bluuebunny/crossref_metadata_2025 huggingface dataset:
Identity in Campaign Finance and Elections: The Impact of Gender and Race on Money Raised in 2010–2018 U.S. House Elections
Authors: Sorensen Ashley , Chen Philip
Published: June 2021

Disproportionate rates of congressional representation based on gender and race are especially stark considering the symbolic and substantive meaning derived from descriptive representation (Mansbridge 1999). Using an original data set consisting of candidate demographics, district characteristics, and campaign finance reports, we analyze an understudied barrier to representation: unequal access to campaign receipts. We argue that it is the simultaneous gendering and racialization of the campaign finance system that produces gaps in campaign fundraising and representation (Crenshaw 1989). Our results underscore the limitations of unitary approaches which conclude that women no longer face a disadvantage in campaign fundraising. Unequal access to campaign receipts serve as a barrier to the descriptive representation of women of color. By analyzing the interaction of both race and gender on campaign receipt totals in U.S. House elections from 2010 to 2018, we assert the path to representation is not equal for all.
The Hierarchical Structure and Predictive Validity of the Personality Inventory for DSM-5 in Chinese Nonclinical Adolescents
Authors: Zhang Wenjuan , Wang Mengcheng , Yu Meng , Wang Jianping
Published: June 2021

To evaluate the factor structure, reliability, and validity of the Personality Inventory for DSM-5 (PID-5) in Chinese nonclinical adolescents, a total of 1,442 Chinese middle school youths ( Mage = 14.85, girls = 52.4%) were recruited in the present study. All the participants completed the full-length 220-item PID-5. Some participants ( n = 1,003) were administered adolescents’ social adjustment as a criterion measure at the same time and 236 participants took part in longitudinal assessment of the PID-5 and adolescents’ social adjustment 6 months later. First, exploratory structural equation modeling analyses supported a six-factor structure of the PID-5 in our present sample. Second, Negative Affectivity, Detachment, Antagonistic, and Disinhibition domains had positive correlations with negative social adjustment, and negative correlations with positive social adjustment concurrently and longitudinally, with the exception of Constraint and Psychoticism. Third, Cronbach’s alpha for the PID-5 traits ranged from .57 to .91 in the full sample. The 6-month test–retest reliability by indexes of interclass correlation coefficient showed poor to good stability. As a whole, our findings provided preliminary evidence of the PID-5 as a reliable and valid measure of adolescents’ maladaptive personality traits in mainland China.
Social Skills Practice Strategy Opportunities for Students With EBD
Authors: Kumm Skip , Reeder Jacob , Farrell Erin
Published: June 2021

Students with emotional and behavioral disorders (EBD) are likely to require interventions to help them navigate the social demands of the school environment. Several meta-analyses of social skills interventions have been conducted, which have provided guidance and demonstrated the effectiveness of social skills training for students with EBD. This article details a framework for teaching and practicing social skills interventions. Included in it are descriptions of several social skills strategies and ways in which the teaching of them can be individualized to meet the needs of students with EBD.
Conducting Meaningful Transition Interviews to Benefit Students With Emotional and Behavioral Disorders
Authors: Yeager Kristopher Hawk
Published: June 2021

Students with emotional and behavioral disorders (EBD) benefit from person-centered transition planning. However, there are few practical guidelines for conducting individualized transition assessments that include interviews with this population. This article describes multiple strategies that special educators can implement to conduct interviews, develop rapport, and encourage students with EBD to take a leadership role in the transition process. Materials are provided for selecting appropriate interview topics, monitoring the use of strategies, and developing effective questions.
Fostering Mathematical Creativity Through Problem Posing and Three-Act Tasks
Authors: Lewis Wendy M. , Colonnese Madelyn W.
Published: June 2021

The National Association for Gifted Children and The National Council of Teachers of Mathematics both call for problem posing. This article illustrates the strategies used during a series of three Three-Act Tasks to foster second grade students’ abilities to problem pose. The students’ problem posing improved across the three Three-Act Tasks and revealed mathematically creative thinking. To support and encourage the students to problem pose, the teacher asked generative questions, modeled various problems, provided concrete manipulatives, and had the students create their own sequel to the Three-Act Tasks.
The Case of the Hungry Hippos: Supporting Students’ Development of Problem-Finding Strategies
Authors: Rubenstein Lisa DaVia , Callan Gregory L. , Shively Kate , Speirs Neumeister Kristie
Published: June 2021

While problem identification is a key stage in creative problem solving, many gifted students may rush to begin developing solutions before they have spent sufficient time accurately identifying the underlying problem or opportunity. As a result, they may develop irrelevant or hackneyed solutions. Despite the importance of problem finding, teachers may struggle to provide opportunities for students to practice authentic problem finding for a variety of reasons, including ambiguity surrounding the problem-finding process and concerns regarding external expectations emphasizing standardized assessment performance. Thus, the purpose of this article is to address these concerns by (a) operationalizing the process of problem finding and (b) delineating an instructional design method to support teachers as they construct problem-finding opportunities for students. Our research team identified four primary cognitive strategies involved in problem finding, including: Resource Management, Elaboration, Analysis, and Manipulation, which we integrate into the “Facilitating Problem-Finding Model” to provide clarity for the problem identification process. Then, we illustrate how teachers may use these specific strategic approaches to create targeted learning objectives. These objectives serve to anchor assessments and classroom experiences, providing students with important opportunities to develop problem-finding skills.
Going Beyond Lip Service When It Comes to Equity: Characteristics of Equity-Minded, Culturally Responsive Allies in Gifted and Talented Education
Authors: Ford Donna Y. , Davis Joy Lawson , Whiting Gilman W. , Moore James L.
Published: June 2021

