bluuebunny/crossref_metadata_2025 huggingface dataset:
Fibroblast Growth Factor 21 Correlates with the Prognosis of Dilated Cardiomyopathy
Authors: Gu Lingyun , Jiang Wenlong , Zheng Ruolong , Yao Yuyu , Ma Genshan
Published: December 2020

Objectives: The goal of this study was to evaluate whether serum fibroblast growth factor 21 (FGF21) levels can be used to predict the prognosis of dilated cardiomyopathy (DCM). Methods: 241 patients with DCM and 80 control subjects were recruited and followed up for an average of 16.12 months. A 2-dimensional (2-D) echocardiography technique was performed to calculate the left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) percentages. The levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and creatinine were measured in routine clinical laboratory tests. Serum FGF21 levels were measured by enzyme-linked immunosorbent assay (ELISA). Results: The levels of serum FGF21 were significantly higher in the DCM groups than in the control groups (225.85 ± 32.57 vs. 145.36 ± 30.57, p < 0.001). Serum FGF21 levels were positively correlated with the NYHA functional classification of heart failure (HF) (r = 0.610, p < 0.001) and NT-proBNP levels (r = 0.741, p < 0.001). Moreover, a negative correlation was observed between the serum FGF21 levels and the LVEF (r = –0.402, p < 0.001). FGF21, NT-proBNP, the LVEF and a history of atrial fibrillation (AF) correlated significantly with NYHA class IV (p < 0.05). The AUC of NT-proBNP for predicting NYHA class IV in DCM patients was greater than that of FGF21 (0.830 vs. 0.772, p < 0.001). Overall, 133 patients with DCM were recorded at the end point. Kaplan-Meier analysis results showed that the survival probability of those individuals with high levels of FGF21 and NT-proBNP was significantly lower than of those with low levels of these factors (p < 0.001). In the multivariate Cox analysis, FGF21 (HR 2.561; 95% CI 1.705–3.849) and NT-proBNP (HR 4.458; 95% CI 2.645–7.513) were independent predictors of a poor prognosis in DCM patients. Conclusions: Serum FGF21 levels were associated with the risk factors, severity, and prognosis of DCM. Therefore, FGF21 may serve as a novel biomarker for the prognosis of DCM.
Association of Ambulatory Blood Pressure with All-Cause Mortality and Cardiovascular Outcomes in Peritoneal Dialysis Patients
Authors: Dai Shuqi , Chen Yun , Shang Da , Ge Xiaolin , Xie Qionghong , Hao Chuan-Ming , Zhu Tongying
Published: December 2020

Background: Ambulatory blood pressure monitoring is the gold standard for the diagnosis of hypertension, but its effects on all-cause mortality and cardiovascular outcomes in peritoneal dialysis (PD) patients remain uncertain. We aimed to investigate the association between ambulatory blood pressure and clinical outcomes in PD patients. Methods: A prospective, observational cohort study was conducted in PD patients enrolled from March 2001 to July 2018 and followed until October 2019. Blood pressure was evaluated using 24-h ambulatory blood pressure monitoring. The endpoints included all-cause mortality, cardiovascular mortality, and cardiovascular events. Multivariable Cox regression was used to identify the associations between ambulatory blood pressure and endpoints. Subsequently, multivariable logistic regression was conducted to identify factors associated with elevated pulse pressure (PP). Results: A total of 260 PD patients (154 men, 59.2%) were recruited. The median follow-up duration was 40.7 months. Our studies revealed that PP was an independent predictor of all-cause mortality (hazard ratio [HR], 1.018; 95% CI, 1.001–1.034; p = 0.032), cardiovascular mortality (HR, 1.039; 95% CI, 1.017–1.061; p < 0.001), and cardiovascular events (HR, 1.028; 95% CI, 1.011–1.046; p = 0.001). Systolic blood pressure was an independent predictor of cardiovascular mortality (HR, 1.023; 95% CI, 1.007–1.040; p = 0.005) and cardiovascular events (HR, 1.018; 95% CI, 1.006–1.030; p = 0.003). Vascular calcification was significantly associated with elevated PP (OR, 3.069; 95% CI, 1.632–5.772; p = 0.001). Conclusion: 24-h ambulatory PP was the most significant predictor of all blood pressure indicators for clinical outcomes in PD patients.
Periodization in Anterior Cruciate Ligament Rehabilitation: A Novel Framework
Authors: Kakavas George , Malliaropoulos Nikolaos , Bikos Georgios , Pruna Ricard , Valle Xavier , Tsaklis Panagiotis , Maffulli Nicola
Published: December 2020

More than 250,000 anterior cruciate ligament (ACL) injuries occur each year in the USA, and approximately 65% of these injuries undergo reconstructive surgery. Appropriate rehabilitation after ACL reconstruction can yield predictably good outcomes, with return to previous levels of activity and high knee function. At present, periodization is used at all levels of sports training. Whether conceptualized and directed by coaches, or by athletes themselves, competitors structure their training in a cyclic fashion, enabling athletes to best realize their performance goals. In practical application, sport physical therapists use periodization: postoperative “protocols” serve as rudimentary forms of periodization, albeit implemented over shorter time frames than that typically employed in preparation for competition. An ACL injury should not be considered a “simple” musculoskeletal pathology with only local mechanical or motor dysfunctions. Together with the psychological trauma and reduction in physical capacity, there is a cascade of events, including neurological insult to the central nervous system and reduction in afferences to the sensorimotor system. Rehabilitation should consider all these issues, and periodization would allow to better define and to plan aims and objectives to return athletes to their sport. Technological resources including advanced neuroimaging methods, virtual reality for injury risk screening and return to sport assessment, and interactive artificial reality-based neuromuscular training methods offer new approaches and tools to address this important biomedical problem. The cost and availability of many of these technologies will continue to decrease, providing greater availability, scientific rigor, and ultimately, utility for cost-effective and data-driven assessments.
Elevated Troponin T and Enlarged Left Atrium Are Associated with the Incidence of Atrial Fibrillation in Patients with CKD Stage 4–5
Authors: Hakamäki Markus , Hellman Tapio , Lankinen Roosa , Koivuviita Niina , Pärkkä Jussi , Kallio Petri , Kiviniemi Tuomas , Airaksinen K.E. Juhani , Järvisalo Mikko J. , Metsärinne Kaj
Published: December 2020

