bluuebunny/crossref_metadata_2025 huggingface dataset:
A case of giant orbital conjunctival cyst mimicking lymphatic malformation
Authors: Suimon Yuka , Kase Satoru , Ito Takako , Ishida Susumu
Published: October 2020

A conjunctival inclusion cyst is a colorless or whitish translucent cystic lesion, frequently occurring on the conjunctiva. Here, we describe a patient with a giant conjunctival cyst, mainly existing in the orbit, which clinically resembled lymphatic malformation. A 34-year-old male complained of a subconjunctival mass on his left infero-medial side persisting since childhood. It had gradually enlarged over the 3 months before the initial visit. He had no history of trauma, surgery, or conjunctivitis. The mass was dark red, with superficial dilated blood vessels. Magnetic resonance imaging showed a well-circumscribed mass in the inferior orbit, measuring 12 × 25 mm, which had an internal septum. The lesion was completely resected without rupture of the mass through a transcutaneous approach. Histopathologically, the mass was a cyst composed of columnar epithelium with goblet cells and lymphoid follicles adjacent to the wall. In conclusion, a giant orbital conjunctival cyst and a lymphatic malformation should be differentiated at diagnosis.
Exercise and the brain in multiple sclerosis
Authors: Lozinski Brian M , Yong V Wee
Published: October 2020

While people with multiple sclerosis (PwMS) historically were advised to avoid physical activity to reduce symptoms such as fatigue, they are now encouraged to remain active and to enlist in programs of exercise. However, despite an extensive current literature that exercise not only increases physical well-being but also their cognition and mental health, many PwMS are not meeting recommended levels of exercise. Here, we emphasize the impact and mechanisms of exercise on functional and structural changes to the brain, including improved connectome, neuroprotection, neurogenesis, oligodendrogenesis, and remyelination. We review evidence from animal models of multiple sclerosis (MS) that exercise protects and repairs the brain, and provide supportive data from clinical studies of PwMS. We introduce the concept of MedXercise, where exercise provides a brain milieu particularly conducive for a brain regenerative medication to act upon. The emphasis on exercise improving brain functions and repair should incentivize PwMS to remain physically active.
Work exposure and associated risk of hospitalisation with pneumonia and influenza: A nationwide study
Authors: Østergaard Lauge , Mortensen Rikke Nørmark , Kragholm Kristian , Dalager-Pedersen Michael , Koch Kristoffer , Køber Lars , Torp-Pedersen Christian , Fosbøl Emil
Published: October 2020

Background:

Pneumonia and influenza are major health concerns and constitute a high economic burden. However, few data are available on the associated risk of pneumonia and influenza and work exposure on a large population scale.

Aim:

This study aimed to examine the associated risk of pneumonia and influenza by type of work exposure.

Methods:

By cross-linking administrative Danish registries, we classified people in 10 different profession types. The main outcome was hospitalisation with pneumonia or influenza. A multivariable Poisson regression analysis was used to assess the associated incidence rate ratio (IRR) of being hospitalised with pneumonia or influenza by type of profession.

Results:

A total of 1,327,606 people added risk time to the analyses. In a multivariable model, work in day care, public transportation, sewers and nursing home care was associated with an increased risk of hospitalisation with pneumonia compared to work within public administration: IRR=1.20 (95% confidence interval (CI) 1.12–1.28), IRR=1.21 (95% CI 1.09–1.34), IRR=1.61 (95% CI 1.19–2.19) and IRR=1.10 (95% CI 1.03–1.18), respectively. In a multivariable analysis, people working within public transportation were associated with an increased risk of hospitalisation with influenza compared to people working within public administration: IRR=2.54 (95% CI 1.79–3.58).

Conclusions:

Working in day care, public transportation, sewers and nursing home care increased the associated risk of hospitalisation with pneumonia, and working within public transportation increased the associated risk of being hospitalised with influenza compared to working within public administration.
Environmental satisfaction levels of the elderly individuals in nursing home gardens
Authors: Eren Emine Tarakci , Dzenli Tuğba , Var Mustafa
Published: October 2020

The present study presents a three-step methodology to determine the environmental satisfaction levels of the elderly individuals in nursing home gardens. The first step comprised the selection of seven nursing homes in five provinces in the Eastern Black Sea region in Turkey. In the second step, 130 participants were selected among the residents of these seven nursing homes via random sampling. In the third step, the satisfaction level of the nursing home residents with the institution gardens was determined. A correlation analysis showed a positive relationship between the environmental and individual characteristics ( r =  0.554; p < 0.01). Simple regression analysis was conducted to determine the effect of environmental characteristics on the satisfaction of individual needs, after determining the direction and level of the relationship between the environmental and the individual characteristics via correlation analysis. The analysis indicated a significant relationship between the environmental and individual characteristics ( R = 0.610; R2 = 0.373; F = 75.991; p <0.001). In conclusion, increased level of satisfaction with the existing physical characteristics of the gardens resulted in an increased level in meeting the psychosocial needs of the elderly individuals, thus, the environmental satisfaction level of nursing home residents increased as well.
Exploring opportunities for holistic family care of parental caregivers of children with life-threatening or life-limiting illnesses
Authors: Bally Jill MG , Burles Meridith , Smith Nicole R , Holtslander Lorraine , Mpofu Chris , Hodgson-Viden Heather , Zimmer Marcelline
Published: October 2020