The authors provide a history of inequities in gifted education and recognize the academic, cultural, and psychosocial needs of gifted and talented Black and Hispanic students, who are in need of advanced programming. They conclude by describing 10 characteristics of culturally responsive, equity-minded allies.
Preventing drug vial wastage and reducing expenditure associated with injectable cancer drugs: International oncology pharmacy survey
Authors: Gilbar Peter J , Chambers Carole R , Musicco Felice
Published: June 2021

Purpose

Our objective was to determine what vial sharing techniques and other strategies were being used globally to reduce wastage from partially used single-use drug vials, what barriers are preventing these strategies being employed, and what savings are being achieved.

Methods

A survey, comprising 19 questions, was distributed to the membership of the International Society of Oncology Pharmacy Practitioners and British Oncology Pharmacy Association. Questions asked included how parenteral cancer drugs are obtained and prepared, what vial sharing strategies are used, what means are employed to extend stability, how prepared products are reused and what cost savings are achieved.

Results

In all, 74 responses were received from 20 countries, most from the United Kingdom. Some manufacturing is done by 60.8% of institution, with 41.9% making all products. Vial sharing strategies, for frequently used drugs, were employed in 53% of cases. Barriers preventing vial sharing being used included government legislation, USP 797 guidelines, and health insurance companies. Extension of stability was possible for 70.2% of centres. Most respondents reported reduction in cytotoxic and biological waste, and alleviation of drug shortages from vial sharing utilisation. Cost savings were achieved in 74% of cases and was significant in one third.

Conclusions

The survey has determined that drug vial wastage and expenditure can be reduced, and vial sharing facilitates this. International collaboration plus the assistance of governments and the pharmaceutical industry is vital in achieving this aim. These findings can hopefully guide oncology pharmacy in establishing appropriate strategies to reduce wastage internationally.
Keywords as method
Authors: Moran Marie
Published: June 2021

This short essay seeks to restore the keywords approach initiated by Williams to a more central place within the cultural materialist paradigm he also developed. Combining Williams’ cultural materialist account of language with the practical orientation of Keywords, it sketches a way of developing the keywords approach as a method of sociocultural analysis. Drawing on some practical examples, it offers ‘keywords-as-method’ as a means of carrying out a historicist and materialist study of the relationship of linguistic to social change, that goes beyond the simple glossary of terms approach that has thus far limited the explanatory and critical potential of Keywords. In so doing, I hope to contribute to the renewal of Williamsian scholarship that has coincided with the centenary of his birth.
Strategic humour: Public diplomacy and comic framing of foreign policy issues
Authors: Chernobrov Dmitry
Published: June 2021

This article explores persuasive applications of humour in public diplomacy. I propose a new concept of strategic humour – the use of humour by state and proxy actors to promote instrumental interpretations of contested international events to foreign and domestic publics. Through strategic humour, states frame events in ways that advance their interests, deflect external criticism, and challenge narratives of other actors. In an entertaining form, strategic humour delivers a serious message that is simple, accessible, memorable, suited to the new media ecologies, and competitive in capturing news media and public attention. I focus on Russia as a state recently involved in a range of major controversies and demonstrate its use of strategic humour in three case studies. I argue that strategic humour is a fast-emerging, multi-format tool in public diplomacy, facilitated by the rise of social media and post-truth politics and less dependent on the state’s broader power resources.
Exploring recruits’ motivations to enter policing in Small Island Developing States: The case of the Trinidad and Tobago Police Service
Authors: Wallace Wendell C.
Published: June 2021

Internationally, there is a substantial amount of research on motivations to enter the police profession; however, scant research attention has been paid to the motivations of individuals in Small Island Developing States (SIDS) such as Trinidad and Tobago who choose policing as a career path. As a result, this research was designed to analyze motivations for entering the police profession by gathering data from recruits who had recently entered police academy training in Trinidad and Tobago. The research utilized a quantitative approach with self-administered questionnaires as the data-gathering instrument. Using data collected from 160 police recruits at the Trinidad and Tobago Police Service (TTPS) police academy who were two months into their induction training, this study attempts to answer four questions related to their motivations for entering policing. Statistical analyses of the data included comparisons between groups in the sample (males/females) to determine the existence of competing motivations. The results indicate that job security was the main motivation for entry into the TTPS and that the motivations of male recruits were more altruistic when compared with those of female recruits, which were generally self-serving. Other results and implications for policy are discussed.
A density functional theory study on the mechanism of the allylpalladium-catalyzed dehydrogenation of aldehydes and cyclic ketones
Authors: Arisha Anan Haj Ichia
Published: June 2021

