bluuebunny/crossref_metadata_2025 huggingface dataset:
The struggle for Singapore’s Chinese heartland: The People’s Action Party versus the Workers’ Party versus the Singapore Democratic Party, 1998–2013
Authors: James Kieran
Published: January 2021

Singapore’s political struggles of the 1950s and 1960s, between a Chinese-educated, working-class left wing and a middle-class, English-educated faction, have not been completely eradicated but continue to cast a shadow over modern political developments. The moderate, English-educated faction achieved an important victory when it took over control of the People’s Action Party (PAP) in the early 1960s. However, the surprise ascendancy of the Workers’ Party (WP), under Low Thia Khiang, has seen a long-marginalized section of the Chinese-educated galvanize around a district, Hougang and Aljunied, and a Teochew-speaking charismatic but low-key individual in Mr Low. The WP’s ability to develop an enduring ‘brand’ over the 2006–2013 period surprised many commentators. By 2013 it had become Singapore’s second-strongest political force.
“We’re Powerful Too, You Know?” A Narrative Inquiry Into Elementary School Counselors’ Experiences of the RAMP Process
Authors: Duquette Kevin
Published: January 2021

This study utilized a qualitative narrative inquiry to explore the experiences of eight elementary school counselors who successfully applied for and received Recognized ASCA Model Program (RAMP) designation for their schools. Participants provided insight into motivations, resources, and other considerations that contributed to their success in earning RAMP distinction. The overarching theme, Don’t be afraid to engage in RAMP process, serves to enlighten and guide current and future school counselors in pursuing RAMP designation. This article discusses findings, implications, and future directions for research related to this study.
A Cross-Linguistic Study of L3 Phonological Acquisition of Stop Contrasts
Authors: Liu Jiaqi , Lin Jiayan
Published: January 2021

The research reported in this article investigated how students learning Japanese or Russian as a third language (L3) perceived and produced word-initial stops in their respective target language and the link between perception and production. The participants in the study were 39 Chinese university students who spoke Mandarin Chinese as their first language (L1), English as their second language (L2), and Japanese or Russian as their L3. An L3 identification task, an L3 reading task, and an L2 reading task were used to investigate the learners’ perception and production of word-initial stops. The results demonstrated that the phonetic similarity in different stop categories between L1, L2, and L3 contributed to learners’ confusion in perception. On the contrary, L3 learners could perceive the new acoustic feature voicing lead, but found it difficult to produce L3 voiced stops. In addition, the study found a positive relationship between the perception and production of voiceless stops in the initial stage of L3 acquisition, but there was no correlation between the perception and production of voiced stops. Pedagogical implications for L3 speech learning are discussed on the basis of the results.
Rhetoric Construction of Chinese Expository Essays: Implications for EFL Composition Instruction
Authors: Liu Donghong , Huang Jing
Published: January 2021

Recent scholarship on Chinese students’ English expository essays tends to blur or mitigate the differences between English and Chinese writings. This alleged convergence of English and Chinese rhetorical norms gives rise to a view that rhetorical aspects in second language writing instruction and research in China should be de-emphasized. Drawing on data from full-score Chinese compositions of College Entrance Examination, this study examines how Chinese expository paragraphs are developed. Results show great disparities between English and Chinese expository writing at paragraph level such as non-English rhetorical mode, reliance on authorities, rhetorical paragraph, and figurative language in topic sentence. We argue that Chinese rhetorical strategies are likely to be transferred to English writing if English rhetoric is not taught and reinforced in college.
Does Formal Credit Enhance Sugarcane Productivity? A Farm-Level Study of Sindh, Pakistan
Authors: Chandio Abbas Ali , Jiang Yuansheng , Rehman Abdul , Akram Waqar
Published: January 2021

In this study, we used the probit model to find out the determinants of access to formal credit and then we applied the Cobb–Douglas production function to examine the impact of formal credit on sugarcane productivity. To elicit the choice and consequence of sugarcane productivity, we divided the farmers into two groups: borrowers and nonborrowers. A total sample comprised 120 sugarcane growers from Badin District—rich in sugarcane production—Sindh, Pakistan. For analysis purposes, we used a binary-choice probit model that reveals significantly positive relationship between access to formal credit and farmer’s education level, landholding size, farming experience, and household size. The main driver to access formal credit is landholding because it is used as collateral against the loan. The age of the farmers, which was found negative and significant, shows that aged farmers are risk-averse and reluctant to access credit. The results of Cobb–Douglas production function affirm significantly positive impact of formal credit on sugarcane productivity. The credit access and use in the production process can enhance the crop production and overall income of the farmers. Therefore, secure and timely availability of crop-specific credit can help the farmers to use inputs in a timely and recommended manner.
Children’s Reading Comprehension and Motivation on Screen Versus on Paper
Authors: Liman Kaban Ayşegül , Karadeniz Sirin
Published: January 2021

