bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of iron supplementation in patients with inflammatory bowel disease treated with anti-tumor necrosis factor-alpha agents
Authors: Kim Su Young , An Sejin , Park Dong Kyun , Kwon Kwang An , Kim Kyoung Oh , Chung Jun-Won , Kim Jung Ho , Kim Yoon Jae
Published: September 2020

Background:

Anemia is a common extraintestinal manifestation of inflammatory bowel disease (IBD). However, data on the influence of anti-tumor necrosis factor-alpha (anti-TNF-α) agents and iron supplementation on anemia in patients with IBD are sparse. We assessed the effect of iron supplementation in patients with IBD initially treated with an anti-TNF-α agent.

Methods:

Data from 79 IBD patients who started anti-TNF-α treatment at a tertiary hospital were analyzed. The patients were divided into the anti-TNF-α ( n = 52) and anti-TNF-α with iron supplementation ( n = 27) groups. Effects on laboratory parameters, the prevalence of anemia, and disease activity were evaluated at baseline (year 0) and 1 year later.

Results:

The hemoglobin (Hb) level significantly increased between years 0 and 1 in both groups [12.0 ± 1.8–13.3 ± 2.0 g/dL in the anti-TNF-α group ( p < 0.001) and 9.8 ± 2.4–11.7 ± 2.3 g/dL in the anti-TNF-α and iron supplementation group ( p = 0.004)]. In a subgroup analysis of severely anemic patients with IBD, iron supplementation increased the magnitude of the improvement in Hb level (8.5 ± 1.5–11.4 ± 2.1 g/dL; p = 0.001) compared with the anti-TNF-α group (9.3 ± 0.8–11.4 ± 2.7 g/dL; p = 0.081). Disease activity was significantly improved in both groups at year 1 compared with year 0. Persistent anemia was significantly correlated with severe anemia at baseline ( p = 0.017).

Conclusion:

In anemic patients with IBD, anti-TNF-α agents led to clinically meaningful improvements in anemia independent of iron supplementation. Also, iron supplementation could be helpful in severely anemic patients with IBD.
A User-Centered Approach to Evaluating Wayfinding Systems in Healthcare
Authors: Bubric Katherine , Harvey Gillian , Pitamber Tiffany
Published: September 2020

Objective:

The purpose of this methodology is to provide the designers of wayfinding systems in healthcare facilities a process for evaluating and optimizing a design prior to implementation. The use of this methodology can improve patient experience in hospitals by preventing the installation of confusing, incomplete, and/or frustrating wayfinding systems.

Background:

Despite known wayfinding and information design principles, wayfinding continues to be a challenge in healthcare environments. One reason is that the design of wayfinding systems is rarely evaluated with end users prior to implementation. The methodology outlined in this article is an application of usability testing that involves end users navigating a space using prototyped signage and other elements of a wayfinding system to determine the effectiveness of the system and identify improvement opportunities. This methodology was developed for use in an emergency department that had outdated signage and required a new wayfinding system.

Conclusion:

This methodology provides a structured process for testing and improving the design of a hospital wayfinding system prior to implementation.
Development of a Novel Computational Model for Evaluating Fall Risk in Patient Room Design
Authors: Novin Roya Sabbagh , Taylor Ellen , Hermans Tucker , Merryweather Andrew
Published: September 2020

Objectives:

This study proposes a computational model to evaluate patient room design layout and features that contribute to patient stability and mitigate the risk of fall.

Background:

While common fall risk assessment tools in nursing have an acceptable level of sensitivity and specificity, they focus on intrinsic factors and medications, making risk assessment limited in terms of how the physical environment contributes to fall risk.

Methods:

We use literature to inform a computational model (algorithm) to define the relationship between these factors and the risk of fall. We use a trajectory optimization approach for patient motion prediction.

Results:

Based on available data, the algorithm includes static factors of lighting, flooring, supportive objects, and bathroom doors and dynamic factors of patient movement. This preliminary model was tested using four room designs as examples of typical room configurations. Results show the capabilities of the proposed model to identify the risk associated with different room layouts and features.

Conclusions:

This innovative approach to room design evaluation and resulting estimation of patient fall risk show promise as a proactive evidence-based tool to evaluate the relationship of potential fall risk and room design. The development of the model highlights the challenge of heterogeneity in factors and reporting found in the studies of patient falls, which hinder our understanding of the role of the built environment in mitigating risk. A more comprehensive investigation comparing the model with actual patient falls data is needed to further refine model development.
Pouring on the Pounds: The Persistent Problem of Sugar-Sweetened Beverage Intake Among Children and Adolescents
Authors: Cooper Christen Cupples
Published: September 2020

Sugar-sweetened beverages (SSBs) are a major source of calories in the diets of American children and adolescents. These beverages, which contain mainly sugar and few beneficial nutrients, have been linked to overweight, obesity, type 2 diabetes, heart disease, dental caries, and other adverse conditions. Children of all ages consume SSBs, and schools, aided by the knowledge and direction of school nurses, can help students understand the health harms of SSBs, implement programs to discourage SSB intake, and play important roles in school and community efforts to limit SSBs.
School Nursing Data Collection During COVID-19
Authors: Maughan Erin D. , Bergren Martha Dewey
Published: September 2020

COVID-19 has affected the 2020-2021 school year for everyone and thrust school nurses into the spotlight. Some school nurses are too overwhelmed to even think about data; others want to collect data differently to illustrate the value of the role of the school nurse. This article provides guidance on data collection during this unique time period. The article is based on a blog originally posted on National Association of School Nurses’s website.
Platelet-Rich Plasma Does Not Inhibit Inflammation or Promote Regeneration in Human Osteoarthritic Chondrocytes In Vitro Despite Increased Proliferation
Authors: Rikkers Margot , Dijkstra Koen , Terhaard Bastiaan F. , Admiraal Jon , Levato Riccardo , Malda Jos , Vonk Lucienne A.
Published: September 2020

Objective

The aims of the study were to assess the anti-inflammatory properties of platelet-rich plasma (PRP) and investigate its regenerative potential in osteoarthritic (OA) human chondrocytes. We hypothesized that PRP can modulate the inflammatory response and stimulate cartilage regeneration.

