bluuebunny/crossref_metadata_2025 huggingface dataset:
Unilateral Nevoid Telangiectasia in a Healthy Man
Authors: Küçük Kirley , Bourlond Florence , Votquenne Nicolas , Benhadou Farida
Published: June 2021

We report the case of a healthy 26-year-old man presenting telangiectatic macules on the left thorax and arm since childhood. The main diagnostic hypothesis were unilateral nevoid telangiectasia (UNT), hereditary benign telangiectasia, atrial myxoma, segmental serpiginous angioma, circumscribed neviform angiokeratoma, and nevus vascularis mixtus. The diagnosis retained was UNT characterized by congenital or acquired telangiectasia distributed asymmetrically along the upper extremities, or the third or fourth cervical dermatomes. The congenital form is extremely rare, predominant in men, and persists in adulthood. The acquired form is most frequent, affects preferentially women, usually appears at puberty or during pregnancy and tends to disappear. Estrogen excess triggers the formation of telangiectasia. UNT is rarely associated with liver or thyroid disorder. Pulsed-dye lasers and normalization of estrogen are proposed as therapeutic options. We report a rare diagnosis of UNT in a young man with no other underlying condition. We would like to highlight that in the presence of unilateral telangiectasia, a complete clinical examination must be performed to rule out signs of hyperestrogenism in man, ocular or neurological abnormalities, a blood test to exclude pregnancy, hepatic and thyroid dysfunctions, and ultrasonography in case of suspicion of atrial myxoma.
Can Xenobiotics Alter the Sex Ratio of Crocodilians in the Wild?
Authors: Kohno Satomi
Published: June 2021

All crocodilians exhibit temperature-dependent sex determination without sex chromosomes. This temperature dependency can be overridden by exposure to estrogen via estrogen receptor 1. Thus, the sex ratio of crocodilian species is vulnerable to estrogenic xenobiotics. Multiple investigations of the mechanism and effects of xenobiotics in crocodilian species have been conducted since the early 1990s. This review focuses on the impact of xenobiotics on sex determination rather than gonadal functions in crocodilians. The thermosensitive and estrogen-sensitive periods that commit the bipotential gonad to develop as an ovary end by stages 24.5 and 25.3, respectively. In contrast, it is ambiguous when the estrogen-sensitive stage begins for ovarian development, although the thermosensitive period for ovarian development initiates around developmental stage 15 at an extreme female-producing temperature of 30°C. To accurately assess the effect of xenoestrogens on sex ratio in crocodilians, it is critical to collect eggs before the sex-determining period and to incubate them under precisely controlled temperatures. A well-studied system of xenobiotic effects on crocodilians is Lake Apopka (FL, USA), an EPA superfund clean-up site heavily contaminated with Dieldrin, Endrin, and p,p'-DDE. The sum of estimated estrogenicity of xenobiotics measured in Lake Apopka was insufficient to activate the estrogen receptor 1 of Alligator mississippiensis, which is an essential receptor to induce ovarian development. Although juvenile A. mississippiensis showed gonadal alterations in sex hormone production and histology, the environmentally relevant concentration of xenobiotics in Lake Apopka was unlikely to alter the sex ratio of A. mississippiensis. Experimental exposure to xenobiotics such as 17α-ethynylestradiol, p,p'-dichlorodiphenyldichloroethylene, and 2,3,7,8-tetrachlorodibenzodioxin at environmentally relevant concentrations in ovo induced more female offspring in A. mississippiensis as compared with the control group. Bisphenol-A, atrazine, 2,4-dichlorophenoxyacetic acid, endosulfan, and Corexit did not alter the sex ratio of A. mississippiensis or Caiman latirostris under the tested conditions. Egg-incubation temperature has pronounced effects on estrogen sensitivity in crocodilian sex determination. Therefore, crocodilians are vulnerable to xenobiotic contamination and climate change in the wild. It is vital to further investigate the detailed mechanism and effects of environmental xenobiotics in crocodilian sex determination to mitigate their effect on sex ratio and conserve this ancient lineage.
Relationship between Energy Intake and Changes in Thigh Echo Intensity during the Acute Phase of Stroke in Older Patients with Hemiplegia
Authors: Kokura Yoji , Kato Mayumi , Kimoto Kazuhito , Okada Yoshie , Habu Daiki
Published: June 2021

Objective: The aim of this study was to investigate the relationship between energy intake and changes in thigh echo intensity (TEI) during the acute phase of stroke in older patients with hemiplegia. Subjects and Methods: Older hemiplegic inpatients with stroke were enrolled in this post hoc analysis of a prospective observational study. Patients were divided into 2 groups according to energy intake during the 7 days after admission as follows: energy sufficient (ES) and energy insufficient (EIS) groups. The outcome was the rate of changes in TEI of the paralyzed and nonparalyzed sides between admission and after 4 weeks. A decrease in skeletal muscle quality is defined as an increase in intramuscular adipose tissues, which shows as an increase in echo intensity. Results: The study included 44 males and 39 females (median age 81 years). The rate of change of TEI in each group was as follows: +4.5% in the ES/paralyzed group, +6.7% in the EIS/paralyzed group, −0.9% in the ES/nonparalyzed group, and +4.4% in the EIS/nonparalyzed group. The univariate analyses showed no significant difference in the rate of change in TEI between ES and EIS groups in both paralyzed side (p = 0.190) and nonparalyzed side (p = 0.183). Multivariate analysis showed that higher energy intake was associated with a smaller increase in the rate of change in TEI on the nonparalyzed side (B = −4.115, 95% confidence interval, −7.127 to −1.103). Conclusions: Higher energy intake during 7 days after admission was associated with a smaller increase in the rate of change in TEI on the nonparalyzed side upon admission and after 4 weeks.
Gendered Memory and Miniaturization in Graphic Design:
Representations of Women on Israeli Postage Stamps
Authors: Gitler Inbal Ben-Asher , Lachover Einat
Published: June 2021