The young generation, born into digital technologies and called Millennials or the Y-Generation, are raised in a world where everybody has a computer in their pockets (Hamari et al., 2014), and they are constantly engaged in digital activities. However, research on the impact of digital devices on learners’ educational performance and motivation is still an emerging field. This article aims to examine perceptions of the sixth-grade students in Turkey of their e-reading experiences on the basis of their personalized/gamified/PDF electronic reading practices in school and the influences of their perceptions on their reading comprehension and levels of motivation in English as a foreign language (EFL) classroom. The study follows a quasi-experimental approach with four treatment groups and a control group, involving 96 sixth-grade state school students in Turkey. The three treatment groups read in order from the personalized/gamified/PDF electronic reading for 5 weeks whereas the control group used printed guided reading program. The results indicate that EFL learners’ use of screen reading has the potential to increase reading motivation of the students. However, no significant difference was observed in their reading comprehension levels despite the use of different reading medium in control and experimental groups.
Allograft Subsidence Decreases Postoperative Segmental Lordosis With Minimal Effect on Global Alignment Following ACDF
Authors: Pinter Zachariah W. , Mikula Anthony , Shirley Matthew , Xiong Ashley , Wagner Scott , Elder Benjamin D. , Freedman Brett A. , Nassr Ahmad , Bydon Mohamad , Currier Bradford , Kaye I. David , Kepler Christopher , Sebastian Arjun S.
Published: January 2021

Study Design:

Retrospective cohort study.

Objective:

Studies investigating the impact of interbody subsidence in ACDF suggest a correlation between subsidence and worse radiographic and patient-reported outcomes. The purpose of this study was to assess whether allograft subsidence assessed on CT is associated with worse cervical alignment.

Methods:

We performed a retrospective review of a prospective cohort of patients undergoing 1 to 3 level ACDF. Cervical alignment was assessed on standing radiographs performed preoperatively, less than 2 months postoperatively, and greater than 6 months postoperatively. Allograft subsidence was assessed on CT scan performed at least 6 months postoperatively. Patients with at least 1 level demonstrating greater than 4mm of cage subsidence were classified as severe subsidence. Student’s t-test was used to compare all means between groups.

Results:

We identified 66 patients for inclusion, including 56 patients with non-severe subsidence and 10 patients with severe subsidence. For the entire cohort, there was a significant increase in C2-7 Lordosis (p = 0.005) and Segmental Lordosis (p < 0.00 001) from preoperative to early postoperative. On comparison of severely and non-severely subsided levels, severely subsided levels demonstrated a significantly greater loss of segmental lordosis from early to mid-term follow-up than non-severely subsided levels (-4.89 versus -2.59 degrees, p < 0.0001), manifesting as a significantly lower segmental lordosis at >6 months postoperative (0.54 versus 3.82 degrees, p < 0.00 001). There were no significant differences in global cervical alignment parameters between patients with severe and non-severe subsidence.

Conclusions:

Severe subsidence is associated with a significant increase in loss of segmental lordosis, but has minimal effect on global cervical alignment parameters.
Is Platelet-Rich Plasma Effective in Enhancing Spinal Fusion? Systematic Overview of Overlapping Meta-Analyses
Authors: Muthu Sathish , Jeyaraman Madhan , Ganie Parvez Ahmad , Khanna Manish
Published: January 2021

Study Design:

Systematic review.

Objectives:

We performed this systematic overview on overlapping meta-analyses that analyzed the role of platelet-rich plasma(PRP) in enhancing spinal fusion and identify which study provides the current best evidence on the topic and generate recommendations for the same.

Materials and Methods:

We conducted independent and duplicate electronic database searches in PubMed, Web of Science, Embase, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects till October-2020 for meta-analyses that analyzed the role of PRP in spinal fusion procedures. Methodological quality assessment was made using Oxford Levels of Evidence, AMSTAR scoring, and AMSTAR 2 grades. We then utilized the Jadad decision algorithm to identify the study with highest quality to represent the current best evidence to generate recommendations.

Results:

3 meta-analyses fulfilling the eligibility criteria were included. The AMSTAR scores of included studies varied from 5-8(mean:6.3) and all included studies had critically low reliability in their summary of results due to their methodological flaws according to AMSTAR 2 grades. The current best evidence showed that utilization of PRP was not associated with significant improvement in patient-reported outcomes such as Visual Analog Score for pain compared to the standard fusion procedure. Moreover, PRP was found to be associated with lower fusion rates.

Conclusion:

Based on this systematic overview, the effectiveness of PRP as a biological agent in augmenting spinal fusion is limited. Current evidence does not support the use of PRP as an adjuvant to enhance spinal fusion.
Early Versus Late Spine Surgery in Severely Injured Patients—Which Is the Appropriate Timing for Surgery?
Authors: Sousa Arnaldo , Rodrigues Cláudia , Barros Luís , Serrano Pedro , Rodrigues-Pinto Ricardo
Published: January 2021

Study Design:

Retrospective cohort study conducted at tertiary spinal trauma referral center.

Objective:

We aimed to determine if early definitive management of spine fractures in patients admitted to the Intensive Care Unit (ICU) shortens the intubation time and the length of stay (LOS), without increasing mortality.

Methods:

The medical records of all patients admitted to the ICU and submitted to surgical stabilization of spine fractures were reviewed over a 10-year period. Time to surgery, number of fractured vertebrae, degree of neurological injury, Simplified Acute Physiology Score (SAPS II), ASA score and associated trauma were evaluated. Surgeries performed on the first 72 hours after trauma were defined as “early surgeries.” Intubation time, LOS on ICU, overall LOS and mortality rate were compared between patients operated early and late.

