). Discussion: Overall results highlight the social patterns for a diverse sample of low-income urban older adults; education and income are identified as risk factors for social losses, COVID-infection experiences, racial/ethnic discrimination during the COVID-pandemic, and positive change behaviors.
Long-term efficacy and safety of subcutaneous concizumab prophylaxis in hemophilia A and hemophilia A/B with inhibitors
Authors: Shapiro Amy D. , Angchaisuksiri Pantep , Astermark Jan , Benson Gary , Castaman Giancarlo , Eichler Hermann , Jiménez-Yuste Victor , Kavakli Kaan , Matsushita Tadashi , Poulsen Lone Hvitfeldt , Wheeler Allison P. , Young Guy , Zupančić-Šalek Silva , Oldenburg Johannes , Chowdary Pratima
Published: March 2022

Despite current therapies, there remains an unmet need for treatment for patients with hemophilia. The main parts of two phase 2 trials established clinical proof-of-concept for once-daily, subcutaneous concizumab prophylaxis in patients with hemophilia A/B with inhibitors (HAwI/HBwI; explorer4) and severe hemophilia A without inhibitors (HA; explorer5). Here, we present results from extension parts of these trials, included to evaluate longer term safety and efficacy. Both trials included main (≥24 weeks) and extension (52-102 weeks) parts, with patients receiving concizumab 0.15 mg/kg with potential dose escalation to concizumab 0.20 or 0.25 mg/kg if they experienced ≥3 treated spontaneous bleeding episodes within 12 weeks. Endpoints included annualized bleeding rate (ABR), adverse events (AEs), and occurrence of antidrug antibodies. Thromboembolic events were AEs of special interest. Thirty-six patients with HA, 15 with HAwI, and 10 with HBwI were exposed to concizumab. Estimated ABRs during the main + extension parts at last dose level were 4.8 (95% confidence interval [CI], 3.2-7.2) and 6.4 (95% CI, 4.1-9.9) in explorer4 and explorer5, respectively (spontaneous ABRs were 1.8 [95% CI, 1.2-2.6] and 2.1 [95% CI, 1.3-3.3]). Most AEs were mild, with no deaths, events leading to withdrawal, or thromboembolic events. Anti-drug antibodies developed in 25% of patients and were low titer and transient, with no observed clinical effect in most cases. Results of the main + extension parts of these trials were consistent with results of the main parts. Ongoing phase 3 trials will further evaluate concizumab as a once-daily, subcutaneous treatment across hemophilia subtypes. These trials were registered at www.clinicaltrials.gov as #NCT03196284 and #NCT03196297.
Miniaturized and Actively Tunable Triple-Band Terahertz Metamaterial Absorber Using an Analogy I-Typed Resonator
Authors: Wang Ben-Xin , Xu Chongyang , Duan Guiyuan , Jiang Jieying , Xu Wei , Yang Zhuchuang , Wu Yangkuan
Published: March 2022

Triple-band terahertz metamaterial absorber with design of miniaturization and compactness is presented in this work. The unit cell of the terahertz absorber is formed by an analogy I-typed resonator (a rectangular patch with two small notches) deposited on top of dielectric sheet and metallic mirror. The miniaturized structure design exhibits three discrete frequency points with near-perfect absorption at terahertz regime. The three absorption peaks could be ascribed to localized resonances of analogy I-typed resonator, while the response positions of these absorption peaks at the analogy I-typed resonator are different by analyzing the near-field patterns of these resonance peaks. Changes in structure parameters of the analogy I-typed resonator are also investigated. Simulation results revealed that the notch sizes of the rectangular patch are the key factor to form the triple-band near-perfect absorption. Further structure optimization is given to demonstrate triple-band polarization insensitive performance. Moreover, actively tunable absorption properties are realized by inserting or introducing vanadium dioxide with adjustable conductivity into the metamaterial structure. It is revealed that the insulator–metal phase transition of vanadium dioxide is the main reason for the modulation of absorption performance. Compared with previous multiple-band absorbers, the device given here has excellent features of high degrees of simplification, miniaturization, and active modulation, these are important in practical applications.
The expression of SAH, IL-1β, Hcy, TNF-α and BDNF in coronary heart disease and its relationship with the severity of coronary stenosis
Authors: Wu You , Wang Lin , Zhan Yu , Zhang Zhixin , Chen Dan , Xiang Yang , Xie Cui
Published: March 2022

Background

To investigate the expression of serum S-adenosylhomocysteine (SAH), interleukin-1β (IL-1β), serum homocysteine (Hcy), tumor necrosis factor-α (TNF-α) and brain derived neurotrophic factor (BDNF) in coronary heart disease and their relationship with the degree of coronary artery disease.