This research investigates postage stamps as a communication design medium that has a key role in the construction of national gendered commemoration. By examining the commemorative depiction of women on Israeli postage stamps, we analyze approaches to miniaturization and discuss graphic design's implications for the visual articulation of gender within national culture. We further discuss the impact of technological transformations and digitization processes on postage stamp design. We apply social semiotic methodologies, archival research, and interviews with the designers, presenting new findings pertaining to research for design. As such, the present research expands our understanding of small-scale communication design for smartphones, icons, and logos.
The Poetics of Service: Making in the Age of
Experience
Authors: Lee Youngsoo , Kim Miso
Published: June 2021

This article proposes a framework for service storytelling by analyzing its key elements with Aristotle's Poetics and synthesizing them using the temporal structure of Joseph Campbell's Hero's Journey. Poetics refer to the art of making that is concerned with the general pattern of human experience. We use this framework to study the four causes of storytelling: material cause, efficient cause, formal cause, and end cause. The Hero's Journey is a cyclical model that encompasses both an ordinary and a special world. We utilize this model to synthesize the four causes into a phasic flow, including deficiency, growth, personalization, and transformation.
A Critical and Analytical Assessment of the 2019 Reformation of the Foreign Investment Regulatory Framework of Oman
Authors: Azmy Hussein M.
Published: June 2021

This article examines the recent reformation of the foreign investment regulatory environment that was introduced by the Foreign Capital Investment Law of Oman (Royal Decree No. 51/2019) and its Executive Regulation (Ministerial Decision No. 72/2020) with the aim of boosting foreign direct investment (FDI) in Oman. This examination focuses on the texts of the current Foreign Capital Investment Law and its Executive Regulation and analyses the provisions that, in the author’s view, will have a direct impact on the foreign investment sector in Oman. Furthermore, these provisions are contrasted with their counterparts in the former Foreign Capital Investment Law (Royal Decree No. 102/1994) to highlight their strengths and weaknesses. Based on this analysis, the article proposes a set of recommendations to address a number of issues with the current foreign investment regulatory framework with the aim of achieving regulatory clarity and enhancement concerning the framework’s scope of application.
Beneficence, Numbers, and the Procreation Asymmetry
Authors: Hanna Jason
Published: June 2021

According to the Weak Procreation Asymmetry, there are weighty reasons not to create miserable people and only weaker reasons to create happy people. This view has several advantages over the Strong Procreation Asymmetry, which holds that there are no reasons to create happy people. Nonetheless, it faces a serious problem: according to some critics, it suggests that our reasons to create lives are as strong as our reasons to save lives. In response, this essay draws on the intuition that we have reason to maximize the number of lives saved, even when doing so would not secure a greater benefit. Numbers are not comparably relevant, however, to choices involving the creation of people. Taken together, these judgments show that there is typically an “extra” consideration that favors saving lives over creating lives. They thereby help to defuse a common objection to the Weak Procreation Asymmetry.
Upconversion Luminescence and Temperature Sensing of InNbO4:Er3+/Yb3+ Phosphors
Authors: Dong Xingbang , Zhang Huanjun , Li Yi , Wang Zheng , Yang Yang , Feng Shiquan , Wang Yongqiang , Yuan Chaosheng , Yang Kun , Cheng Xuerui
Published: June 2021

Er3+/Yb3+ co-doped InNbO4 phosphors were synthesized using solid state reaction method. Crystal structure was characterized using X-ray diffraction (XRD), which confirm all obtained phosphors had a monoclinic-wolframite structure and no impurity phase
was introduced upon doping. Upon 980 nm excitation, upconversion (UC) emission from Er3+ ions was observed in green and red range. UC emission was obviously enhanced after co-doping Yb3+ ions and reached the maximum for 10 mol% Yb3+ ions. The relation between
emission intensity and pump power was performed, revealing that the UC emission result from two-photon processes. Optical temperature sensing property was investigated by exploiting fluorescence intensity ratio (FIR) between 2H11/2 and 4S3/2 levels
of Er3+ ions. Its maximum value of absolute sensitivity obtained was 0.0091 K-1, suggesting InNbO4:Er3+/Yb3+ phosphors show potential application in optical thermometry.
Graphene Directly Growth on Non-Metal Substrate from Amorphous Carbon Nano Films Without Transfer and Its Application in Photodetector
Authors: Xu Kun , Ding Pei , Li Yan , Chen Leiming , Xu Junwei , Duan Xiangyang , Zeng Fanguang
Published: June 2021