Results:

Fifty patients were included, 21 with cervical fractures, 23 thoracic and 6 lumbar. Baseline characteristics did not differ between patients in both groups. Patients with early surgical stabilization had significantly shorter intubation time, ICU-LOS and overall LOS, with no differences in terms of mortality rate. After multivariate adjustments overall LOS was significantly shorter in patients operated earlier.

Conclusions:

Early spinal stabilization (<72 hours) of severely injured patients is beneficial and shortens the intubation time, ICU-LOS and overall LOS, with no differences in terms of mortality rate. Although some patients may require a delay in treatment due to necessary medical stabilization, every reasonable effort should be made to treat patients with unstable spinal fractures as early as possible.

Level of Evidence of the Study:

Level III.
Return to Driving After Anterior Cruciate Ligament Reconstruction: A Systematic Review
Authors: Salem Hytham S. , Park Do H. , Friedman Jamie L. , Jones Steven D. , Bravman Jonathan T. , McCarty Eric C. , Frank Rachel M.
Published: January 2021

Background:

Guidelines for return to driving after anterior cruciate ligament reconstruction (ACLR) have not been established.

Purpose:

To review the literature pertaining to driving after ACLR and provide evidence-based guidelines to aid clinicians in counseling patients about driving after ACLR.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Two independent reviewers searched PubMed, EMBASE, and the Cochrane Library using the terms anterior cruciate ligament, ACL, drive, and driving. Studies reporting on functional recovery after ACLR were included when data regarding return to driving were reported.

Results:

Five studies were included. Two studies included patients who underwent right-sided ACLR. Of these, 1 study evaluated bone-patellar tendon-bone autograft and reported that brake response time (BRT) returned to normal approximately 4 to 6 weeks postoperatively. The other study found that BRT returned to normal 3 weeks after allograft ACLR, but 6 weeks elapsed after autograft ACLR before values were not significantly different than controls. One study reported that patients who underwent left-sided hamstring tendon autograft ACLR demonstrated BRTs similar to controls within 2 weeks, while those with right-sided ACLR had significantly slower BRTs until 6 weeks postoperatively. Another study including patients who underwent either right- or left-sided ACLR and employed a manual transmission simulator found that 4 to 6 weeks should elapse after ACLR with hamstring tendon autograft. Survey data from 1 study demonstrated that the mean time for patients to resume driving was 13 and 10 days after right- and left-sided ACLR, respectively.

Conclusion:

BRT returned to normal values approximately 4 to 6 weeks after right-sided ACLR and approximately 2 to 3 weeks after left-sided ACLR. According to 1 study in this review, ACLR laterality should be disregarded for patients who drive manual transmission automobiles, as a 4- to 6-week time period was required for driving ability to reach the level of healthy controls. Future studies should aim to elucidate the influence of graft choice and transmission type on return to driving after ACLR.
Patient Satisfaction With Heart Health Clinics in Fraser Health, Canada
Authors: Koning Clare , Lock Adinet , Bushe Judy , Guo Charles
Published: January 2021

The Fraser Health heart function clinics explored patient satisfaction using a survey with the goal of understanding and improving care and service delivery. Data were collected from 124 respondents at 3 ambulatory care sites in the region. Patient satisfaction scores were high, with an average score of 8.85 out of 10 and 95% of respondents rating the service higher than 6 out of 10. The results highlighted the importance of multidisciplinary teams, good communication, adequate information, and emphasis on how a patient is treated. The patient’s understanding of the information provided and of their heart health treatment plan were identified as two areas that require greater awareness.
Phenomena of Psychological Sufferings Among Nepalese Stroke Survivors and Analysis of Applicability of Samkhya Philosophy for Enhancing Their Psychological Wellbeing
Authors: Hatthakit Urai , Aryal Kalpana Paudel , Timalsina Rekha
Published: January 2021

Introduction

Psychological suffering is commonly found among stroke survivors, particularly in the acute stage.

Objectives

This study aimed to explore the phenomenon of psychological sufferings of stroke survivors and analyze the applicability of Samkhya philosophy for enhancing their psychological wellbeing.

Methods

A qualitative study was conducted at a university hospital of Nepal among 16 stroke patients in the acute stage, selected by purposive sampling. Data collection was done by using semi-structured interviews. Data were analyzed using deductive content analysis. Additionally, the analysis of Samkhya philosophy was done by using descriptive literature review from online databases.

Results

Stroke survivors in the acute stage experienced psychological sufferings, which were analyzed as intrinsic, extrinsic, and divine based on Samkhya philosophy. The intrinsic sufferings were (a) shock and denial with a sudden loss of normal body function, (b) worry about the possibility of lifelong disability and future life, and (c) fear and concern about the consequences of the disease to self. The extrinsic sufferings consisted of (a) worry when thinking about dependent family members and (b) feelings of making trouble or being a burden to the family members because of their dependency. The divine suffering consisted of feeling of being a burden caused by distress resulting from an inability to perform religious rituals. Samkhya philosophy explains the methods of relieving these sufferings by using yoga practice.

