bluuebunny/crossref_metadata_2025 huggingface dataset:
Engaging Occupational Safety and Health Professionals in Bridging Research and Practice: Evaluation of a Participatory Workshop Program in the Danish Construction Industry
Authors: Brandt Mikkel , Wilstrup Ninna Maria , Jakobsen Markus D. , Van Eerd Dwayne , Andersen Lars L. , Ajslev Jeppe Z. N.
Published: August 2021

Engaging occupational safety and health (OSH) professionals has scarcely been evaluated as a means for transferring knowledge to practice about physical workload in the construction industry. The aim of this work was to examine how participants used and incorporate research-based knowledge from a three-day training course into practice. Twenty OSH professionals from the Danish construction industry participated in a workshop-training course. Researchers presented new knowledge and results about physically demanding work. The participants selected which themes they wanted to work with and developed an action plan. Evaluation was done using surveys and phone interviews. Analysis was based on how the OSH-professionals describe themselves, organizations, and the construction industry. Participant’s average scores on the level of implementation of their chosen action plans were 3 (on a response scale from 1–5, where 1 is ‘to a very low degree’ and 5 is ‘to a very high degree’) immediately after the workshop program and 2.5 at follow-up. Qualitative evaluations showed that actions had been initiated, and some progress had been made. The participants were satisfied with the workshop course and the possibility to increase their knowledge through inputs from researchers and colleges and strongly believe that they would succeed with implementing their action plans in the future.
Inter-Annual and Seasonal Variations of Water Quality and Trophic Status of a Reservoir with Fluctuating Monsoon Precipitation
Authors: Moon Ye-eun , Kim Hyun-su
Published: August 2021

Long-term evaluation from 2000 to 2020 of a temperate reservoir indicated that water quality and trophic status were not critically controlled by the inter-annual dynamics of monsoon precipitation. The fluctuation of annual concentrations of TP, TSS, and EC did not always correlate with the variation of precipitation. BOD and COD demonstrated monotonically increasing trends with Sen’s slope of 0.02 and 0.01, respectively, while Chl-a manifested a decreasing trend (slope = −0.23). The increases of different magnitudes in the levels of TP, TSS, and Chl-a in the monsoon and the early post-monsoon periods were observed in the drought, flood, and normal years. The drought years showed distinct seasonal variations in many parameters, while those in the flood and the normal years were very similar. Pearson correlation and empirical regression analyses resulted in weaker correlation between water quality and hydrological parameters than other reservoirs, which, along with low impact of precipitation, was attributed to the low drainage ratio (28.8) of the study area. BOD/COD ratios were higher than 0.5 in the reservoir, indicating the presence of a significant fraction of biodegradable organic matter. The ratio increased in the longitudinal flow direction (>50% in the drought years), implying the possibility of autochthonous sources of organic matter. TSID evaluation resulted in variation of limiting factors not related to the fluctuation of annual precipitation. The loadings of the significant principal components were very similar among the different precipitation groups, supporting the other findings that annual precipitation governed by monsoon intensity would not solely control the water quality dynamics of the study area.
Reference Data for Fat Mass and Fat-Free Mass Measured by Bioelectrical Impedance in Croatian Youth
Authors: Kasović Mario , Štefan Lovro , Neljak Boris , Petrić Vilko , Knjaz Damir
Published: August 2021

Fat mass and fat-free mass have become useful clinical indices in determining healthy growth and physical development during critical periods of childhood and adolescence; however, despite a wide range of nutritional surveillance its study is limited by a lack of reference data. The purpose of this study was to establish sex-specific and age-specific standards for fat mass and fat-free mass in a large sample of Croatian children and adolescents. In this cross-sectional study, we collected data from 12,678 participants aged 11 to 18 years old (mean age ± standard deviation (SD): 14.17 ± 2.25 years; height 164.56 ± 11.31 cm; weight: 57.45 ± 13.73 kg; body mass index: 21.24 ± 3.67 kg/m2; 53% girls). Fat mass and fat-free mass were measured three times by bioelectrical impedance. The Lambda, Mu and Sigma methods were used to create percentile charts for fat mass index (FMI) and fat-free mass index (FFMI; fat mass and fat-free mass divided by height2). Sex and age differences were calculated using an analysis of variance (ANOVA) with post hoc comparisons. Boys had lower FMI (from 2.66 to 3.89) and higher FFMI values (from 16.90 to 17.80) in all age groups, compared to girls (for FMI from 2.79 to 5.17 and for FFMI from 14.50 to 14.90, p < 0.001). In boys, FMI slightly declined until the age of 14, after which an increase from the age of 15 to 18 was observed. In girls, FMI gradually increased from the age of 11 to 18 (p < 0.001). In general, FFMI increased by age in boys [F(7,5440) = 52.674, p < 0.001], while girls had more stable FFMI across all age groups [F(7,7222) = 2.728, p = 0.057]. The newly established sex-specific and age-specific reference data could be used for national surveillance and to screen for children and adolescents with high FMI and low FFMI.
Linking Innovative Human Capital, Economic Growth, and CO2 Emissions: An Empirical Study Based on Chinese Provincial Panel Data
Authors: Lin Xi , Zhao Yongle , Ahmad Mahmood , Ahmed Zahoor , Rjoub Husam , Adebayo Tomiwa Sunday
Published: August 2021

