bluuebunny/crossref_metadata_2025 huggingface dataset:
A Case-Report of Drug-Induced Mixed Liver Injury Resulting From Cefepime Exposure
Authors: Malhotra Kyle , Fazylov Roman , Friedman-Jakubovics Michelle
Published: June 2021

A 99-year-old African-American male presented to the hospital with severe sepsis secondary to a urinary tract infection. Upon initial presentation he was tachycardic, hypotensive and had leukocytosis. While he had signs of acute kidney injury, no signs of acute liver injury were present with his alanine transferase (ALT) and amino transferase (AST) levels measuring at 22 and 44 U/L, respectively. During the treatment course the patient began to show signs of clinical improvement. Despite this, his ALT and AST began to increase on day 2 of treatment and reached their peak of 210 and 239 U/L on day 4. Cefepime-induced liver injury was suspected and cefepime was discontinued. Upon cefepime discontinuation, liver enzymes downtrended and gradually returned to normal. No other likely medication causes of liver injury could be identified and alternative medical causes were ruled out. The lack of an alternative cause and the temporal relationship of cefepime use to hepatic dysfunction support the diagnosis of cefepime-induced liver injury. The patient’s Roussel Uclaf Causality Assessment Methods score was 7, indicating this was a possible case of cefepime-induced liver injury, and the Naranjo Nomogram score was 5 indicating this was a probable case of cefepime-induced liver injury. While cefepime-induced liver injury is rare, clinicians should be cognizant of the potential for this adverse effect if liver enzyme elevation is detected during cefepime therapy and other common causes have been ruled out.
Use of Intravenous Vitamin C in Critically Ill Patients With COVID-19 Infection
Authors: Li Matthew , Ching Tsung Han , Hipple Christopher , Lopez Ricardo , Sahibzada Asad , Rahman Habibur
Published: June 2021

Introduction

The pathophysiology for Coronavirus Disease 2019 (COVID-19) infection is characterized by cytokine oxidative stress and endothelial dysfunction. Intravenous (IV) vitamin C has been utilized as adjuvant therapy in critically ill patients with sepsis for its protective effects against reactive oxygen species and immunomodulatory effects. The primary objective of this study was to evaluate the effects of IV vitamin C in critically ill patients with COVID-19 infection.

Methods

Retrospective observational cohort study with propensity score matching of intensive care unit (ICU) patients who received 1.5 grams IV vitamin C every 6 hours for up to 4 days for COVID-19 infection. The primary study outcome was in-hospital mortality. Secondary outcomes included vasopressor requirements in norepinephrine equivalents, ICU length of stay, and change in Sequential Organ Failure Assessment (SOFA) score.

Results

Eight patients received IV vitamin C and were matched to 24 patients. Patients in the IV vitamin C group had higher rates of hospital mortality [7 (88%) vs. 19 (79%), P = 0.049]. There was no difference in the daily vasopressor requirement in the treatment group or between the 2 groups. The mean SOFA scores post-treatment was higher in the IV vitamin C group (12.4 ± 2.8 vs. 8.1 ± 3.5, P < 0.005). There was no difference in ICU length of stay between the treatment and control groups.

Conclusion

Adjunctive IV vitamin C for the management of COVID-19 infection in critically ill patients may not decrease the incidence of mortality, vasopressor requirements, SOFA scores, or ventilator settings.
Numerical investigation of the radial cold rolling process of the grooves
Authors: Nitu Eduard Laurentiu , Iordache Daniela Monica , Badulescu Claudiu
Published: June 2021

The radial cold rolling process is widely used in industry due to the advantages of chip removing processing. In this study, circular complex profiles were formed by cold-rolling with radial feed, using a patented device with two roller-tools. By achieving several numerical simulations of the radial rolling process, the study aimed to establish the influence that the maximum set force and the diameter of the workpiece have on the productivity of the process and the quality of the formed trapezoidal and metric grooves. The numerical simulations were performed with ABAQUS/Explicit software and by using a previously validated finite element model. The penetration curve of the roller-tools in the material was introduced in the simulation as an analytical function and was determined based on experimental researches. To express the dependency of the penetration curve coefficients on other rolling conditions, a multivariable analysis using a design of experiments technique was performed. The parameters that result from numerical simulations and were analyzed in this study are the profile forming time, the maximum radial force, the distribution of the equivalent strains in the axial section of the profiles, and the profile dimensions. The conclusions that were drawn from the analysis of the results regarding the influence of the set maximum force and the workpiece diameter on the analyzed parameters of the numerical simulations, together with the definition of efficient process criteria, allowed also the identification of the optimal conditions of the rolling process.
Trends in the European Monetary Union. An Overview
Authors: Christos Papageorgiou , Athanasios Anastasiou , Panagiotis Liargovas
Published: June 2021