Conclusion

Psychological sufferings are prevalent among Nepalese stroke survivors, and Samkhya philosophy might be one of suitable strategies to relieve these sufferings of the Hindu stroke survivors in the acute stage, and promote their psychological wellbeing. This study recommends integrating yoga in caring for stroke patients in the acute stage to promote psychological wellbeing.
Estimation of earthquake damage to urban environments using sparse modeling
Authors: Ogawa Yoshiki , Sekimoto Yoshihide , Shibasaki Ryosuke
Published: January 2021

For the establishment of precise disaster prevention measures in response to the Nankai megathrust earthquakes predicted to occur in the future, it is necessary to conduct numerous earthquake simulations and evaluate the vulnerability of the urban environment quantitatively. This vulnerability is evaluated on the basis of factors such as the extent of damage from earthquakes, as well as the attributes of residents, urban infrastructure, and systems in the environment. In this study, we propose a sparse modeling (SpM)-based technique for the evaluation of potential damage to urban environments due to Nankai megathrust earthquakes in Japan. As explanatory variables, any variables related to urban environments in Kochi Prefecture are considered. The results show that, unlike the so-called “complex disaster” events, the number of critical variables that characterize damage states when external disaster forces data (e.g. estimated seismic motion and tsunami height) and urban environment data are available is low, regardless of the magnitude of damage. In other words, urban system variables selected for damage states may be extracted as variables indicating vulnerability to earthquake damage. In addition, we evaluated the characteristics of different cities by visualizing the SpM results on a radar chart. The proposed technique is useful for gaining a deeper understanding of the influence of urban environment variables on earthquake damages. Furthermore, it is expected that measures for improving urban system resilience will be explored based on the proposed technique.
Geo-tagged environmental noise measurement with smartphones: Accuracy and perspectives of crowdsourced mapping
Authors: Pődör Andrea , Szabó Szilard
Published: January 2021

Environmental noise affects life and health within urban environments through interfering with sleep, rest, study and personal communication. Noise mapping is an important issue of local authorities but due to its requirements (staff, costs and frequency), the available data are limited or outdated. Our aim was to involve people with smartphones in the mapping process and to determine the accuracy of the measurements performed with these devices in a natural environment. The main questions were whether the measured data were dependent on the type of applied software and smartphones. We tested three software (Noise Watch, Noise Meter and Sound Level Meter) and 12 different smartphones. We evaluated the measurements with hypothesis testing and correlation analysis. Although the accuracy of smartphones was below the professional equipment, measurements can be conducted easily due to their availability; thus, a reliability analysis is important. We found that comparison between professional devices and smartphones in a laboratory was misleading as it lacks the environmental factors biasing the measurements. The best method to compare the measurements carried out with smartphones and professional Noise Meters was to use large number of measuring points in a heterogenic outdoor environment where the noise ranged from the low to large values. We revealed that both the applied software and smartphones have relevant effect on the measurements, and, although it is possible to use these devices for noise mapping, one should consider not to apply different software and smartphones. Accordingly, crowdsourcing is not a reliable data collection method because: (1) measurements should be supervised, (2) smartphones’ accuracy should be tested and (3) measurement circumstances should be the same. If any of these requirements are violated, the quality of the resulting maps can be questioned.
Burkitt lymphoma in the modern era: real-world outcomes and prognostication across 30 US cancer centers
Authors: Evens Andrew M. , Danilov Alexey , Jagadeesh Deepa , Sperling Amy , Kim Seo-Hyun , Vaca Ryan , Wei Catherine , Rector Daniel , Sundaram Suchitra , Reddy Nishitha , Lin Yong , Farooq Umar , D'Angelo Christopher , Bond David A. , Berg Stephanie , Churnetski Michael C. , Godara Amandeep , Khan Nadia , Choi Yun Kyong , Yazdy Maryam , Rabinovich Emma , Varma Gaurav , Karmali Reem , Mian Agrima , Savani Malvi , Burkart Madelyn , Martin Peter , Ren Albert , Chauhan Ayushi , Diefenbach Catherine , Straker-Edwards Allandria , Klein Andreas K. , Blum Kristie A. , Boughan Kirsten Marie , Smith Scott E. , Haverkos Brad M. , Orellana-Noia Victor M. , Kenkre Vaishalee P. , Zayac Adam , Ramdial Jeremy , Maliske Seth M. , Epperla Narendranath , Venugopal Parameswaran , Feldman Tatyana A. , Smith Stephen D. , Stadnik Andrzej , David Kevin A. , Naik Seema , Lossos Izidore S. , Lunning Matthew A. , Caimi Paolo , Kamdar Manali , Palmisiano Neil , Bachanova Veronika , Portell Craig A. , Phillips Tycel , Olszewski Adam J. , Alderuccio Juan Pablo
Published: January 2021