A layer of nano amorphous carbon was fabricated on the target substrate by precisely controlled magnetron sputtering, and then a layer of copper film was fabricated on the amorphous carbon. By using a vertical cold wall chemical vapor deposition system under protective atmosphere, the
carbon atoms at high temperature was catalyzed by copper to form graphene films. The amorphous carbon nano thin film was converted into monolayer graphene on a SiO2 substrate directly. The experimental results show that the graphene film has high crystal quality and conductivity.
Compared with other methods, the process is simple and the process window is wider. By virtue of this technique, a graphene-Si photodetector was also demonstrated. The photoelectric response and frequency characteristics have been studied which shows good device characteristics.
Synthesis and Electrochemical Performances of MnV2O6/rGO Nanocomposite as New Anode Material for Lithium-Ion Battery Application
Authors: Zheng Hao , Li Lin , Peng Shu-Ting , Li Mo-Xi , Yang Li-Hong , Feng Chuan-Qi , Yang Shui-Jin
Published: June 2021

Base on high theoretical capacity and synergistic effect of metal ions of transition metal vanadate composite, the MnV2O6/graphene (MnV2O6/rGO) nanocomposite was successfully synthesized through a hydrothermal method. The MnV2O6
nanoparticles were uniformly distributed and deposited on graphene networks. Benefited from the outstanding properties of the graphene nanosheets, the electrode conductivity was improved and the volume expansion was reduced. As an anode, the MnV2O6/graphene (MnV2O6/rGO)
nanocomposite exhibited excellent lithium storage properties. An initial discharge capacity was 1350 mAh g-1, which increased to 1381 mAh g-1 after 100 cycles at 200 mA g-1, and showed a satisfactory reversible capacity of 640 mAh g-1 after 400 cycles
at 5000 mA g-1.
Patternable Quantum-Dot Photoresist with High Photolithographic Uniformity
Authors: Lin Jianyao , Chen Yu , Ye Yun , Xu Sheng , Guo Tailiang , Chen Enguo
Published: June 2021

We present a ligand-exchange-free photo-patternable quantum-dot photoresist (QDPR) with high photolithographic uniformity. The dispersion mechanism between the QD’s surface ligands and the functional groups of photoresist polymers are studied. Results show that the dispersibility
and photoluminescent intensity of this QDPR can be both improved by controlling dispersant and antioxidant. For device demonstration, multi-colored quantum dot color conversion films (QDCCF) were prepared and patterned by a photolithography process. High QD dispersibility and film-forming
uniformity were both achieved with this QDCCF. It is believed that the proposed QDPR has the potential to be extensively used in lighting or display applications.
Application of New Bone Cement Biomaterials in Osteoporotic Compression Fractures
Authors: Xu Bin , Sun Hui , Jia Hongwei , Li Zhiyong , Sang Linzhao , Wu Ye , Cao Junming , Wang Zhihong , Qi Xiangbei
Published: June 2021

Silk fibroin (SF) is a kind of natural protein, which is widely used in biomedical materials because of its biodegradability, easy modification, biocompatibility and good mechanical properties. In this exploration, it was used as bone cement materials and compared with conventional
bone cement materials to obtain the efficacy of different bone cement materials in the treatment of osteoporotic vertebral compression fractures. First, the effect of degumming time of silk in boiling on SF was analyzed. Then, hydroxyapatite silk fibroin (HA-SF) was added to calcium phosphate
cement (Cap) by coprecipitation method. The properties of the composite bone cement were analyzed by morphology analysis and mechanical properties testing. Finally, 40 patients who underwent percutaneous kyphoplasty (PKP) from May 2019 to June 2020 were selected and divided into two groups.
Among them, one group used the composite bone cement material proposed in this exploration, and the other group used the conventional bone cement material. Patients in different groups were evaluated for postoperative treatment. In the experiment, the sericin could be removed by boiling, and
the SF short fiber could be peeled by boiling for a long time; the compressive strength of Cap material could be improved by adding HA-SF. At the same time, the introduction of SF could shorten the coagulation time under the premise of injectability, so as to improve the anti-collapse ability
of Cap; the patients using different bone cement materials were compared, and the cobb angle, anterior height of vertebral body and VAS score of different groups were analyzed 3 days and 3 months after operation. The results show that the bone cement material proposed in this exploration can
effectively treat osteoporotic vertebral compression fractures.
Teleconnections between Rainfall in Equatorial Africa and Tropical Sea-Surface Temperatures: A Focus on Western Uganda
Authors: Diem Jeremy E. , Salerno Jonathan D. , Palace Michael W. , Bailey Karen , Hartter Joel
Published: June 2021

