bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of colchicine prescription in COVID-19-related hospital admissions: a survival analysis
Authors: Madrid-García Alfredo , Pérez Inés , Colomer José Ignacio , León-Mateos Leticia , Jover Juan A , Fernández-Gutiérrez Benjamín , Abásolo-Alcazar Lydia , Rodríguez-Rodríguez Luis
Published: March 2021

Aims:

To analyze the association between colchicine prescription and COVID-19-related hospital admissions in patients with rheumatic and musculoskeletal diseases (RMDs).

Methods:

Patients attending a rheumatology outpatient clinic from a tertiary care center in Madrid, Spain, from 1 September 2019 to 29 February 2020 were included. Patients were assigned as exposed or unexposed based on whether they were prescribed with colchicine in their last visit to the clinic during the 6 months before the start of the observation period. Treatment changes during the observation period were also considered. The primary outcome was COVID-19-related hospital admissions between 1 March and 20 May 2020. Secondary outcome included COVID-19-related mortality. Several weighting techniques for data balancing, based and non-based on the propensity score, followed by Cox regressions were performed to estimate the association of colchicine prescription on both outcomes.

Discussion:

The number of patients entered in the study was 9379, with 406 and 9002 exposed and unexposed follow-up periods, respectively. Generalized Boosted Models (GBMs) and Empirical Balancing Calibration Weighting (EBCW) methods showed the best balance for COVID-19-related hospital admissions. Colchicine prescription did not show a statistically significant association after covariable balancing ( p-value = 0.195 and 0.059 for GBM and EBCW, respectively). Regarding mortality, the low number of events prevented a success variable balancing and analysis.

Conclusion:

Colchicine prescription does not play a significant protective or risk role in RMD patients regarding COVID-19-related hospital admissions. Our observations could support the maintenance of colchicine prescription in those patients already being treated, as it is not associated with a worse prognosis.

Plain language title:

Colchicine influence in COVID-19-related hospital admissions
Entitlement problems in digital markets and how antitrust shapes the appropriation of network externalities
Authors: Hoffmann Linus J.
Published: March 2021

The engine of value creation in the digital economy is network externalities, i.e. the phenomenon by which the value to a new user from adopting a good or service increases in the number of users who already adopted it. But network externalities are not manna from heaven. They are ‘sponsored’ by firms who make demand expanding investments. In areas with imperfect property institutions like the digital economy, a key business decision for profit maximizing firms consists in devising value capture strategies to appropriate their investments. This paper identifies three recurrent types of appropriation disputes in digital markets: Access to software platforms, limitations to the exploitation of raw data and claims over digital content. At the heart of each dispute lies the controversial exercise of an entitlement over a digital asset that is embedded in a context of or exhibits itself network externalities. The appropriation of this asset and its integration into the firm’s ecosystem could make the firm benefit from network efficiencies. Controlling the digital asset in question becomes a proxy. Appropriation strategies by proxy can have pro- and anti-competitive effects. This is why each dispute can not only be understood as a problem of appropriability, but also as a problem of potential harm to competition. And indeed, competition enforcers have brought forward various cases with underlying appropriation disputes. This paper tracks the influence of three of them on the appropriability of assets in the digital economy, and on digital firms’ strategies to capture the value of network externalities.
Memes and the Moroccan Far-Right
Authors: Moreno-Almeida Cristina , Gerbaudo Paolo
Published: March 2021

Facebook meme pages in the Middle East and North Africa (MENA) have flared-up in the past decade. Since 2017, some Moroccan pages have started sharing exclusively patriarchal, ultra- and ethnonationalist, misogynist, and racist content shaped to look in line with “alt-right” online aesthetics. Self-identifying as right-wing, these pages have memetized an entire ecosystem of scapegoats as enemies of the nation. Furthermore, they have rescued symbols from the past, such as the late King Hassan II or the Marinid flag, to formally establish the Moroccan Right. In view of this trend, this paper examines Moroccan Facebook meme pages that share ultranationalist content and build on a scapegoating strategy to understand how Far-Right ideologies have been adapted in the MENA. Through multimodal discourse analysis of memes posted since 2017 until April 2020, this paper studies the ways in which the revival of Far-Right tropes is contributing to reshaping local digital political landscapes and pushing toward an Arab Right. By examining a collection of over 1,600 memes, our paper argues that this new online Moroccan Far-Right discourse is adapting Far-Right views, particularly in terms of gender and race, to local politics. This research contends that internet memes are effectively acting as an entry point in the creation of a Moroccan Far-Right. As a newly formed trend, however, the Moroccan Far Right is still negotiating its main tenets.
Defining and Measuring News Media Quality: Comparing the Content Perspective and the Audience Perspective
Authors: Bachmann Philipp , Eisenegger Mark , Ingenhoff Diana
Published: March 2021