We examined adults with untreated Burkitt lymphoma (BL) from 2009 to 2018 across 30 US cancer centers. Factors associated with progression-free survival (PFS) and overall survival (OS) were evaluated in univariate and multivariate Cox models. Among 641 BL patients, baseline features included the following: median age, 47 years; HIV+, 22%; Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2 to 4, 23%; >1 extranodal site, 43%; advanced stage, 78%; and central nervous system (CNS) involvement, 19%. Treatment-related mortality was 10%, with most common causes being sepsis, gastrointestinal bleed/perforation, and respiratory failure. With 45-month median follow-up, 3-year PFS and OS rates were 64% and 70%, respectively, without differences by HIV status. Survival was better for patients who received rituximab vs not (3-year PFS, 67% vs 38%; OS, 72% vs 44%; P < .001) and without difference based on setting of administration (ie, inpatient vs outpatient). Outcomes were also improved at an academic vs community cancer center (3-year PFS, 67% vs 46%, P = .006; OS, 72% vs 53%, P = .01). In multivariate models, age ≥ 40 years (PFS, hazard ratio [HR] = 1.70, P = .001; OS, HR = 2.09, P < .001), ECOG PS 2 to 4 (PFS, HR = 1.60, P < .001; OS, HR = 1.74, P = .003), lactate dehydrogenase > 3× normal (PFS, HR = 1.83, P < .001; OS, HR = 1.63, P = .009), and CNS involvement (PFS, HR = 1.52, P = .017; OS, HR = 1.67, P = .014) predicted inferior survival. Furthermore, survival varied based on number of factors present (0, 1, 2 to 4 factors) yielding 3-year PFS rates of 91%, 73%, and 50%, respectively; and 3-year OS rates of 95%, 77%, and 56%, respectively. Collectively, outcomes for adult BL in this real-world analysis appeared more modest compared with results of clinical trials and smaller series. In addition, clinical prognostic factors at diagnosis identified patients with divergent survival rates.
Ignoring instead of chasing after coagulation factor VII during warfarin management: an interrupted time series study
Authors: Oskarsdottir Alma R. , Gudmundsdottir Brynja R. , Jensdottir Hulda M. , Flygenring Bjorn , Palsson Ragnar , Onundarson Pall T.
Published: January 2021

During warfarin management, variability in prothrombin time-based international normalized ratio (PT-INR) is caused, in part, by clinically inconsequential fluctuations in factor VII (FVII). The new factor II and X (Fiix)-prothrombin time (Fiix-PT) and Fiix-normalized ratio (Fiix-NR), unlike PT-INR, are only affected by reduced FII and FX. We assessed the incidence of thromboembolism (TE) and major bleeding (MB) in all 2667 patients on maintenance-phase warfarin managed at our anticoagulation management service during 30 months; 12 months prior to and 18 months after replacing PT-INR monitoring with Fiix-NR monitoring. Months 13 to 18 were predefined as transitional months. Using 2-segmented regression, a breakpoint in the monthly incidence of TE became evident 6 months after test replacement, that was followed by a 56% reduction in incidence (from 2.82% to 1.23% per patient-year; P = .019). Three-segmented regression did not find any significant trend in TE incidence (slope, +0.03) prior to test replacement; however, during months 13 to 18 and 19 to 30, the incidence of TE decreased gradually (slope, −0.12; R2 = 0.20; P = .007). The incidence of MB (2.79% per patient-year) did not differ. Incidence comparison during the 12-month Fiix and PT periods confirmed a statistically significant reduction (55-62%) in TE. Fiix monitoring reduced testing, dose adjustments, and normalized ratio variability and prolonged testing intervals and time in range. We conclude that ignoring FVII during Fiix-NR monitoring in real-world practice stabilizes the anticoagulant effect of warfarin and associates with a major reduction in TEs without increasing bleeding.
A phase 3 double-blind study of the addition of tocilizumab vs placebo to cyclosporin/methotrexate GVHD prophylaxis
Authors: Kennedy Glen A. , Tey Siok-Keen , Buizen Luke , Varelias Antiopi , Gartlan Kate H. , Curley Cameron , Olver Stuart D. , Chang Karshing , Butler Jason P. , Misra Ashish , Subramoniapillai Elango , Morton A. James , Durrant Simon , Henden Andrea S. , Moore John , Ritchie David , Gottlieb David , Cooney Julian , Paul Sanjoy K. , Hill Geoffrey R.
Published: January 2021

We determined the efficacy of tocilizumab (TCZ) in preventing grade 2-4 acute graft-versus-host disease (aGVHD) in patients with acute leukemia or myelodysplasia undergoing matched sibling donor (MSD) or volunteer unrelated donor (VUD) allogeneic stem cell transplantation after myeloablative or reduced-intensity conditioning across 5 Australian centers. A total of 145 patients (50 MSD, 95 VUD) were randomly assigned to placebo or TCZ on day −1. All patients received T-cell–replete peripheral blood stem cell grafts and graft-versus-host disease (GVHD) prophylaxis with cyclosporin/methotrexate. A planned substudy analyzed the VUD cohort. With a median follow-up of 746 days, the incidence of grade 2-4 aGVHD at day 100 for the entire cohort was 36% for placebo vs 27% for TCZ (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.38-1.26; P = .23) and 45% vs 32% (HR, 0.61; 95% CI, 0.31-1.22; P = .16) for the VUD subgroup. The incidence of grade 2-4 aGVHD at day 180 for the entire cohort was 40% for placebo vs 29% for TCZ (HR, 0.68; 95% CI, 0.38-1.22; P = .19) and 48% vs 32% (HR, 0.59; 95% CI, 0.30-1.16; P = .13) for the VUD subgroup. Reductions in aGVHD were predominantly in grade 2 disease. For the entire cohort, transplant-related mortality occurred in 8% vs 11% of placebo-treated vs TCZ-treated patients, respectively (P = .56), and overall survival was 79% vs 71% (P = .27). Median day to neutrophil and platelet engraftment was delayed by 2 to 3 days in TCZ-treated patients, whereas liver toxicity and infectious complications were similar between groups. In this phase 3 randomized double-blind trial, TCZ showed nonsignificant trends toward reduced incidence of grade 2-4 aGVHD in recipients from HLA-matched VUDs but no improvements in long term-survival.
Introduction to a How I Treat series on acquired hemolytic anemia
Authors: Cazzola Mario
Published: January 2021