Life-threatening and life-limiting illnesses in children have profound implications for all family members, many of whom experience unmet health and support needs. Guided by literature on family-centered care and an Interpretive Description methodology, qualitative focus group interviews were conducted with 18 parental caregivers and health care and support providers to explore family experiences and identify care and support needs across the illness trajectory. Data analysis resulted in three themes related to parental participation in children’s medical care, parental and familial psychological well-being, and social support needs. These inter-related themes reflect the complex nature of family life with childhood illness, highlighting families’ holistic needs and how children’s physical and psychological care is intertwined with the psychological and social well-being of the family system. Additionally, the findings revealed the significance of communication to parental caregivers’ hope, coping, and well-being. The findings add depth to existing literature, and identify opportunities for addressing families’ unmet needs, with specific attention to the role that social workers can play in facilitating family-centred care to promote effective support of parental caregivers. As such, the findings emphasize the important contributions that social workers can make within health care teams and in educational settings to optimize parents’ ability to care for ill children while maintaining family functioning and well-being, and as advocates for social and policy change.
Clinical Applications of RNA Editing Technology for the Early Detection of Cancer and Future Directions
Authors: Ullah Mujib , Akbar Asma , Yannarelli Gustavo
Published: October 2020

Early detection of cancer has great clinical importance and potentially improves cure, survival rate and treatment outcome. RNA editing technology can be used as targeted and precise molecular scissors to cut and replace disease-causing genes with healthy ones. This is a post transcriptional modification that can lead to the recoding of proteins. RNA editing technology is in its infancy, but it can be used for early diagnoses and effective treatment of cancer. The full potential of precision medicine will be achieved by using the knowledge of RNA reversible-recoding to edit the protein. RNA editing technology could be used to expose chemo resistant cancer cells, dormant cancer stem cells and other malignant tumors. RNA editing generates RNA and protein diversity to accelerate and enhance the screening window for early detection of cancer. We propose that the RNA editing sites could be used as a novel tool for early detection of cancer.
Multi-Wavelength Fluorescence in Image-Guided Surgery, Clinical Feasibility and Future Perspectives
Authors: van Beurden Florian , van Willigen Danny M. , Vojnovic Borivoj , van Oosterom Matthias N. , Brouwer Oscar R. , der Poel Henk G. van , Kobayashi Hisataka , van Leeuwen Fijs W.B. , Buckle Tessa
Published: October 2020

With the rise of fluorescence-guided surgery, it has become evident that different types of fluorescence signals can provide value in the surgical setting. Hereby a different range of targets have been pursued in a great variety of surgical indications. One of the future challenges lies in combining complementary fluorescent readouts during one and the same surgical procedure, so-called multi-wavelength fluorescence guidance. In this review we summarize the current clinical state-of-the-art in multi-wavelength fluorescence guidance, basic technical concepts, possible future extensions of existing clinical indications and impact that the technology can bring to clinical care.
From Grandma’s Attic to Amnesty Programs: Adventures in Accessioning Archaeological Collections
Authors: Murphy Tracy L.
Published: October 2020

Canyons of the Ancients Visitor Center and Museum (the Center) located in Dolores, Colorado is a federal Bureau of Land Management curation facility for archaeological collections generated from permitted projects on public lands in southwest Colorado. As with many museums, the Center receives artifacts without contextual information that were collected without permits and transferred through a variety of sources like law enforcement actions. Numerous donation scenarios are provided. The curation of artifacts without provenience or contextual information can be difficult to justify because of high curation costs and limited space. However, the Center has identified and clarified the value of unprovenienced collections and found paths to provide public benefit through the application of Department of Interior and Bureau of Land Management policy and guidance.
A Surgeon’s Guide for Various Lung Nodule Localization Techniques and the Newest Technologies
Authors: Cornella Katie N. , Repper Danielle C. , Palafox Brian A. , Razavi Mahmood K. , Loh Christopher T. , Markle Kelly M. , Openshaw Lauren E.
Published: October 2020

Preoperative image-guided localization of lung nodules is necessary for successful intraoperative localization and resection. However, current localization techniques carry significant intraoperative disadvantages for surgeons. Articles were selected through multiple search engines using key search terms and reviewed to compare results, outcomes, advantages, limitations, and complications of various localization methods. Current methods utilize microcoils, hookwires, contrast media, dyes, cyanoacrylate, radiotracers, or fluorescence tracers, which are associated with many intraoperative disadvantages even when paired with other imaging modalities including computed tomography and bronchoscopy techniques. Novel technologies including robotic bronchoscopy, 4-hook anchor, SPiN Thoracic Navigation System, superDimension, Ion Endoluminal System, and the SCOUT system are reviewed including their advantages, which may change the future direction of minimal thoracoscopic surgery with potential to improve intraoperative accuracy and efficiency.
Involvement of cannabinoid type 1 receptor in fasting-induced analgesia
Authors: Lee Jeong-Yun , Lee Grace J. , Nakamura Ayumi , Lee Pa Reum , Kim Yeajin , Won Chan Hee , Furue Hidemasa , Oh Seog Bae
Published: October 2020