Four indicators corresponding to the four targets of the European Monetary Union were calculated. The study showed that: (a) concerning the deviation of state’s general government deficit/surplus from 3% of gross domestic product (GDP), all member states had reached their target, with the exception of Cyprus, which was slightly under the target, (b) concerning the deviation of state’s general government debt from 60% of GDP, half of all European Union (EU) member states did not reach their targets, and there was a lot to be done, especially from the EU15 member states, (c) concerning the deviation of state’s inflation rate from the mean of the three states with best results of +1.5%, it was observed that the average value of EU28 member states had reached the final target, mainly due to the performances of the EU15 member states, (d) and concerning the deviation of state’s interest rate from the mean of the three states with the best results of +2%, it was observed that the average value of EU28 member states had reached the final target.
Investigation of vibration damping properties of electroactive polyanthracene/silicone oil dispersions
Authors: Calis Ismetoglu Gokce , Unal Halil Ibrahim
Published: June 2021

Electrorheological (ER) fluids generate mechanical responses to applied electric field strength via changing their rheological properties from liquid to solid and vice-versa reversibly. As a result of this, ER fluids can be used in the industrial vibration damping systems. In order to increase applicability of ER fluids, it is necessary to understand electric field induced polarization and ER mechanism of different materials. Therefore, the aim of this study is to illuminate ER and vibration damping properties of polyanthracene (PAT), which is a new material for ER studies. PAT was synthesized from anthracene and characterized by several techniques namely: ATR-FTIR spectroscopy, particle size, SEM image, four-point probe conductivity, and magnetic susceptibility measurements. A series of PAT/silicone oil (SO) dispersions having various concentrations were prepared and subjected to dielectric and ER tests. Then, the colloidal stabilities of 20% PAT/SO and 20% PAT/SO/TritonX systems were determined. Dynamic viscoelastic data obtained by the oscillation tests showed that viscous behavior was dominant under zero electric field, whereas elastic behavior was prevailing under external electric field strength and highlighting the vibration damping characteristics of PAT/SO dispersion. In the creep-recovery measurements, the highest %recovery was recorded to be 62% indicating potential industrial use of PAT/SO dispersion.
The Contribution Transport Time Makes to Outdoor Programs: A Third Place?
Authors: North Chris , Beames Simon , Stanton Toby , Chan Bacon
Published: June 2021

Background: During transport to and from outdoor education field trips, students experience a period of togetherness and minimal imposed structure. Transport time also appears to align with Oldenburg’s third places, where people spend time together without a particular agenda. Purpose: To examine educators’ perspectives on the contribution that transport time makes to OE programs through an analysis featuring the characteristics of third places. Methodology/Approach: The perspectives of 16 outdoor educators (four each from New Zealand, Australia, Hong Kong, and Scotland) were gathered using a semi-structured interview protocol. Data were analyzed using a deductive process based on the third place characteristics; four unforeseen themes also emerged. Findings/Conclusions: Findings highlighted the centrality of conversation between students and between students and educators; the low profile of transport time; and a sense of excitement and fun. Students controlled the intensity of their “presence” through the use of devices (where allowed) and by selecting their sitting position in the vehicle. Implications: The findings show that transport time allowed students to have a broad variety of conversations that could be variously silly and fun, deep and introspective. Educators are encouraged to more carefully consider the contribution that transport time makes to their programs.
Patterns of Child Maltreatment and the Development of Conflictual Emerging Adult Romantic Relationships: An Examination of Mechanisms and Gender Moderation
Authors: Handley Elizabeth D. , Russotti Justin , Warmingham Jennifer M. , Rogosch Fred A. , Todd Manly Jody , Cicchetti Dante
Published: June 2021

Individuals who experienced child maltreatment are at heightened risk for involvement in conflictual romantic relationships. The aim of this study was to examine the effect of patterns of child maltreatment on the development of maladaptive romantic relationships in emerging adulthood (EA), as well as to determine whether childhood physical aggression and disinhibition mediate this risk. Utilizing a longitudinal sample of emerging adult participants ( N = 398 emerging adults; Mage = 19.67 years) who took part in a summer research camp as children (Mage = 11.27 years), we employed a combination of person-centered and variable-centered methods to test study aims. Significant differences in child behavior and developmental pathways emerged not only between those who experienced maltreatment and those who did not, but also among maltreated individuals with different constellations of maltreatment experiences. Specifically, childhood aggression was a robust mechanism underlying the risk associated with chronic/multi-subtype maltreatment, and the risk associated with neglect only, for involvement in dysfunctional EA romantic relationships. Together, these findings highlight the utility of person-centered methods for conceptualizing maltreatment, identify childhood aggression as a pathway of risk, and the underscore the criticality of prevention and early intervention to interrupt the intergenerational transmission of high conflict and aggression within families.
Long-time dynamics of a class of nonlocal extensible beams with time delay
Authors: Meng Fengjuan , Liu Cuncai , Zhang Chang
Published: June 2021

This work is devoted to the following nonlocal extensible beam equation with time delay:

[Formula: see text]

on a bounded smooth domain [Formula: see text]. The main purpose of this paper is to consider the long-time dynamics of the system. Under suitable assumptions, the quasi-stability property of the system is established, based on which the existence and regularity of a finite-dimensional compact global attractor are obtained. Moreover, the existence of exponential attractors is proved.
The importance of casting an eye beyond the dental arch: A case report
Authors: Sweeney Jill , McCann Catherine , McLaughlin Paul
Published: June 2021