Diagnosis and treatment of acquired hemolytic anemia can be challenging. In this How I Treat series, edited by Mario Cazzola, clinical experts discuss their approaches to the treatment of patients with 4 different classes of acquired hemolytic anemia.
Central airway and peripheral lung structures in airway disease-dominant COPD
Authors: Tanabe Naoya , Shimizu Kaoruko , Terada Kunihiko , Sato Susumu , Suzuki Masaru , Shima Hiroshi , Oguma Akira , Oguma Tsuyoshi , Konno Satoshi , Nishimura Masaharu , Hirai Toyohiro
Published: January 2021

The concept that the small airway is a primary pathological site for all COPD phenotypes has been challenged by recent findings that the disease starts from the central airways in COPD subgroups and that a smaller central airway tree increases COPD risk. This study aimed to examine whether the computed tomography (CT)-based airway disease-dominant (AD) subtype, defined using the central airway dimension, was less associated with small airway dysfunction (SAD) on CT, compared to the emphysema-dominant (ED) subtype.

COPD patients were categorised into mild, AD, ED and mixed groups based on wall area per cent (WA%) of the segmental airways and low attenuation volume per cent in the Kyoto–Himeji (n=189) and Hokkaido COPD cohorts (n=93). The volume per cent of SAD regions (SAD%) was obtained by nonrigidly registering inspiratory and expiratory CT.

The AD group had a lower SAD% than the ED group and similar SAD% to the mild group. The AD group had a smaller lumen size of airways proximal to the segmental airways and more frequent asthma history before age 40 years than the ED group. In multivariable analyses, while the AD and ED groups were similarly associated with greater airflow limitation, the ED, but not the AD, group was associated with greater SAD%, whereas the AD, but not the ED, group was associated with a smaller central airway size.

The CT-based AD COPD subtype might be associated with a smaller central airway tree and asthma history, but not with peripheral lung pathologies including small airway disease, unlike the ED subtype.
The safety of cardioselective β1-blockers in asthma: literature review and search of global pharmacovigilance safety reports
Authors: Bennett Miriam , Chang Catherina L. , Tatley Michael , Savage Ruth , Hancox Robert J.
Published: January 2021

Introduction

Beta-blockers are key in the management of cardiovascular diseases but blocking airway β2-receptors can cause severe and sometimes fatal bronchoconstriction in people with asthma. Although cardioselective β1-blockers may be safer than non-selective β-blockers, they remain relatively contraindicated and under-prescribed. We review the evidence of the risk associated with cardioselective β1-blocker use in asthma.

Methods

We searched “asthma” AND “beta-blocker” in PubMed and EmbaseOvid from start to May 2020. The World Health Organization (WHO) global database of individual case safety reports (VigiBase) was searched for reports of fatal asthma or bronchospasm and listed cardioselective β1-blocker use (accessed February 2020). Reports were examined for evidence of pre-existing asthma.

Results

PubMed and EmbaseOvid searches identified 304 and 327 publications, respectively. No published reports of severe or fatal asthma associated with cardioselective β1-blockers were found. Three large observational studies reported no increase in asthma exacerbations with cardioselective β1-blocker treatment. The VigiBase search identified five reports of fatalities in patients with pre-existing asthma and reporting asthma or bronchospasm during cardioselective β1-blocker use. Four of these deaths were unrelated to cardioselective β1-blocker use. The circumstances of the fifth death were unclear.

Conclusions

There were no published reports of cardioselective β1-blockers causing asthma death. Observational data suggest that cardioselective β1-blocker use is not associated with increased asthma exacerbations. We found only one report of an asthma death potentially caused by cardioselective β1-blockers in a patient with asthma in a search of VigiBase. The reluctance to use cardioselective β1-blockers in people with asthma is not supported by this evidence.
Emergency medicine matters: epidemiology of medical pathology and changes in patient outcomes after implementation of a post-graduate training program at a Tertiary Teaching Hospital in Kigali, Rwanda
Authors: Moretti Katelyn , Uwamahoro Doris Lorette , Naganathan Sonya , Uwamahoro Chantal , Karim Naz , Nkeshimana Menales , Aluisio Adam R.
Published: January 2021

Background

Emergency care is a new but growing specialty across Africa where medical conditions have been estimated to account for 92% of all disability-adjusted life years. This study describes the epidemiology of medical emergencies and the impact of formalized emergency care training on patient outcomes for medical conditions in Rwanda.