The endocannabinoid system (ECS) is known to modulate not only food intake but also pain, especially via the cannabinoid type 1 receptor (CB1R) expressed throughout the central nervous system and the peripheral tissues. Our previous study demonstrated that fasting produces an analgesic effect in adult male mice, which is reversed by intraperitoneal (i.p.) administration of CB1R antagonist (SR 141716). In the present study, we further examined the effect of CB1R expressed in the peripheral tissues. In the formalin-induced inflammatory pain model, i.p. administration of peripherally restricted CB1R antagonist (AM 6545) reversed fasting-induced analgesia. However, intraplantar administration of SR 141716 did not affect fasting-induced analgesia. Furthermore, mRNA expression of CB1R did not change in the formalin model by fasting in the dorsal root ganglia. The formalin-induced c-Fos expression at the spinal cord level was not affected by fasting, and in vivo recording from the superficial dorsal horn of the lumbar spinal cord revealed that fasting did not affect formalin-induced neural activity, which indicates minimal involvement of the spinal cord in fasting-induced analgesia. Finally, when we performed subdiaphragmatic vagotomy to block the hunger signal from the gastrointestinal (GI) system, AM 6545 did not affect fasting-induced analgesia, but SR 141716 still reversed fasting-induced analgesia. Taken together, our results suggest that both peripheral and central CB1Rs contribute to fasting-induced analgesic effects and the CB1Rs in the GI system which transmit fasting signals to the brain, rather than those in the peripheral sensory neurons, may contribute to fasting-induced analgesic effects.
Efficacy of FF/UMEC/VI compared with FF/VI and UMEC/VI in patients with COPD: subgroup analysis of the Spain cohort in IMPACT
Authors: Marín José M. , Mateos Luis , Roldán Juan , Echave-Sustaeta José M. , Pascual-Guardia Sergi , Pardo Maria V. , Velasco Beatriz , Jones C. Elaine , Kilbride Sally , Lipson David A.
Published: October 2020

Objectives:

The IMPACT trial has compared the benefit in the reduction of moderate/severe exacerbations of single inhaler triple therapy (SITT) with fluticasone furoate (FF)/umeclidinium (UMEC)/vilanterol (VI) versus dual therapy with FF/VI (ICS/LABA) and UMEC/VI (LAMA/LABA) in the treatment of patients with chronic obstructive disease (COPD). This study performs a subgroup analysis of the cohort from Spain in the IMPACT study.

Materials and Methods:

In IMPACT, a 52-week randomized, double-blind, parallel-group, multicenter study ( N = 10,355), patients ⩾40 years of age with COPD and ⩾1 moderate/severe exacerbations in the previous year were randomized 2:2:1 to once-daily FF/UMEC/VI 100/62.5/25 µg, FF/VI 100/25 µg or UMEC/VI 62.5/25 µg administered via the Ellipta inhaler. Here, we present a subgroup analysis of the 499 patients from Spain, included in the intent-to-treat (ITT) population in the study. Endpoint assessed included exposure-adjusted rate of moderate and severe exacerbations.

Results:

In the Spain cohort, the exposure-adjusted rate of on-treatment moderate/severe COPD exacerbations per year for FF/UMEC/VI was 1.31 versus 1.43 and 1.57 for FF/VI and UMEC/VI, respectively. No new adverse events were identified. The results are consistent with those observed in the overall ITT study population.

Conclusion:

In the Spain cohort of the IMPACT study, patients receiving triple therapy with FF/UMEC/VI had a lower exposure-adjusted rate of exacerbations compared with FF/VI and UMEC/VI, similar to the overall population. Study Title: A Phase III, 52 Week, Randomized, Double-blind, 3-arm Parallel Group Study, Comparing the Efficacy, Safety and Tolerability of the Fixed Dose Triple Combination FF/UMEC/VI With the Fixed Dose Dual Combinations of FF/VI and UMEC/VI, All Administered Once-daily in the Morning Via a Dry Powder Inhaler in Subjects With Chronic Obstructive Pulmonary Disease URL: https://www.clinicaltrialsregister.eu/ctr-search/search?query=CTT116855/ https://clinicaltrials.gov/ct2/show/NCT02164513 Registration number: GSK (CTT116855/NCT02164513). The reviews of this paper are available via the supplemental material section.
HRCT evaluation of patients with interstitial lung disease: comparison of the 2018 and 2011 diagnostic guidelines
Authors: Nathan Steven D. , Pastre Jean , Ksovreli Inga , Barnett Scott , King Christopher , Aryal Shambhu , Ahmad Kareem , Fukuda Cesar , Ramalingam Vijaya , Chung Jonathan H.
Published: October 2020

Background and aims:

Chest high-resolution computed tomography (HRCT) is the central diagnostic tool in discerning idiopathic pulmonary fibrosis (IPF) from other interstitial lung disease (ILDs). In 2018, new guidelines were published and the nomenclature for HRCT interpretation was changed. We sought to evaluate how clinicians’ interpretation would change based on reading HRCTs under the framework of the old versus new categorization.

Materials and methods:

We collated HRCTs from 50 random cases evaluated in the Inova Fairfax ILD clinic. Six ILD experts were provided the deidentified HRCTs. They were all instructed to independently provide two reads of each HRCT, based on the old and the new guidelines.