The results of density functional theory calculations at the APFD/SDD level are detailed herein in order to study the main steps in the α,β-dehydrogenation of aldehydes and cyclic ketones in the presence of an allylpalladium complex catalyst. The mechanism is believed to proceed via an allylpalladium enolate complex (A) in equilibrium with the carbon-bonded complex (B), followed by β-hydride elimination to yield the allylpalladium hydride coordinated to the α,β-unsaturated carbonyl (complex C). The optimized structures and detailed energy profiles of these intermediates and their corresponding transition states are presented herein. The results indicate that the intermediates and their transition states are more stable in THF solution than in the gas phase. In detail, the energy barriers for the two steps are found to be 25.22 and 11.13 kcal/mol, respectively, in THF, and 29.93 and 9.77 kcal/mol, respectively, in the gas phase.
Influence of the liner-type treatment on the trailing-edge noise generated by a flat plate
Authors: Yakhina Gyuzel , Dignou Bastien , Pasco Yann , Moreau Stéphane
Published: June 2021

Several liner-type treatments (three different rectangular grooves covered by three different low porosity wire-mesh screens) on the trailing edge of a flat plate have been investigated in the anechoic wind-tunnel of Université de Sherbrooke. Far-field acoustic directivity measurements have been achieved at Reynolds numbers based on the plate length from [Formula: see text] to [Formula: see text], yielding radiation maps of all possible liner combinations that are then compared to the reference solid flat plate and to the plate with inserts alone. Noise from the flat plate corresponds to dipolar trailing-edge scattering with an extra shallow hump attributed to the unsteady flow recirculation behind the thick plate. When grooves are added, the latter contribution is amplified and additional cavity noise is observed with several tones and humps. The tones are shown to be resonance between high order modified Rossiter modes and cavity depthwise modes. The hump is a combination of drag dipoles and cavity monopoles from the groove row. The addition of screens always reduces the amplification of the dipolar edge scattering but exhibits very different non-linear responses for the cavity noise. The combination screen with the smallest cells and the insert with the shallowest cavities (corresponding to the same type of treatment applied previously on the Controlled-Diffusion airfoil) yields the lowest levels overall, while the screen with intermediate cell size almost always triggers noise amplification and the screen with a coarse mesh has an intermediate behavior. At high frequencies, the previously reported roughness noise is also observed.
Quantitative acoustic emission investigation on the crack evolution in concrete prisms by frequency analysis based on wavelet packet transform
Authors: Wang Zonglian , Ding Keqin , Ren Huilan , Ning Jianguo
Published: June 2021

To gain an insight into the evolution of micro-cracks in concrete materials, a quantitative acoustic emission investigation on the damage process of concrete prisms subjected to three-point bending loading was performed. Each of the monitored acoustic emission signals was processed by a two-level wavelet packet decomposition into four different frequency bands (AA2, DA2, AD2, and DD2), and the energy coefficients R1, R2, R3, and R4 that parameterize their characteristic frequency bands were calculated. By analyzing variations in energy coefficients of the lowest frequency band (AA2), R1, and the energy coefficients of the highest frequency band (DD2), R4, the whole damage process was divided into three stages: crack initiation, crack growth, and crack coalescence. An inverse relationship between the frequency of the acoustic emission signal emitted by the propagating crack and the crack size in concrete materials was acquired based on the damage theory of brittle materials and the strain energy release theory. The statistical analysis results of the experimental data indicated that the average of R1 increased in turn, and the average of R4 correspondingly decreased in turn from Stage 1 to Stage 3. It revealed that the frequencies of acoustic emission signals decreased gradually with the evolution of the damage of concrete prisms, which is in a good agreement with the theoretical analysis result.
Uncertainty quantification for impact location and force estimation in composite structures
Authors: Seno Aldyandra Hami , Aliabadi MH Ferri
Published: June 2021

Structural health monitoring of impact location and severity using Lamb waves has been proven to be a reliable method under laboratory conditions. However, real-life operational and environmental conditions (vibration noise, temperature changes, different impact scenarios, etc.) and measurement errors are known to generate variation in Lamb wave features which may significantly affect the accuracy of these estimates. Therefore, these uncertainties should be considered, as a deterministic approach may lead to erroneous decisions. In this article, a novel data-driven stochastic Kriging-based method for impact location and maximum force estimation, that is able to reliably quantify the output uncertainty is presented. The method utilises a novel modification of the kriging technique (normally used for spatial interpolation of geostatistical data) for statistical pattern matching and uncertainty quantification using Lamb wave features to estimate the location and maximum force of impacts. The data was experimentally obtained from a composite panel equipped with piezoelectric sensors. Comparison with a deterministic benchmark method developed in prior studies shows that the proposed method gives a more reliable estimate for experimental impacts under various simulated environmental and operational conditions by estimating the uncertainty. The developed method highlights the suitability of data-driven methods for uncertainty quantification, by taking advantage of the relationship between data points in the reference database that is a mandatory component of these methods (and is often seen as a disadvantage). By quantifying the uncertainty, there is more information for operators to reliably locate impacts and estimate the severity, leading to robust maintenance decisions.
Stabilizing Technique for Bridging Stent Placement in Branched Endovascular Aortic Repair
Authors: Zander Tobias , García Giovanni , Concepción Yamileth , Parra Felipe , Valdés Michel , Maynar Manuel
Published: June 2021

Purpose

To present a bailout technique for bridging covered stent placement during branched endovascular aortic repair (BEVAR) in complex anatomy.

Technique

BEVAR is an alternative technique for the treatment of thoracoabdominal aortic aneurysms (TAAAs). Visceral and renal vessels must be preserved by bridging covered stent placement through downward-oriented branches of the main stent graft device. Challenging anatomy such as kinking and elongation of the aorta, or type III aortic arch configuration may impede successful catheterization of these branches due to reduced steerability and pushability of the endovascular material. Different alternative techniques have been described to overcome these anatomic barriers. This technical note adds another endovascular solution to complex cases using the guiding sheath stabilizing technique. It is based on a standard “through-and-through” technique. An attached snare is inserted via femoral approach, providing a stable position for branch catheterization and bridging covered stent deployment.