Introduction: Atrial fibrillation (AF) and CKD are commonly coexisting conditions. However, data on epidemiology of AF in patients with CKD stage 4–5 is scarce. Methods: We prospectively enrolled 210 consecutive non-dialysis patients with CKD stage 4–5 between 2013 and 2017. Follow-up data on AF incidence along with medical history, laboratory tests, and echocardiography at baseline were gathered. Results: At baseline, mean age was 62 years, estimated glomerular filtration rate 12.8 mL/min, and 73/210 (34.8%) participants were female. Altogether, 41/210 (19.5%) patients had a previous diagnosis of AF. After median follow-up of 46 [IQR 27] months, new-onset AF occurred in 33/169 (19.5%) patients (69.9 events/1,000 person-years). In the Cox proportional hazard model, age >60 years (HR 4.27, CI 95% 1.57–11.64, p < 0.01), elevated troponin T (TnT) >50 ng/L (HR 3.61, CI 95% 1.55–8.37, p < 0.01), and left atrial volume index (LAVI) >30 mL/m2 (HR 4.82, CI 95% 1.11–21.00, p = 0.04) were independently associated with the incidence of new-onset AF. Conclusion: The prevalence and incidence of AF was markedly high in this prospective study on patients with CKD stage 4–5. Elevated TnT and increased LAVI were independently associated with the occurrence of new-onset AF in patients with severe CKD.
Estrogens and the Angiotensin II Type 2 Receptor Control Flow-Mediated Outward Remodeling in the Female Mouse Mesenteric Artery
Authors: Vessieres Emilie , Guihot Anne-Laure , Grimaud Linda , Rivron Jordan , Arnal Jean-François , Loufrani Laurent , Henrion Daniel
Published: December 2020

Flow-mediated outward remodeling (FMR) is involved in postischemic revascularization. Angiotensin II type 2 receptor (AT2R), through activation of T-cell-mediated IL-17 production, and estrogens are involved in FMR. Thus, we investigated the interplay between estrogens and AT2R in FMR using a model of ligation of feed arteries supplying collateral pathways in mouse mesenteric arteries in vivo. Arteries were collected after 2 (inflammatory phase), 4 (diameter expansion phase), and 7 days (remodeling completed). We used AT2R+/+ and AT2R−/− ovariectomized (OVX) female mice treated or not with 17-beta-estradiol (E2). Seven days after ligation, arterial diameter was larger in high flow (HF) compared to normal flow (NF) arteries. FMR was absent in OVX mice and restored by E2. AT2R gene expression was higher in HF than in NF arteries only in E2-treated OVX AT2R+/+ mice. CD11b and TNF alpha levels (inflammatory phase), MMP2 and TIMP1 (extracellular matrix digestion), and NOS3 (diameter expansion phase) expression levels were higher in HF than in NF arteries only in E2-treated AT2R+/+ mice, not in the other groups. Thus, E2 is necessary for AT2R-dependent diameter expansion, possibly through activation of T-cell AT2R, in arteries submitted chronically to high blood flow.
Impact of Plasma Potassium Normalization on Short‐Term Mortality in Patients With Hypertension and Hyperkalemia
Authors: Krogager Maria Lukács , Søgaard Peter , Torp‐Pedersen Christian , Bøggild Henrik , Gislason Gunnar , Kragholm Kristian
Published: December 2020

Background

Hyperkalemia can be harmful, but the effect of correcting hyperkalemia is sparsely studied. We used nationwide data to examine hyperkalemia follow‐up in patients with hypertension.

Methods and Results

We identified 7620 patients with hypertension, who had the first plasma potassium measurement ≥4.7 mmol/L (hyperkalemia) within 100 days of combination antihypertensive therapy initiation. A second potassium was measured 6 to 100 days after the episode of hyperkalemia. All‐cause mortality within 90 days of the second potassium measurement was assessed using Cox regression. Mortality was examined for 8 predefined potassium intervals derived from the second measurement: 2.2 to 2.9 mmol/L (n=37), 3.0 to 3.4 mmol/L (n=184), 3.5 to 3.7 mmol/L (n=325), 3.8 to 4.0 mmol/L (n=791), 4.1 to 4.6 mmol/L (n=3533, reference), 4.7 to 5.0 mmol/L (n=1786), 5.1 to 5.5 mmol/L (n=720), and 5.6 to 7.8 mmol/L (n=244). Ninety‐day mortality in the 8 strata was 37.8%, 21.2%, 14.5%, 9.6%, 6.3%, 6.2%, 10.0%, and 16.4%, respectively. The multivariable analysis showed that patients with concentrations >5.5 mmol/L after an episode of hyperkalemia had increased mortality risk compared with the reference (hazard ratio [HR], 2.27; 95% CI, 1.60–3.20;
P
<0.001). Potassium intervals 3.5 to 3.7 mmol/L and 3.8 to 4.0 mmol/L were also associated with increased risk of death (HR, 1.71; 95% CI, 1.23–2.37;
P
<0.001; HR, 1.36; 95% CI, 1.04–1.76;
P
<0.001, respectively) compared with the reference group. We observed a trend toward increased risk of death within the interval 5.1 to 5.5 mmol/L (HR, 1.29; 95% CI, 0.98–1.69). Potassium concentrations <4.1 mmol/L and >5.0 mmol/L were associated with increased risk of cardiovascular death.