Results:

The kappa statistic for concordance for HRCT reads under old guidelines was 0.5, while for the new guidelines it was 0.38. Under the framework of the old guidelines, there were 22 HRCTs with unanimous consensus reads, while only 15 with the new guidelines. There were 12 HRCTs read unanimously as usual interstitial pneumonia (UIP) pattern based on both the old and the new guidelines. Ten HRCTs were read as a possible UIP pattern based on the old guidelines and were classified in nine cases as probable UIP and one indeterminate based on the new guidelines. Of the 28 inconsistent UIP HRCTs (old guidelines), 25 were read as alternative diagnosis suggested, two were read as indeterminate and one as probable UIP.

Conclusion:

Implementation of the new guidelines to categorize HRCTs in ILD patients appears to be associated with greater inter-interpreter variability. How or whether new guidelines improve the care and management of ILD patients remains unclear. The reviews of this paper are available via the supplemental material section.
Five-Year Cost-Effectiveness Modeling of Primary Care-Based, Nonmydriatic Automated Retinal Image Analysis Screening Among Low-Income Patients With Diabetes
Authors: Fuller Spencer D. , Hu Jenny , Liu James C. , Gibson Ella , Gregory Martin , Kuo Jessica , Rajagopal Rithwick
Published: October 2020

Background:

Artificial intelligence-based technology systems offer an alternative solution for diabetic retinopathy (DR) screening compared with standard, in-office dilated eye examinations. We performed a cost-effectiveness analysis of Automated Retinal Image Analysis System (ARIAS)-based DR screening in a primary care medicine clinic that serves a low-income patient population.

Methods:

A model-based, cost-effectiveness analysis of two DR screening systems was created utilizing data from a recent study comparing adherence rates to follow-up eye care among adults ages 18 or older with a clinical diagnosis of diabetes. In the study, the patients were prescreened with an ARIAS-based, nonmydriatic (undilated), point-of-care tool in the primary care setting and were compared with patients with diabetes who were referred for dilated retinal screening without prescreening, as is the current standard of care. Using a Markov model with microsimulation resulting in a total of 600 000 simulated patient experiences, we calculated the incremental cost-utility ratio (ICUR) of the two screening approaches, with regard to five-year cost-effectiveness of DR screening and treatment of vision-threatening DR.

Results:

At five years, ARIAS-based screening showed similar utility as the standard of care screening systems. However, ARIAS reduced costs by 23.3%, with an ICUR of $258 721.81 comparing the current practice to ARIAS.

Conclusions:

Primary care-based ARIAS DR screening is cost-effective when compared with standard of care screening methods.
Anwulignan Alleviates Carbon Tetrachloride-Induced Acute Liver Injury in Mice
Authors: Yuchong Zhang , Xinyun Zhang , Yao Wang , Huijiao Lin , Chunyan Yu , Shu Jing , Wenyue Zhuang , Chunmei Wang , Jinghui Sun , He Li , Jianguang Chen
Published: October 2020

Acute liver injury is a serious threat to human health. Complementary therapy including a traditional Chinese herb has been used for the prevention and treatment of liver injuries. Schisandrae sphenantherae fructus (Schisandra) is the mature dry fruit of Schisandra sphenanthera Rehd. et Wils. Wuzhi capsule, a preparation containing Schisandra and its main component anwulignan, is used to treat hepatitis and hepatic insufficiency caused by viruses and drugs in the clinic. However, to date, there has been little study to reveal the effect of anwulignan in the protection of the liver. Therefore, in this study, we hypothesized that anwulignan could protect carbon tetrachloride (CCl4)-induced acute liver injury in mice. Anwulignan was shown to reduce significantly the liver index, decrease liver histopathological injury, decrease the serum level of aspartate aminotransferase and alanine aminotransferase, increase the activities of superoxide dismutase (SOD) and glutathione peroxidase, reduce liver malondialdehyde content, and downregulate the expression levels of interleukin (IL)-6, IL-1β, and tumor necrosis factor-α in the liver tissue, as well as the protein expression levels of receptor-interacting serine/threonine-protein kinase 1 (RIPK1), RIPK3, and phosphorylated mixed lineage kinase domain-like protein. All these results suggest that anwulignan can alleviate the CCl4-induced acute liver injury in mice, which may be related to its antioxidant, anti-inflammation, and inhibition of liver cell necroptosis effects.
Something Happened in the Room: Conceptualizing Intersubjectivation
Authors: Dunlop Melissa , Del Negro Gaia , De Munck Katrien , Gale Ken , Mackay Susan Moir , Price Mark , Sakellariadis Artemi , Soler Gabriel , Speedy Jane , Van Hove Geert
Published: October 2020

A panel convened around the idea of intersubjectivation, loosely conceived as a process of actively, consciously, and reciprocally adjusting the structures and power dynamics of our social relations, thereby mutually (and consensually) reconfiguring our subjectivities and, over time, our wider cultures. Through a series of explorations of how one may elicit, reach, or realize a shared sense of intersubjectivity, the panel reflected on and challenged conceptions of the human subject as unitary, discretely embodied, economically accountable, and objectively measurable by a proscribed set of validating criteria. Speakers invited, allowed, or insisted upon the (re)presentation of hidden, unrecognized, or misconstrued aspects of subjectivities: their own or other people’s. While considering varied examples, variously presented, of the process we came to call intersubjectivation, something happened in the room: feeling intensified… shifted… becoming more… an enhanced sense of intimacy perhaps… affectively charged empathic stillness … sensations of interconnection. And we became. Using recollections and reflections from those present, this paper attempts a representation of what happened in the room, intangible yet perceptible—precious and alive—in hope of building understanding of how intersubjectivation may be conceptualized and achieved, whether actively intended or obliquely manifested through some peripheral, perhaps-parallel perhaps-integral, process.
Administration of Dexamethasone for Bacterial Meningitis: An Unreliable Quality Measure
Authors: Dujari Shefali , Gummidipundi Santosh , He Zihuai , Gold Carl A.
Published: October 2020

Objective:

To validate the use of administrative data to identify patients with bacterial meningitis and quantify the rate of dexamethasone administration as defined in the American Academy of Neurology Inpatient and Emergency Care Quality Measurement Set.