Study models are frequently used in orthodontics and are a key part of both initial assessment and treatment planning. They are an important part of comprehensive orthodontic records; furthermore, study models are an essential diagnostic aid that can be studied in detail without the patient being present. We present a case of a 14-year-old boy with an abnormal palatal swelling detected by his specialist orthodontist after review of study models taken at the initial appointment. At the assessment alone, the significance of the abnormality was not recognised and without the help of study models, diagnosis and treatment of his fibrous dysplasia may have been significantly delayed.
Your Uber is arriving now: An analysis of platform location decisions through an institutional lens
Authors: Punt Matthijs B. , van Kollem Jesse , Hoekman Jarno , Frenken Koen
Published: June 2021

The disruptive impact of platform businesses on local economies has received much attention, but virtually none has been paid to the factors that impact platforms’ decisions about where to locate their activities. The novel, disruptive nature of platforms limits the relevance of traditional theories about location decisions. We argue that local institutional conditions and global legitimacy spillovers affect the choices of platform businesses about where to operate. We analyze the controversial case of ride-hailing platform Uber, an app-based service that matches uncertified chauffeurs with passengers. We find that Uber showed a preference for cities that promote competition and innovation. A spillover analysis shows how Uber leveraged its global pool of customers by choosing cities whose visitors were already familiar with Uber’s service. Our study illuminates the key role played by the brand’s mobile customer base as global carriers of legitimacy for Uber’s controversial innovation.
Test and analysis of the porosity of cotton fiber assembly
Authors: Yong Li , Jian Li , Xian Liu , Bei Wu
Published: June 2021

Porosity is one of the most important properties of textile materials that ensures their comfort and usability. The internal pore structure of the cotton fiber assembly is complex and changeable, surface pore is difficult to explain its pore structure. It is intended to develop a method to predict the pore morphology of cotton fiber assembly. Pore image of the multi-layer fiber assembly is collected by a fiber photography instrument, used the Image Pro Plus 6.0 software to analyze, and obtained the white area indicators of image which can be applied to describe void space of fiber assembly. Using multiple linear regression analysis method, the regression equation of the white area index of image and porosity index of cotton fiber assembly is established. The results indicate that the white area index can largely be explained by three pore index namely the porosity ε, mean length of fiber between the adjacent contacts B and fiber tortuosity coefficient. Appropriate regression equations can be formulated for the pore of white area index which can aid in predicting the pore texture. Comparing the data indicators, it is found that mean length of fiber between the adjacent contacts B and the porosity ε, fiber tortuosity coefficient τ, and air permeability q have good linear correlation.
Buckling of a ballasted curved track under unloaded conditions
Authors: Hasan Nazmul
Published: June 2021

There is no industry accepted analytical model to compute the critical temperature differential for the buckling of an unloaded curved track in North American literature. In this paper, the critical temperature differential for the buckling of an unloaded curved track is formulated by incorporating a value of unity for the factor of safety in the previously developed formula, which was developed considering thermal loading only. The factor of safety was the ratio between the resistance of a tie in an unloaded track against lateral displacement in the ballast and the lateral thermal load on a tie. The derived formula of the critical temperature differential for the buckling of an unloaded curved track is simple opposed to a complicated formula endorsed in the current European literature from 1969. The new formula is also validated in this paper. The critical temperature differentials for buckling of sharp and super-sharp curves have significant implications for track design and maintenance.
Evaluating the prospects for university-based ethical governance in artificial intelligence and data-driven innovation
Authors: Hine Christine
Published: June 2021

There has been considerable debate around the ethical issues raised by data-driven technologies such as artificial intelligence. Ethical principles for the field have focused on the need to ensure that such technologies are used for good rather than harm, that they enshrine principles of social justice and fairness, that they protect privacy, respect human autonomy and are open to scrutiny. While development of such principles is well advanced, there is as yet little consensus on the mechanisms appropriate for ethical governance in this field. This paper examines the prospects for the university ethics committee to undertake effective review of research conducted on data-driven technologies in the university context. Challenges identified include: the relatively narrow focus of university-based ethical review on the human subjects research process and lack of capacity to anticipate downstream impacts; the difficulties of accommodating the complex interplay of academic and commercial interests in the field; and the need to ensure appropriate expertise from both specialists and lay voices. Overall, the challenges identified sharpen appreciation of the need to encourage a joined-up and effective system of ethical governance that fosters an ethical culture rather than replacing ethical reflection with bureaucracy.
Parotid tumours
Authors: Balai Edward , Bhamra Navdeep , Jolly Karan
Published: June 2021

Salivary gland tumours are uncommon and account for just 6% of all head and neck neoplasms. Worldwide incidence varies, from 0.4 to 13.5 cases per 100 000 population. The parotid gland is by far the most commonly affected site, accounting for 80% of cases. The vast majority of these tumours are benign; only approximately 20–25% being malignant. This article considers the relevant clinical anatomy of the parotid gland, key aspects of assessment with history and examination, and when to refer to secondary care for further investigation. It will touch on the common benign and malignant parotid neoplasms and give an overview of secondary care management.
The Ring Rotation Illusion: Properties and Links of a Novel Illusion of Motion
Authors: Mattler Uwe , Stein Maximilian , Fendrich Robert
Published: June 2021