Conclusion

The stabilizing technique is safe and easy to perform and provides a stable position of the guiding sheath when antegrade branch catheterization is challenging. This technique is an additional tool for handling challenging cases.
Cognitive Behavioral-Active Music Pastoral Therapy for Millennials’ Academic Anxiety: How & Why?
Authors: Situmorang Dominikus David Biondi
Published: June 2021

This study used quasi-experimental design with repeated measures (pre-test, post-test, and follow-up). Based on the post-test and the follow-up comparison, active music therapy was effective in reducing academic anxiety after two weeks of the treatment. Active music therapy which are integrated in CBT group counseling not only can overcome individual problems, but the therapies can also help individuals analyze their own thoughts and behavior.
A Chaplain’s Ministry to a Grieving Mother
Authors: Close, Th. M. Henry
Published: June 2021

This clinical report describes some rather unusual procedures used in a chaplain’s ministry to a seriously disturbed mother in her struggle to grieve for members of her family who had died in a fire.
One-pot synthesis of Acanthus ilicifolius Linn alkaloid 2-benzoxazolinone derivatives via a tandem Ugi 4-component coupling/haloform cyclization
Authors: Zhu Jun , Tian Xiao-Qiong , Kong Ling-Qi , Ke Li-Na , Ran Feng-Ying , Wu Lun , Wang Hong-Mei , Chen Qin-Hua , Zeng Xiao-Hua
Published: June 2021

A one-pot, base-mediated approach to Acanthus ilicifolius Linn alkaloid 2-benzoxazolinone derivatives is developed. Starting from trichloroacetic acid, o-aminophenol, substituted benzaldehydes and alkyl isocyanides, the desired 2-benzoxazolinone derivatives are obtained in good yields via a tandem Ugi condensation and intramolecular haloform cyclization at room temperature in the presence of Et3N.
The association between training load indices and upper respiratory tract infections (URTIs) in elite soccer players
Authors: Tiernan Caoimhe , Comyns Thomas , Lyons Mark , Nevill Alan M , Warrington Giles
Published: June 2021

This study aimed to investigate the association between training load indices and Upper Respiratory Tract Infection (URTI) across different lag periods in elite soccer players. Internal training load was collected from 15 elite soccer players over one full season (40 weeks). Acute, chronic, Acute:Chronic Workload Ratio (ACWR), Exponentially Weighted Moving Averages (EWMA) ACWR, 2, 3 and 4-week cumulative load, training strain and training monotony were calculated on a rolling weekly basis. Players completed a daily illness log, documenting any signs and symptoms, to help determine an URTI. Multilevel logistic regression was used to analyze the associations between training load indices and URTIs across different lag periods (1 to 7-days). The results found a significant association between 2-week cumulative load and an increased likelihood of a player contracting an URTI 3 days later (Odds Ratio, 95% Confidence Interval: OR = 2.07, 95% CI = 0.026-1.431). Additionally, a significant association was found between 3-week cumulative load and a players’ increased risk of contracting an URTI 4 days later (OR = 1.66, 95% CI = 0.013–1.006). These results indicate that accumulated periods of high training load (2- and 3-week) associated with an increased risk of a player contracting an URTI, which may lead to performance decrements, missed training sessions or even competitions.
An algorithm using clinical data to predict the optimal individual glucocorticoid dosage to treat multiple sclerosis relapses
Authors: Gili-Kovács Judit , Hoepner Robert , Salmen Anke , Bagnoud Maud , Gold Ralf , Chan Andrew , Briner Myriam
Published: June 2021

Background:

Glucocorticoid (GC) pulse therapy is used for multiple sclerosis (MS) relapse treatment; however, GC resistance is a common problem. Considering that GC dosing is individual with several response-influencing factors, establishing a predictive model, which supports clinicians to estimate the maximum GC dose above which no additional therapeutic value can be expected presents a huge clinical need.

Method:

We established two, independent retrospective cohorts of MS patients. The first was an explorative cohort for model generation, while the second was established for its validation. Using the explorative cohort, a multivariate regression analysis with the GC dose used as the dependent variable and serum vitamin D (25D) concentration, sex, age, EDSS, contrast enhancement on cranial magnetic resonance imaging (MRI), immune therapy, and the involvement of the optic nerve as independent variables was established.

Results:

In the explorative cohort, 113 MS patients were included. 25-hydroxyvitamin D (25D) serum concentration and the presence of optic neuritis were independent predictors of the GC dose needed to treat MS relapses [(25D): −25.95 (95% confidence interval (CI)): −47.40 to −4.49; p = 0.018; optic neuritis: 2040.51 (95% CI: 584.64–3496.36), p = 0.006]. Validation of the multivariate linear regression model was performed within a second cohort. Here, the predicted GC dose did not differ significantly from the dose administered in clinical routine (mean difference: −843.54; 95% CI: −2078.08–391.00; n = 30, p = 0.173).