Methods:

The Vizient Clinical Data Base and Resource Manager was used to identify patients with International Classification of Diseases, Tenth Revision (ICD-10) codes for bacterial meningitis from October 2015 to June 2019. Chart review was performed on patients identified at a single quaternary-care hospital. The positive predictive value (PPV) of Vizient was determined. Demographic, clinical, and laboratory data were assessed using descriptive statistics.

Results:

Of all hospitals that submitted complete data to Vizient during the study period, a median of 19 patients per hospital had ICD-10 codes for bacterial meningitis in the 45-month period. We identified 79 patients using Vizient at our institution of whom 69 had a diagnosis of bacterial meningitis confirmed by chart review (PPV = 87%). 15 patients were eligible to receive dexamethasone per the quality measurement set. Six of these patients (40%) received dexamethasone.

Conclusion:

It is feasible to use the Vizient Clinical Data Base and Resource Manager to identify patients with bacterial meningitis. Due to low prevalence across multiple institutions and high rate of exclusion criteria at our institution, this study suggests that the rate of dexamethasone administration in bacterial meningitis may be an unreliable indicator of quality of care provided by inpatient neurologists. The creation of a registry for hospitalized neurology patients could enhance development of future quality measures.
An Investigation into the Bitewing Radiographic Prescribing Patterns of West Kent General Dental Practitioners
Authors: Mauthe Peter W , Eaton Kenneth A
Published: October 2020

Aims

The primary aims of the study were to investigate the use of bitewing radiography within primary dental care and adherence to guidelines on bitewing radiography by general dental practitioners (GDPs) in the West Kent Primary Care Trust (PCT) area. Within the overall aims, the study had objectives to investigate the use of radiographic guidelines, audit and caries risk assessment, the influence of private and National Health Service (NHS) practice, and the influence of the demographic profile of the GDPs on these variables.

Methods

Data were gathered via a piloted self-completion questionnaire, circulated to all GDPs listed on the NHS Choices website as practising in the West Kent PCT area. Three mailings and follow-up telephone calls were used. The resulting data were entered into a statistical software database and, where relevant, statistically tested, using the chi-square test.

Results

Of 223 GDPs, 167 responded (75%). GDPs with a high NHS commitment were significantly less likely to follow Faculty of General Dental Practice (UK) guidance on prescribing bitewing radiographs for adults ( P<0.01) and children ( P<0.05) than were mainly private GDPs. Mainly NHS GDPs were more likely ‘always/mostly’ to follow National Institute for Health and Clinical Excellence guidance (83 compared to 59) ( P<0.05) and also to risk-assess patients (83 compared to 62). Only 115 (71%) had carried out a radio graphic audit or peer review in the preceding three years. Those with postgraduate qualifications were more likely ( P<0.05) to carry out radiographic audit.

Conclusions

The study confirmed previous research reporting the under-use of radiography for caries detection and also the failure of some GDPs to comply with ionising radiation regulations. West Kent GDPs with a high NHS commitment were less likely to follow radiographic guidance than their private counterparts. This suggests that further efforts to disseminate information on radiographic guidelines and to educate GDPs are necessary to improve adherence with all aspects of radiography within general dental practice. Research into factors that influence GDPs’ decision-making with regards to radiographic prescription may further inform the profession as to the best methods to lead to behavioural change. The dental profession and its regulators need to make a concerted effort to educate and inform GDPs so that this behaviour is modified.
Electronic-prescribing tools improve N-acetylcysteine prescription accuracy and timeliness for patients who present following a paracetamol overdose: A digital innovation quality-improvement project
Authors: McCulloch Adam , Sarwar Asif , Bate Tom , Thompson Dave , McDowell Patrick , Sharif Qamar , Sapey Elizabeth , Seccombe Adam
Published: October 2020

Objectives

Prescription error rates and delays in treatment provision are high for N-acetylcysteine (NAC) when prescribed for paracetamol overdose (POD). We hypothesised that an electronic tool which proposed the complete NAC regimen would reduce prescription errors and improve the timeliness of NAC provision. Error rates and delays in the provision of NAC were assessed following POD, before and after the implementation of an electronic prescribing tool.

Methods

The NAC electronic prescribing tool proposed the three NAC infusions (dosed for weight) following entry of the patient’s weight. All NAC prescriptions were reviewed during a three-month period prior to and after the tool’s implementation. Error rates were divided into dose, infusion volume or infusion rate. Delays in NAC provision were identified using national Emergency Medicine guidelines.

Results

108 NAC prescriptions were analysed for all adult patients admitted to the emergency department of a secondary care hospital in the UK between July-September 2017 and August-October 2018, respectively. There were no differences in the demographics of patients or the seniority of the prescribing clinician before or after the introduction of the electronic tool. The electronic prescribing tool was associated with a decrease in prescribing errors (25% to 0%, p < 0.0071) and an increase in the provision of NAC within recommended times (11.1% to 47.4%, p = 0.029).