We report a novel visual illusion we call the Ring Rotation Illusion (RRI). When a ring of stationary points replaces a circular outline, the ring of points appears to rotate to a halt, although no actual motion has been displayed. Three experiments evaluate the clarity of the illusory rotation. Clarity decreased as the diameter of the circle and ring increased and increased as the number of points forming the ring increased. The optimal interstimulus interval (ISI) between the circle and ring was 90 ms when stimulus presentations lasted 100 ms but 0 ms with 500 ms presentations. We compare the RRI to the Motion Bridging Effect (MBE), a similar illusion in which a stationary ring of points replaces an initial ring of points that spins so rapidly it looks like a stationary outline. A rotation of the stationary ring is seen that usually matches the direction of the initial ring’s invisible spin. Participants reported a slightly more frequent and clearer motion percept with the MBE than RRI. ISI manipulations had similar effects on the two illusions, but the effects of number of points and ring diameter were largely restricted to the RRI. We suggest that both the RRI and MBE motion percepts are produced by a visual heuristic that holds that the transition from an outline circle to a ring of points is plausibly explained by a rapid spin decelerating to a halt, but in the case of the MBE, an additional direction-sensitive mechanism contributes to this percept.
Leveraging Containers for Reproducible Psychological Research
Authors: Wiebels Kristina , Moreau David
Published: June 2021

Containers have become increasingly popular in computing and software engineering and are gaining traction in scientific research. They allow packaging up all code and dependencies to ensure that analyses run reliably across a range of operating systems and software versions. Despite being a crucial component for reproducible science, containerization has yet to become mainstream in psychology. In this tutorial, we describe the logic behind containers, what they are, and the practical problems they can solve. We walk the reader through the implementation of containerization within a research workflow with examples using Docker and R. Specifically, we describe how to use existing containers, build personalized containers, and share containers alongside publications. We provide a worked example that includes all steps required to set up a container for a research project and can easily be adapted and extended. We conclude with a discussion of the possibilities afforded by the large-scale adoption of containerization, especially in the context of cumulative, open science, toward a more efficient and inclusive research ecosystem.
Integrating Rehabilitation and Psychoanalysis in the Form of Object Relation Therapy in a Case with Marital Disharmony
Authors: Kaur Harneet
Published: June 2021

Psychoanalysis and psychiatric rehabilitation are two vastly different theoretical concepts in psychiatry which can be used in patient’s interest when the resources are scarce. This case was approached with the objective of studying a case and its management using the psychoanalytic approach towards psychosocial rehabilitation in the low resource countries. A 37-year-old female presented with the chief complaint of stress and severe IPR issues with husband resulting in the socio-occupational dysfunction. Via psychoanalysis, the issues were resolved, and couple was rehabilitated in society with restoration of normal functioning. This study puts forward the concept of applying and integrating psychoanalysis as an approach towards rehabilitation.
Open Capsulorrhaphy for Recurrent Multidirectional Instability of the Shoulder
Authors: Bolia Ioanna K. , Griffith Rebecca , Fretes Nickolas , Petrigliano Frank A.
Published: June 2021

Background:

The management of multidirectional instability (MDI) of the shoulder remains challenging, especially in athletes who participate in sports and may require multiple surgical procedures to achieve shoulder stabilization. Open or arthroscopic procedures can be performed to address shoulder MDI.

Indications:

Open capsulorrhaphy is preferred in patients with underlying tissue hyperlaxity and who had 1 or more, previously failed, arthroscopic shoulder stabilization procedures.

Technique Description:

With the patient in the beach-chair position (45°), tissue dissection is performed to the level of subscapularis tendon via the deltopectoral approach. The subscapularis tenotomy is performed in an L-shaped fashion, and the subscapularis tendon is tagged with multiple sutures and mobilized. Careful separation of the subscapularis tendon from the underlying capsular tissue is critical. Capsulotomy is performed, consisting of a vertical limb and an inferior limb that extends to the 5 o’clock position on the humeral neck (right shoulder). After evaluating the integrity of the labrum, the capsule is shifted superiorly and laterally, and repaired using 4 to 5 suture anchors. The redundant capsule is excised, and the subscapularis tendon is repaired in a side-to-side fashion, augmented by transosseous equivalent repair using the capsular sutures.

Results:

Adequate shoulder stabilization was achieved following open capsulorrhaphy in a young female athlete with tissue hyperlaxity and history of a previously failed arthroscopic soft tissue stabilization surgery of the shoulder. The athlete returned to sport at 6 months postoperatively and did not experience recurrent shoulder instability episodes at midterm follow-up.