Design

Primary human chondrocytes from OA knees were treated with manually prepared PRP, after which cell migration and proliferation were assessed. Next, tumor necrosis factor-α–stimulated chondrocytes were treated with a range of concentrations of PRP. Expression of genes involved in inflammation and chondrogenesis was determined by real-time polymerase chain reaction. In addition, chondrocytes were cultured in PRP gels and fibrin gels consisting of increasing concentrations of PRP. The production of cartilage extracellular matrix (ECM) was assessed. Deposition and release of glycosaminoglycans (GAG) and collagen was quantitatively determined and visualized by (immuno)histochemistry. Proliferation was assessed by quantitative measurement of DNA.

Results

Both migration and the inflammatory response were altered by PRP, while proliferation was stimulated. Expression of chondrogenic markers COL2A1 and ACAN was downregulated by PRP, independent of PRP concentration. Chondrocytes cultured in PRP gel for 28 days proliferated significantly more when compared with chondrocytes cultured in fibrin gels. This effect was dose dependent. Significantly less GAGs and collagen were produced by chondrocytes cultured in PRP gels when compared with fibrin gels. This was qualitatively confirmed by histology.

Conclusions

PRP stimulated chondrocyte proliferation, but not migration. Also, production of cartilage ECM was strongly downregulated by PRP. Furthermore, PRP did not act anti-inflammatory on chondrocytes in an in vitro inflammation model.
Current clinical utilization of risk assessment tools in pulmonary arterial hypertension: a descriptive survey of facilitation strategies, patterns, and barriers to use in the United States
Authors: Wilson Melisa , Keeley Jennifer , Kingman Martha , Wang Jiajing , Rogers Fran
Published: September 2020

Practice guidelines suggest that treatment decisions in pulmonary arterial hypertension be informed by periodic assessment of patients’ clinical risk. Several tools, well validated for risk discrimination, such as the Registry to Evaluate Early and Long‐term Pulmonary Arterial Hypertension Disease Management calculator, were developed to assess pulmonary arterial hypertension patients’ risk of death based on multiple parameters, including functional class, hemodynamics, biomarkers, comorbidities, and exercise capacity. Using an online survey, we investigated the use of risk assessment tools by pulmonary hypertension healthcare providers in the United States. Of 121 survey respondents who make treatment decisions, 59% reported using risk assessment tools. The use of these tools was lower for non‐physicians (48% vs. 65% physicians) and for practitioners at centers with 1 to 100 pulmonary arterial hypertension patients compared with centers with >100 patients (47% vs. 64%). Risk was most frequently assessed by decision makers at the time of diagnosis (cited by 54%) and at the time of worsening symptoms (cited by 42%), suggesting that use of pulmonary arterial hypertension risk assessment tools remains low. In our survey, non‐physicians compared with physicians cited two major barriers to increased tool use: lack of education and training (20% vs. 4%) and lack of clarity on the best tool to use (30% vs. 18%). Information technology tools, such as electronic medical record integration and web or phone‐based risk calculating applications, were cited most frequently as ways to increase the use of risk assessment tools.
Endovascular treatment of arterio-ureteral fistula with new-generation balloon-expandable stent graft using a 7-French system
Authors: Yoshioka Naoki , Takagi Kensuke , Morita Yasuhiro , Kawase Makoto , Morishima Itsuro
Published: September 2020

Arterio-ureteral fistulas are relatively rare, but a potentially life-threatening condition because of the possible massive bleeding. An 82-year-old woman with a history of hysterectomy and irradiation for uterine cancer was treated with ureteric stents for recurrent bilateral ureteral stenosis. During the adjustments of the stent, removing the right ureteric stent immediately resulted in massive hematuria. Computed tomography showed that the right ureter coursed above and seemed to be connected to the right external iliac artery. From the clinical history and computed tomography findings, an arterio-ureteral fistula between the right external iliac artery and right ureter was strongly suspected. The GORE® VIABAHN® VBX Stent Graft was deployed from the common iliac artery to the external iliac artery via a 7-French femoral system, followed by post-dilatation. The patient did not develop any complications or recurrence of hematuria after the procedure during the 11-month follow-up. The VBX is a useful device, with a low- profile device and a size-adjustable balloon-expandable stent that depended on the individual vessel size for post-dilatation. However, there are several concerns, such as risk of infection, stent thrombosis/stenosis, and chronic outcome while using stent grafts for treatment. Patients with arterio-ureteral fistulas who were treated using stent grafts should be carefully followed up.
lncRNA DLEU2 accelerates gastric cancer growth by downregulating miR-30a-5p
Authors: Zhu Hua-Li , Zou Jing
Published: September 2020

Introduction:

lncRNA DLEU2 has been indicated to act a crucial role in the bioprocess of cancer. But, the role and molecular mechanisms of lncRNA DLEU2 in gastric cancer (GC) remain unknown.