Methods

A total of 132 patients with coronary heart disease (CHD) from March 2020 to April 2021 were included in this retrospective study. The experimental group was composed of CHD patients, including single-vascular group (46 cases), dual-vascular group (49 cases), and multi-vascular group (37 cases). 145 healthy subjects during the same period for physical examination constituted the control group.

Results

The levels of SAH, IL-1β, Hcy, TNF-α and BDNF in single-vascular group, dual-vascular group and multi-vascular group were higher than that in control group, and the differences were statistically significant (P < 0.05). The serum levels of SAH, IL-1β, Hcy, TNF-α and BDNF in multi-vascular group were higher than those in single-vascular group and dual-vascular group, and the serum levels of SAH, IL-1β, Hcy, TNF-α and BDNF in dual-vascular group were higher than those in single-vascular group, with statistical significance (P < 0.05). Kendall’s tau-b correlation showed that the levels of SAH, IL-1β, Hcy, TNF-α and BDNF were positively correlated with the number of stenosis vessels (r = 0.421, 0.533, 0.301, 0.265, 0.678, P = 0.016, 0.009, 0.023, 0.036, 0.004).

Conclusion

SAH, IL-1β, Hcy, TNF-α and BDNF in serum of patients with CHD can be used as effective biological indicators to monitor the degree of CHD and severity of coronary stenosis.
Left atrial dysfunction may precede left atrial enlargement and abnormal left ventricular longitudinal function: a cardiac MR feature tracking study
Authors: Zhou Di , Yang Wenjing , Yang Yingxia , Yin Gang , Li Shuang , Zhuang Baiyan , Xu Jing , He Jian , Wu Weichun , Jiang Yong , Sun Xiaoxin , Wang Yining , Sirajuddin Arlene , Zhao Shihua , Lu Minjie
Published: March 2022

Background

The role of the dysfunction of left atrium in the occurrence and development of cardiovascular disease has been gradually recognized. We aim to compare the impact on left atrial (LA) function between patients with hypertrophic cardiomyopathy (HCM) and hypertension (HTN) without LA enlargement using cardiovascular magnetic resonance feature tracking (CMR-FT), and if possible, explore the capability of LA function for providing clinical implication and predicting clinical adverse events in the early stage of cardiovascular disease.

Methods

Consecutive 60 HCM patients and 60 HTN patients with normal LA size among 1413 patients who underwent CMR were retrospectively analyzed as well as 60 controls. Left atrial and ventricular functions were quantified by volumetric and CMR-FT derived strain analysis from long and short left ventricular view cines. The primary endpoint was a composite of all-cause death, stroke, new-onset or worsening heart failure to hospitalization, and paroxysmal or persistent atrial fibrillation.

Results

Compared to the controls, both HTN and HCM participants had impaired LA reservoir function (εs) and conduit function (εe) with the different stage of LA booster pump dysfunction (εa). LA strain was more sensitive than LV longitudinal strain (GLS) for evaluate primary endpoint (εs: 33.9% ± 7.5 vs. 41.2% ± 14.3, p = 0.02; εe: 13.6% ± 6.2 vs. 17.4% ± 10.4, p = 0.03; εa: 20.2% ± 6.0 vs. 23.7% ± 8.8, p = 0.07; GLS: -19.4% ± 6.4 vs. -20.0% ± 6.8, p = 0.70, respectively). After a mean follow-up of 6.8 years, 23 patients reached primary endpoint. Cox regression analyses indicated impaired LA reservoir and booster pump strain were associated with clinical outcomes in patients at the early stage of HTN and HCM (p < 0.05).