Discussion/Conclusion:

Based on the existing literature, 82% to 97% of patients who underwent open capsulorrhaphy for MDI had no recurrent shoulder instability episodes at midterm follow-up. One study reported 64% return-to-sport rate following open capsulorrhaphy in 15 adolescent athletes with Ehlers-Danlos syndrome, but more research is necessary to better define the indications and outcomes of this procedure in physically active patients.
A Study on the Effect of the Structural Parameters and Internal Mechanism of a Bilateral Gate-Controlled S/D Symmetric and Interchangeable Bidirectional Tunnel Field Effect Transistor
Authors: Jin Xiaoshi , Wang Yicheng , Ma Kailu , Wu Meile , Liu Xi , Lee Jong-Ho
Published: June 2021

A bilateral gate-controlled S/D symmetric and interchangeable bidirectional tunnel field effect transistor (B-TFET) is proposed in this paper, which shows the advantage of bidirectional switching characteristics and compatibility with CMOS integrated circuits compared to the conventional asymmetrical TFET. The effects of the structural parameters, e.g., the doping concentrations of the N+ region and P+ region, length of the N+ region and length of the intrinsic region, on the device performances, e.g., the transfer characteristics, Ion–Ioff ratio and subthreshold swing, and the internal mechanism are discussed and explained in detail.
The GEnetic Syntax Score: a genetic risk assessment implementation tool grading the complexity of coronary artery disease—rationale and design of the GESS study
Authors: Vizirianakis Ioannis S. , Chatzopoulou Fani , Papazoglou Andreas S. , Karagiannidis Efstratios , Sofidis Georgios , Stalikas Nikolaos , Stefopoulos Christos , Kyritsis Konstantinos A. , Mittas Nikolaos , Theodoroula Nikoleta F. , Lampri Aggeliki , Mezarli Eleni , Kartas Anastasios , Chatzidimitriou Dimitrios , Papa-Konidari Anna , Angelis Eleftherios , Karvounis Ηaralambos , Sianos Georgios
Published: June 2021

Background

Coronary artery disease (CAD) remains one of the leading causes of mortality worldwide and is associated with multiple inherited and environmental risk factors. This study is designed to identify, design, and develop a panel of genetic markers that combined with clinical and angiographic information, will facilitate the creation of a personalized risk prediction algorithm (GEnetic Syntax Score—GESS). GESS score could be a reliable tool for predicting cardiovascular risk for future adverse events and for guiding therapeutic strategies.

Methods

GESS (ClinicalTrials.gov Identifier: NCT03150680) is a prospective, non-interventional clinical study designed to enroll 1080 consecutive patients with no prior history of coronary revascularization procedure, who undergo scheduled or emergency coronary angiography in AHEPA, University General Hospital of Thessaloniki. Next generation sequencing (NGS) technology will be used to genotype specific single-nucleotide polymorphisms (SNPs) across the genome of study participants, which were identified as clinically relevant to CAD after extensive bioinformatic analysis of literature-based SNPs. Enrichment analyses of Gene Ontology-Molecular Function, Reactome Pathways and Disease Ontology terms were also performed to identify the top 15 statistically significant terms and pathways. Furthermore, the SYNTAX score will be calculated for the assessment of CAD severity of all patients based on their angiographic findings. All patients will be followed-up for one-year, in order to record any major adverse cardiovascular events.

Discussion

A group of 228 SNPs was identified through bioinformatic and pharmacogenomic analysis to be involved in CAD through a wide range of pathways and was correlated with various laboratory and clinical parameters, along with the patients' response to clopidogrel and statin therapy. The annotation of these SNPs revealed 127 genes being affected by the presence of one or more SNPs. The first patient was enrolled in the study in February 2019 and enrollment is expected to be completed until June 2021. Hence, GESS is the first trial to date aspiring to develop a novel risk prediction algorithm, the GEnetic Syntax Score, able to identify patients at high risk for complex CAD based on their molecular signature profile and ultimately promote pharmacogenomics and precision medicine in routine clinical settings.

Trial registration GESS trial registration: ClinicalTrials.gov Number: NCT03150680. Registered 12 May 2017- Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT03150680.
The application of artificial intelligence methods to gene expression data for differentiation of uncomplicated and complicated appendicitis in children and adolescents - a proof of concept study –
Authors: Reismann Josephine , Kiss Natalie , Reismann Marc
Published: June 2021

Background

Genome wide gene expression analysis has revealed hints for independent immunological pathways underlying the pathophysiologies of phlegmonous (PA) and gangrenous appendicitis (GA). Methods of artificial intelligence (AI) have successfully been applied to routine laboratory and sonographic parameters for differentiation of the inflammatory manifestations. In this study we aimed to apply AI methods to gene expression data to provide evidence for feasibility.

Methods

Modern algorithms from AI were applied to 56.666 gene expression data sets from 13 patients with PA and 16 with GA aged 7–17 years by using resampling methods (bootstrap). Performance with respect to sensitivities and specificities where investigated with receiver operating characteristic (ROC) analysis.

Results

Within the experimental setting a best performing discriminatory biomarker signature consisting of a set of 4 genes could be defined: ERGIC and golgi 3, regulator of G-protein signaling 2, Rho GTPase activating protein 33, and Golgi Reassembly Stacking Protein 2. ROC analysis showed a mean area under the curve of 84%.