To study the economic and environmental effects of human capital, previous studies measure human capital based on education; however, this approach has many shortcomings because not all educated people are innovative human capital. Hence, this study introduces the concept of innovative human capital by developing a new index that measures human capital based on the number of patents every one million R&D staff full-time equivalent. After this, this paper studies the impact of innovative human capital on CO2 emissions in China. The provincial panel data of 30 Chinese provinces from 2003 to 2017 is analyzed using the fixed effect, ordinary least squares, and the system generalized method of moments (SYS-GMM). The analysis revealed that innovative human capital alleviates environmental deterioration in China. The findings unfold the existence of the environmental Kuznets curve (EKC) considering innovative human capital in the model. It implies that Chinese economic development will eventually support environmental sustainability if China continues to develop its innovative human capital. Among the control variables, economic structure, population density, and energy intensity stimulate environmental degradation by increasing CO2 emissions. However, FDI has a negative relationship with CO2 emissions. Lastly, the study proposes comprehensive policies to increase innovative human capital for environmental sustainability.
Adsorption Characteristics of Activated Carbon Fibers in Respirator Cartridges for Toluene
Authors: Balanay Jo Anne G. , Oh Jonghwa
Published: August 2021

Respirator use has been shown to be associated with overall discomfort. Activated carbon fiber (ACF) has potential as an alternative adsorbent for developing thinner, lightweight, and efficient respirators due to its larger surface area, microporosity, and fabric form. The purpose of this pilot study was to determine the adsorption characteristics of commercially available ACF in respirator cartridges with varying ACF composition for toluene protection. Seven ACF types (one cloth, six felt) with varying properties were tested. Seven ACF cartridge configurations with varying ACF composition were challenged with five toluene concentrations (20–500 ppm) at constant air temperature (23 °C), relative humidity (50%), and air flow (32 LPM). Breakthrough curves were obtained using photoionization detectors. Breakthrough times (10%, 50%, and 5 ppm) and adsorption capacities were compared among ACF cartridge configurations to determine their suitable application in respiratory protection. Results showed that ACF cartridges containing the densest ACF felt types had the longest average breakthrough times (e.g., ~250–270 min to reach 5 ppm breakthrough time) and those containing ACF felt types with the highest specific surface areas had the highest average adsorption capacity (~450–470 mg/g). The ACF cartridges demonstrated breakthrough times of <1 h for 500 ppm toluene and 8–16 h for 20 ppm toluene. The ACF cartridges are more reliable for use at low ambient toluene concentrations but still have potential for use at higher concentrations for short-term protection. ACF felt forms with appropriate properties (density of ~0.07 g/cm3; specific surface area of ~2000 m2/g) have shown promising potential for the development of lighter and thinner respirators for protection against toluene.
Facing the Growing COVID-19 Infodemic: Digital Health Literacy and Information-Seeking Behaviour of University Students in Slovenia
Authors: Vrdelja Mitja , Vrbovšek Sanja , Klopčič Vito , Dadaczynski Kevin , Okan Orkan
Published: August 2021

The entire world is faced with the COVID-19 pandemic, which is also accompanied by an infodemic. This refers to the rapid spread of (accurate and false) information, mainly through internet usage increasing. Digital health literacy (DHL) is therefore important for addressing challenges related to online health information and services, as well as for navigation through the complex information landscape with huge amounts of different (and conflicting) information about COVID-19. The aim of this study is to examine the level of DHL in relation to COVID-19 in Slovenian university students and to determine online information-seeking behaviour in order to plan and prepare effective communication interventions for this sub-population. A cross-sectional survey, administered by an online questionnaire, was conducted to collect data on DHL. A total of 3621 students participated, of whom 70% were female and the average age was 22.65 years (SD = 4.65). Bivariate analyses were performed to assess the association of key characteristics with DHL. Overall, the results show that the level of DHL among students is sufficient. Most difficulties were reported in assessing the reliability of information (n = 1484, 49.3%). Approximately one third of the students (n = 847, 27.9%) reported having problems in finding information of their interest, and somewhat more (n = 900, 29.6%) reported difficulties in making a selection among all the information found. Students with a sufficient level of DHL are more likely to seek information through search engines and websites of official institutions, while students with a limited level of DHL more frequently reported using social media for health information searches. It is necessary to establish interventions for a systematic lift of the DHL and health literacy (HL) of all population groups.
Involving Moral and Ethical Principles in Safety Management Systems
Authors: Lindhout Paul , Reniers Genserik
Published: August 2021