Conclusion:

Our model could predict the GC dose given in clinical, routine MS relapse care, above which clinicians estimate no further benefit. Further studies should validate and improve our algorithm to help the implementation of predictive models in GC dosing.
Outcomes and complications of distal humeral hemiarthroplasty for distal humeral fractures – A systematic review
Authors: Wilfred Ann M , Akhter Shakib , Horner Nolan S , Aljedani Ahmed , Khan Moin , Alolabi Bashar
Published: June 2021

Background

Distal humeral hemiarthroplasty has been performed for a variety of indications with the most common being management of distal humeral fractures. This systematic review evaluates the outcomes and complications of distal humeral hemiarthroplasty for this pathology.

Methods

We searched PubMed, EMBASE, and MEDLINE for studies reporting indications and outcomes of patients undergoing distal humeral hemiarthroplasty. Study screening, risk of bias assessment, and data extraction were performed. Summery statistics were provided.

Results

We included 11 studies ( N = 163) in this review. In all studies, the indication for distal humeral hemiarthroplasty was the presence of an intraarticular, comminuted, unreconstructable fracture. The mean post-operative MEPS, FullDASH, and QuickDASH (SD) scores were 83.6 (6.1) points, 25.4 (10.3), and 15.7 (7.4) points, respectively. The mean post-operative range of motion (SD) was 106° (11°) in the flexion and extension arc and 153° (19°) in the protonation and supination arc. The overall rate of adverse events and complication was 63%. The rate for major complications was 11%. The mean total revision rate was 4% (0% to 15) and total re-operation rate was 29% (0% to 88%).

Conclusion

Distal humeral hemiarthroplasty is a suitable option for unreconstructable distal humeral fractures and offers good functional outcomes with acceptable complication rates.
External validity of clinical trials with diverse trastuzumab-based chemotherapy regimens in advanced gastroesophageal adenocarcinoma: data from the AGAMENON-SEOM registry
Authors: Jimenez-Fonseca Paula , Carmona-Bayonas Alberto , Martinez-Torron Alba , Alsina Maria , Custodio Ana , Serra Olbia , Cacho Lavin Diego , Limón María Luisa , Sauri Tamara , López Flora , Visa Laura , Granja Mónica , Martínez Lago Nieves , Arrazubi Virginia , Vidal Tocino Rosario , Hernandez Raquel , Aguado Gema , Cano Juana María , Martín Carnicero Alfonso , Mangas Monserrat , Pimentel Paola , Fernández Montes Ana , Macias Declara Ismael , Longo Federico , Ramchandani Avinash , Martín Richard Marta , Hurtado Alicia , Azkarate Aitor , Hernández Pérez Carolina , Serrano Raquel , Gallego Javier ,   on behalf of the AGAMENON-SEOM study group
Published: June 2021

Background:

Trastuzumab combined with cisplatin and fluoropyrimidines, either capecitabine or 5-fluorouracile (XP/FP), is the standard first-line treatment for advanced, HER2-positive, gastric cancer patients based on the ToGA trial. Despite the lack of phase III trials, many clinicians administer trastuzumab with alternative regimens. One meta-analysis suggests that substituting cisplatin for oxaliplatin might lead to greater efficacy and less toxicity.

Methods:

594 patients with HER2-positive gastroesophageal adenocarcinoma were recruited from the AGAMENON-SEOM registry. The objective was to evaluate the external validity of clinical trials with chemotherapy and trastuzumab.

Results:

The regimens used in at least 5% of the patients were XP (27%), oxaliplatin and capecitabine (CAPOX) (26%), oxaliplatin and 5-fluorouracil (FOLFOX) (14%), FP (14%), triplet with anthracycline/docetaxel (7%), and carboplatin-FU (5%). Median exposure to trastuzumab was longer with FOLFOX (11.4 months, 95% CI, 9.1–21.0) versus ToGA regimens (7.5, 6.4–8.5), p < 0.001. Patients with HER2-IHC 3+ cancers had higher response rates than those with IHC 2+/FISH+, odds-ratio 1.97 (95% CI, 1.25–3.09). The results achieved with CAPOX–trastuzumab were comparable to those attained with ToGA regimens. FOLFOX–trastuzumab was superior to ToGA schemes in terms of overall survival (OS), with a greater magnitude of effect in IHC 2+/FISH+ tumors (HR 0.47, 0.24–0.92) compared with IHC 3+ (HR 0.69, 0.49–0.96), and in diffuse (HR 0.37, 0.20–0.69) versus intestinal-type tumors (HR 0.76, 0.54–1.06).

Conclusion:

We have updated the external validity of clinical trials with trastuzumab in first-line treatment of gastric cancer. Our data confirm the comparable outcomes of ToGA regimens and CAPOX–trastuzumab in clinical practice and point toward a possible benefit of FOLFOX–trastuzumab, contingent on the subtypes typically less sensitive to trastuzumab, to be confirmed in clinical trials.
Advocacy for School Nurses and Student Health and Safety: Highlighting National and State Efforts
Authors: Largent Piper
Published: June 2021

Annually, the National Association of School Nurses (NASN) sets advocacy goals. The goals include legislative and policy priorities. The COVID-19 pandemic brought attention to the need to heighten advocacy efforts, specifically to provide for additional school nurses and supplies necessary to meet the challenge of safely returning students to school. While advocating at the national level, NASN also encouraged advocacy at the state and local levels. This article provides a brief summary of NASN’s advocacy efforts as well as providing examples from two different state associations demonstrating the importance of collaboration in advocacy efforts in areas related to the pandemic and in general areas related to school nursing.
A rare case: Mania associated with pazopanib
Authors: Tan Bryan Ling Wei , Gudi Alakananda
Published: June 2021