Conclusions

Overcorrection of hyperkalemia to levels <4.1 mmol/L was frequent and associated with increased all‐cause and cardiovascular mortality. Potassium concentrations >5.5 mmol/L were also associated with an increased all‐cause and cardiovascular mortality.
Baroreflex Sensitivity in Patients With Atrial Fibrillation
Authors: Miyoshi Miho , Kondo Hidekazu , Ishii Yumi , Shinohara Tetsuji , Yonezu Keisuke , Harada Taisuke , Sato Hiroki , Yano Yudai , Yoshimura Seiichiro , Abe Ichitaro , Shuto Takashi , Akioka Hidefumi , Teshima Yasushi , Wada Tomoyuki , Yufu Kunio , Nakagawa Mikiko , Anai Hirofumi , Miyamoto Shinji , Takahashi Naohiko
Published: December 2020

Background

It has been reported that atrial fibrillation (AF) may contribute to impairment of baroreflex sensitivity (BRS). However, the difference of BRS between patients with persistent AF (PeAF) and those with paroxysmal AF (PAF) is unknown. We tested the hypothesis that patients with PeAF have a more impaired BRS compared with those with PAF.

Methods and Results

From October 2015 onwards, a total of 67 patients (14 women [20.9%]; mean age 65.2±10.1 years) with PAF (n=46, 68.7%) and PeAF (n=21, 31.3%), who underwent catheter ablation, were prospectively enrolled. The baseline BRS was evaluated during sinus rhythm. The baseline BRS in patients with PeAF was significantly lower than those with PAF (2.97 [0.52–6.62] ms/mm Hg versus 4.70 [2.36–8.37] ms/mm Hg,
P
=0.047). The BRS was significantly depressed after catheter ablation in all the patients (4.66 [1.80–7.37] ms/mm Hg versus 0.55 [−0.15 to 1.22] ms/mm Hg,
P
<0.001). However, the depression of BRS because of catheter ablation appeared attenuated in patients with PeAF when compared with those with PAF. The number of patients who did not show depression of BRS was significantly greater, that is, patients with PeAF (3/12, 25%) than those with PAF (0/46, 0%,
P
<0.01).

Conclusions

Our findings demonstrated that the baseline BRS was more depressed in patients with PeAF compared with PAF. Catheter ablation depressed BRS irrespective of the type of AF, with a greater effect in patients with PAF than PeAF.
Statin Use for Atherosclerotic Cardiovascular Disease Prevention Among Sexual Minority Adults
Authors: Guo Yi , Wheldon Christopher W. , Shao Hui , Pepine Carl J. , Handberg Eileen M. , Shenkman Elizabeth A. , Bian Jiang
Published: December 2020

Background

Sexual minority, or lesbian, gay, and bisexual (LGB), individuals are at increased risk for cardiovascular disease attributable to elevated rates of health risk factors. However, although there is clear evidence that statin use can prevent cardiovscular disease in certain adult populations, no studies have examined how statins are being used among the LGB population. This study aimed to examine the prevalence and predictors of statin use among LGB and non‐LGB individuals using Facebook‐delivered online surveys.

Methods and Results

We conducted a cross‐sectional online survey about statin use in adults ≥40 years of age between September and December 2019 using Facebook advertising (n=1531). We calculated the prevalence of statin use by age, sexual orientation, and statin benefit populations. We used multivariable logistic regression to examine whether statin use differed by sexual orientation, adjusting for covariates. We observed a significantly lower rate of statin use in the LGB versus non‐LGB respondents (20.8% versus 43.8%;
P
<0.001) in the primary prevention population. However, the prevalence of statin use was not statistically different in the LGB versus non‐LGB respondents in the secondary prevention population. Adjusting for the covariates, the LGB participants were less likely to use statins than the non‐LGB respondents in the primary prevention population (odds ratio, 0.37; 95% CI, 0.19–0.70).

Conclusions

Our results are the first to emphasize the urgent need for tailored, evidence‐based cardiovascular disease prevention programs that aim to promote statin use, and thus healthy aging, in the LGB population.
Intravesical Bacillus Calmette-Guerin and its complications: 12 years of learning experience in a single local institution
Authors: Yang X , Toh Q , Huang HH , Sng LH , Tan TT , Ng LG
Published: December 2020