Methods

A retrospective cohort study was performed using a database of randomly sampled patients presenting to the emergency center (EC) at the University Teaching Hospital of Kigali. All patients, > 15 years of age treated for medical emergencies pre- and post-implementation of an Emergency Medicine (EM) residency training program were eligible for inclusion. Patient characteristics and final diagnosis were described by time period (January 2013–September 2013 versus September 2015–June 2016). Univariate chi-squared analysis was performed for diagnoses, EC interventions, and all cause EC and inpatient mortality stratified by time period.

Results

A random sample of 1704 met inclusion with 929 patients in the pre-residency time period and 775 patients in the post-implementation period. Demographics, triage vital signs, and shock index were not different between time periods. Most frequent diagnoses included gastrointestinal, infectious disease, and neurologic pathology. Differences by time period in EC management included antibiotic use (37.2% vs. 42.2%,p= 0.04), vasopressor use (1.9% vs. 0.5%,p= 0.01), IV crystalloid fluid (IVF) use (55.5% vs. 47.6%,p= 0.001) and mean IVF administration (2057 ml vs. 2526 ml,p< 0.001). EC specific mortality fell from 10.0 to 1.4% (p< 0.0001) across time periods.

Conclusions

Mortality rates fell across top medical diagnoses after implementation of an EM residency program. Changes in resuscitation care may explain, in part, this mortality decrease. This study demonstrates that committing to emergency care can potentially have large effects on reducing mortality.
Regulation of the antennal transcriptome of the dengue vector, Aedes aegypti, during the first gonotrophic cycle
Authors: Hill Sharon Rose , Taparia Tanvi , Ignell Rickard
Published: January 2021

Background

In the light of dengue being the fastest growing transmissible disease, there is a dire need to identify the mechanisms regulating the behaviour of the main vectorAedes aegypti. Disease transmission requires the female mosquito to acquire the pathogen from a blood meal during one gonotrophic cycle, and to pass it on in the next, and the capacity of the vector to maintain the disease relies on a sustained mosquito population.

Results

Using a comprehensive transcriptomic approach, we provide insight into the regulation of the odour-mediated host- and oviposition-seeking behaviours throughout the first gonotrophic cycle. We provide clear evidence that the age and state of the female affects antennal transcription differentially. Notably, the temporal- and state-dependent patterns of differential transcript abundance of chemosensory and neuromodulatory genes extends across families, and appears to be linked to concerted differential modulation by subsets of transcription factors.

Conclusions

By identifying these regulatory pathways, we provide a substrate for future studies targeting subsets of genes across disparate families involved in generating key vector behaviours, with the goal to develop novel vector control tools.
Adherence to prescription guidelines and achievement of treatment goals among persons with coronary heart disease in Tromsø 7
Authors: Pedersen Elisabeth , Garcia Beate Hennie , Halvorsen Kjell H. , Eggen Anne Elise , Schirmer Henrik , Waaseth Marit
Published: January 2021

Background

Adherence to clinical practice guidelines for coronary heart disease (CHD) reduces morbidity, mortality and treatment costs. We aimed to describe and compare adherence to prescription guidelines for persons with CHD, and explore its association with treatment goal achievement.

Method

We included all participants reporting myocardial infarction, angina, percutaneous coronary intervention and/or coronary artery bypass surgery in the seventh wave of the Tromsø Study (2015–2016, n = 1483). Medication use and treatment goal measures (blood pressure, low-density lipoprotein (LDL)-cholesterol and HbA1c) were compared to clinical practice guidelines on secondary CHD prevention. Propensity score matched logistic regression was used to assess the association between the use of antihypertensive drugs and achievement of treatment goal for blood pressure, and the use of lipid-lowering drugs (LLDs) and achievement of treatment goal for LDL-cholesterol.

Results

The prevalence of pharmacological CHD treatment was 76% for LLDs, 72% for antihypertensive drugs and 66% for acetylsalicylic acid. The blood pressure goal (< 140/90 mmHg, < 140/80 mmHg if diabetic) was achieved by 58% and the LDL-cholesterol goal (< 1.8 mmol/l or < 70 mg/dL) by 9%. There was a strong association between using LLDs and achieving the treatment goal for LDL-cholesterol (OR 14.0, 95% CI 3.6–54.7), but not between using antihypertensive drugs and blood pressure goal achievement (OR 1.4, 95% CI 0.7–2.7).

Conclusion

Treatment goal achievement of LDL-cholesterol and blood pressure was low, despite the relatively high use of LLDs and antihypertensive drugs. Further research is needed to find the proper actions to increase achievement of the treatment goals.
Baseline thrombopoietin level is associated with platelet count improvement in thrombocytopenic chronic hepatitis C patients after successful direct-acting antiviral agent therapy
Authors: Chen Yen-Chun , Ko Ping-Hung , Lee Chi-Che , Tseng Chih-Wei , Tseng Kuo-Chih
Published: January 2021

Background

Thrombocytopenia can rapidly improve in chronic hepatitis C (CHC) patients receiving direct-acting antiviral agents (DAA). The role of baseline (BL) thrombopoietin (TPO) in this phenomenon is unclear.

Methods

From June 2016 to February 2019, a total of 104 CHC patients receiving DAA, with a sustained virologic response and BL thrombocytopenia, at Dalin Tzu Chi Hospital, were enrolled in this retrospective study. Significant platelet count improvement and platelet count improvement ratio were analyzed for correlation with BL TPO.