Conclusions

Gene expression based application of AI methods is feasible and represents a promising approach for future discriminatory diagnostics in children with acute appendicitis.
How do care providers evaluate collaboration? - qualitative process evaluation of a cluster-randomized controlled trial of collaborative and stepped care for patients with mental disorders
Authors: Maehder Kerstin , Werner Silke , Weigel Angelika , Löwe Bernd , Heddaeus Daniela , Härter Martin , von dem Knesebeck Olaf
Published: June 2021

Background

Collaborative and stepped care (CSC) models are recommended for mental disorders. Their successful implementation depends on effective collaboration between involved care providers from primary and specialist care. To gain insights into the collaboration experiences of care providers in CSC against the backdrop of usual mental health care, a qualitative process evaluation was realized as part of a cluster-randomized controlled trial (COMET) of a collaborative and stepped care model in Hamburg (Germany).

Methods

Semi-structured interviews were conducted with N = 24 care providers from primary and specialist care (outpatient psychotherapists and psychiatrists, inpatient/ day clinic mental health providers) within and outside of COMET at the trial’s beginning and 12 months later. Interviews were analyzed applying a qualitative structuring content analysis approach, combining deductive and inductive category development.

Results

Usual mental health care was considered deficient in resources, with collaboration being scarce and mainly taking place in small informal networks. Within the COMET trial, quicker referral paths were welcomed, as were quarterly COMET network meetings which provided room for exchange and fostered mutual understanding. Yet, also in COMET, collaboration remained difficult due to communication problems, the unfavorable regional distribution of the COMET care providers and interprofessional discrepancies regarding each profession’s role, competencies and mutual esteem. Ideas for improvement included more localized networks, the inclusion of further professions and the overall amelioration of mental health care regarding resources and remuneration, especially for collaborative activities.

Conclusions

The process evaluation of the COMET trial revealed the benefits of creating room for interprofessional encounter to foster collaborative care. Despite the benefits of faster patient referrals, the COMET network did not fulfill all care providers’ prior expectations. A focus should be set on interprofessional competencies, mutual perception and role clarification, as these have been revealed as significant barriers to collaboration within CSC models such as COMET.

Trial registration

The COMET trial (Collaborative and Stepped Care in Mental Health by Overcoming Treatment Sector Barriers) has been registered on July 24, 2017 under the trial registration number NCT03226743.
Evaluation of a mobile safety center’s impact on pediatric home safety behaviors
Authors: Furman Leah , Strotmeyer Stephen , Vitale Christine , Gaines Barbara A.
Published: June 2021

Background

A Mobile Safety Center (MSC) provides safety resources to families to prevent pediatric injury. The primary objective of this study was to assess the impact of an MSC on home safety behaviors.

Methods

We conducted a prospective observational study with 50 parents and guardians recruited at community events attended by an MSC. Participants completed a pre-test assessing demographics and home safety behaviors prior to participating in the MSC’s home safety educational program. We conducted follow-up with participants 4 weeks (follow-up 1) and 6 months (follow-up 2) after their visit to the MSC to reassess home safety behaviors. We used descriptive statistics in addition to Friedman, Wilcoxon sum-rank, and Fisher’s exact testing to analyze respondent demographics and changes in home safety practices. Friedman and Wilcoxon sum-rank testing was performed only for participants who completed all surveys.

Results

Of our 50 participants, 29 (58%) completed follow-up 1, 30 (60%) completed follow-up 2, and 26 (52%) completed both. Participants were more likely to have a fire-escape plan at follow-up 1 than on the pre-test (p = 0.014). They were also more likely to have the Poison Control Hotline number accessible in their cellphone or near a home phone at follow-up 1 compared to the pre-test (p = 0.002) and follow-up 2 compared to the pre-test (p < 0.001). Families with at least one household member who smoked or used e-cigarettes at any point during the study (n = 16 for the total population, n = 9 for those who completed both surveys) were less likely to have more than two smoke detectors installed at home during the pre-test (p = 0.049). However, this significantly changed across timepoints (p = 0.018), and while 44.4% reported more than two detectors during the pre-test, 88.9% reported this at both follow-ups.

Conclusions

Home safety education through an MSC positively changed some reported safety behaviors and maintained these changes at long-term follow-up. By encouraging the adoption of better home safety practices, education at an MSC may decrease pediatric injury rates.
Does concurrent adenoidectomy or tonsillectomy affect the graft success rate of cartilage myringoplasty in adults?
Authors: Lou Zhengcai
Published: June 2021

Background

The objective of this study was to evaluate the graft success and hearing outcomes of concurrent adenoidectomy or tonsillectomy and myringoplasty.

Methods

Medical case notes were reviewed for all adult patients with dry perforations who had undergone myringoplasty, with or without concurrent throat surgery, from December 2015 to February 2018. The study population was divided into concurrent myringoplasty and throat surgery (Group A) and single myringoplasty (Group B) groups. The air–bone gap (ABG) and graft success rate were evaluated in both groups.