Substantial research on the teleconnections between rainfall and sea-surface temperatures (SSTs) has been conducted across equatorial Africa as a whole, but currently no focused examination exists for western Uganda, a rainfall transition zone between eastern equatorial Africa (EEA) and central equatorial Africa (CEA). This study examines correlations between satellite-based rainfall totals in western Uganda and SSTs – and associated indices – across the tropics over 1983-2019. It is found that rainfall throughout western Uganda is teleconnected to SSTs in all tropical oceans, but much more strongly to SSTs in the Indian and Pacific Oceans than the Atlantic Ocean. Increased Indian Ocean SSTs during boreal winter, spring, and autumn and a pattern similar to a positive Indian Ocean Dipole during boreal summer are associated with increased rainfall in western Uganda. The most spatially complex teleconnections in western Uganda occur during September-December, with northwestern Uganda being similar to EEA during this period and southwestern Uganda being similar to CEA. During boreal autumn and winter, northwestern Uganda has increased rainfall associated with SST patterns resembling a positive Indian Ocean Dipole or El Niño. Southwestern Uganda does not have those teleconnections; in fact, increased rainfall there tends to be more associated with La Niña-like SST patterns. Tropical Atlantic Ocean SSTs also appear to influence rainfall in southwestern Uganda in boreal winter as well as in boreal summer. Overall, western Uganda is a heterogeneous region with respect to rainfall-SST teleconnections; therefore, southwestern Uganda and northwestern Uganda require separate analyses and forecasts, especially during boreal autumn and winter.
Regime Behavior in the Upper Stratosphere as a Precursor of Stratosphere-Troposphere Coupling in the Northern Winter
Authors: Lu Hua , Gray Lesley J. , Martineau Patrick , King John C. , Bracegirdle Thomas J.
Published: June 2021

A new regime index is constructed to capture the seasonal development of the stratospheric polar vortex in the northern winter, based on the standard deviation of Ertel’s potential vorticity in the upper stratosphere in November-December. The narrow-jet flow regime is characterized by a polar vortex that is more confined to high latitudes in the early winter upper stratosphere. This upper-level vortex configuration is more susceptible to the disturbances of upward propagating planetary-scale Rossby waves; the stratospheric polar vortex thus weakens earlier and is vertically shallower. The wide-jet flow regime is characterized by a broader-than-average polar vortex that extends further into the subtropics in the early-winter upper stratosphere. The polar night jet then gradually strengthens, moves poleward and penetrates deep into the lowermost stratosphere, with a sharply-defined polar vortex edge accompanied due to more frequent Rossby wave breaking.

Composite differences analyses show that the wide and narrow jet regimes, defined in the uppermost stratosphere in November-December, lead to different circulation anomalies of the lower-stratosphere and the troposphere in January-February, offering the potential for improved predictability of sub-seasonal to seasonal forecasts up to two months ahead. The lower tropospheric responses in January-February are zonally asymmetric. The narrow-jet regime projects most strongly over the North Atlantic, with an equatorward-shifted, and/or broader mid-latitude westerly jet. The wide-jet-regime response is characterized by a weakened mid-latitude westerly jet over the North Pacific. The two flow regimes also differ in their impacts on the storm track over Western Europe and the east coast of America, which may have implications for extreme weather events in those regions.
Tools in Their Toolbox: How Community College Faculty Transfer Industry Experience Into Their Teaching
Authors: Wagner Brit , Zhu Xiwei , Wang Xueli
Published: June 2021

Objective: This study is aimed at understanding the ways in which faculty at community colleges utilize their industry experiences to inform their teaching. Method: The research drew on Merriam’s basic qualitative approach in analyzing data from 14 semi-structured qualitative interviews. Results: Our findings expand upon prior research surrounding faculty development and community college faculty experiences. Our analysis revealed several themes in regard to how community college faculty with industry backgrounds follow diverse pathways leading to their teaching positions; how they teach using practical applications of concepts and sharing real-life examples; how they utilize their industry networks to enhance their academic programs and create practical opportunities for students; how they replicate workplace settings in their classrooms; and how they prepare students for their future careers. Contribution: Our study contributes new empirical evidence on the myriad ways in which faculty apply industry experiences in their instruction. The findings indicate that community colleges would benefit from offering targeted supports and pedagogical training for faculty with an industry background; encouraging faculty from all backgrounds and disciplines to share successful teaching strategies; and utilizing faculty members’ expertise, networks, and experiences from industry in mathematics-oriented classrooms.
Über-Alienated: Powerless and Alone in the Gig Economy
Authors: Glavin Paul , Bierman Alex , Schieman Scott
Published: June 2021

While the gig economy has expanded rapidly in the last decade, few have studied the psychological ramifications of working for an online labor platform. Guided by classical and modern theories of work and alienation, we investigate whether engagement in platform work is associated with an increased sense of powerlessness and isolation. We analyze data from two national surveys of workers from the Canadian Quality of Work and Economic Life Study in September 2019 ( N = 2,460) and March 2020 ( N = 2,469). Analyses reveal greater levels of powerlessness and loneliness among platform workers—a pattern that is not fully explained by their higher levels of financial strain. Additional analyses of platform activity reveal that rideshare driving is more strongly associated with powerlessness and isolation than engagement in online crowdwork. We interpret our findings in light of platform firms’ use of algorithmic control and distancing strategies that may undermine worker autonomy and social connection.
Efficacy of Benson’s Relaxation Technique on Anxiety and Depression among Patients Undergoing Hemodialysis: A Systematic Review
Authors: Abu Maloh Haya Ibrahim Ali , Soh Kim Lam , AbuRuz Mohannad Eid , Chong Seng Choi , Ismail Siti Irma Fadhilah , Soh Kim Geok , Abu Maloh Dima Ibrahim
Published: June 2021