Mania typically presents with a well-denoted period of abnormal and persistently elevated or irritable mood, and increased activity or energy almost daily for at least a week. This mood disturbance is usually functionally dilapidating in aspects of social or occupational functioning, sometimes even requiring hospitalisation to prevent harm to self or others. We report an interesting case of first presentation of mania in a 61-year-old female with ongoing metastatic sarcoma, with a potential association with a chemotherapy drug – pazopanib.
Association of Wilms tumor in multicystic dysplastic kidneys: case report and review of the literature
Authors: Andreas Darian , Glick Richard D , Fish Jonathan D , Fein Levy Carolyn , Gitlin Jordan S
Published: June 2021

Multicystic dysplastic kidney is a rare urinary anomaly characterized by multiple non-communicating cysts resulting in a non-functional kidney. In addition to association with hypertension and contralateral renal anomalies, children with multicystic dysplastic kidney have an increased risk of Wilms tumor. Cohort studies and systematic reviews are hampered in estimating the true risk of this association due to the rarity and infrequent reporting of the condition. We present a case of a 2-year-old male child with an antenatal diagnosis of multicystic dysplastic kidney undergoing surveillance ultrasonography who presented with a symptomatic Wilms tumor.

Level of evidence: Not applicable for this multicentre audit.
Comparing tolerability of local anaesthetic transperineal and transrectal prostate biopsies
Authors: Starmer Benjamin , Iordan Nic , McCabe John
Published: June 2021

Objectives:

Local anaesthetic transperineal prostate biopsies have been demonstrated as tolerable. However, to date, the tolerability has not been directly compared to the standard of care for transrectal biopsy. We set out to prospectively compare the tolerability of local anaesthetic transperineal and transrectal prostate biopsies.

Patients and methods:

All patients between 3 April 2019 to 6 December 2019 undergoing local anaesthetic transperineal / transrectal ultrasound biopsy were prospectively asked to complete a questionnaire using visual analogue scales assessing the tolerability of their biopsy.

Results:

108 patients were included. Baseline characteristics (mean): age 66.4 years, prostate-specific antigen 13.7 ng/dl, prostate volume 48 ml. Of the patients 51% had ⩾ Gleason 3+4 prostate cancer. 56 patients had transperineal and 52 patients had transrectal biopsy. Median visual analogue scale scores (0–9: transperineal vs transrectal) for probe insertion, probe presence, local anaesthetic injection and taking biopsy were 3 vs 4 ( p=0.66), 3 vs 3 ( p=0.91), 3 vs 2 ( p=0.15) and 3 vs 3 ( p=0.18), respectively. Median visual analogue scale scores (0–3) for overall pain, embarrassment and how they would describe it to a friend were 1 vs 1 ( p=0.17), 0 vs 0 ( p=0.34) and 1 vs 1 ( p=0.2), respectively (transperineal vs transrectal ultrasound). 42 of the 56 patients in the transperineal group had prior transrectal biopsy. 24/42 patients described local anaesthetic transperineal biopsy as the same or better than transrectal; 15/42 described it as a little worse.

Conclusion:

Tolerability of local anaesthetic transperineal biopsy is comparable to transrectal biopsy. As such, we advocate the routine use of transperineal biopsy and to phase out the transrectal approach where possible.

Level of evidence:

2b
Ladakh and the Creative Greening of the Desert: The Life Work of Sonam Wangchuk and Rebecca Norman Through Alternative Practices in Education and Farming
Authors: Visvanathan Susan
Published: June 2021

This article attempts to understand the way in which climate change affects the once dry cold desert of Ladakh and how local communities have adapted to these changes by becoming excellent organic gardeners. The contributions of Sonam Wangchuk and his work with regard to water harvesting and alternative education have been recognised by the Ramon Magsaysay Committee for 2018. This will propel Sonam to complete his life mission, which is the construction of a whole new township in Phey, to relieve Leh of the overload it now experiences. The article provides a background to the work of Sonam and his wife Rebecca Norman in the details of everyday life and work, which they bring to their school, SECMOL.
The Big Indian Dream Package and IIT JEE
Authors: Sankar Mahalakshmi
Published: June 2021

This case study describes the macro-environmental factors responsible for the growth of coaching classes in India with particular reference to IIT JEE preparation. The case chronicles the explosive growth in the coaching classes industry fuelled by big dollar packages promised to IIT graduates. Consumer behaviour related to selecting a coaching class is analysed with particular reference to dissonance-reducing buyer behaviour that parents strive to achieve. The role of advertising appeals and sales promotion through admission and scholarship examinations in influencing consumer behaviour can be debated and analysed. The case study opens up a discussion on the effect of National Education Policy 2020 on the industry.
A case of thrombocytopenia and multiple thromboses after vaccination with ChAdOx1 nCoV-19 against SARS-CoV-2
Authors: Tølbøll Sørensen Anne Louise , Rolland Magalie , Hartmann Jacob , Harboe Zitta Barrella , Roed Casper , Jensen Tomas Ø. , Kolte Lilian , El Fassi Daniel , Hillingsø Jens , Radziwon-Balicka Aneta , Soyka Robert Sebastian , Hansen Klaus , Kirkby Nikolai , Goetze Jens P. , Gybel-Brask Mikkel , Leinøe Eva Birgitte , Hvas Anne-Mette , Kampmann Peter , Stensballe Jakob
Published: June 2021