Conclusions

CMR-FT-derived strain is a potential and robust tool in demonstrating impaired LA mechanics, quantifying LA dynamics and underlining the impacts on LA-LV coupling in patients with HTN and HCM without LA enlargement. The corresponding LA dysfunction is a promising metric to assess clinical implication and predict prognosis at the early stage, superior to GLS.
Clinicopathologic characteristics and prognosis of synchronous colorectal cancer: a retrospective study
Authors: Chen Huaxian , Yin Shi , Xiong Zhizhong , Li Xianzhe , Zhang Fengxiang , Chen Xijie , Guo Jianping , Xie Minghao , Mao Chaobin , Jin Longyang , Lian Lei
Published: March 2022

Background

The clinical characteristics of synchronous colorectal cancer (SCRC) reported in previous studies differ significantly. Furthermore, little is known about the characteristics of early-onset synchronous colorectal cancer (EO-SCRC). The aim of this retrospective study was to identify the clinicopathological characteristics of SCRC and EO-SCRC and define their relevant prognostic factors.

Methods

Patients who underwent surgery for SCRC and primary unifocal colorectal cancer (PCRC) between January 2007 and December 2020 were included in this study. The clinical, histological, and molecular characteristics of the patient’s tumours were analysed. The primary endpoint was overall survival (OS). Univariate and multivariate Cox regression analyses were used to assess the association between clinicopathological factors and patient survival.

Results

A total of 1554 patients were included in the analysis. Of these, 1132 (72.84%) had PCRC and 422 (27.16%) had SCRC. SCRC occurred more frequently in the elderly (P < 0.001) and in male patients (P = 0.002). The 5-year OS rate was 73.7% ± 2.0% for PCRC and 61.9% ± 3.9% for SCRC (P < 0.05). However, the Cox regression analysis showed that SCRC was not an independent prognostic factor for the prediction of OS. A total of 64 patients (15.17%) in the SCRC group had early-onset colorectal cancer (EOCRC), whereas 257 (22.70%) in the PCRC group had EOCRC (P = 0.001). The proportion of patients with deficient mismatch repair proteins (dMMR) in EO-SCRC subgroup was significantly higher than that in late-onset synchronous colorectal cancer (LO-SCRC) subgroup (23.44% vs. 10.34%, P = 0.006). Patients with EO-SCRC had more TNM stage IV (P < 0.001) and fewer opportunities for radical surgery (79.69% vs. 92.22%, P = 0.007) than those with early-onset primary unifocal colorectal cancer (EO-PCRC). There was no significant difference in 5-year OS between the EO-SCRC and LO-SCRC subgroups (P = 0.091) and between the EO-SCRC and EO-PCRC subgroups (P = 0.094). Multivariate analysis revealed that EOCRC was an independent good prognostic parameter for colorectal cancer (CRC) and SCRC.

Conclusion

For patients with operative treatment, EO-SCRC is different from LO-SCRC and EO-PCRC. Patients with SCRC show a poorer survival rate than those with PCRC. However, SCRC is not an independent prognostic factor for CRC, whereas EOCRC is a good prognostic factor for CRC and SCRC.
Intestinal parasites in stool testing among refugees at a primary care clinic in Toronto, Canada
Authors: Müller Frank , Chandra Shivani , Bogoch Isaac I. , Rashid Meb , Redditt Vanessa
Published: March 2022

Background

Enteric parasites are endemic in many of the countries from which refugees originate. Clinical guidelines vary in approaches to screening for and treating intestinal parasites in refugee receiving countries. This study aims to investigate the prevalence and species of intestinal parasites identified in stool ova and parasite (O&P) specimens in a sample of newly arrived refugees in Toronto, Canada.

Methods

We conducted a retrospective chart review of 1042 refugee patients rostered at a specialized primary care clinic in Toronto from December 2011 to September 2016. Patients who completed recommended stool O&P analyses were included. Basic sociodemographic and clinical variables and results of stool O&P were examined.

Results

419 patients (40.2%) had a stool O&P positive for any protozoan or helminth species. Sixty-nine patients (6.6%) had clinically significant parasite species (excluding B hominis, D fragilis, and E dispar, given their lower risk for causing symptoms/complications): 2.3% had clinically significant protozoans and 4.2% had helminths on stool analysis.