This study aimed to evaluate the efficacy of Benson’s relaxation technique on anxiety and depression among patients undergoing hemodialysis. A systematic review of randomized controlled trials was conducted. Searching databases included EBSCO Host, PubMed, ProQuest, Science Direct, Sage Journals, Ovid, and Google Scholar from January 2000 to September 2020. Five randomized controlled trials were identified. Findings revealed a statistically significant decrease in anxiety score. Concerning depression; one RCT showed a statistically significant decrease and two RCTs revealed a non-significant difference in depression level. The overall quality of the RCTs was not high. Despite that the RCTs showed benefits of BRT in managing anxiety. However, this is not the same for depression. The lack of high-quality scientific evidence supporting its retinue use indicates that additional well designed randomized controlled trials in multiple countries are warranted to support the efficacy of Benson’s relaxation technique on anxiety and depression among patients undergoing hemodialysis.
Safety verification of genetically modified rice morphology, hereditary nature, and quality
Authors: Jeon Dong Won , Park Jae-Ryoung , Jang Yoon-Hee , Kim Eun-Gyeong , Ryu Taehun , Kim Kyung-Min
Published: June 2021

Background

The drought environment occurs frequently due to the unpredictable future climate change, and drought has a direct negative impact on crops, such as yield reduction. Drought events are random, frequent, and persistent. Molecular breeding can be used to create drought-tolerant food crops, but the safety of genetically modified (GM) plants must be demonstrated before they can be adopted. In this research, the environmental risk of drought-tolerant GM rice was explored by assessing phenotype and gene flow. Drought resistance genes CaMsrB2 inserted HV8 and HV23 were used as GM rice to analyze the possibility of various agricultural traits and gene flow along with non-GM rice.

Results

When the traits 1000-grain weight, grain length/width, and yield, were compared with GM rice and non-GM rice, all agricultural traits of GM rice and non-GM rice were the same. In addition, when the germination rate, viviparous germination rate, pulling strength, and bending strength were compared to analyze the possibility of weediness, all characteristic values of GM rice and non-GM rice were the same. Protein, amylose, and moisture, the major nutritional elements of rice, were also the same.

Conclusions

The results of this research are that GM rice and non-GM rice were the same in all major agricultural traits except for the newly assigned characteristics, and no gene mobility occurred. Therefore, GM rice can be used as a means to solve the food problem in response to the unpredictable era of climate change in the future.
Responses of cutaneous C-fiber afferents and spinal microglia after hindlimb cast immobilization in rats
Authors: Ota Hiroki , Takebe Haruna , Mizumura Kazue , Taguchi Toru
Published: June 2021

Previous studies have shown that persistent limb immobilization using a cast increases nociceptive behavior to somatic stimuli in rats. However, the peripheral neural mechanisms of nociception remain unclear. Using single-fiber electrophysiological recordings in vitro, we examined the general characteristics of cutaneous C-fiber afferents in the saphenous nerve and their responsiveness to mechanical and heat stimuli in a rat model of immobilization-induced pain by subjecting the rats to hindlimb cast immobilization for 4 weeks. The mechanical response of C-fibers appeared to increase in the model; however, statistical analysis revealed that neither the response threshold nor the response magnitude was altered. The general characteristics and heat responses of the C-fibers were not altered. The number of microglia and cell diameters significantly increased in the superficial dorsal horn of the lumbar spinal cord. Thus, activated microglia-mediated spinal mechanisms are associated with the induction of nociceptive hypersensitivity in rats after persistent cast immobilization.
Learning health systems in primary care: a systematic scoping review
Authors: Nash Danielle M. , Bhimani Zohra , Rayner Jennifer , Zwarenstein Merrick
Published: June 2021

Background

Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions.

Methods

We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature.

Results

We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research.

Conclusions

We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.
Gliosarcoma vs. glioblastoma: a retrospective case series using molecular profiling
Authors: Dardis Christopher , Donner David , Sanai Nader , Xiu Joanne , Mittal Sandeep , Michelhaugh Sharon K. , Pandey Manjari , Kesari Santosh , Heimberger Amy B. , Gatalica Zoran , Korn Michael W. , Sumrall Ashley L. , Phuphanich Surasak
Published: June 2021

Background

Gliosarcoma (GS) refers to the presence of mesenchymal differentiation (as seen using light microscopy) in the setting of glioblastoma (GB, an astrocytoma, WHO Grade 4). Although the same approach to treatment is typically adopted for GS and GB, there remains some debate as to whether GS should be considered a discrete pathological entity. Differences between these tumors have not been clearly established at the molecular level.

Methods

Patients with GS (n=48) or GB (n=1229) underwent molecular profiling (MP) with a pan-cancer panel of tests as part of their clinical care. The methods employed included next-generation sequencing (NGS) of DNA and RNA, copy number variation (CNV) of DNA and immunohistochemistry (IHC). The MP comprised 1153 tests in total, although results for each test were not available for every tumor profiled. We analyzed this data retrospectively in order to determine if our results were in keeping with what is known about the pathogenesis of GS by contrast with GB. We also sought novel associations between the MP and GS vs. GB which might improve our understanding of pathogenesis of GS.