Conclusions

An electronic prescribing tool improved prescription errors and the timeliness of NAC provision following POD. Further studies will determine the effect of this on length of stay and the benefit of wider implementation in other secondary care hospitals.
Older ill persons’ and their adult children’s experiences with primary healthcare: A reflective lifeworld research approach
Authors: Andersen Helle E. , Hoeck Bente , Nielsen Dorthe S. , Ryg Jesper , Delmar Charlotte
Published: October 2020

Aging in place puts ill and frail older persons in a vulnerable situation, and relatives, especially adult children, are expected to assume caring responsibilities. Healthcare professionals, like homecare nurses, play a key role in providing care to older persons needing support to live at home. However, the quality of primary home care has been questioned. The aim of this study was to describe older persons living at home and their adult children’s lived experiences with caring responsibility assumed by healthcare professionals. We used a reflective lifeworld research approach and analyzed 23 interviews and eight diaries. The COREQ checklist was followed. The findings revealed that caring responsibility is tantamount to being professionally competent and balancing immanent power to either promote or inhibit important areas of the older persons’ and their adult children’s lifeworld. Blurred lines of caring responsibility between the participants, the healthcare professionals, and the healthcare systems occurred and indicated that there were errors of commission and omission regarding the safety of older persons in their own homes.
MicroRNA-301a inhibition enhances the immunomodulatory functions of adipose-derived mesenchymal stem cells by induction of macrophage M2 polarization
Authors: Hsu Li-Wen , Huang Kuang-Tzu , Nakano Toshiaki , Chiu King-Wah , Chen Kuang-Den , Goto Shigeru , Chen Chao-Long
Published: October 2020

MicroRNAs (miRNAs) are a class of short non-coding RNAs that play a significant role in biological processes in various cell types, including mesenchymal stem cells (MSCs). However, how miRNAs regulate the immunomodulatory functions of adipose-derived MSCs (AD-MSCs) remains unknown. Here, we showed that modulation of miR-301a in AD-MSCs altered macrophage polarization. Bone marrow (BM)-derived macrophages were stimulated with LPS (1 μg/ml) and co-cultured with miRNA transfected AD-MSCs for 24 h. The expression of M1 and M2 markers in macrophages was analyzed. Inhibition of miR-301a induced M2 macrophage with arginase-1, CD163, CD206, and IL-10 upregulation. Additionally, toll-like receptor (TLR)-4 mRNA expression in macrophages was downregulated in co-cultures with AD-MSCs transfected with a miR-301a inhibitor. Nitric oxide (NO) in the supernatant of AD-MSC/macrophage co-culture was also suppressed by inhibition of miR-301a in AD-MSCs. We further found that suppression of miR-301a in AD-MSCs increased prostaglandin E2 (PGE2) concentration in the conditioned medium of the co-culture. Taken together, the results of our study indicate that miR-301a can modulate the immunoregulatory functions of AD-MSCs that favor the applicability as a potential immunotherapeutic agent.
Identifying spatio-temporal hotspots of human activity that are popular non-work destinations
Authors: Lopez Roberto Ponce , Ferreira Joseph
Published: October 2020

The improved temporal and spatial granularity of data now available from current information technologies offers an opportunity to study previously unexplored dimensions of the relationship between built environment and social outcomes. Within the field of urban studies, an old question worth revisiting with these new technologies is how to best trace the spatial boundaries that circumscribe a place or location to explore non-work activity. In this study, we explore a data-driven definition of places as units of analysis that can be used to explore non-work activity in Singapore. Such a definition of place characterizes an urban space in terms of its concentration of activity and the topology of the built environment–features that are especially important to urban planners. We utilize available smartphone data to develop a systematic framework to identify locations with a concentrated human presence. Using a cylinder moving over a grid representing Singapore, we scan aggregated smartphones locational requests (by time and cell), identifying areas with atypical high concentrations at a given time. Our tool identified 93 places with a concentrated human presence. Direct observation of six of these places at the selected times in conjunction with additional transportation and population data indicated that the topology of commercial establishments provided a strong approximation of non-work activity at a given time and place. Having established the relevance of commercial establishments in approximating non-work activity, then points-of-interest data within the 93 derived places are used to propose a typology of commercial patches, based on their spatial configuration. Nine metrics of the geometry and topology of patches of establishments, such as compacity and their dependence on proximity to shopping malls, were developed. These combined variables revealed more temporal and spatial variety within locations than had previously been recognized. The most popular places for non-work activity were densely configured with various commercial sub-spaces or patches appealing to different lifestyles and income groups. This study suggests that a location/place can be best defined as a highly detailed, multi-faceted, and always evolving area of activity rather than as a fixed location with temporal and unmovable boundaries. Suggesting a dynamic redefinition of location/place that builds on other recent work, this work offers potential contributions to locational models for non-work activity.
Bojarite, Cu3(N3C2H2)3(OH)Cl2⋅6H2O, a new mineral species with a microporous metal–organic framework from the guano deposit at Pabellón de Pica, Iquique Province, Chile
Authors: Chukanov Nikita V. , Möhn Gerhard , Zubkova Natalia V. , Ksenofontov Dmitry A. , Pekov Igor V. , Agakhanov Atali A. , Britvin Sergey N. , Desor Joy
Published: October 2020