Some organisations, and some individual humans, violate moral and ethical rules, whether or not they are written down in laws or codes of conduct. Corporate transgressions, as this behaviour is called, occur because of the actions of those in charge, usually bright and dedicated people. Immoral and unethical conduct can adversely affect the safety of workers, the general public and the environment. A scoping review method for a literature search is used to explore morality and ethics in relation to health and safety management. Our findings show that controlling the risks associated with misconduct and corporate transgression is not usually seen as a responsibility allocated to safety systems but is left to general management and corporate governance. The moral and ethical principles, however, can be applied in safety management systems to prevent misconduct and transgression-related safety risks. Our results show that ethical leadership, ethical behaviour, sustaining an ethical climate and implementation of an ethical decision-making process emerge as key preventive measures. The discussion presents a proposed way to include these measures in safety management systems. Conclusion and recommendations underline that unwanted behaviour and transgression risks can be brought under control, starting from a set of best practices. Not only the managers themselves but also board members, independent external supervisors and government regulators need to embrace these practices.
Behavioural Improvements in Children with Autism Spectrum Disorder after Participation in an Adapted Judo Programme Followed by Deleterious Effects during the COVID-19 Lockdown
Authors: Morales Jose , Fukuda David H. , Garcia Vanessa , Pierantozzi Emanuela , Curto Cristina , Martínez-Ferrer Josep O. , Gómez Antonia M. , Carballeira Eduardo , Guerra-Balic Myriam
Published: August 2021

The public health lockdown prompted by the novel coronavirus (COVID-19) pandemic, which included school closures that may have potentially serious consequences for people with disabilities or special educational needs, disrupted an ongoing adapted judo training intervention in children with Autism Spectrum Disorder (ASD). The purpose of this study was to compare repetitive behaviours, social interaction, social communication, emotional responses, cognitive style and maladaptive speech scores across four time-points: baseline, after an eight-week control period, after an eight-week judo intervention and after an eight-week lockdown period due to COVID-19. The sample consisted of 11 children diagnosed with ASD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-V), with an intelligence quotient (IQ) range between 60 and 70. Significant improvements were shown following the judo intervention period compared to the baseline and control periods. However, the same values significantly declined during the COVID-19 lockdown period resulting in values lower than those recorded at baseline, and following the control period and the judo intervention. The decline in psychosocial and behavioural scores are likely due to the stress caused by the sudden halt in activity and the increase in sedentary practices associated with the lockdown.
The Utility of Next-Generation Sequencing for Identifying the Genetic Basis of Dementia
Authors: Klimkowicz-Mrowiec Aleksandra , Dziubek Anna , Sado Małgorzata , Karpiński Marek , Gorzkowska Agnieszka
Published: August 2021

The clinical manifestations of dementia are often rapidly matched to a specific clinical syndrome, but the underlying neuropathology is not always obvious. A genetic factor often plays an important role in early onset dementia, but there are cases in which the phenotype has a different genetic basis than is assumed. Two patients, at different times, presented to the Memory Clinic because of memory problems and difficulty in performing daily activities and work. Neither caregiver complained of marked behavioural or personality changes, except for apathy. Patients underwent standard dementia evaluation procedures including clinical symptoms, family history, neuroimaging, neuropsychological evaluation, and genetic analysis of selected genes. Based on specific clinical phenotypes and genetic analysis of selected genes, both patients were diagnosed with frontal variant of Alzheimer’s disease. The presence of a rare polymorphism in PSEN2 in both patients allowed the discovery that they belong to the same family. This fact reinforced the belief that there is a strong genetic factor responsible for causing dementia in the family. Next-generation sequencing based on a panel of 118 genes was performed to identify other potential genetic factors that may determine the background of the disease. A mutation in the GRN gene was identified, and the previous diagnosis was changed to frontotemporal dementia. The described cases show how important it is to combine all diagnostic tests available in the diagnostic centre, including new generation genetic tests, in order to establish/confirm the pathological background of clinical symptoms of dementia. If there is any doubt about the final diagnosis, persistent efforts should be made to verify the cause.
Electroencephalogram Application for the Analysis of Stress Relief in the Seasonal Landscape
Authors: Wang Yuting , Xu Ming
Published: August 2021

This study proposes an integrated approach to assess the psychological and physiological responses of people in natural seasonal landscapes. The questionnaire of restoration outcomes scale (ROS), willingness to visit (WTV), cultural ecosystem services (CES) cognitive classification, and the neuroscientific technique based on electroencephalogram (EEG) measurements were applied. The effects of different landscapes on human perception were studied by comparing the EEG data of different landscape types and different seasons. The coupling relationship between EEG data and stress recovery was also examined. The results showed the following: First, there was a significant difference between the winter landscape and the summer natural landscape. Second, only the winter landscape showed significant gender differences. Third, the values of ROS and WTV in the summer landscape were greater than those in the winter landscape. Fourth, the number of CES in the summer landscape was significantly higher than that in the winter landscape, and the number of CES in water was higher than that in the forest and grassland. Thus, brain wave data and quantified values from questionnaires including ROS, WTV, and CES showed significant seasonality. Therefore, an EEG can be used as a new, more objective tool and method for landscape evaluation and planning in the future.
Impact of Cations (Na+, K+, Mg+2) and Anions (F−, Cl−, SO42−) Leaching from Filters Packed with Natural Zeolite and Ferric Nanoparticles for Wastewater Treatment
Authors: Miramontes-Gutierrez Evelyn Maria , Ochoa-Rivero Jesus Manuel , Rubio-Arias Hector Osbaldo , Ballinas-Casarrubias Lourdes , Rocha-Gutiérrez Beatriz Adriana
Published: August 2021