Methods:

The correlation of DLEU2 or miR-30a-5p with the clinical parameters and outcomes of GC patents was implemented by TCGA cohort. Cell viability and invasion were estimated by MTT and Transwell assays. The interplay between DLEU2 and miR-30a-5p was confirmed by a luciferase report assay. The effects of DLEU2 on miR-30a-5p or MMP2/9 were detected by qRT-PCR and Western blot.

Results:

We found that the enhanced expression of DLEU2 was linked to the pathological stage and poor survival in GC patients. Overexpressing DLEU2 prompted the cell proliferation and invasion of AGS cells, but silencing DLEU2 weakened these effects in MKN-28 cells. In addition, DLEU2 could negatively modulate and be bound with miR-30a-5p, which could counteract DLEU2-caused cell proliferation. High expression of miR-30a-5p was linked to a favorable survival in patients with GC.

Conclusion:

Our findings suggested that lncRNA DLEU2 could favor the growth of GC by downregulating miR-30a-5p.
Prevalence, risk factors, challenges, and the currently available diagnostic tools for the determination of helminths infections in human
Authors: Riaz Muhammad , Aslam Nosheen , Zainab Rida , Aziz-Ur-Rehman  , Rasool Ghulam , Ullah Muhammad Irfan , Daniyal Muhammad , Akram Muhammad
Published: September 2020

Soil transmitted helminthes (STH) are among the major public health issues in tropical and sub-tropical countries infecting more than 2 billion humans worldwide. STH causes considerable morbidity in children, affecting their cognitive development and physical growth. Endemic areas with poor sanitation and limited access to good quality water supply have the highest burden of STH infection. Various approaches to reduce and control the worm infections include the intermittent deworming of children with anti-helminthic drugs. Individual patient management and population based studies can only be successful upon using the diagnostic techniques with high accuracy. The lack of reliable tools for the provision of correct diagnostic results about the status and intensity of infection is a major challenge, as these factors varies considerably in areas of low infection intensities. The techniques currently available for the diagnosis of parasitic infections show limited specificity and sensitivity and as such several techniques in combination are normally used in diagnosing the variety of parasite species infection. This review article was planned to study the prevalence, risk factors, and the available diagnostic techniques for soil and water transmitted helminthes infections in humans. This article also discussed the challenges in diagnosis, treatment, and management of worm infections particularly helminthes. The articles available online on important portals like google scholar, PubMed, Digital Libraries, PakMediNet, Science direct, and the Directory of Open Access Journals (DOAJ) were searched for inclusion of the data in this review study. Duplicate studies and irrelevant reports describing the general aspects of parasite infections were excluded. This review study provides a comprehensive report on the prevalence, accurate diagnostic, and chemotherapeutic protocols to reduce the burden of worms infections. WHO suggests the chemotherapy for worm infections as feasible and cost effective strategy in schools due to the lack of proper policy for the prevention of intestinal worms.
Trajectory-based Qualitative Comparative Analysis: Accounting for case-based time dynamics
Authors: Pagliarin Sofia , Gerrits Lasse
Published: September 2020

Qualitative comparative analysis was initially time-agnostic, but efforts to make the method more time-sensitive have been made since the mid-2000s. These attempts mainly focus on cross-case differences, accounting for change over time at the level of attributes or conditions. While useful, they cannot account for the fact that individual cases also develop over time. As such, strategies regarding ‘within-case’ development have remained under-theorized in qualitative comparative analysis (QCA). To address this gap, we propose trajectory-based qualitative comparative analysis (TJ-QCA) building on the logic of the diversity-oriented approach: meaningful within-case change is carefully defined in terms of development stages that capture qualitative case-based change patterns. We conceptualize configurations dynamically so that they express different development stages. Theoretically, our method is rooted in a complexity-informed understanding of cases describing trajectories through the property space. Trajectory-based qualitative comparative analysis works with both numerical and qualitative data. We will illustrate the method empirically by re-elaborating a well-known published time-sensitive qualitative comparative analysis study.
The Role of Primary Care in a Pandemic: Reflections During the COVID-19 Pandemic in Canada
Authors: Kearon Joanne , Risdon Cathy
Published: September 2020

As COVID-19 cases began to rise in Ontario, Canada, in March 2020, increasing surge capacity in hospitals and intensive care units became a large focus of preparations. As part of these preparations, primary care physicians were ready to be redeployed to the hospitals. However, due to the effective implementation of community-wide public health measures, the hospital system was not overwhelmed. As Ontario prepares now for a potential second wave of COVID-19, primary care physicians have an opportunity to consider the full breadth and depth of scope for primary care during a pandemic. From planning to surveillance to vaccination, primary care physicians are positioned to play a unique and vital role in a pandemic. Nevertheless, there are specific barriers that will need to be overcome.
Extracorporeal Cardiopulmonary Resuscitation During Cesarean Delivery in a Patient With D-Transposition of the Great Vessels, Years Following Mustard Operation
Authors: Brozzi Nicolas Ariel , Cifuentes Renzo Otoniel , Ghodsizad Ali , Saab Amanda , Yasin Salih , Loebe Mathias
Published: September 2020