INTRODUCTION Intravesical Bacillus Calmette-Guerin (BCG) therapy is the standard adjuvant treatment for non-muscle-invasive bladder carcinoma (NMIBC) with carcinoma in situ, in addition to tumour resection. We aimed to study BCG complications that preclude adequate treatment of NMIBC in an Asian population. METHODS This retrospective study was conducted using a large, prospectively maintained bladder cancer database. 336 patients received intravesical BCG therapy for bladder cancer in our institution between 2004 and 2016, with an average follow-up duration of 63 months. RESULTS The study included 258 (76.8%) male and 78 (23.2%) female patients. The median age of the patients at diagnosis of bladder cancer was 69 (range 17–94) years, and the median number of BCG instillations was 6 (range 1–27). 52 (15.5%) patients received maintenance therapy. The most common complications included urinary tract infection with/without sepsis (n = 18, 5.4%), haematuria (n = 9, 2.7%) and acute urinary retention (n = 4, 1.2%). 93.3% of the patients with complications presented early, within one month of completion of therapy. 22 out of 30 complications were Clavien-Dindo grade ≤ 2. 10 (33.3%) patients were admitted to hospital because of BCG-related adverse effects. The most common reasons for termination were urosepsis (2/30, 6.7%) and acute urinary retention (2/30, 6.7%). Patients aged ≥ 80 years at diagnosis were at higher risk of developing BCG-related complications (19.0% vs. 7.5%, p = 0.01). CONCLUSION This retrospective cohort and subgroup study showed that intravesical BCG therapy is well tolerated and has a low incidence of complications even in the elderly and patients with multiple comorbidities.
Validation of the kidney failure risk equation in predicting the risk of progression to kidney failure in a multi-ethnic Singapore chronic kidney disease cohort
Authors: Kwek JL , Pang HQJ , Li H , Lim WWL , Choo JCJ , Choong HL , Foo MWY , Chan CM
Published: December 2020

INTRODUCTION The Kidney Failure Risk Equation (KFRE) was developed to predict the risk of progression to end-stage kidney disease (ESKD). Although the KFRE has been validated in multinational cohorts, the Southeast Asian population was under-represented. This study aimed to validate the KFRE in a multi-ethnic Singapore chronic kidney disease (CKD) cohort. METHODS Stage 3–5 CKD patients referred to the renal medicine department at Singapore General Hospital in 2009 were included. The primary outcome (time to ESKD) was traced until 30 June 2017. The eight- and four-variable KFRE (non-North America) models using age, gender, estimated glomerular filtration rate, urine albumin-creatinine ratio, serum albumin, phosphate, bicarbonate and calcium were validated in our cohort. Cox regression, likelihood ratio (Χ2), adequacy index, Harrell’s C-index and calibration curves were calculated to assess the predictive performance, discrimination and calibration of these models on the cohort. RESULTS A total of 1,128 patients were included. During the study period, 252 (22.3%) patients reached ESKD at a median time to ESKD of 84.8 (range 0.1–104.7) months. Both the eight- and four-variable KFRE models showed excellent predictive performance and discrimination (eight-variable: C-index 0.872, 95% confidence interval [CI] 0.850–0.894, adequacy index 97.3%; four-variable: C-index 0.874, 95% CI 0.852–0.896, adequacy index 97.9%). There was no incremental improvement in the prediction ability of the eight-variable model over the four-variable model in this cohort. CONCLUSION The KFRE was validated in a multi-ethnic Singapore CKD cohort. This risk score may help to identify patients requiring early renal care.
A review of COVID-19-related thrombosis and anticoagulation strategies specific to the Asian population
Authors: Poh Kai Chin , Tay Victoria Yu Jia , Lin Sarah Huixin , Chee Huei Leng , Thangavelautham Suhitharan
Published: December 2020

The coronavirus disease 2019 (COVID-19) pandemic has placed an immense burden on healthcare systems worldwide. There is intensive research targeted at better understanding of the virus pathogenicity, development of effective treatment strategies and vaccines against COVID-19. It is increasingly being recognised that the pathogenicity of COVID-19 extends beyond the respiratory system. In severe cases, there can be widespread activation of the immune system, vascular injury and a resultant pro-thrombotic state. Severe COVID-19 is widely regarded as a risk factor for venous thromboembolism. Interim European and American guidelines have been created to guide anticoagulation strategies in COVID-19 patients. However, it is unclear if these guidelines can be extrapolated directly to Asians, in whom there are differences in the baseline risk of thrombosis and bleeding. Our review article aimed to summarise the current understanding of arteriovenous thromboembolic complications in COVID-19 and discuss management strategies for prevention and treatment of thrombotic events in Asian COVID-19 patients.
Minimum Snow/Ice Extent over the Northern Circumpolar Landmass in 2000–19: How Much Snow Survives the Summer Melt?
Authors: Trishchenko Alexander P. , Ungureanu Calin
Published: December 2020

A novel satellite image processing technique developed at the Canada Centre for Remote Sensing has been utilized to produce annual time series of the minimum snow/ice (MSI) extent over the northern circumpolar landmass area (9,000 km × 9,000 km) for 2000–19. The information has been derived from the Moderate Resolution Imaging Spectroradiometer 10-day clear-sky composites generated at 250-m spatial resolution over the April–September period. Derived interannual variations agree very well with the warm-season average surface air temperatures from the European reanalysis (ERA5). The region-average correlation coefficient is −0.78. The total MSI extent demonstrated a statistically significant declining trend equal to −1,477 km2 yr−1. Results have been compared with data from the Randolph Glacier Inventory (RGI 6.0). The comparison points to a significant contribution of minimum seasonal snow cover relative to RGI glacierized areas. Quantitative estimates obtained for the first time showed that the region-average snow extent that survives the summer melt and resides outside of RGI area can be as high as 15% (or 53 × 103 km2) while in the northern Canadian Arctic it can reach 41% (or 43 × 103 km2). The derived MSI time series data can be recommended to the glacier and land-cover scientific community as a source of validation data and annual updates of snow and ice maps over the northern circumpolar landmass.
Human Capital Formation and Economic Growth in Sub-Saharan African Countries: An Empirical Investigation
Authors: Akinlo Taiwo , Oyeleke Olusola Joel
Published: December 2020