Natural zeolites have been employed to adsorb contaminants in water. This study is aimed to evaluate the cation and anion leaching from the zeolite after the wastewater was passed through filters packed with a natural zeolite (heulandite-CaAl2Si7O18·6H2O). Eight treatments were evaluated in a 2 × 2 × 2 factorial treatment design. Factor A was the zeolite with two levels: 127 g and 80.4 g. Factor B was the nanoparticles with two levels: one bag (3.19 g) and two bags (6.39 g); and Factor C was the use of a magnet: with and without. There were two replications; hence, a total of 16 filters were employed. The water was obtained from a municipal wastewater treatment plant (MWTP). The cations (Na+, K+; Mg+2 and Ca+2) and anions (F−, Cl− and SO42−) were measured before (influent = IW) and after filtering (effluent = EW) three times. All treatments leached the cations Na+ (EW in a range of 175 to 232 ppm), K+ (EW in a range of 15.4 to 33.2 ppm), and Mg+2 (EW in a range of 7.40 to 10.8 ppm) but did not leach Ca+2. Likewise, the treatments leached the anions F− (EW in a range of 7.59 to 8.87 ppm), Cl− (EW in a range of 85.9 to 120 ppm), and SO42− (EW in a range of 139 to 146 ppm). We conclude that this natural zeolite leaches cations (except Ca+2) and anions in MWTP passed through filters. Therefore, its application in wastewater treatment should be considered for purposes such as agriculture and animal production and not for drinking water.
Effects of Self-Esteem, Problem-Solving Ability, and Professional Nursing Values on the Career Identity of Nursing College Students in South Korea: A Cross-Sectional Study
Authors: Min Jisun , Kim Hyunlye , Yoo Jaeyong
Published: August 2021

In Korea, the number of admissions to nursing colleges has greatly increased over the past 20 years to address the shortage of nurses. However, many nursing students have unclear career identities during college and stop working in healthcare after graduation. This study aimed to examine the effects of self-esteem, problem-solving ability, and professional nursing values on career identity. The participants were 140 third- and fourth-year nursing students recruited from a university in South Korea. Data were collected between September and October 2019 using a self-administered questionnaire. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson’s correlation, and multiple linear regression. The results showed significant correlations between satisfaction with college life and major subject, subjective academic achievement, self-esteem, problem-solving ability, professional nursing values, and career identity. The factors that significantly affected career identity were self-esteem and professional nursing values. Nursing educators can support the career development of nursing students by enhancing their self-esteem and professionalism, along with efforts to improve satisfaction with their college life and major.
Women Suffered More Emotional and Life Distress than Men during the COVID-19 Pandemic: The Role of Pathogen Disgust Sensitivity
Authors: Ding Yi , Yang Jie , Ji Tingting , Guo Yongyu
Published: August 2021

The outbreak of the COVID-19 has brought upon unprecedented challenges to nearly all people around the globe. Yet, people may differ in their risks of social, economic, and health well-being. In this research, we take a gender-difference approach to examine whether and why women suffered greater emotional and life distress than men at the early stage of the COVID-19 outbreak in China. Using a large nationwide Chinese sample, we found that compared to men, women reported higher levels of anxiety and fear, as well as greater life disturbance during the COVID-19 pandemic. Importantly, that women suffered more was partly explained by their higher level of pathogen disgust sensitivity. Our findings highlight the important consequences of gender differences in response to the threat of the COVID-19 pandemic and suggest that policymakers pay more attention to gender inequalities regarding COVID-19 responses.
Comparison of the Effect of Amaranth Oil vs. Rapeseed Oil on Selected Atherosclerosis Markers in Overweight and Obese Subjects: A Randomized Double-Blind Cross-Over Trial
Authors: Jamka Małgorzata , Morawska Anna , Krzyżanowska-Jankowska Patrycja , Bajerska Joanna , Przysławski Juliusz , Walkowiak Jarosław , Lisowska Aleksandra
Published: August 2021

It is well known that rapeseed oil improves lipid profile and has antiatherosclerotic properties. Recently, amaranth oil has also become popular due to its potential health benefits. However, the effect of this oil on atherosclerosis markers in humans is not clear. Therefore, this study aimed to compare the effect of amaranth and rapeseed oils on selected atherosclerosis-related parameters in overweight and obese subjects. In this randomized cross-over study, 44 subjects were instructed to consume 20 mL of amaranth oil and rapeseed oil during two consecutive three-week intervention periods separated by a washout period of the same duration as the intervention. The outcome variables included changes in tumor necrosis factor-alpha, adiponectin, oxidized low-density lipoprotein, apolipoproteins (Apo) A1, B and E as well as glucose and insulin homeostasis markers. Compared to rapeseed oil, amaranth oil had a slight positive effect on adiponectin levels (mean (95% confidence interval): 0.55 (0.22–0.89) vs. -0.29 (−0.75–0.16), p = 0.0002) but negatively affected ApoB concentrations (0.05 (−0.01–0.11) vs. 0.03 (−0.07–0.00), p = 0.0004) and ApoB/A1 ratio (0.01 (−0.03–0.05) vs. −0.02 (−0.04–0.00), p = 0.0113). No differences between the other analyzed parameters were observed. In conclusion, amaranth oil does not have a greater beneficial effect on atherosclerosis markers than rapeseed oil. However, further studies with a longer intervention period are needed. The study was retrospectively registered with the German Clinical Trials Register within the number: DRKS00014046, date of registration: 3 May 2018.
The Patterns and Impact of Off-Working Hours, Weekends and Seasonal Admissions of Patients with Major Trauma in a Level 1 Trauma Center
Authors: Abdelrahman Husham , Al-Thani Hassan , Khan Naushad Ahmad , Mollazehi Monira , Asim Mohammad , El-Menyar Ayman
Published: August 2021