Results

Potentially meaningful associations (p<0.1, Fisher’s exact test (FET)) were found for 14 of these tests in GS vs. GB. A novel finding was higher levels of proteins mediating immuno-evasion (PD-1, PD-L1) in GS. All of the differences we observed have been associated with epithelial-to-mesenchymal transition (EMT) in other tumor types. Many of the changes we saw in GS are novel in the setting of glial tumors, including copy number amplification in LYL1 and mutations in PTPN11.

Conclusions

GS shows certain characteristics of EMT, by contrast with GB. Treatments targeting immuno-evasion may be of greater therapeutic value in GS relative to GB.
Evaluation of body-surface-area adjusted dosing of high-dose methotrexate by population pharmacokinetics in a large cohort of cancer patients
Authors: Arshad Usman , Taubert Max , Seeger-Nukpezah Tamina , Ullah Sami , Spindeldreier Kirsten C. , Jaehde Ulrich , Hallek Michael , Fuhr Uwe , Vehreschild Jörg Janne , Jakob Carolin
Published: June 2021

Background

The aim of this study was to identify sources of variability including patient gender and body surface area (BSA) in pharmacokinetic (PK) exposure for high-dose methotrexate (MTX) continuous infusion in a large cohort of patients with hematological and solid malignancies.

Methods

We conducted a retrospective PK analysis of MTX plasma concentration data from hematological/oncological patients treated at the University Hospital of Cologne between 2005 and 2018. Nonlinear mixed effects modeling was performed. Covariate data on patient demographics and clinical chemistry parameters was incorporated to assess relationships with PK parameters. Simulations were conducted to compare exposure and probability of target attainment (PTA) under BSA adjusted, flat and stratified dosing regimens.

Results

Plasma concentration over time data (2182 measurements) from therapeutic drug monitoring from 229 patients was available. PK of MTX were best described by a three-compartment model. Values for clearance (CL) of 4.33 [2.95–5.92] L h− 1 and central volume of distribution of 4.29 [1.81–7.33] L were estimated. An inter-occasion variability of 23.1% (coefficient of variation) and an inter-individual variability of 29.7% were associated to CL, which was 16 [7–25] % lower in women. Serum creatinine, patient age, sex and BSA were significantly related to CL of MTX. Simulations suggested that differences in PTA between flat and BSA-based dosing were marginal, with stratified dosing performing best overall.

Conclusion

A dosing scheme with doses stratified across BSA quartiles is suggested to optimize target exposure attainment. Influence of patient sex on CL of MTX is present but small in magnitude.
Quantifying prescribed high dose opioids in the community and risk of overdose
Authors: Schofield Joe , Steven Deborah , Foster Rebecca , Matheson Catriona , Baldacchino Alexander , McAuley Andrew , Parkes Tessa
Published: June 2021

Background

Opioid prescribing for a range of health issues is increasing globally. The risk of fatal and non-fatal overdose is increased among people prescribed strong opioids: in high doses in the context of polypharmacy (the use of multiple medications at the same time), especially with other sedatives; and among people with multiple morbidities including cardiorespiratory, hepatic and renal conditions. This study described and quantified the prescribing of strong opioids, comorbidities and other overdose risk factors among those prescribed strong opioids, and factors associated with high/very high opioid dosage in a regional health authority in Scotland as part of a wider service improvement exercise.

Methods

Participating practices ran searches to identify patients prescribed strong opioids and their characteristics, polypharmacy, and other overdose risk factors. Data were anonymised before being analysed at practice and patient-level. Morphine Equivalent Doses were calculated for patients based on drug/dose information and classed as Low/Medium/High/Very High. Descriptive statistics were generated on the strong opioid patient population and overdose risk factors. The relationship between the prescribing of strong opioids and practice/patient-level factors was investigated using linear and logistic regression models.

Results

Eighty-five percent (46/54) of GP practices participated. 12.4% (42,382/341,240) of individuals in participating practices were prescribed opioids and, of these, one third (14,079/42,382) were prescribed strong opioids. The most common comorbidities and overdose risk factors among strong opioid recipients were pain (67.2%), cardiovascular disease (43.2%), and mental health problems (39.3%). There was a positive significant relationship between level of social deprivation among practice caseload and level of strong opioid prescribing (p < 0.001). People prescribed strong opioids tended to be older (mean 59.7 years) and female (8638, 61.4%) and, among a subset of patients, age, gender and opioid drug class were significantly associated with prescribing of High/Very High doses.

Conclusions

Our findings have identified a large population at potential risk of prescription opioid overdose. There is a need to explore pragmatic models of tailored interventions which may reduce the risk of overdose within this group and clinical practice may need to be tightened to minimise overdose risk for individuals prescribed high dose opioids.
Investigation of the relationships between perceived causes of COVID-19, attitudes towards vaccine and level of trust in information sources from the perspective of Infodemic: the case of Turkey
Authors: Karabela Şemsi Nur , Coşkun Filiz , Hoşgör Haydar
Published: June 2021

Background

The main purpose in this study carried out from the perspective of infodemic was to investigate the relationships between individuals’ perceived causes of COVID-19, their attitudes towards vaccine and their levels of trust in information sources in terms of various descriptive characteristics.