The new triazolate mineral bojarite (IMA2020-037), Cu3(N3C2H2)3(OH)Cl2⋅6H2O, is found in a guano deposit located at the Pabellón de Pica Mountain, Iquique Province, Tarapacá Region, Chile. Associated minerals are salammoniac, halite, nitratine and belloite. Bojarite occurs as blue fine-grained porous aggregates up to 1 mm × 3 mm × 5 mm combined typically in interrupted earthy crusts. The mineral is brittle. The Mohs hardness is 2.Dcalc= 2.057 g cm–3. The IR and Raman spectra show the presence of the 1,2,4-triazolate anion and H2O molecules. Bojarite is optically isotropic andn= 1.635(2) (λ = 589 nm). The chemical composition (electron-microprobe data for Na, Mg, Fe, Cu and Cl; H, C and N contents measured by gas chromatography on products of ignition at 1200°C; wt.%) is: Na 0.22, Mg 0.74, Fe 0.99, Cu 29.73, Cl 13.62, N 20.4, C 11.6, H 3.3, O (calculated by stoichiometry) 19.93, total 100.53.

The empirical formula is (Cu2.68Mg0.17Fe0.10Na0.05)Σ3(N3C2H2)2.755[(OH)][Cl2.19(H2O)3.77(OH)0.04]Σ6⋅2.3H2O. The idealised formula is Cu3(N3C2H2)3(OH)Cl2⋅6H2O. The crystal structure of bojarite was refined based on powder X-ray diffraction data, using the Rietveld method. The final agreement factors are:Rp= 0.0225,Rwp= 0.0310 andRobs= 0.0417. The new mineral is cubic, space groupFd$\bar{3}$c;a= 24.8047(5) Å,V= 15,261.6(5) Å3andZ= 32. The strongest reflections of the powder X-ray diffraction pattern [d, Å (I,%)(hkl)] are: 8.83 (31)(220), 7.19 (100)(222), 6.23 (35)(400), 5.077 (28)(422), 4.194 (28)(531), 3.584 (23)(444), 2.865 (28)(660, 751) and 2.723 (22)(753, 842).
COPD in the time of COVID-19: an analysis of acute exacerbations and reported behavioural changes in patients with COPD
Authors: McAuley Hamish , Hadley Kate , Elneima Omer , Brightling Christopher E. , Evans Rachael A. , Steiner Michael C. , Greening Neil J.
Published: October 2020

Introduction

The impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and associated “lockdown” measures on acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is unknown. We aimed to evaluate the change in AECOPD treatment frequency during the first 6 weeks of lockdown in the UK compared with 2019 and assess changes in self-reported behaviour and wellbeing.

Methods

In this observational study in Leicestershire, UK, patients with COPD under a secondary care clinic were recruited. Exacerbation frequency in the first 6 weeks of COVID-19 lockdown was compared with the same period in 2019 using electronic health records. A telephone survey was used to assess changes in anxiety, inhaler adherence, physical activity and behaviour during the pre-lockdown and lockdown periods compared with normal.

Results

160 participants were recruited (mean±sdage 67.3±8.1 years, 88 (55%) males, mean±sdforced expiratory volume in 1 s 34±13% pred). 140 (88%) reported at least one AECOPD in the previous year. Significantly more community managed exacerbations were observed in 2020 compared with 2019 (126versus99; p=0.026). The increase was a result of multiple courses of treatment, with a similar proportion of patients receiving at least one course (34.4%versus33.8%).

Discussion

During lockdown participants reported significantly increased anxiety, adherence to their preventative inhalers and good adherence to shielding advice (all p<0.001). A significant reduction in self-reported physical activity and visitors was reported (both p<0.001).

Conclusions

Treatment for AECOPD events increased during the first 6 weeks of the SARS-CoV-2 pandemic in the UK compared with 2019. This was associated with increased symptoms of anxiety and significant behavioural change.
A non-linear optimisation method to extract summary statistics from Kaplan-Meier survival plots using the published P value
Authors: Irvine Andrew F. , Waise Sara , Green Edward W. , Stuart Beth
Published: October 2020

Background

Meta-analyses of studies evaluating survival (time-to-event) outcomes are a powerful technique to assess the strength of evidence for a given disease or treatment. However, these studies rely on the adequate reporting of summary statistics in the source articles to facilitate further analysis. Unfortunately, many studies, especially within the field of prognostic research do not report such statistics, making secondary analyses challenging. Consequently, methods have been developed to infer missing statistics from the commonly published Kaplan-Meier (KM) plots but are liable to error especially when the published number at risk is not included.

Methods

We therefore developed a method using non-linear optimisation (nlopt) that only requires the KM plot and the commonly published P value to better estimate the underlying censoring pattern. We use this information to then calculate the natural logarithm of the hazard ratio (ln (HR)) and its variance (var) ln (HR), statistics important for meta-analyses.

Results

We compared this method to the Parmar method which also does not require the number at risk to be published. In a validation set consisting of 13 KM studies, a statistically significant improvement in calculating ln (HR) when using an exact P value was obtained (mean absolute error 0.014 vs 0.077, P = 0.003). Thus, when the true HR has a value of 1.5, inference of the HR using the proposed method would set limits between 1.49/1.52, an improvement of the 1.39/1.62 limits obtained using the Parmar method. We also used Monte Carlo simulations to establish recommendations for the number and positioning of points required for the method.