Background: The trauma incidence follows specific patterns in different societies and is expected to increase over the weekend and nighttime. We aimed to explore and analyze the incidence, pattern, and severity of trauma at different times (working hours vs. out off-working hours, weekdays vs. weekends and season). Methods: A retrospective analysis was conducted at a level 1 trauma facility in Qatar. All injured patients admitted between June 2017 and May 2018 were included. The data were analyzed to determine whether outcomes and care parameters of these patients differed between regular working hours and off-working hours, weekdays vs. weekends, and between season intervals. Results: During the study period, 2477 patients were admitted. A total of 816 (32.9%) patients presented during working hours and 1500 (60.6%) during off-working hours. Off-working hours presentations differed significantly with the injury severity score (ISS) (p  <  0.001), ICU length of stay (p  =  0.001), blood transfusions (p = 0.001), intubations (p = 0.001), mortality rate (9.7% vs. 0.7%; p < 0.001), and disposition to rehabilitation centers. Weekend presentations were significantly associated with a higher ISS (p = 0.01), Priority 1 trauma activation (19.1% vs. 14.7%; p = 0005), and need for intubation (21% vs. 16%; p = 0.002). The length of stay (ICU and hospital), mortality, and disposition to rehabilitation centers and other clinical parameters did not show any significant differences. No significant seasonal variation was observed in terms of admissions at the trauma center. Conclusions: The off-working hours admission showed an apparent demographic effect in involved mechanisms, injury severity, and trauma activations, while outcomes, especially the mortality rate, were significantly different during nights but not during the weekends. The only observed seasonal effect was a decrease in the number of admissions during the summer break.
Advanced Practice Nursing in Cardiology: The Slovak Perspective for the Role Development and Implementation
Authors: Grešš Halász Beáta , Dimunová Lucia , Rónayová Ivana , Knap Viliam , Lizáková Ľubomíra
Published: August 2021

Background: Cardiovascular diseases (CVDs) are the number one cause of death globally. Most can be prevented by addressing behavioral risk factors, where advanced practice nurses- clinical specialists in cardiovascular nursing play a fundamental role. This modern and effective role is based on advanced activities, knowledge, skills, and experience in a specialized field, which can make a significant contribution to solving the problems of these civilization diseases. The aim of this work is to explore the self-perception of advanced-practice nurses (APNs) working in cardiology and vascular medicine departments within the context of advanced-practice nursing. Methods: This quantitative exploratory study included 103 APNs working in cardiology and vascular diseases departments of specialized hospitals in Slovakia. A validated instrument was used. Results: The overall perception was at the level of 68.01%. The highest-rated domain was the outcomes for patients/clients, and subdomains were meeting the needs, education of healthcare workers, and quality in relation to management. There was a significant difference found among hospitals with a better scoring of specialized institutions. Conclusion: There have been promising advances due to the current legislation in Slovakia defining APNs and specialists’ competencies. However, the practice in nursing for CVD patients remains fragmented, uncategorized and less valued by stakeholders and the public. According to the results, nurses have the potential and preparedness for this role in the context of their knowledge and skills in general. The Authors conclude that there is a need of such specialization of APNs in Slovakia.
Spatial Analysis of Gunshot Reports on Twitter in Mexico City
Authors: García-Tejeda Enrique , Fondevila Gustavo , Siordia Oscar S.
Published: August 2021

The quarantine and stay-at-home measures implemented by most governments significantly impacted the volume and distribution of crime, and already, a body of literature exists that focuses on the effects of lockdown on crime. However, the effects of lockdown on firearm violence have yet to be studied. Within this context, this study analyzes reports of gunshots in Mexico City registered on Twitter from October 2018 to 2019 (pre-COVID-19) and from October 2019 to 2020 (during COVID-19), using a combination of spatial (nearest neighbor ratio, Ripley’s K function and kernel estimation) and non-spatial (Fisher’s exact test) methods. The results indicate a spatial concentration of gunshot reports in Mexico City and a reduction in frequency of reports during the pandemic. While they show no change in the overall concentration of gunshots during lockdown, they do indicate an expansion in the patterns of spatial intensity (moving from the west to the center of the city). One possible explanation is the capacity of possible victims of firearm crimes in certain municipalities to comply with lockdown measures and thus avoid exposure to such crimes.
Data Analysis of the Risks of Type 2 Diabetes Mellitus Complications before Death Using a Data-Driven Modelling Approach: Methodologies and Challenges in Prolonged Diseases
Authors: Lin Ming-Yen , Liu Jia-Sin , Huang Tzu-Yang , Wu Ping-Hsun , Chiu Yi-Wen , Kang Yihuang , Hsu Chih-Cheng , Hwang Shang-Jyh , Luh Hsing
Published: August 2021