Results

This cohort included 40 men (38.5%). Seventy-two (69.2%) patients had advanced fibrosis. The platelet count [median (range)] increased from 110.5 (32–149) × 103/µL at BL to 116.5 (40–196) and 118.0 (35–275) × 103/µL at end of treatment (EOT) and 12 weeks after EOT (P12), respectively, (EOT vs. BL, P < 0.001; P12 vs. BL, P < 0.001). BL TPO was positively correlated with significant platelet count improvement (P < 0.001), platelet count improvement ratio at EOT (P = 0.004), and P12 (P < 0.001). The area under the receiver operating characteristic curve and optimal cutoffs (pg/ml) were 0.77 (95% confidence interval, 0.67–0.86) and 120, respectively, for significant platelet count improvement prediction. The sensitivity, specificity, and accuracy were 88.6%, 71.7%, and 78.8%, respectively.

Conclusions

BL TPO level might be a useful marker for predicting significant platelet count improvement in thrombocytopenic patients after successful DAA therapy.
Using Baidu search values to monitor and predict the confirmed cases of COVID-19 in China: – evidence from Baidu index
Authors: Tu Bizhi , Wei Laifu , Jia Yaya , Qian Jun
Published: January 2021

Background

New coronavirus disease 2019 (COVID-19) has posed a severe threat to human life and caused a global pandemic. The current research aimed to explore whether the search-engine query patterns could serve as a potential tool for monitoring the outbreak of COVID-19.

Methods

We collected the number of COVID-19 confirmed cases between January 11, 2020, and April 22, 2020, from the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). The search index values of the most common symptoms of COVID-19 (e.g., fever, cough, fatigue) were retrieved from the Baidu Index. Spearman’s correlation analysis was used to analyze the association between the Baidu index values for each COVID-19-related symptom and the number of confirmed cases. Regional distributions among 34 provinces/ regions in China were also analyzed.

Results

Daily growth of confirmed cases and Baidu index values for each COVID-19-related symptom presented robust positive correlations during the outbreak (fever: rs=0.705, p=9.623× 10− 6; cough: rs=0.592, p=4.485× 10− 4; fatigue: rs=0.629, p=1.494× 10− 4; sputum production: rs=0.648, p=8.206× 10− 5; shortness of breath: rs=0.656, p=6.182× 10–5). The average search-to-confirmed interval (STCI) was 19.8 days in China. The daily Baidu Index value’s optimal time lags were the 4 days for cough, 2 days for fatigue, 3 days for sputum production, 1 day for shortness of breath, and 0 days for fever.

Conclusion

The searches of COVID-19-related symptoms on the Baidu search engine were significantly correlated to the number of confirmed cases. Since the Baidu search engine could reflect the public’s attention to the pandemic and the regional epidemics of viruses, relevant departments need to pay more attention to areas with high searches of COVID-19-related symptoms and take precautionary measures to prevent these potentially infected persons from further spreading.
An open label, randomised controlled trial of rifapentine versus rifampicin based short course regimens for the treatment of latent tuberculosis in England: the HALT LTBI pilot study
Authors: Surey J. , Stagg H. R. , Yates T. A. , Lipman M. , White P. J. , Charlett A. , Muñoz L. , Gosce L. , Rangaka M. X. , Francis M. , Hack V. , Kunst H. , Abubakar I.
Published: January 2021

Background

Ending the global tuberculosis (TB) epidemic requires a focus on treating individuals with latent TB infection (LTBI) to prevent future cases. Promising trials of shorter regimens have shown them to be effective as preventative TB treatment, however there is a paucity of data on self-administered treatment completion rates. This pilot trial assessed treatment completion, adherence, safety and the feasibility of treating LTBI in the UK using a weekly rifapentine and isoniazid regimen versus daily rifampicin and isoniazid, both self-administered for 12 weeks.

Methods

An open label, randomised, multi-site pilot trial was conducted in London, UK, between March 2015 and January 2017. Adults between 16 and 65 years with LTBI at two TB clinics who were eligible for and agreed to preventative therapy were consented and randomised 1:1 to receive either a weekly combination of rifapentine/isoniazid (‘intervention’) or a daily combination of rifampicin/isoniazid (‘standard’), with both regimens taken for twelve weeks; treatment was self-administered in both arms. The primary outcome, completion of treatment, was self-reported, defined as taking more than 90% of prescribed doses and corroborated by pill counts and urine testing. Adverse events were recorded.

Results

Fifty-two patients were successfully enrolled. In the intervention arm 21 of 27 patients completed treatment (77.8, 95% confidence interval [CI] 57.7–91.4), compared with 19 of 25 (76.0%, CI 54.9–90.6) in the standard of care arm. There was a similar adverse effect profile between the two arms.

Conclusion

In this pilot trial, treatment completion was comparable between the weekly rifapentine/isoniazid and the daily rifampicin/isoniazid regimens. Additionally, the adverse event profile was similar between the two arms. We conclude that it is safe and feasible to undertake a fully powered trial to determine whether self-administered weekly treatment is superior/non-inferior compared to current treatment.

Trial registration

The trial was funded by the NIHR, UK and registered with ISRCTN (26/02/2013-No.04379941).