This study explored human capital–economic growth nexus and determine if the relationship is influenced by the level of economic development in 36 sub-Saharan African countries during the period from 1986–2018. The study used dynamic generalised method of moments (GMM) and static estimations to achieve the objective of the study. The study used alternative indicators of human capital to provide strong evidence and robust results. The study also considered the income groups within the region. The study found that human capital contributed to economic growth, as its indicators are positive and significant. The study also found that the connection that exists between human capital and economic growth also depends on the level of economic development. Generally, our finding emphasised that both education and health measures of human capital are important, and that policymakers must consider the level of economic development while formulating policies that can enhance the impact of human capital on economic growth in the Sub-Saharan Africa region.
Qualitative and Quantitative Neuropathology Approaches Using Magnetic Resonance Microscopy (Diffusion Tensor Imaging) and Stereology in a Hexachlorophene Model of Myelinopathy in Sprague-Dawley Rats
Authors: Sills Robert C. , Johnson G. Allan , Anderson Robert J. , Johnson Crystal L. , Staup Michael , Brown Danielle L. , Churchill Sheba R. , Kurtz David M. , Cushman Jesse D. , Waidyanatha Suramya , Robinson Veronica Godfrey , Cesta Mark F. , Andrews Danica M.K. , Behl Mamta , Shockley Keith R. , Little Peter B.
Published: December 2020

It is well established that hexachlorophene, which is used as an antibacterial agent, causes intramyelinic edema in humans and animal models. The hexachlorophene myelinopathy model, in which male Sprague-Dawley rats received 25 to 30 mg/kg hexachlorophene by gavage for up to 5 days, provided an opportunity to compare traditional neuropathology evaluations with magnetic resonance microscopy (MRM) findings. In addition, stereology assessments of 3 neuroanatomical sites were compared to quantitative measurements of similar structures by MRM. There were positive correlations between hematoxylin and eosin and luxol fast blue stains and MRM for identifying intramyelinic edema in the cingulum of corpus callosum, optic chiasm, anterior commissure (aca), lateral olfactory tracts, pyramidal tracts (py), and white matter tracts in the cerebellum. Stereology assessments were focused on the aca, longitudinal fasciculus of the pons, and py and demonstrated differences between control and treated rats, as was observed using MRM. The added value of MRM assessments was the ability to acquire qualitative 3-dimensional (3-D) images and obtain quantitative measurements of intramyelinic edema in 26 neuroanatomical sites in the intact brain. Also, diffusion tensor imaging (fractional anisotropy [FA]) indicated that there were changes in the cytoarchitecture of the white matter as detected by decreases in the FA in the treated compared to the control rats. This study demonstrates creative strategies that are possible using qualitative and quantitative assessments of potential white matter neurotoxicants in nonclinical toxicity studies. Our results lead us to the conclusion that volumetric analysis by MRM and stereology adds significant value to the standard 2-D microscopic evaluations.
Rationale and Methodology of the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS): A 16-year Follow-up Survey: Raison D’être Et Méthodologie De L’enquête De Suivi Sur La Santé Mentale Des Membres Des Forces Armées Canadiennes Et Des Anciens Combattants, 2018 (ESSMFACM)
Authors: Afifi Tracie O. , Bolton Shay-Lee , Mota Natalie , Marrie Ruth Ann , Stein Murray B. , Enns Murray W. , El-Gabalawy Renée , Bernstein Charles N. , Mackenzie Corey , VanTil Linda , MacLean Mary Beth , Wang Jian Li , Patten Scott , Asmundson Gordon J. G. , Sareen Jitender
Published: December 2020

Objective:

Knowledge is limited regarding the longitudinal course and predictors of mental health problems, suicide, and physical health outcomes among military and veterans. Statistics Canada, in collaboration with researchers at the University of Manitoba and an international team, conducted the Canadian Armed Forces Members and Veterans Mental Health Follow-Up Survey (CAFVMHS). Herein, we describe the rationale and methods of this important survey.

Method:

The CAFVMHS is a longitudinal survey design with 2 time points (2002 and 2018). Regular Force military personnel who participated in the first Canadian Community Health Survey Cycle 1.2—Mental Health and Well-Being, Canadian Forces Supplement (CCHS-CFS) in 2002 ( N = 5,155) were reinterviewed in 2018 ( n = 2,941). The World Mental Health Survey–Composite International Diagnostic Interview was used with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition ( DSM-IV) criteria.

Results:

The CAFVMHS includes 2,941 respondents (66% veterans; 34% active duty) and includes data on mental disorder diagnoses, physical health conditions, substance use, medication use, general health, mental health services, perceived need for care, social support, moral injury, deployment experiences, stress, physical activity, military-related sexual assault, childhood experiences, and military and sociodemographic information.

Conclusions:

The CAFVMHS provides a unique opportunity to further understand the health and well-being of military personnel in Canada over time to inform intervention and prevention strategies and improve outcomes. The data are available through the Statistics Canada Research Data Centres across Canada and can be used cross-sectionally or be longitudinally linked to the 2002 CCHS-CFS data.
Correlations between person-descriptive items are predictable from the product of their mid-point-centered social desirability values
Authors: Leising Daniel , Vogel Diana , Waller Vincent , Zimmermann Johannes
Published: December 2020