(1) Background: A disease prediction model derived from real-world data is an important tool for managing type 2 diabetes mellitus (T2D). However, an appropriate prediction model for the Asian T2D population has not yet been developed. Hence, this study described construction details of the T2D Holistic Care model via estimating the probability of diabetes-related complications and the time-to-occurrence from a population-based database. (2) Methods: The model was based on the database of a Taiwan pay-for-performance reimbursement scheme for T2D between November 2002 and July 2017. A nonhomogeneous Markov model was applied to simulate multistate (7 main complications and death) transition probability after considering the sequential and repeated difficulties. (3) Results: The Markov model was constructed based on clinical care information from 163,452 patients with T2D, with a mean follow-up time of 5.5 years. After simulating a cohort of 100,000 hypothetical patients over a 10-year time horizon based on selected patient characteristics at baseline, a good predicted complication and mortality rates with a small range of absolute error (0.3–3.2%) were validated in the original cohort. Better and optimal predictabilities were further confirmed compared to the UKPDS Outcomes model and applied the model to other Asian populations, respectively. (4) Contribution: The study provides well-elucidated evidence to apply real-world data to the estimation of the occurrence and time point of major diabetes-related complications over a patient’s lifetime. Further applications in health decision science are encouraged.
Fat-to-Muscle Ratios and the Non-Achievement of LDL Cholesterol Targets: Analysis of the Korean Genome and Epidemiology Study
Authors: Cho A-Ra , Lee Jun-Hyuk , Kwon Yu-Jin
Published: August 2021

Maintaining optimal low-density lipoprotein (LDL) cholesterol levels is necessary to prevent cardiovascular disease (CVD). Excessive fat mass and decreased muscle mass are both associated with increased risks of developing dyslipidemia. Thus, we investigated the longitudinal relationship between the fat-to-muscle ratio (FMR) and the non-achievement of LDL cholesterol targets. We analyzed a total of 4386 participants aged 40–69 years from the Korean Genome and Epidemiology Study. FMR was defined as the ratio of total fat mass to total muscle mass, measured by bioelectrical impedance. The non-achievement of an LDL cholesterol target was defined as an LDL cholesterol level higher than the established target level according to individual CVD risk. The adjusted hazard ratios and 95% confidence interval for the incidence of non-achievement of LDL cholesterol targets for the sex-specific middle and highest tertiles vs. the referent lowest tertile of FMR were 1.56 (1.29–1.90) and 1.86 (1.47–2.31) in men and 1.40 (1.18–1.66) and 1.31 (1.06–1.62) in women after adjusting confounders. Our findings suggest that FMR, a novel indicator of the combined effects of fat and muscle mass, is useful for predicting non-achievement of LDL cholesterol targets.
De Novo Cancer Incidence after Kidney Transplantation in South Korea from 2002 to 2017
Authors: Kim Boyeon , Kang Minjin , Kim Yoonjung , Lee Hyung Soon , Kim Banseok , Lee Jung Jun , Park Yongjung , Lee Kyung-A
Published: August 2021

Advances in patient care and immunosuppressive drugs have improved graft survival, resulting in an increase in kidney transplantation (KT); however, persistent immunosuppression is thought to cause late occurrence of cancer. This population-based study consisted of a total of 14,842 patients whose data from the years 2002 to 2017 were collected from the National Health Information Database in South Korea. Malignancies occurred in 7.6% of the total KT patients. Prostate and thyroid cancers were the most common in males and females, respectively. From the age-adjusted incidence analysis, Kaposi’s sarcoma showed the highest standardized incidence ratio in both male and female patients. According to the linear regression model, cancer incidence in KT recipients under immunosuppressive conditions increased by approximately 0.1% each month. Patients’ age over 39 and the use of prednisolone as an initial steroid regimen were associated with increased risk of cancer development after KT. Our regression and proportional hazards models will help clinicians to predict the approximate cancer incidence risk when monitoring KT recipients. Based on the largest available national database, screening or monitoring methods for cancer detection and prevention can be established for KT patients by considering the factors involved in cancer development.
Natural-Course Evaluation of Infants with Positional Severe Plagiocephaly Using a Three-Dimensional Scanner in Japan: Comparison with Those Who Received Cranial Helmet Therapy
Authors: Noto Takanori , Nagano Nobuhiko , Kato Risa , Hashimoto Shin , Saito Katsuya , Miyabayashi Hiroshi , Sasano Mari , Sumi Koichiro , Yoshino Atsuo , Morioka Ichiro
Published: August 2021