Results

A total of 131 ears of 131 patients were included in this study. In total, 33 ears of 33 patients were assigned to Group A and 98 to Group B. Of the 33 patients in Group A, adenoid residue was detected in 3, chronic tonsillitis in 21, and tonsil hypertrophy in 9. The graft success rate was 96.9 % in Group A and 96.9 % in Group B at 6 months postoperatively (p = 0.993). In addition, the graft success rate was 87.9 % in Group A and 92.8 % in Group B at 24 months postoperatively (p = 0.372). Reperforation occurred in three patients in Group A and four in Group B; the difference was not significant. No significant group differences were observed in preoperative (p = 0.654) or postoperative (p = 0.791) ABG values or mean ABG gain (p = 0.439). No patient in either group developed cholesteatoma of the middle ear.

Conclusions

Simultaneous adenoidectomy or tonsillectomy and myringoplasty is feasible but does not improve the graft success rate or hearing outcome.
Correction to: Quality of life after laparoscopic hysterectomy versus abdominal hysterectomy
Authors: Kotani Yasushi , Murakami Kosuke , Fujishima Risa , Kanto Akiko , Takaya Hisamitsu , Shimaoka Masao , Nakai Hidekatsu , Matsumura Noriomi
Published: June 2021

An amendment to this paper has been published and can be accessed via the original article.
Hand hygiene behavior among Sri Lankan medical students during COVID-19 pandemic
Authors: Liyanage Guwani , Dewasurendra Madushika , Athapathu Ashan , Magodarathne Lakmini
Published: June 2021

Background

Poor compliance with hand hygiene practices among medical students poses a risk for cross-infection. It has become more critical during the COVID-19 pandemic than ever before. This study aimed to determine the knowledge, attitudes, practices of hand hygiene among final-year medical students. It also explored reported hand hygiene behavior before the COVID-19 pandemic and the need for educational strategies to correct the deficiencies.

Methods

A concurrent mixed-method approach was used. In the quantitative strand, a cross-sectional online survey was carried out via a Google form. Mann-Whitney U test and Chi-squared test were used for comparisons. In the qualitative strand, twelve participants were interviewed, based on a semi-structured interview guide and audio recorded. Transcribed data were evaluated with thematic content analysis.

Results

A total of 225 final-year medical students were studied in the quantitative strand. Most were females. The mean score for knowledge was 3.35 ± 0.795 out of six. Of them, 31.6 % of participants scored below 3 points (< 50 % of the total). Most (78.9 %) had positive attitudes (score of > 80 %). Only 36.4 % reported “adequate” hand hygiene performance in all eight dimensions of the behavior domain. Noticeably, fewer participants reported to clean their hands after checking blood pressure (55.6 %), and only 66.2 % stated carrying a hand sanitizer in their pocket. Significant correlations were not found between reported behavior and attitudes (p = 0.821) or knowledge (p = 0.794). The qualitative strand with 12 respondents revealed the positive influence of both hierarchical and non-hierarchal role models. Time constraints, skin irritation, and workload pressures were the main barriers. Frequent reminders, supervision, and interactive teaching were suggested as methods to improve hand hygiene compliance. They also stated that increased enthusiasm was noted on hand hygiene during the COVID-19 pandemic compared to the pre-pandemic period.

Conclusions

Most of the participants had positive attitudes towards hand hygiene. Yet, a considerable gap between attitudes and knowledge and reported hand hygiene behavior was evident. Coupling educational programs that use cognitive and behavioral methods, including role modeling, supervision, and frequent reminders, is recommended to bridge the knowledge-attitude-behavior gap.
The regulation of healthcare professions and support workers in international context
Authors: Saks Mike
Published: June 2021

Background

The objective of this paper is to outline and compare the regulation of paid healthcare professions and associated support workers in international context, bringing out the lessons to be learned as appropriate. Modern neo-liberal societies have sought to enhance healthcare through greater professional regulation, albeit in different ways and at variable pace. This general trend is illustrated with reference to medicine in the UK. However, although such reforms have helpfully cascaded to other health professions, government policy in high-income countries has not yet adequately regulated the interrelated group of non-professionalised health support workers who form the largest and least recognised part of the workforce. Nonetheless, in low- and middle-income (LMIC) countries—aside from the greater need for regulation of health professions—there is even more of an imperative to regulate the disparate, largely invisible support workforce.

Methods

With reference to existing studies of the medical and wider health professions in the UK and selected other higher income societies, the importance of health professional regulation to the public is underlined in the Global North. The larger gap in the regulation of support workers in modern neo-liberal countries is also emphasised on a similar basis, with an increasingly ageing population and advances in healthcare. It is argued from the very limited patchwork of secondary literature, though, that policy-makers may want to focus even more on enhancing regulation of both the professional and non-professional workforce in LMIC societies centred mainly in the Global South, drawing on lessons from the Global North.