Recently, reports of severe thromboses, thrombocytopenia, and hemorrhage in persons vaccinated with the chimpanzee adenovirus-vectored vaccine (ChAdOx1 nCoV-19, AZD1222, Vaxzevria; Oxford/AstraZeneca) against severe acute respiratory syndrome coronavirus 2 have emerged. We describe an otherwise healthy 30-year-old woman who developed thrombocytopenia, ecchymosis, portal vein thrombosis, and cerebral venous sinus thrombosis the second week after she received the ChAdOx1 nCoV-19 vaccine. Extensive diagnostic workup for thrombosis predispositions showed heterozygosity for the prothrombin mutation, but no evidence of myeloproliferative neoplasia or infectious or autoimmune diseases. Her only temporary risk factor was long-term use of oral contraceptive pills (OCPs). Although both the prothrombin mutation and use of OCPs predispose to portal and cerebral vein thrombosis, the occurrence of multiple thromboses within a short time and the associated pattern of thrombocytopenia and consumption coagulopathy are highly unusual. A maximum 4T heparin-induced thrombocytopenia (HIT) score and a positive immunoassay for anti-platelet factor 4/heparin antibodies identified autoimmune HIT as a potential pathogenic mechanism. Although causality has not been established, our case emphasizes the importance of clinical awareness. Further studies of this potentially new clinical entity have suggested that it should be regarded as a vaccine-induced immune thrombotic thrombocytopenia.
A contemporary practical approach to the multidisciplinary management of unclassifiable interstitial lung disease
Authors: Ryerson Christopher J. , Corte Tamera J. , Myers Jeffrey L. , Walsh Simon L.F. , Guler Sabina A.
Published: June 2021

Fibrotic interstitial lung diseases (ILDs) frequently have nonspecific and overlapping clinical and radiological features, resulting in ∼10–20% of patients with ILD lacking a clear diagnosis and thus being labelled with unclassifiable ILD. The objective of this review is to describe how patients with unclassifiable ILD should be evaluated, and what impact specific clinical, radiological and histopathological features may have on management decisions, focusing on patients with a predominantly fibrotic phenotype. We highlight recent data that have suggested an increasing role for antifibrotic medications in a variety of fibrotic ILDs, but justify the ongoing importance of making an accurate ILD diagnosis given the benefit of immunomodulatory therapies in many patient populations. We provide a practical approach to support management decisions that can be used by clinicians and tested by clinical researchers, and further identify the need for additional research to support a rational and standardised approach to the management of patients with unclassifiable ILD.
Haemoglobin as a biomarker for clinical outcomes in chronic obstructive pulmonary disease
Authors: Balasubramanian Aparna , Henderson Robert J. , Putcha Nirupama , Fawzy Ashraf , Raju Sarath , Hansel Nadia N. , MacIntyre Neil R. , Jensen Robert L. , Kinney Gregory L. , Stringer William W. , Hersh Craig P. , Bowler Russell P. , Casaburi Richard , Han MeiLan K. , Porszasz Janos , Make Barry J. , McCormack Meredith C. , Wise Robert A.
Published: June 2021

In COPD, anaemia is associated with increased morbidity, but the relationship between haemoglobin over its entire observed range and morbidity is poorly understood. Such an understanding could guide future therapeutic targeting of haemoglobin in COPD management. Leveraging the COPDGene study, we conducted a cross-sectional analysis of haemoglobin from COPD participants, examining symptoms, quality of life, functional performance, and acute exacerbations of COPD (AECOPD). Haemoglobin was analysed both as a continuous variable and categorised into anaemia, normal haemoglobin, and polycythaemia groups. Fractional polynomial modelling was used for continuous analyses; categorical models were multivariable linear or negative binomial regressions. Covariates included demographics, comorbidities, emphysema, diffusing capacity, and airflow obstruction. From 2539 participants, 366 (14%) were identified as anaemic and 125 (5%) as polycythaemic. Compared with normal haemoglobin, anaemia was significantly associated with increased symptoms (COPD Assessment Test score: p=0.006, modified Medical Research Council (mMRC) Dyspnoea Score: p=0.001); worse quality of life (St. George's Respiratory Questionnaire (SGRQ) score: p<0.001; Medical Outcomes Study Short Form 36-item Questionnaire (SF-36) General Health: p=0.002; SF-36 Physical Health: p<0.001), decreased functional performance (6-min walk distance (6MWD): p<0.001), and severe AECOPD (p=0.01), while polycythaemia was not. Continuous models, however, demonstrated increased morbidity at both ends of the haemoglobin distribution (p<0.01 for mMRC, SGRQ, SF-36 Physical Health, 6MWD, and severe AECOPD). Evaluating interactions, both diffusing capacity and haemoglobin were independently associated with morbidity. We present novel findings that haemoglobin derangements towards either extreme of the observed range are associated with increased morbidity in COPD. Further investigation is necessary to determine whether haemoglobin derangement drives morbidity or merely reflects systemic inflammation, and whether correcting haemoglobin towards the normal range improves morbidity.
The epidemiology of nontuberculous mycobacterial pulmonary disease in the Netherlands
Authors: Schildkraut Jodie Anne , Zweijpfenning Sanne Maria Henriëtte , Nap Martijn , He Kun , Dacheva Elena , Overbeek Jetty , Tostmann Alma , Wertheim Heiman F.L. , Hoefsloot Wouter , van Ingen Jakko
Published: June 2021

Background

Nontuberculous mycobacteria (NTM) are emerging opportunistic pathogens of humans. Because NTM pulmonary disease (PD) is not a notifiable disease in Europe, the epidemiology of NTM-PD is not well known. However, the prevalence of NTM-PD is thought to be increasing, particularly in countries where tuberculosis rates have decreased. Here we aim to determine the prevalence of NTM-PD in the Netherlands.