Conclusion

Given the relatively low prevalence of clinically significant parasites identified, our findings do not support universal screening for enteric parasites with stool O&P among refugee claimants/asylum seekers. However, stool analysis should be considered in certain clinical situations, as part of a more tailored approach.
Bacteraemia and quick Sepsis Related Organ Failure Assessment (qSOFA) are independent risk factors for long-term mortality in very elderly patients with suspected infection: retrospective cohort study
Authors: Hernández-Quiles Rubén , Merino-Lucas Esperanza , Boix Vicente , Fernández-Gil Adela , Rodríguez-Díaz Juan C. , Gimeno Adelina , Valero Beatriz , Sánchez-Martínez Rosario , Ramos-Rincón Jose-Manuel
Published: March 2022

Background

In older adult patients, bloodstream infections cause significant mortality. However, data on long-term prognosis in very elderly patients are scarce. This study aims to assess 1-year mortality from bacteraemia in very elderly patients.

Methods

Retrospective cohort study in inpatients aged 80 years or older and suspected of having sepsis. Patients with (n = 336) and without (n = 336) confirmed bacteraemia were matched for age, sex, and date of culture, and their characteristics were compared. All-cause mortality and risk of death were assessed using the adjusted hazard ratio (aHR).

Results

Compared to controls, cases showed a higher 1-year mortality (34.8% vs. 45.2%) and mortality rate (0.46 vs. 0.69 deaths per person-year). Multivariable analysis showed significant risk of 1-year mortality in patients with bacteraemia (aHR: 1.31, 95% confidence interval [CI] 1.03–1.67), quick Sepsis Related Organ Failure Assessment (qSOFA) score of 2 or more (aHR: 2.71, 95% CI 2.05–3.57), and age of 90 years or older (aHR 1.53, 95% CI 1.17–1.99).

Conclusions

In elderly patients suspected of sepsis, bacteraemia is associated with a poor prognosis and higher long-term mortality. Other factors related to excess mortality were age over 90 years and a qSOFA score of 2 or more.
Pentosan polysulfate ameliorates fibrosis and inflammation markers in SV40 MES13 cells by suppressing activation of PI3K/AKT pathway via miR-446a-3p
Authors: Xiao Liangxiang , Chen Anqun , Gao Qing , Xu Bo , Guo Xiaodan , Guan Tianjun
Published: March 2022

Background

Renal fibrosis is a common outcome of various renal damage, including diabetic nephropathy (DN), the leading cause of end-stage renal disease. Currently, there are no effective therapies for renal fibrosis. The present study aimed to determine whether pentosan polysulphate sodium (PPS), a FDA approved medication for interstitial cystitis, protects diabetic renal fibrosis.

Methods

Cell viability and apoptosis were evaluated in mouse mesangial cells (SV40-MES13) after incubating with the advanced glycation end products (AGEs), which play important roles in the pathogenesis of DN. Western blot and ELISA were performed to determine the expression of transforming growth factor-beta1 (TGF-β1) and fibronectin (FN), two biomarkers of renal fibrosis, as well as interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFα), two biomarkers of inflammation. The miRNA-mRNA regulatory network involved in the phosphatidylinositol 3-kinase (PI3K)/Ser and Thr Kinase (AKT) signalling was investigated by miRNA deep sequencing and validated by RT-PCR and miRNA transfection.

Results

AGEs significantly inhibited cell proliferation and promoted cell apoptosis, which was associated with the overexpression of TGF-β1, FN, IL-6, and TNFα. PPS almost completely reversed AGEs-induced biomarkers of fibrosis and inflammation, and significantly altered the miRNA expression profile in AGEs-treated cells. Notably, the PI3K/AKT signalling was one of the most significantly enriched pathways targeted by PPS-related differentially expressed miRNAs. PPS significantly up-regulated miR-466a-3p, which was shown to target PIK3CA, and mediated the inhibitory effect of PPS on AGEs-induced activation of PI3K/AKT pathway.

Conclusions

The treatment of PPS protected against AGEs-induced toxicity in SV40 MES13 cells via miR-466a-3p-mediated inhibition of PI3K/AKT pathway.