Conclusion

The proposed non-linear optimisation method is an improvement on the existing method when only a KM plot and P value are included and as such will enhance the accuracy of meta-analyses performed for studies analysing time-to-event outcomes. The nlopt source code is available, as is a simple-to-use web implementation of the method.
“College fields of study and substance use”
Authors: Chen Wei-Lin , Chen Jen-Hao
Published: October 2020

Background

Numerous studies have documented factors that are associated with substance use behaviors among college-aged individuals. However, relatively few studies have considered the heterogeneity of the college experience by field of study (i.e., college major) and how that educational context might affect students’ health behaviors differently. Drawing from theories and prior research, this study investigates whether college majors are associated with different substance use behaviors, both during college and upon graduation.

Methods

The study analyzed longitudinal data from the National Longitudinal Survey of Youth 97 (N = 1031), specifically data on individuals who obtained a bachelor’s degree, to examine the associations between college fields of study and trajectories of three substance use behaviors: smoking, heavy alcohol use, and marijuana use.

Results

The results indicate that social science and business majors were associated with more substance use behaviors than arts and humanities and STEM majors. However, social science majors were associated with a faster decrease in substance use behaviors over time. Importantly, the differences we found in mean levels of substance use behaviors and trajectories were not explained by demographic characteristics, family SES background, childhood health conditions, and employment experience. Further analysis that examined college major and each substance use behavior individually suggests that the associations were stronger for heavy alcohol use and marijuana use. Moreover, we found the associations were more pronounced in men than women.

Conclusions

The study finds that not all college majors show the same level of engagement in substance use behaviors over time, and that the associations also vary by (1) the specific substance use behavior examined and (2) by gender. These findings suggest it is important to consider that the different learning and educational contexts that college majors provide may also be more or less supportive of certain health behaviors, such as substance use. Practical implications are discussed.
Are there pulmonary sequelae in patients recovering from COVID-19?
Authors: Rogliani Paola , Calzetta Luigino , Coppola Angelo , Puxeddu Ermanno , Sergiacomi Gianluigi , D’Amato Dejanira , Orlacchio Antonio
Published: October 2020

It has been recently hypothesized that infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may lead to fibrotic sequelae in patients recovering from coronavirus disease 2019 (COVID-19). In this observational study, hospitalized patients with COVID-19 had a HRCT of the chest performed to detect the extension of fibrotic abnormalities via Hounsfield Units (HU). At follow-up, the lung density significantly improved in both lungs and in each lobe of all patients, being in the normal range (− 950 to − 700 HU). This study provides preliminary evidence that hospitalized patients with mild-to-moderate forms of COVID-19 are not at risk of developing pulmonary fibrosis.
Quality of life status determinants in hypertrophic cardiomyopathy as evaluated by the Kansas City Cardiomyopathy Questionnaire
Authors: Capota Razvan , Militaru Sebastian , Ionescu Alin Alexandru , Rosca Monica , Baicus Cristian , Popescu Bogdan Alexandru , Jurcut Ruxandra
Published: October 2020

Purpose

The present study evaluated how heart failure (HF) negatively impacts health-related quality of life (HRQoL) in hypertrophic cardiomyopathy (HCM) patients and explored the major clinical determinants associated with HRQoL impairment in this population.

Methods

This was a cross-sectional single-center study of health-related HRQoL that included 91 consecutive patients with HCM. Evaluation was performed based on a comprehensive protocol that included the recommended diagnostic studies, as well as administration of the translated validated version of the Kansas City Cardiomyopathy Questionnaire (KCCQ) (CV Outcomes Inc) as a health status measure.

Results

The cohort included 52 (57%) males, median age 58 (20–85) years. The median global KCCQ score was 67 (12.5–100) corresponding to a moderate impairment in HRQoL. There was an inverse correlation between the median global KCCQ score and NYHA class (Kendall’s tau b coefficient r − 0.33, p = 0.001). Patients with pulmonary hypertension (PHT), defined as resting pulmonary artery systolic pressure of ≥ 45 mmHg, presented a significantly worse HRQoL as compared to those without PHT (median KCCQ score 56.2 vs 77.5, p = 0.013). The KCCQ score mildly correlated with age (r − 0.18, p = 0.014), history of syncope (r − 0.18, p = 0.045), estimated glomerular filtration rate (eGFR) (r 0.31, p < 0.001), plasmatic creatinine (r − 0.18, p = 0.017) and urea levels (r − 0.27, p < 0.001), left ventricular (LV) end-systolic dimensions (r − 0.18, p = 0.014), maximal provoked intraventricular gradient (r 0.20, p = 0.039), LV ejection fraction (r 0.15, p = 0.04), average E/e′ (r − 0.16, p = 0.039), pulmonary acceleration time (r 0.21, p = 0.007), pulmonary artery systolic pressure (r − 0.20, p = 0.016). In ordinal regression, the independent predictors of HRQoL were NYHA class and eGFR.

Conclusions

Patients with HCM and HF present a moderate degree of alteration in HRQoL. This is especially true for patients with PHT and more severe functional impairment. Renal failure and NYHA class are potential markers of HRQoL in clinical practice.