Results/conclusions

Efforts to reform health professional regulatory approaches in more economically developed countries, while needing refinement, are likely to have had a positive effect. However, even in these societies there are still substantial shortfalls in the regulation of health support workers. There are even larger gaps in LMICs where there are fewer health professional staff and a greater dependence on support workers. With higher rates of morbidity and mortality, there is much more scope here for reforming health regulation in the public interest to extend standards and mitigate risk, following the pattern for healthcare professions in the Global North.
Implementation of deep learning-based auto-segmentation for radiotherapy planning structures: a workflow study at two cancer centers
Authors: Wong Jordan , Huang Vicky , Wells Derek , Giambattista Joshua , Giambattista Jonathan , Kolbeck Carter , Otto Karl , Saibishkumar Elantholi P. , Alexander Abraham
Published: June 2021

Purpose

We recently described the validation of deep learning-based auto-segmented contour (DC) models for organs at risk (OAR) and clinical target volumes (CTV). In this study, we evaluate the performance of implemented DC models in the clinical radiotherapy (RT) planning workflow and report on user experience.

Methods and materials

DC models were implemented at two cancer centers and used to generate OAR and CTVs for all patients undergoing RT for a central nervous system (CNS), head and neck (H&N), or prostate cancer. Radiation Therapists/Dosimetrists and Radiation Oncologists completed post-contouring surveys rating the degree of edits required for DCs (1 = minimal, 5 = significant) and overall DC satisfaction (1 = poor, 5 = high). Unedited DCs were compared to the edited treatment approved contours using Dice similarity coefficient (DSC) and 95% Hausdorff distance (HD).

Results

Between September 19, 2019 and March 6, 2020, DCs were generated on approximately 551 eligible cases. 203 surveys were collected on 27 CNS, 54 H&N, and 93 prostate RT plans, resulting in an overall survey compliance rate of 32%. The majority of OAR DCs required minimal edits subjectively (mean editing score ≤ 2) and objectively (mean DSC and 95% HD was ≥ 0.90 and ≤ 2.0 mm). Mean OAR satisfaction score was 4.1 for CNS, 4.4 for H&N, and 4.6 for prostate structures. Overall CTV satisfaction score (n = 25), which encompassed the prostate, seminal vesicles, and neck lymph node volumes, was 4.1.

Conclusions

Previously validated OAR DC models for CNS, H&N, and prostate RT planning required minimal subjective and objective edits and resulted in a positive user experience, although low survey compliance was a concern. CTV DC model evaluation was even more limited, but high user satisfaction suggests that they may have served as appropriate starting points for patient specific edits.
Fine-scale estimation of key life-history parameters of malaria vectors: implications for next-generation vector control technologies
Authors: Morris Aaron L. , Ghani Azra , Ferguson Neil
Published: June 2021

Background

Mosquito control has the potential to significantly reduce malaria burden on a region, but to influence public health policy must also show cost-effectiveness. Gaps in our knowledge of mosquito population dynamics mean that mathematical modelling of vector control interventions have typically made simplifying assumptions about key aspects of mosquito ecology. Often, these assumptions can distort the predicted efficacy of vector control, particularly next-generation tools such as gene drive, which are highly sensitive to local mosquito dynamics.

Methods

We developed a discrete-time stochastic mathematical model of mosquito population dynamics to explore the fine-scale behaviour of egg-laying and larval density dependence on parameter estimation. The model was fitted to longitudinal mosquito population count data using particle Markov chain Monte Carlo methods.

Results

By modelling fine-scale behaviour of egg-laying under varying density dependence scenarios we refine our life history parameter estimates, and in particular we see how model assumptions affect population growth rate (Rm), a crucial determinate of vector control efficacy.

Conclusions

Subsequent application of these new parameter estimates to gene drive models show how the understanding and implementation of fine-scale processes, when deriving parameter estimates, may have a profound influence on successful vector control. The consequences of this may be of crucial interest when devising future public health policy.

Graphical abstract
Epigenetic mechanisms underlying prostate cancer radioresistance
Authors: Macedo-Silva Catarina , Benedetti Rosaria , Ciardiello Fortunato , Cappabianca Salvatore , Jerónimo Carmen , Altucci Lucia
Published: June 2021

Radiotherapy (RT) is one of the mainstay treatments for prostate cancer (PCa), a highly prevalent neoplasm among males worldwide. About 30% of newly diagnosed PCa patients receive RT with a curative intent. However, biochemical relapse occurs in 20–40% of advanced PCa treated with RT either alone or in combination with adjuvant-hormonal therapy. Epigenetic alterations, frequently associated with molecular variations in PCa, contribute to the acquisition of a radioresistant phenotype. Increased DNA damage repair and cell cycle deregulation decreases radio-response in PCa patients. Moreover, the interplay between epigenome and cell growth pathways is extensively described in published literature. Importantly, as the clinical pattern of PCa ranges from an indolent tumor to an aggressive disease, discovering specific targetable epigenetic molecules able to overcome and predict PCa radioresistance is urgently needed. Currently, histone-deacetylase and DNA-methyltransferase inhibitors are the most studied classes of chromatin-modifying drugs (so-called ‘epidrugs’) within cancer radiosensitization context. Nonetheless, the lack of reliable validation trials is a foremost drawback. This review summarizes the major epigenetically induced changes in radioresistant-like PCa cells and describes recently reported targeted epigenetic therapies in pre-clinical and clinical settings.