Patients with surgically repaired complex congenital cardiac anomalies present unique characteristics that can make the implementation of extracorporeal membrane oxygenation (ECMO) support especially challenging. Very few series have reported the outcomes of ECMO support during pregnancy and peripartum. We report a case of successful extracorporeal cardiopulmonary resuscitation during cesarean delivery in a patient with surgically repaired d-transposition of the great arteries, and we discuss particular aspects that contributed to successful implementation of ECMO support and hospital discharge.
A Group Intervention for Prospective First-Generation College Students: Application With an Urban, African American Population
Authors: Malott Krista , Havlik Stacey , Gosai Shivam , Diaz Davila Jose
Published: September 2020

We applied a qualitative inquiry to explore the experiences of African American youth engaging in a group intervention at an urban high school. Group topics were tailored to the needs of prospective first-generation college students to enhance youth social and academic capitol and identity strengthening. Experiences included changed perspectives and increased knowledge of the college-going experience that, in turn, increased participant sense of efficacy in completing college. We discuss implications for school counselors.
Advancing cross-national planning and partnership: Proceedings from the International Multimorbidity Symposium 2019
Authors: Nicholson Kathryn , De Burghgraeve Tine , Fortin Martin , Griffith Lauren E , Licher Silvan , Lizotte Daniel , Mair Frances S , Miozzo Ruben , Nouri Maede Sadat , Ryan Bridget L , Lee Eng Sing , Smith Susan , Stewart Moira , Terry Amanda L , Tisminetzky Mayra , Ukhanova Maria , Wetmore Stephen , Stranges Saverio
Published: September 2020

The International Multimorbidity Symposium was held in November 2019 at Western University to achieve three main objectives: to discuss progress and findings from various jurisdictions; to facilitate collaboration through group discussion to identify strategies to move multimorbidity research forward; and to create concrete plans to ensure advances in multimorbidity research and knowledge can be achieved through cross-national partnership. This event included keynote presentations, elevator pitch presentations and breakout sessions and there was a total of 35 attendees from eight countries, representing diverse disciplines and training levels. The overall themes arising from the event were: the importance of integrating the study and management of multimorbidity from both the primary care and public health perspectives; meaningful engagement and collaboration with patients and caregivers to understand key dimensions of multimorbidity; the considerable benefit of collaborative international partnerships; and the need to spread and scale innovations for health care systems that can better respond to the complex needs of patients and caregivers who are living with multimorbidity. Finally, it was well-acknowledged among the attendees that expanding the collaboration and discussion among international colleagues via in-person and virtual events will be important to move multimorbidity research forward.
Intravenous administration of tranexamic acid in total hip arthroplasty does not change the blood coagulopathy: a prospective thrombelastography analysis
Authors: Zhang Xing-chen , Sun Ma-ji , Pan Sheng , Rui Min , Zhao Feng-chao , Zha Guo-chun , Pang Yong , Zheng Xin , Guo Kai-jin
Published: September 2020

Objective:

Despite the wide use of tranexamic acid (TXA) in the perioperative period of total hip arthroplasty (THA), whether the hemostatic state changes after the application of intravenous (IV)-TXA are still unknown. The aim of this study was to investigate whether IV administration of TXA changes the blood coagulation following primary THA via thrombelastography (TEG) analysis and conventional laboratory tests.

Methods:

A total of 174 patients who underwent primary THA from September 2016 to July 2018 were selected. They were randomly divided into two groups, 86 patients with IV administration of 15 mg/kg TXA and 88 controls without TXA usage. Demographic data, TEG paremeters, d-dimer levels, fibrin degradation products, hemoglobin, hematocrit concentration, platelet, transfusion rates, perioperative blood loss, and the occurrence of deep vein thrombosis were collected. TEG and conventional laboratory tests were performed the day before operation, the first day after operation, and seventh day after operation.

Results:

There were no differences with regard to TEG or conventional laboratory tests between the two groups ( p > 0.05). The total blood loss and drain blood loss in the TXA group were significantly lower than those in the control group ( p < 0.05). The transfusion rates and the volume of blood transfusion of the control group were higher than those of the TXA group ( p < 0.05).

Conclusion:

The administration of IV-TXA resulted in a significant reduction in total blood loss, transfusion volumes, and transfusion rates without the increase of thromboembolic complications. Moreover, it was confirmed that TXA would not change the coagulation via the TEG analysis.
Do Modern Designs of Metal-Backed Glenoid Components Show Improved Clinical Results in Total Shoulder Arthroplasty? A Systematic Review of the Literature
Authors: Kim Dong Min , Alabdullatif Fahad , Aldeghaither Mohammed , Shin Myung Jin , Kim Hyojune , Park Dongjun , Kholinne Erica , Jeon In-Ho , Koh Kyoung Hwan
Published: September 2020

Background:

Despite the increased popularity of reverse total shoulder arthroplasty, total shoulder arthroplasty is the standard treatment for advanced shoulder arthritis in young adult patients. Conventional metal-backed glenoid (MBG) designs result in more loosening and revision surgery compared with cemented polyethylene glenoid components. However, modern MBG designs have been recently devised to overcome such drawbacks.

Purpose:

To compare the radiolucency, loosening, and failure rates of modern MBG designs with those of conventional designs.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A search for relevant articles was carried out using the PubMed, Cochrane Library, and Embase databases using MeSH (Medical Subject Headings) terms and natural keywords. A total of 362 articles were screened. We descriptively analyzed numerical data between the groups and statistically analyzed categorical data, such as the presence of loosening, failure, and revision surgery. The main outcome was the rate of revision surgery or failure. Subgroup analysis according to follow-up duration was performed to reduce heterogeneity.