This paper presents a series of pre-registered analyses testing the same theoretically derived hypothesis: If (a) the attitudes that perceivers have toward targets contribute to the variance of judgments on most items, and (b) items’ rated social desirability values align very closely with the extent to which that is the case, then the product of two items’ mid-point-centered social desirability values should predict the amount of shared variance, and thus the correlation, between these items. This hypothesis applies equally to other ratings and self-ratings. Across samples, effect sizes ranged from r = .36 to r = .80 (average r = .61) and were statistically significant in every single case. We also found that the average effect is much larger for other-ratings ( r = .71) than for self-ratings ( r = .49). This difference was also replicable and is likely rooted in the greater relative importance of the attitude factor in other-ratings, as compared to self-ratings. An exploratory item resampling analysis suggested that scales may achieve good internal consistency, and correlate substantially with other scales, based solely on shared attitude variance. We discuss the relevance of these findings across different domains of psychological assessment, and possible ways of dealing with the issue.
Validity of the Clinical Dementia Rating Scale Sum of Boxes in Staging and Detection of Cognitive Impairment in Mexican Americans
Authors: Julayanont Parunyou , DeToledo John C.
Published: December 2020

Objective:

We evaluated the utility of the Clinical Dementia Rating Sum of Boxes score (CDR-SB) in staging and detecting amnestic-mild cognitive impairment (a-MCI) and Alzheimer’s disease (AD) among Mexican Americans.

Methods:

Receiver operator curves were generated to evaluate the validity of the CDR-SB in staging and detecting a-MCI and AD in 1,073 Mexican Americans (758 controls, 163 a-MCI, and 152 AD).

Results:

Optimal ranges of the CDR-SB were 0, 0.5-4, 4.5-8.0, 8.5-13 and 13.5-18 for staging the global CDR score of 0, 0.5, 1, 2, and 3, respectively. The CDR-SB ≥ 0.5 differentiated the a-MCI patients from the controls (sensitivity 100% and specificity 99.5%) and ≥ 2.0 distinguished the AD from a-MCI patients (sensitivity 83.6% and specificity 87.1%). These cutoffs were also appropriate for patients with ≤6 years of education.

Conclusion:

The CDR-SB is useful to detect and stage a-MCI and AD in Mexican Americans with diverse education levels.
Proceduralizing control and discretion: Human oversight in artificial intelligence policy
Authors: Koulu Riikka
Published: December 2020

This article is an examination of human oversight in EU policy for controlling algorithmic systems in automated legal decision making. Despite the shortcomings of human control over complex technical systems, human oversight is advocated as a solution against the risks of increasing reliance on algorithmic tools. For law, human oversight provides an attractive, easily implementable and observable procedural safeguard. However, without awareness of its inherent limitations, human oversight is in danger of becoming a value in itself, an empty procedural shell used as a stand-in justification for algorithmization but failing to provide protection for fundamental rights. By complementing socio-legal analysis with Science and Technology Studies, critical algorithm studies, organization studies and human-computer interaction research, the author explores the importance of keeping the human in the loop and asks what the human element at the core of legal decision making is. Through algorithmization it is made visible how law conceptualises decision making through human actors, personalises legal decision making through the decision-maker’s discretionary power that provides proportionality and common sense, prevents gross miscarriages of justice and establishes the human encounter deemed essential for the feeling of being heard. The analysis demonstrates the necessary human element embedded in legal decision making, against which the meaningfulness of human oversight needs to be examined.
Nurses’ perspectives of an environment of optimum mental health: a grounded theory study
Authors: Atieno Wagoro Miriam Carole , Duma Sinegugu E
Published: December 2020

Background

The Government’s aspiration to make Kenya a middle-income country and achieve the United Nations' sustainable development goal 3, ‘good health and well-being’, are threatened by poor quality of mental health services. Environment and lack of a conceptual model of nursing to guide care were some of the reasons that were attributed to poor quality of mental health services. The purpose of the study was to discover and describe an appropriate conceptual model of mental health nursing practice. This paper describes the environment which is one of the metaparadigms of a conceptual model grounded on data collected from Kenyan mental health nurses.

Methods

A grounded theory study was conducted with 33 mental health nurses selected by purposive, open and theoretical sampling procedures. The study sites were level 5 and 6 mental health facilities across the country. Data were collected over a period of 11 months through audio-recorded in-depth interviews and field notes. Analysis was performed using Straussian Grounded Theory steps of open, axial and selective coding processes aided by NVivo version 10. Dimensions and properties of environment metaparadigm grounded on nurses’ views were discovered. The study was conducted within the dictates of the institutional and national ethics and research review boards.

Results

Environment evolved as an intervening condition and a supra-system for mental health nursing. A homely environment emerged as a space with properties that nurture optimum mental health contrary to a hostile environment that precipitates mental disorders and prolongs recovery.

Conclusion

Grounded theory methodology was useful in discovering an environment metaparadigm as the context that influences mental health while nursing practice is the central phenomenon for optimum mental health. Nurses can ensure homely environments from diverse cultures and conduct comparative studies on the recovery of patients in the two environments.
Use of antidiabetic medications and risk of chronic obstructive pulmonary disease exacerbation requiring hospitalization: a disease risk score-matched nested case–control study
Authors: Wang Meng-Ting , Lai Jyun-Heng , Huang Ya-Ling , Kuo Feng-Chih , Wang Yun-Han , Tsai Chen-Liang , Tu Min-Yu
Published: December 2020

Background

Exacerbation of chronic obstructive pulmonary disease (COPD) severely impacts the quality of life and causes high mortality and morbidity. COPD is involved with systemic and pulmonary inflammation, which may be attenuated with antidiabetic agents exerting anti-inflammatory effects. Real-world evidence is scant regarding the effects of antidiabetic agents on COPD exacerbation. Accordingly, we conducted a disease risk score (DRS)-matched nested case–control study to systemically assess the association between each class of oral hypoglycemic agents (OHAs) and risk of severe COPD exacerbation in a nationwide COPD population co-diagnosed with diabetes mellitus (DM).