This study aimed to clarify the natural course of positional plagiocephaly using a three-dimensional (3D) scanner and investigate the effectiveness of cranial helmet therapy (CHT). One hundred infants with severe plagiocephaly who visited our institutions between April 2020 and March 2021 were included. Cranial shape was measured using an Artec Eva 3D scanner. A cranial asymmetry (CA) >12 mm was diagnosed as severe plagiocephaly. An infant whose CA subsided to <12 mm was considered to have improved naturally or by CHT. The difference in CA between the second and initial scans was defined as the improvement value (median scan interval was two months). In the natural-course group comprising 56 infants with severe plagiocephaly, 37 (66%) with a median CA of 15.6 mm exhibited no improvement after two months. In the scan age- and evaluation interval-matched case-control study, the CA value in the CHT group improved by three times that in the natural-course group (−4.6 mm [n = 33] vs. −1.55 mm [n = 24], p < 0.001). Severe plagiocephaly did not improve naturally in 66% of the cases. Therefore, CHT should be considered if the CA is >12 mm on the initial evaluation.
Early Measurement of Blood sST2 Is a Good Predictor of Death and Poor Outcomes in Patients Admitted for COVID-19 Infection
Authors: Sánchez-Marteles Marta , Rubio-Gracia Jorge , Peña-Fresneda Natacha , Garcés-Horna Vanesa , Gracia-Tello Borja , Martínez-Lostao Luis , Crespo-Aznárez Silvia , Pérez-Calvo Juan Ignacio , Giménez-López Ignacio
Published: August 2021

Although several biomarkers have shown correlation to prognosis in COVID-19 patients, their clinical value is limited because of lack of specificity, suboptimal sensibility or poor dynamic behavior. We hypothesized that circulating soluble ST2 (sST2) could be associated to a worse outcome in COVID-19. In total, 152 patients admitted for confirmed COVID-19 were included in a prospective non-interventional, observational study. Blood samples were drawn at admission, 48–72 h later and at discharge. sST2 concentrations and routine blood laboratory were analyzed. Primary endpoints were admission at intensive care unit (ICU) and mortality. Median age was 57.5 years [Standard Deviation (SD: 12.8)], 60.4% males. 10% of patients (n = 15) were derived to ICU and/or died during admission. Median (IQR) sST2 serum concentration (ng/mL) rose to 53.1 (30.9) at admission, peaked at 48–72 h (79.5(64)) and returned to admission levels at discharge (44.9[36.7]). A concentration of sST2 above 58.9 ng/mL was identified patients progressing to ICU admission or death. Results remained significant after multivariable analysis. The area under the receiver operating characteristics curve (AUC) of sST2 for endpoints was 0.776 (p = 0.001). In patients admitted for COVID-19 infection, early measurement of sST2 was able to identify patients at risk of severe complications or death.
Validation of Risk-Adapted Venous Thromboembolism Prediction in Multiple Myeloma Patients
Authors: Barrett Aisling , Quinn John , Lavin Michelle , Thornton Patrick , O’Donnell James , Murphy Philip , Glavey Siobhán
Published: August 2021

Multiple myeloma (MM) is associated with an increased risk of venous thrombosis (VTE). In the United Kingdom Medical Research Council (MRC) XI study of patients treated with immunomodulatory therapy, the VTE rate was 11.8% despite 87.7% of the patients being on thromboprophylaxis at the time of thrombosis. In order to effectively prevent VTE events in MM patients, a better understanding of patient and disease risk factors that might predict thrombosis is required. We performed a retrospective cohort analysis of over 300 newly diagnosed MM patients at a tertiary referral centre to determine the VTE rate, predictive factors for VTE, value of the Khorana score for MM VTE events and long-term mortality outcomes. Fifty-four percent of the patients were receiving thromboprophylaxis at the time of the VTE event. The mortality odds ratio was 3.3 (95% CI, 2.4–4.5) in patients who developed VTE in comparison to age-matched controls with MM. A younger age at diagnosis and higher white cell count (WCC) were found to be predictive of VTE events. Our data suggest that standard thromboprophylaxis may not be effective in preventing VTE events in myeloma patients, and alternative strategies, which could include higher-intensity thromboprophylaxis in young patients with a high WCC, are necessary.
3D-Printed Titanium Custom-Made Prostheses in Reconstruction after Pelvic Tumor Resection: Indications and Results in a Series of 14 Patients at 42 Months of Average Follow-Up
Authors: Zoccali Carmine , Baldi Jacopo , Attala Dario , Scotto di Uccio Alessandra , Cannavò Luca , Scotto Gennaro , Luzzati Alessandro
Published: August 2021

Wide resection is currently considered the mainstay treatment for primary bone tumors. When the tumor is located in anatomically complex segments, 3D-Printed Titanium Custom-Made Prostheses (3DPTCMP) are possible reconstructive solutions. The aim of the present paper is to analyze indications, results and complications of a series of 14 patients who underwent pelvis reconstruction with 3DPTCMP after tumor removal from January 2015 to December 2019. Chondrosarcoma was the main histology; indications were tumors located in the acetabular area without enough residual bone to support a cup with an iliac stem, and tumors located near the sacrum-iliac joint. The margins were wide in 12 cases, and marginal and intralesional in one case each. In three cases, resection also included the sacrum-iliac joint, so a spine stabilization was performed and linked to the pelvic prosthesis; The average MSTS score was 46.3%; the 5-year local recurrence-free survival was 85.7%. Wound dehiscences were the main complication, resolved with multiple debridements; nevertheless, prosthesis removal was necessary in one case. Currently, the 3DPTCMP is an effective resource for reconstruction after resection of tumors located in the pelvis. Further studies are necessary to value long-term results; more strategies are necessary to try to reduce the infection rate and improve osteointegration.
Efficacy and Safety of Empagliflozin Continuation in Patients with Type 2 Diabetes Hospitalised for Acute Decompensated Heart Failure
Authors: Pérez-Belmonte Luis M. , Ricci Michele , Sanz-Cánovas Jaime , Millán-Gómez Mercedes , Osuna-Sánchez Julio , Ruiz-Moreno M. Isabel , Bernal-López M. Rosa , López-Carmona María D. , Jiménez-Navarro Manuel , Gómez-Doblas Juan J. , Lara José P. , Gómez-Huelgas Ricardo
Published: August 2021