Results:

A total of 25 articles (2036 shoulders) were included; 15 articles (1579 shoulders) involved a conventional MBG design, and 10 (457 shoulders) involved a modern design. The mean age of the patients was 64.2 and 66.5 years in the conventional and modern design groups, respectively, with a mean follow-up duration of 102.0 and 56.1 months, a mean gain of forward elevation of 35.1° and 61.7°, and a mean gain of external rotation of 24.2° and 39.2°. The rate of radiolucency was 48.0% and 16.7%, the rate of loosening was 11.2% and 4.9%, and the rate of revision was 15.9% and 2.4%, for the conventional and modern design groups, respectively. Subgroup analysis according to follow-up duration showed that the rates of loosening and revision were significantly lower in the modern design group ( P < .001).

Conclusion:

Our findings suggest that modern MBG designs showed significantly lower loosening and failure rates than conventional designs. The overall results of the comparison, including loosening, failure, change in range of motion, and clinical scores, indicate that modern MBG designs are promising. More long-term follow-up studies on modern MBGs should be conducted.
Postoperative Deep Gluteal Syndrome After Hip Arthroscopic Surgery
Authors: Uchida Soshi , Kizaki Kazuha , Hirano Fumitaka , Martin Hal David , Sakai Akinori
Published: September 2020

Background:

Deep gluteal syndrome (DGS) is an uncommon source of buttock and groin pain, resulting from entrapment of the sciatic nerve in the deep gluteal space. The incidence and risk factors of postoperative DGS after primary hip arthroscopic surgery are currently unknown.

Purpose:

To investigate the incidence and risk factors of postoperative DGS after primary hip arthroscopic surgery.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

This study reviewed 1167 patients who underwent arthroscopic surgery between 2010 and 2018 by a single surgeon at a single center in Japan. DGS was defined using the seated piriformis stretch test, active hamstring test, and evidence of a hypertrophic sciatic nerve on magnetic resonance imaging. Overall, 11 of 1167 patients were diagnosed with DGS postoperatively. The DGS group (n = 11) was compared with the non-DGS group (n = 1156). Patient age, sex, body mass index (BMI), generalized joint laxity (GJL; Beighton score >6), number of hip arthroscopic procedures, and radiographic parameters including lateral center-edge angle, Sharp angle, vertical center anterior angle, Tönnis angle, alpha angle, ischiofemoral distance, ischiofemoral space, and quadratus femoris space were compared. The prevalence of developmental dysplasia of the hip (DDH) and borderline DDH (BDDH) was also compared. Logistic regression analysis was conducted to identify potential predictors for a postoperative DGS diagnosis.

Results:

The incidence of postoperative DGS in our study was 0.9%. Female sex (male:female ratio: 0:11 in DGS group vs 568:588 in non-DGS group; P < .01), mean number of hip surgical procedures (1.8 ± 0.9 in DGS group vs 1.1 ± 0.4 in non-DGS group; P < .01), and GJL ( P < .01) were significantly higher in the DGS group, while the mean BMI was significantly lower in the DGS group (19.8 ± 1.8 vs 22.7 ± 3.6 kg/m2, respectively; P < .01). Radiographic parameters were not significantly different between groups. Logistic regression analysis revealed that female sex (odds ratio [OR], 22.0 [95% CI, 1.29-374.56]), multiple surgical procedures (OR, 7.8 [95% CI, 2.36-25.95]), GJL (OR, 40.9 [95% CI, 8.74-191.70]), lower BMI (OR, 0.77 [95% CI, 0.644-0.914]), and DDH/BDDH (OR, 18.1 [95% CI, 2.30-142.10]) were potential predictors of postoperative DGS.

Conclusion:

The incidence of postoperative DGS in our study was 0.9%. The predictors for postoperative DGS after hip arthroscopic surgery were female sex, GJL, multiple hip surgical procedures, and DDH/BDDH. Although hip arthroscopic surgery can provide favorable clinical outcomes, surgeons should be aware of the risk factors for DGS as a complication of hip arthroscopic surgery.
Hematologic Profiles of Ethiopian Preterm Infants With Clinical Diagnoses of Early-Onset Sepsis, Perinatal Asphyxia, and Respiratory Distress Syndrome
Authors: Tigabu Kebede Zemene , Matebe Yohannes Hailu , Demisse Abayneh Girma , Yimer Mulugeta Ayalew , Mekasha Amha , Worku Alemayehu , Demtse Gebremedhin Asrat , McClure Elizabeth M. , Nigussie Assaye K. , Worku Bogale , Gidi Netsanet Workneh , Metaferia Gesit , Goldenberg Robert L. , Muhe Lulu M.
Published: September 2020