Methods

We enrolled 23,875 COPD patients receiving at least one OHA for management of DM by analyzing the Taiwan National Health Insurance claims database between January 1, 2000, and December 31, 2015. Cases of severe exacerbation were defined as those who had the first hospital admission for COPD. Each case was individually matched with four randomly-selected controls by cohort entry date, DRS (the estimated probability of encountering a severe COPD exacerbation), and COPD medication regimens using the incidence density sampling approach. Conditional logistic regressions were performed to estimate odds ratios (OR) of severe COPD exacerbation for each type of OHAs.

Results

We analyzed 2700 cases of severe COPD exacerbation and 9272 corresponding controls after DRS matching. Current use of metformin versus other OHAs was associated with a 15% (adjusted OR [aOR], 0.85; 95% confidence interval [CI] 0.75–0.95) reduced risk of severe COPD exacerbation, whereas the reduced risk was not observed with other types of antidiabetic agents. When considering the duration of antidiabetic medication therapy, current use of metformin for 91–180 and 181–365 days was associated with a 28% (aOR, 0.72; 95% CI 0.58–0.89) and 37% (aOR, 0.63; 95% CI 0.51–0.77) reduced risk of severe COPD exacerbation, respectively. Similarly, 91–180 days of sulfonylureas therapy led to a 28% (aOR, 0.72; 95% CI 0.58–0.90) lower risk, and longer treatments consistently yielded 24–30% lower risks. Current use of thiazolidinediones for more than 181 days yielded an approximately 40% decreased risk.

Conclusions

Duration-dependent beneficial effects of current metformin, sulfonylurea, and thiazolidinedione use on severe COPD exacerbation were observed in patients with COPD and DM.
Correction to: One Plus One Equals Two—will that do? A trial protocol for a Swedish multicentre randomised controlled trial to evaluate a clinical practice to reduce severe perineal trauma
Authors: Edqvist M. , Dahlen H. G. , Häggsgård C. , Tern H. , Ängeby K. , Tegerstedt G. , Teleman P. , Ajne G. , Rubertsson C.
Published: December 2020

An amendment to this paper has been published and can be accessed via the original article.
Multi-factor authentication for shibboleth identity providers
Authors: Ribeiro de Mello Emerson , Silva Wangham Michelle , Bristot Loli Samuel , da Silva Carlos Eduardo , Cavalcanti da Silva Gabriela , de Chaves Shirlei Aparecida , Bristot Loli Bruno
Published: December 2020

The federated identity model provides a solution for user authentication across multiple administrative domains. The academic federations, such as the Brazilian federation, are examples of this model in practice. The majority of institutions that participate in academic federations employ password-based authentication for their users, with an attacker only needing to find out one password in order to personify the user in all federated service providers. Multi-factor authentication emerges as a solution to increase the robustness of the authentication process. This article aims to introduce a comprehensive and open source solution to offer multi-factor authentication for Shibboleth Identity Providers. Based on the Multi-factor Authentication Profile standard, our solution provides three extra second factors (One-Time Password, FIDO2 and Phone Prompt). The solution has been deployed in the Brazilian academic federation, where it was evaluated using functional and integration testing, as well as security and case study analysis.
Predictors of illness course and health maintenance following inpatient treatment among patients with anorexia nervosa
Authors: Glasofer Deborah R. , Muratore Alexandra F. , Attia Evelyn , Wu Peng , Wang Yuanjia , Minkoff Hillary , Rufin Teresa , Walsh B. Timothy , Steinglass Joanna E.
Published: December 2020

Background

Anorexia nervosa (AN) is a life-threatening psychiatric disorder associated with significant medical and psychosocial impairment. Hospital-based behavioral treatment is an effective intervention in the short-term. However, relapse rates following discharge are high and thus, there is a need to identify predictors of longitudinal outcome. The current study provides information regarding illness course and health maintenance among patients with AN over 5 years following discharge from an eating disorder inpatient unit.

Methods

Participants were individuals with AN who were discharged from a specialized, inpatient behaviorally-based unit. Prior to discharge, height and weight were measured and participants completed self-report measures of eating disorder severity and general psychopathology (depression, anxiety, harm avoidance). Participants were contacted annually for self-report measures of weight, eating disorder severity and clinical impairment. Outcome was defined by illness course (body mass index (BMI) and clinical impairment during the 5 years) and health maintenance (categories of weight and eating disorder symptom severity) across follow-up, using all available data. Linear mixed models were used to examine whether demographic and clinical parameters at discharge predicted BMI and clinical impairment over time. Additional analyses examined whether these variables significantly influenced an individual’s likelihood of maintaining inpatient treatment gains.

Results

One-hundred and sixty-eight individuals contributed data. Higher trait anxiety at discharge was associated with a lower BMI during follow-up (p = 0.012). There was a significant interaction between duration of illness and time, whereby duration of illness was associated with a faster rate of weight loss (p = 0.003) during follow-up. As duration of illness increased, there was a greater increase in self-reported clinical impairment (p = 0.011). Increased eating disorder severity at discharge was also associated with greater clinical impairment at follow-up (p = 0.004). Higher BMI at discharge was significantly associated with maintaining healthy weight across a priori BMI-based definitions of health maintenance.