Methods

Annual prevalence estimates of NTM-PD in the Netherlands (2012–2019) were derived from four separate databases, including two drug dispensing databases, an ICD-10 code database and a hospitalisation database. Databases covered a fraction of the Dutch population and were extrapolated. In addition, annual NTM-PD prevalence was also estimated by means of a pulmonologist survey.

Results

The estimated annual prevalence of NTM-PD using databases is between 2.3 and 5.9 patients per 100 000 inhabitants. Prevalence estimates derived from the drug dispensing databases, the hospitalisation database and the claims database were 2.3, 5.9, 3.5 and 4.5 per 100 000 inhabitants, respectively. The annual prevalence estimated in the pulmonologist survey was between 6.2 and 9.9 per 100 000 inhabitants. The annual prevalence remained stable over the included period.

Conclusion

The estimated annual prevalence of NTM-PD using databases was between 2.3 and 5.9 patients per 100 000 inhabitants. Due to the possible presence of tuberculosis patients and low coverage in one dispensing database, we believe an annual prevalence of between 2.3 and 4.5 patients per 100 000 inhabitants is more probable, which still renders NTM-PD a serious health threat. This estimate is lower than the estimate from the pulmonologist survey, indicating physicians likely overestimate prevalence.
Challenging the obesity paradox: extreme obesity and COPD mortality in the SUMMIT trial
Authors: Brigham Emily P. , Anderson Julie A. , Brook Robert D. , Calverley Peter M.A. , Celli Bartolome R. , Cowans Nicholas J. , Crim Courtney , Diserens James E. , Martinez Fernando J. , McCormack Meredith C. , Newby David E. , Yates Julie , Vestbo Jorgen , Wu Tianshi David , Wise Robert A.
Published: June 2021

Populations with COPD demonstrate higher survival in overweight and obese compared with normal weight; the “obesity paradox”. Relationships in less-severe COPD are unclear, as is the impact of cardiovascular risk, and few studies include individuals at extremes of obesity.

 We examined the relationship between body mass index (BMI; defined as underweight: <20 kg·m−2, normal: 20–25 kg·m−2, overweight: 25– <30 kg·m−2, obese class I: 30– <35 kg·m−2, class II: 35– <40 kg·m−2and class III: ≥40 kg·m−2), morbidity, and mortality in the SUMMIT trial population (n=16 485), characterised by moderate COPD and heightened cardiovascular risk with a substantial proportion with class III obesity. The association between BMI category and time to event was modelledviaproportional hazards (reference normal weight) adjusted for demographics and cardiorespiratory disease.

 Consistent with the paradox, underweight individuals demonstrated higher mortality (hazard ratio (HR) 1.31 (95% CI 1.04–1.64)), with lower mortality among overweight (HR 0.62 (95% CI 0.52–0.73)) and obese class I (HR 0.75 (95% CI 0.62–0.90)). However, mortality increased in obese class III (HR 1.36 (95% CI 1.00–1.86)). Death was primarily attributable to cardiovascular causes.

 Within a large, multinational cohort with moderate COPD and increased cardiovascular risk, the phenomenon of reduced mortality with obesity did not persist at BMI >40 kg·m−2, suggesting that obesity may not remain protective at the extremes in this population.
Assesment of the potential of cargo bikes and electrification for last-mile parcel delivery by means of simulation of urban freight flows
Authors: Llorca Carlos , Moeckel Rolf
Published: June 2021

Background

The paper presents a simulation model for freight. In the paper, this model is applied to understand the impacts of electric vans and cargo bikes for the last-mile delivery of parcels. Cargo bikes are electrically assisted vehicles that distribute parcels from micro depots located close to the final customers by means of short tours. The parcels are sent from the major distribution center to micro depots in vans (called feeders).

Materials and methods

An agent-based model is used for the purpose of the paper. The model is based on the disaggregation of commodity flows to represent trucks (for all commodities) and individual shipments (for parcel deliveries). The model represents microscopically every freight vehicle in the study area.

Results

The simulation of various scenarios with different shares of cargo bikes and electric vans assesses the impacts of electrification and cargo bikes. The use of cargo bikes to deliver parcels allows to reduce the number of motorized vehicles, although the presence of large parcels requires that at least half of deliveries by vans are still required. The shift to cargo bikes represents a slight increase in the total operating time to deliver the parcel demand. With low shares of cargo bikes, the total distance traveled increases, since the reduction of van tours cannot compensate the additional feeder trips from distribution centers to micro depots. The cargo bikes also do not reduce the number of vehicles for the served area, but modify the composition of vehicle types. Low noise, smaller, low emission vehicles increase, while delivery vans are reduced.

Conclusion

Both cargo bikes and electric vans are able to reduce CO2 emissions, even after accounting for the emissions related to electricity production.