Methods

In this cross-sectional and correlational study conducted with 1216 individuals from different provinces of Turkey, the Perception of Causes of COVID-19 (PCa-COVID-19) Scale was used. In addition, a questionnaire including the participants’ descriptive characteristics, their attitudes towards vaccine and their level of trust in information sources about Covid-19 was used.

Results

The mean age of the participants was 35.9 ± 12.3 years. Of them, 62.5% were women, 59.0% were married, and 62.1% were university graduates. As for their view of having the Covid-19 vaccine, 54.1% thought to have it, 16.2% did not think, and 29.7% were undecided. Although the correlation was not significant, of the participants, those who considered having vaccination mostly trusted YouTube as their source of information. Of the participants, those whose level of trust in government institutions and health professionals was high displayed significantly more favorable attitudes towards vaccine. The participants obtained the highest mean score from the Conspiracy Theories subscale of the PCa-COVID-19 scale. There was a positive and low-level relationship between attitudes towards COVID-19 vaccine, and the Conspiracy Theories (r: 0.214) and Faith Factors (r: 0.066) sub-dimensions of the PCa-COVID-19 Scale.

Conclusions

The level of vaccine hesitancy in Turkey is at an alarming level, and the virus is defined by moderate conspiracy theories. In this context, in the fight against infodemic, it is critical to implement mechanisms that can reveal misinformation and to plan initiatives that can increase the health literacy levels of societies.
Risk factors associated with infection recurrence of posttraumatic osteomyelitis treated with Ilizarov bone transport technique—a retrospective study of 149 cases
Authors: Yalikun Ainizier , Yushan Maimaiaili , Li Wenqiang , Abulaiti Alimujiang , Yusufu Aihemaitijiang
Published: June 2021

Background

Post-traumatic tibial osteomyelitis is considered as complex clinical problem due to its unique characteristics such as prolonged course, multi-staged treatment and high recurrence rate. The purpose of this study is to identify and analyze the causes and risk factors associated with infection recurrence of tibial osteomyelitis treated with Ilizarov technique.

Methods

From January 2011 to January 2019, a total of 149 patients with post-traumatic tibial osteomyelitis treated with Ilizarov bone transport technique were included in this study. Demographic and clinical data were collected and analyzed. Univariate analysis and logistic regression analysis were used to analyze the factors that may affect the recurrence or reinfection of post-traumatic tibial osteomyelitis after treated with Ilizarov bone transport technique.

Results

All included patients were successfully followed up with an average of 37.5 month (18–78 month), among them, 17 patients (11.4%) occurred with recurrence or reinfection of tibial osteomyelitis in which 2 cases were in distraction area and 15 cases in docking site. Among them, 5 patients were treated successfully with appropriate intravenous antibiotic, the remaining 12 patients were intervened by surgical debridement or bone grafting after debridement. Univariate analysis showed that Pseudomonas aeruginosa infection, bone exposure, number of previous operations (> 3 times), blood transfusion during bone transport surgery, course of osteomyelitis > 3 months, diabetes was associated with recurrence or reinfection of postoperative tibial osteomyelitis. According to the results of logistic regression analysis, Pseudomonas aeruginosa infection, bone exposure, and the number of previous operations (> 3 times) are risk factors for recurrence or reinfection of posttraumatic tibial osteomyelitis treated with Ilizarov bone transport technique, with odds ratios (OR) of 6.055, 7.413, and 1.753, respectively.

Conclusion

The number of previous operations (> 3 times), bone exposure, and Pseudomonas aeruginosa infection are risk factors for infection recurrence of posttraumatic tibial osteomyelitis treated with Ilizarov bone transport technique.
Correlation and responsiveness of global health, upper extremity-specific, and shoulder-specific functional outcome measures following reverse total shoulder arthroplasty for proximal humerus fracture
Authors: Barger James , Zhang Dafang , Stenquist Derek S. , Ostergaard Peter , Hall Matthew , Dyer George S. M. , Earp Brandon E. , von Keudell Arvind
Published: June 2021

Purpose

Reverse total shoulder arthroplasty (rTSA) is effective and increasingly utilized for the management of proximal humerus fracture (PHF). However, the optimal patient-reported outcome metrics (PROMs) for the evaluation of patient outcomes after this surgery are unclear. We investigated the correlation among global, upper extremity-specific, and shoulder-specific PROMs in patients undergoing rTSA for PHF as well as the responsiveness of these PROMs as assessed by floor and ceiling effects. We hypothesized that patients’ post-operative outcome would be best reflected by a combination of these metrics.

Methods

Thirty patients with a history of rTSA for ipsilateral PHF filled out the following outcomes questionnaires at a minimum of 3 years post-op: EQ-5D, EQ-5D VAS, PROMIS physical function, DASH, SSV, SPADI, and ASES. Correlation between metrics was assessed using the Spearman correlation coefficient. Responsiveness was assessed by comparing the proportion of patients reaching floor or ceiling values using McNemar’s test.