Objective. To determine the hematologic profile of preterm infants with regard to different diseases. Methods. A prospective, cross-sectional, observational study, conducted in 5 hospitals in Ethiopia from July 2016 to May 2018. Preterm babies <7 days of age were included and investigated with complete blood counts (CBC) and other investigations, accordingly. Results. Out of 4919 preterms, 3852 (78.3%) were admitted to a newborn intensive care unit, and of these, 68.3% had a CBC performed. The mean values of hemoglobin, white blood cell (WBC) and platelet counts were 17.9 mg/dL; 12 685 cells/mm3, and 159 340 cells/mm3, respectively. Early onset neonatal sepsis (EONS) 1433 (37%), asphyxia 266 (6.9%), and respiratory distress syndrome (RDS) 1738 (45.3%) were common reasons for admission. The WBC count was <5000 cells/mm3 for 8.8%, 9.0%, and 11.1% of neonates with EONS, asphyxia and RDS, respectively. The hemoglobin value was <7 mg/dL for 0.6%, 1.7%, and 0.4% of preterm infants with EONS, asphyxia, and RDS, respectively. The platelet count was <50 000 cells/mm3 for 16.8%, 17.7%, and 19.8% of preterms admitted with a diagnosis of EONS, asphyxia, and RDS, respectively. Conclusion. WBC and platelet counts were the most common to be associated with EONS, asphyxia, and RDS. Further study is recommended to determine the effect of abnormal hematologic profile on the outcome of preterm babies.
Trends and Disparities in Subjective Upward Mobility since 1940
Authors: Berger Thor , Engzell Per
Published: September 2020

Concerns that prospects for upward mobility are fading are common in popular and scientific discourse. The fact that fewer Americans today surpass their parents’ economic status than in the past has been invoked to explain trends ranging from the recent spike in drug and alcohol poisonings to the growing appeal of right-wing populism. Using General Social Survey data, the authors ask whether people actually feel that their standard of living is falling short of that of previous generations. In contrast to data on income, education, or occupation, a majority still perceive that they have attained a higher standard of living than their parents. At the same time, mobility experiences are becoming increasingly polarized: subjective upward mobility is rising among highly educated, minority, and urban populations and declining among less educated and rural populations.
Real-Time Strategic Change: Flashback to Whole Systems Change and Relating to Organisation Development Sponsors in India
Authors: Sachdev Anil , Chakravarty Arjya
Published: September 2020

This article intends to introduce and explore the process and execution of change in complex dynamic organisation systems. Transformations are purposeful system-wide journey of organisational change. The emphasis is on the interaction between system elements more than on the analysis of each component. ‘Whole System transformation’ is involved in creating renewed organisations from within itself by enabling or allowing the system to transform itself.

Real-time strategic change is presented as a framework in this context of evolutionary open systems. This article explores organisational change in a richer and more insightful way. The large-scale interaction process (LSIP) is illustrated and explained and its relationship to transformation and change in organisations is explored in a procedural view of this change paradigm.

The authors outline the theoretical aspects of organisational change processes in Kathie Dannemiller’s whole systems thinking intellectual heritage. The article draws from experiences in many organisations that have benefited from this approach over the last 25 years with capability built among hundreds of facilitators to carry this approach forward.
Mechanisms of orthopnoea in patients with advanced COPD
Authors: Elbehairy Amany F. , Faisal Azmy , McIsaac Hannah , Domnik Nicolle J. , Milne Kathryn M. , James Matthew D. , Neder J. Alberto , O'Donnell Denis E.
Published: September 2020

Many patients with severe chronic obstructive pulmonary disease (COPD) report an unpleasant respiratory sensation at rest, which is further amplified by adoption of a supine position (orthopnoea). The mechanisms of this acute symptomatic deterioration are poorly understood.

Sixteen patients with advanced COPD and a history of orthopnoea and 16 age- and sex-matched healthy controls underwent pulmonary function tests (PFTs) and detailed sensory–mechanical measurements including inspiratory neural drive (IND) assessed by diaphragm electromyography (EMGdi), oesophageal pressure (Pes) and gastric pressure (Pga), in both sitting and supine positions.

Patients had severe airflow obstruction (forced expiratory volume in 1 s (FEV1): 40±18% pred) and lung hyperinflation. Regardless of the position, patients had lower inspiratory capacity (IC) and higher IND for a given tidal volume (VT) (i.e.greater neuromechanical dissociation (NMD)), higher intensity of breathing discomfort, higher minute ventilation (V′E) and higher breathing frequency (fB) compared with controls (all p<0.05). For controls in a supine position, IC increased by 0.48 Lversussitting erect, with a small drop inV′E, mainly due to reducedfB(all p<0.05). By contrast, IC remained unaltered in patients with COPD, but dynamic lung compliance (CLdyn) decreased (p<0.05) in the supine position. Breathing discomfort, inspiratory work of breathing (WOB), inspiratory effort, IND, NMD and neuroventilatory uncoupling all increased in COPD patients in the supine position (p<0.05), but not in the healthy controls. Orthopnoea was associated with acute changes in IND (r=0.65, p=0.01), neuroventilatory uncoupling (r=0.76, p=0.001) and NMD (r=0.73, p=0.002).

In COPD, onset of orthopnoea coincided with an abrupt increase in elastic loading of the inspiratory muscles in recumbency, in association with increased IND and greater NMD of the respiratory system.
Accelerated FEV1decline and risk of cardiovascular disease and mortality in a primary care population of COPD patients
Authors: Whittaker Hannah R. , Bloom Chloe , Morgan Ann , Jarvis Deborah , Kiddle Steven J. , Quint Jennifer K.
Published: September 2020

Accelerated lung function decline has been associated with increased risk of cardiovascular disease (CVD) in a general population, but little is known about this association in chronic obstructive pulmonary disease (COPD). We investigated the association between accelerated lung function decline and CVD outcomes and mortality in a primary care COPD population.