Conclusions

Weight status (higher BMI) and duration of illness are key factors in the prognosis of AN. Higher weight targets in intensive treatments may be of value in improving outcomes.
Percutaneous Peripheral Nerve Stimulation of the Brachial Plexus for Intractable Phantom Pain of the Upper Extremity: A Case Report
Authors: Finneran John J. , Furnish Timothy , Curran Brian P. , Ilfeld Brian M.
Published: December 2020

Phantom limb pain is a common condition occurring after amputations. Percutaneous peripheral nerve stimulation (PNS) has been reported to provide analgesia for established lower extremity phantom pain. However, this modality has never been applied to upper extremity phantom pain. A patient presented with acute exacerbation of established upper extremity phantom pain 2 years following forequarter amputation. A percutaneous PNS lead placed adjacent to the patient’s brachial plexus under ultrasound guidance provided analgesia of the phantom pain for several weeks. PNS of the brachial plexus may provide analgesia for patients with upper extremity phantom pain.
Η αίσθηση του θάμβους και της κατάπληξης όταν τα μικρά παιδιά προσεγγίζουν τη φύση: ξαναδιαβάζοντας τη Rachel Carson
Authors: Τσεβρένη Ίριδα
Published: December 2020

Στην εργασία αυτή επιχειρείται η προσέγγιση του έργου της Rachel Carson για τη φύση και τα μικρά παιδιά υπό το πρίσμα των νέων εξελίξεων και ρευμάτων στον χώρο της παιδαγωγικής έρευνας και πράξης και της περιβαλλοντικής εκπαίδευσης. H αίσθηση του θάμβους και της κατάπληξης όταν τα μικρά παιδιά προσεγγίζουν τον φυσικό κόσμο, όπως αναδεικνύεται από την Carson, αναλύεται στη βάση μιας ολιστικής, ενσώματης και βασισμένης στις αισθήσεις παιδαγωγικής εμπειρίας που αποσκοπεί στη θεραπεία της αποξένωσης από τον μη ανθρώπινο κόσμο. Η αίσθηση του θάμβους και της κατάπληξης, επίκαιρη όσο ποτέ, επαναπροσεγγίζεται στην εργασία αυτή ως συναίσθημα, ως τρόπος μάθησης, ως διαδικασία επικοινωνίας και ως επιλογή συνύπαρξης και συμπόρευσης με τον μη ανθρώπινο κόσμο. Στο πλαίσιο της ενδυνάμωσης της σχέσης των παιδιών με τον φυσικό κόσμο, η αίσθηση του θάμβους και της κατάπληξης αποτελεί στοιχείο έμπνευσης για τη διαμόρφωση μίας παιδαγωγικής φιλοσοφίας που συνασπίζεται με την επίκαιρη, διεπιστημονική συζήτηση σχετικά με τον οραματισμό για την επανένωση νου και σώματος, πολιτισμού και φύσης.
Mitochondrial isolation: when size matters
Authors: Bury Alexander G. , Vincent Amy E. , Turnbull Doug M. , Actis Paolo , Hudson Gavin
Published: December 2020

Mitochondrial vitality is critical to cellular function, with mitochondrial dysfunction linked to a growing number of human diseases. Tissue and cellular heterogeneity, in terms of genetics, dynamics and function means that increasingly mitochondrial research is conducted at the single cell level. Whilst there are several technologies that are currently available for single-cell analysis, each with their advantages, they cannot be easily adapted to study mitochondria with subcellular resolution. Here we review the current techniques and strategies for mitochondrial isolation, critically discussing each technology’s limitations for future mitochondrial research. Finally, we highlight and discuss the recent breakthroughs in sub-cellular isolation techniques, with a particular focus on nanotechnologies that enable the isolation of mitochondria from subcellular compartments. This allows isolation of mitochondria with unprecedented spatial precision with minimal disruption to mitochondria and their immediate cellular environment.
Management of hand fractures
Authors: Popova Dardan , Welman Ted , Vamadeva Sarita V , Pahal Gurjinderpal S
Published: December 2020

Hand fractures are the most common fractures of the upper extremity, with a reported incidence of 3.7 per 1000 per year for men and 1.3 per 1000 per year for women. Understanding the diagnosis and management of these injuries is vital for any clinician working in the emergency department, plastic or orthopaedic surgery or providing community care. This review identifies the most common presentations and outlines how to assess and manage such fractures appropriately, with an emphasis on clinical and radiographic examination. The majority of hand fractures are managed conservatively and operative management should be carefully considered on a case-by-case basis with analysis of patient and fracture-related factors, in order to achieve optimal hand function following treatment.
Hand infections
Authors: Pillai S , Campbell E , Mifsud A , Vamadeva SV , Pahal GS
Published: December 2020

The hand is an extremely versatile organ adapted for fine tasks with various clinicoanatomical compartments. This article reviews the types of common hand infections that present to the emergency department and/or hand surgeon, with relevant investigations and strategies for diagnosis and treatment, with the emphasis on distinguishing between superficial and more serious infections.
Management of bleeding in women on HRT
Authors: Holloway Debby
Published: December 2020

Bleeding while on hormone replacement therapy is common. Debby Holloway explains the causes of this, investigations needed, and how to tailor treatment to the individual if no pathology is found

Bleeding while taking hormone replacement therapy (HRT) is a relatively common problem. The majority of women with post-menopausal bleeding – on and off HRT – will have either no cause or a benign cause, but about 10% of women will have endometrial cancer. Post-menopausal bleeding is defined as unscheduled vaginal bleeding that occurs a year after the last natural menstrual period or any breakthrough bleeding on cyclical HRT or breakthrough bleeding after 6 months on continuous combined therapy when there has been established amenorrhoea. Practice nurses must be aware of the problem of bleeding on HRT and each individual needs to be assessed for pathology. If no pathology is found, treatment should be tailored to the individual to overcome the bleeding issues.