There is little evidence on the use of sodium−glucose cotransporter 2 inhibitors in hospitalised patients. This work aims to analyse the glycaemic and clinical efficacy and safety of empagliflozin continuation in patients with type 2 diabetes hospitalised for acute decompensated heart failure. This real-world observational study includes patients treated using our in-hospital antihyperglycaemic regimens (basal-bolus insulin vs. empagliflozin-basal insulin) between 2017 and 2020. A propensity matching analysis was used to match a patient on one regimen with a patient on the other regimen. Our primary endpoints were the differences in glycaemic control, as measured via mean daily blood glucose levels, and differences in the visual analogue scale dyspnoea score, NT-proBNP levels, diuretic response, and cumulative urine output. Safety endpoints were also analysed. After a propensity matching analysis, 91 patients were included in each group. There were no differences in mean blood glucose levels (152.1 ± 17.8 vs. 155.2 ± 19.7 mg/dL, p = 0.289). At discharge, NT-proBNP levels were lower and cumulative urine output greater in the empagliflozin group versus the basal-bolus insulin group (1652 ± 501 vs. 2101 ± 522 pg/mL, p = 0.032 and 16,100 ± 1510 vs. 13,900 ± 1220 mL, p = 0.037, respectively). Patients who continued empagliflozin had a lower total number of hypoglycaemic episodes (36 vs. 64, p < 0.001). No differences were observed in adverse events, length of hospital stay, or in-hospital deaths. For patients with acute heart failure, an in-hospital antihyperglycaemic regimen that includes continuation of empagliflozin achieved effective glycaemic control, lower NT-proBNP, and greater urine output. It was also safer, as it reduced hypoglycaemic episodes without increasing other safety endpoints.
Detailed Phenotype of GLA Variants Identified by the Nationwide Neurological Screening of Stroke Patients in the Czech Republic
Authors: Reková Petra , Dostálová Gabriela , Kemlink David , Paulasová Schwabová Jaroslava , Dubská Zora , Vaneckova Manuela , Mašek Martin , Kodet Ondřej , Poupětová Helena , Mazurová Stella , Rajdova Aneta , Vlckova Eva , Táboříková Alena , Fafejtová Štěpánka , Nevsimalova Miroslava , Linhart Aleš , Tomek Aleš
Published: August 2021

Fabry disease (FD) is a rare X-linked disorder of glycosphingolipid metabolism caused by pathogenic variants within the alpha-galactosidase A (GLA) gene, often leading to neurological manifestations including stroke. Multiple screening programs seeking GLA variants among stroke survivors lacked detailed phenotype description, making the interpretation of the detected variant’s pathogenicity difficult. Here, we describe detailed clinical characteristics of GLA variant carriers identified by a nationwide stroke screening program in the Czech Republic. A total of 23 individuals with 8 different GLA variants were included in the study. A comprehensive diagnostic workup was performed by a team of FD specialists. The investigation led to the suggestion of phenotype reclassification for the G325S mutation from late-onset to classical. A novel variant R30K was found and was classified as a variant of unknown significance (VUS). The typical manifestation in our FD patients was a stroke occurring in the posterior circulation with an accompanying pathological finding in the cerebrospinal fluid. Moreover, we confirmed that cornea verticillata is typically associated with classical variants. Our findings underline the importance of detailed phenotype description and data sharing in the correct identification of pathogenicity of gene variants detected by high-risk-population screening programs.
Is Post-Transplant Cyclophosphamide the New Methotrexate?
Authors: Mussetti Alberto , Paviglianiti Annalisa , Parody Rocio , Sureda Anna
Published: August 2021

Introducing post-transplant, cyclophosphamide (PT-Cy) graft-versus-host disease (GVHD) prophylaxis in the setting of haploidentical donor transplantation has marked the most important advance in allogeneic hematopoietic cell transplantation (alloHCT) within the past 15 years. The efficacy of this procedure and its simple features have allowed for the significantly widespread application of alloHCT worldwide. Indeed, the procedure’s effectiveness in reducing immunological complications in the haploidentical setting has even challenged the status quo use of calcineurin-inhibitor, methotrexate-based GVHD prophylaxis in the setting of HLA-identical donors. Currently, however, prospective clinical trials in support of PT-Cy-based GVHD prophylaxis in the HLA-matched setting are striving to resolve the matter of its potential role. This review will briefly report the overall outcomes of PT-Cy-based GVHD prophylaxis in the haploidentical setting and summarize results obtained in the HLA-identical field. We will present future perspectives at the end of the manuscript.