COPD patients without a history of CVD were identified in the Clinical Practice Research Datalink (CPRD)-GOLD primary care dataset (n=36 382). Accelerated decline in forced expiratory volume in 1 s (FEV1) was defined using the fastest quartile of the COPD population's decline. A Cox regression was used to assess the association between baseline accelerated FEV1decline and a composite CVD outcome over follow-up (myocardial infarction, ischaemic stroke, heart failure, atrial fibrillation, coronary artery disease and CVD mortality). The model was adjusted for age, sex, smoking status, body mass index, history of asthma, hypertension, diabetes, statin use, Modified Medical Research Council (mMRC) dyspnoea score, exacerbation frequency and baseline FEV1% predicted.

6110 COPD patients (16.8%) had a CVD event during follow-up; median length of follow-up was 3.6 years (interquartile range (IQR) 1.7–6.1 years). Median rate of FEV1decline was –19.4 mL·year−1(IQR –40.5–1.9); 9095 patients (25%) had accelerated FEV1decline (> –40.5 mL·year−1), 27 287 (75%) did not (≤ –40.5 mL·year−1). Risk of CVD and mortality was similar between patients with and without accelerated FEV1decline (HRadj0.98, 95% CI 0.90–1.06). Corresponding risk estimates were 0.99 (95% CI 0.83–1.20) for heart failure, 0.89 (95% CI 0.70–1.12) for myocardial infarction, 1.01 (95% CI 0.82–1.23) for stroke, 0.97 (95% CI 0.81–1.15) for atrial fibrillation, 1.02 (95% CI 0.87–1.19) for coronary artery disease and 0.94 (95% CI 0.71–1.25) for CVD mortality. Rather, risk of CVD was associated with a mMRC score ≤2 and two or more exacerbations in the year prior.

CVD outcomes and mortality were associated with exacerbation frequency and severity and increased mMRC dyspnoea score but not with accelerated FEV1decline.
Current clinical methods of measurement of respiratory rate give imprecise values
Authors: Drummond Gordon B. , Fischer Darius , Arvind D.K.
Published: September 2020

Background

Respiratory rate is a basic clinical measurement used for illness assessment. Errors in measuring respiratory rate are attributed to observer and equipment problems. Previous studies commonly report rate differences ranging from 2 to 6 breaths·min−1between observers.

Methods

To study why repeated observations should vary so much, we conducted a virtual experiment, using continuous recordings of breathing from acutely ill patients. These records allowed each breathing cycle to be precisely timed. We made repeated random measures of respiratory rate using different sample durations of 30, 60 and 120 s. We express the variation in these repeated rate measurements for the different sample durations as the interquartile range of the values obtained for each subject. We predicted what values would be found if a single measure, taken from any patient, were repeated and inspected boundary values of 12, 20 or 25 breaths·min−1, used by the UK National Early Warning Score, for possible mis-scoring.

Results

When the sample duration was nominally 30 s, the mean interquartile range of repeated estimates was 3.4 breaths·min−1. For the 60 s samples, the mean interquartile range was 3 breaths·min−1, and for the 120 s samples it was 2.5 breaths·min−1. Thus, repeat clinical counts of respiratory rate often differ by >3 breaths·min−1. For 30 s samples, up to 40% of National Early Warning Scores could be misclassified.

Conclusions

Early warning scores will be unreliable when short sample durations are used to measure respiratory rate. Precision improves with longer sample duration, but this may be impractical unless better measurement methods are used.
Remission of adult-onset asthma is rare: a 15-year follow-up study
Authors: Almqvist Linnéa , Rönmark Eva , Stridsman Caroline , Backman Helena , Lindberg Anne , Lundbäck Bo , Hedman Linnéa
Published: September 2020

Background

There are few long-term clinical follow-up studies of adult-onset asthma. The aim of this article was to study clinical characteristics of adult-onset asthma in relation to remission and persistence of the disease in a 15-year follow-up.

Methods

A cohort of 309 adults aged 20–60 years with asthma onset during the last 12 months verified by bronchial variability, was recruited between 1995 and 1999 from the general population in northern Sweden. The cohort was followed-up in 2003 (n=250) and between 2012 and 2014 (n=205). Structured interviews and spirometry were performed at recruitment and the follow-ups. Bronchial hyperreactivity (BHR) and skin-prick tests were performed at recruitment and blood samples were collected at the last follow-up. Remission of asthma was defined as no asthma symptoms and no use of asthma medication during the last 12 months.

Results

Of eight individuals in remission in 2003, five had relapsed between 2012 and 2014 and in total, 23 (11%) were in remission, while 182 had persistent asthma. Those in remission had higher mean forced expiratory volume in 1 s % predicted at recruitment than those with persistent asthma (94.6versus88.3, p=0.034), fewer had severe BHR (27.3%versus50.9%, p=0.037) and they had less body mass index increase (+1.6versus+3.0, p=0.054). Of those with persistent asthma, 13% had uncontrolled asthma and they had higher levels of blood neutrophils than those with partly controlled or controlled asthma.