Results

Global health metrics (EQ-5D and PROMIS physical function) were strongly correlated with the upper extremity-specific metric (DASH). Shoulder-specific outcomes (SPADI, ASES, and ASES) were moderately correlated with both the global metrics and DASH. There was no significant difference between PROMs with regards to floor and ceiling effects.

Conclusions

The DASH score has been shown to be valid and responsive for shoulder interventions, and our data demonstrate that it correlates strongly with overall quality of life. Shoulder-specific metrics are valid and responsive for shoulder interventions but correlate less with global quality of life. An optimal PROM strategy in rTSA for PHF might involve both DASH and a shoulder-specific score. Based on our assessment of floor and ceiling effects, none of these metrics should be excluded for poor responsiveness.
Design and usability testing of an in-house developed performance feedback tool for medical students
Authors: Roa Romero Yadira , Tame Hannah , Holzhausen Ylva , Petzold Mandy , Wyszynski Jan-Vincent , Peters Harm , Alhassan-Altoaama Mohammed , Domanska Monika , Dittmar Martin
Published: June 2021

Background

Feedback is essential in a self-regulated learning environment such as medical education. When feedback channels are widely spread, the need arises for a system of integrating this information in a single platform. This article reports on the design and initial testing of a feedback tool for medical students at Charité-Universitätsmedizin, Berlin, a large teaching hospital. Following a needs analysis, we designed and programmed a feedback tool in a user-centered approach. The resulting interface was evaluated prior to release with usability testing and again post release using quantitative/qualitative questionnaires.

Results

The tool we created is a browser application for use on desktop or mobile devices. Students log in to see a dashboard of “cards” featuring summaries of assessment results, a portal for the documentation of acquired practical skills, and an overview of their progress along their course. Users see their cohort’s average for each format. Learning analytics rank students’ strengths by subject. The interface is characterized by colourful and simple graphics. In its initial form, the tool has been rated positively overall by students. During testing, the high task completion rate (78%) and low overall number of non-critical errors indicated good usability, while the quantitative data (system usability scoring) also indicates high ease of use. The source code for the tool is open-source and can be adapted by other medical faculties.

Conclusions

The results suggest that the implemented tool LevelUp is well-accepted by students. It therefore holds promise for improved, digitalized integrated feedback about students’ learning progress. Our aim is that LevelUp will help medical students to keep track of their study progress and reflect on their skills. Further development will integrate users’ recommendations for additional features as well as optimizing data flow.
Universal capability of 3-ketosteroid Δ1-dehydrogenases to catalyze Δ1-dehydrogenation of C17-substituted steroids
Authors: Wójcik Patrycja , Glanowski Michał , Wojtkiewicz Agnieszka M. , Rohman Ali , Szaleniec Maciej
Published: June 2021

Background

3-Ketosteroid Δ1-dehydrogenases (KSTDs) are the enzymes involved in microbial cholesterol degradation and modification of steroids. They catalyze dehydrogenation between C1 and C2 atoms in ring A of the polycyclic structure of 3-ketosteroids. KSTDs substrate spectrum is broad, even though most of them prefer steroids with small substituents at the C17 atom. The investigation of the KSTD’s substrate specificity is hindered by the poor solubility of the hydrophobic steroids in aqueous solutions. In this paper, we used 2-hydroxpropyl-β-cyclodextrin (HBC) as a solubilizing agent in a study of the KSTDs steady-state kinetics and demonstrated that substrate bioavailability has a pivotal impact on enzyme specificity.

Results

Molecular dynamics simulations on KSTD1 from Rhodococcus erythropolis indicated no difference in ΔGbind between the native substrate, androst-4-en-3,17-dione (AD; − 8.02 kcal/mol), and more complex steroids such as cholest-4-en-3-one (−﻿ 8.40 kcal/mol) or diosgenone (−﻿ 6.17 kcal/mol). No structural obstacle for binding of the extended substrates was also observed. Following this observation, our kinetic studies conducted in the presence of HBC confirmed KSTD1 activity towards both types of steroids. We have compared the substrate specificity of KSTD1 to the other enzyme known for its activity with cholest-4-en-3-one, KSTD from Sterolibacterium denitrificans (AcmB). The addition of solubilizing agent caused AcmB to exhibit a higher affinity to cholest-4-en-3-one (Ping-Pong bi bi KmA = 23.7 μM) than to AD (KmA = 529.2 μM), a supposedly native substrate of the enzyme. Moreover, we have isolated AcmB isoenzyme (AcmB2) and showed that conversion of AD and cholest-4-en-3-one proceeds at a similar rate. We demonstrated also that the apparent specificity constant of AcmB for cholest-4-en-3-one (kcat/KmA = 9.25∙106 M−1 s−1) is almost 20 times higher than measured for KSTD1 (kcat/KmA = 4.71∙105 M−1 s−1).

Conclusions

We confirmed the existence of AcmB preference for a substrate with an undegraded isooctyl chain. However, we showed that KSTD1 which was reported to be inactive with such substrates can catalyze the reaction if the solubility problem is addressed.