Conclusion

Higher forced expiratory volume in 1 s % predicted and less-severe BHR was associated with remission of adult-onset asthma, but still, the proportion in remission in this 15-year follow-up was low.
A step towards unraveling the paleogeographic attribution of pre-Mesozoic basement complexes in the Western Alps based on U–Pb geochronology of Permian magmatism
Authors: Ballèvre Michel , Camonin Audrey , Manzotti Paola , Poujol Marc
Published: September 2020

The Briançonnais Domain (Western Alps) represented the thinned continental margin facing the Piemonte-Liguria Ocean, later shortened during the Alpine orogeny. In the external part of the External Briançonnais Domain (Zone Houillère), the Palaeozoic basement displays microdioritic intrusions into Carboniferous sediments and andesitic volcanics resting on top of the Carboniferous sediments. These magmatic rocks are analysed at two well-known localities (Guil volcanics and Combarine sill). Geochemical data show that the two occurrences belong to the same calc-alkaline association. LA-ICP-MS U–Pb ages have been obtained for the Guil volcanics (zircon: 291.3 ± 2.0 Ma and apatite: 287.5 ± 2.6 Ma), and the Combarine sill (zircon: 295.9 ± 2.6 Ma and apatite: 288.0 ± 4.5 Ma). These ages show that the calc-alkaline magmatism is of Early Permian age. During Alpine orogeny, a low-grade metamorphism, best recorded by lawsonite-bearing veins in the Guil andesites, took place at about 0.4 GPa, 350 °C in the External Briançonnais and Alpine metamorphism was not able to reset the U–Pb system in apatite. The Late Palaeozoic history of the Zone Houillère is identical to the one recorded in the Pinerolo Unit, located further East in the Dora-Maira Massif, and having experienced a garnet-blueschist metamorphism during the Alpine orogeny. The comparison of these two units allows for a better understanding of the link between the Palaeozoic basements, mostly subducted during the Alpine convergence, and their Mesozoic covers, generally detached at an early stage of the convergence history.
Calcitonin gene related peptide monoclonal antibody treats headache in patients with active idiopathic intracranial hypertension
Authors: Yiangou Andreas , Mitchell James L. , Vijay Vivek , Grech Olivia , Bilton Edward , Lavery Gareth G. , Fisher Claire , Edwards Julie , Mollan Susan P. , Sinclair Alexandra J.
Published: September 2020

Background

Headache is the dominant factor for quality of life related disability in idiopathic intracranial hypertension (IIH) and typically has migraine-like characteristics. There are currently no evidence-based therapeutics for headache in IIH, and consequently this is an important unmet clinical need.

Case series

We report a series of seven patients in whom headaches were the presenting feature of IIH and the headaches had migraine-like characteristics, as is typical in many IIH patients. Papilloedema settled (ocular remission) but headaches continued. These headaches responded markedly to erenumab, a monoclonal antibody targeted against the calcitonin gene related peptide (CGRP) receptor. Of note, there was a recurrence of raised ICP, as evidenced by a return of the papilloedema, however the headaches did not recur whilst treated with erenumab.

Conclusions

Those with prior IIH who have their headaches successfully treated with CGRP therapy, should remain under close ocular surveillance (particularly when weight gain is evident) as papilloedema can re-occur in the absence of headache. These cases may suggest that CGRP could be a mechanistic driver for headache in patients with active IIH.
Protective role of mirtazapine in adult female Mecp2+/− mice and patients with Rett syndrome
Authors: Flores Gutiérrez Javier , De Felice Claudio , Natali Giulia , Leoncini Silvia , Signorini Cinzia , Hayek Joussef , Tongiorgi Enrico
Published: September 2020

Background

Rett syndrome (RTT), an X-linked neurodevelopmental rare disease mainly caused by MECP2-gene mutations, is a prototypic intellectual disability disorder. Reversibility of RTT-like phenotypes in an adult mouse model lacking the Mecp2-gene has given hope of treating the disease at any age. However, adult RTT patients still urge for new treatments. Given the relationship between RTT and monoamine deficiency, we investigated mirtazapine (MTZ), a noradrenergic and specific-serotonergic antidepressant, as a potential treatment.

Methods

Adult heterozygous-Mecp2 (HET) female mice (6-months old) were treated for 30 days with 10 mg/kg MTZ and assessed for general health, motor skills, motor learning, and anxiety. Motor cortex, somatosensory cortex, and amygdala were analyzed for parvalbumin expression. Eighty RTT adult female patients harboring a pathogenic MECP2 mutation were randomly assigned to treatment to MTZ for insomnia and mood disorders (mean age = 23.1 ± 7.5 years, range = 16–47 years; mean MTZ-treatment duration = 1.64 ± 1.0 years, range = 0.08–5.0 years). Rett clinical severity scale (RCSS) and motor behavior assessment scale (MBAS) were retrospectively analyzed.

Results

In HET mice, MTZ preserved motor learning from deterioration and normalized parvalbumin levels in the primary motor cortex. Moreover, MTZ rescued the aberrant open-arm preference behavior observed in HET mice in the elevated plus-maze (EPM) and normalized parvalbumin expression in the barrel cortex. Since whisker clipping also abolished the EPM-related phenotype, we propose it is due to sensory hypersensitivity. In patients, MTZ slowed disease progression or induced significant improvements for 10/16 MBAS-items of the M1 social behavior area: 4/7 items of the M2 oro-facial/respiratory area and 8/14 items of the M3 motor/physical signs area.

Conclusions

This study provides the first evidence that long-term treatment of adult female heterozygous Mecp2tm1.1Bird mice and adult Rett patients with the antidepressant mirtazapine is well tolerated and that it protects from disease progression and improves motor, sensory, and behavioral symptoms.