High-quality news is important, not only for its own sake but also for its political implications. However, defining, operationalizing, and measuring news media quality is difficult, because evaluative criteria depend upon beliefs about the ideal society, which are inherently contested. This conceptual and methodological paper outlines important considerations for defining news media quality before developing and applying a multimethod approach to measure it. We refer to Giddens' notion of double hermeneutics, which reveals that the ways social scientists understand constructs inevitably interact with the meanings of these constructs shared by people in society. Reflecting the two-way relationship between society and social sciences enables us to recognize news media quality as a dynamic, contingent, and contested construct and, at the same time, to reason our understanding of news media quality, which we derive from Habermas' ideal of deliberative democracy. Moreover, we investigate the Swiss media system to showcase our measurement approach in a repeated data collection from 2017 to 2020. We assess the content quality of fifty news media outlets using four criteria derived from the deliberative ideal ( N = 20,931 and 18,559 news articles and broadcasting items, respectively) and compare the results with those from two representative online surveys ( N = 2,169 and 2,159 respondents). The high correlations between both methods show that a deliberative understanding of news media quality is anchored in Swiss society and shared by audiences. This paper shall serve as a showcase to reflect and measure news media quality across other countries and media systems.
Hydrophilic polymer embolization following flow diversion of cerebral aneurysms
Authors: Abdalkader Mohamad , Sathya Anvitha , Ma Alice , Cervantes-Arslanian Anna M , Chung David Y , Barest Glenn , Nguyen Thanh N
Published: March 2021

Foreign body embolization is a rare and potentially under-recognized complication of neuroendovascular procedures. This complication should be considered in the differential diagnosis for clinical or radiological deterioration following neurovascular interventions. We report a case of foreign body hydrophilic coating embolization that occurred following an attempted flow diversion of an intracranial aneurysm with dramatic flare-up after repeat exposure. We also provide a literature review of all reported cases of hydrophilic polymer embolization following flow diversion procedures.
Nomenclature and clinical phenotypes of atopic dermatitis
Authors: Girolomoni Giampiero , de Bruin-Weller Marjolein , Aoki Valeria , Kabashima Kenji , Deleuran Mette , Puig Luis , Bansal Ashish , Rossi Ana B.
Published: March 2021

Atopic dermatitis is a heterogeneous disease and resists classification. In this review, we discuss atopic dermatitis nomenclature and identify morphologic phenotypes, which will facilitate correct diagnoses and development of treatment strategies. We support using the term ‘atopic dermatitis’ rather than eczema, because it describes the allergic background and inflammation (‘itis’) as drivers of the disease. Atopic dermatitis has many morphologic manifestations that vary by topographic area affected, age, or race and require consideration in differential diagnosis. Different phenotypes based on morphology and topographic location, ethnicity, and age are discussed. A better-defined phenotype identification for atopic dermatitis will facilitate earlier and correct diagnosis of this complex condition and inform selection of the most appropriate treatment choice in an era in which targeted therapies may generate more individualized patient care.
Evolution of randomized, controlled studies of medical therapy in chronic thromboembolic pulmonary hypertension
Authors: Kim Nick H. , Papamatheakis Demosthenes G. , Fernandes Timothy M.
Published: March 2021

Although pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH), many patients have inoperable disease, and some have persistent or recurrent pulmonary hypertension (PH) after surgery. Alternative options (balloon pulmonary angioplasty (BPA) and PH‐targeted medical therapy) are, therefore, required. Studies of medical therapies for CTEPH have evolved since Aerosolized Iloprost Randomized (AIR), the first randomized, controlled study of a PH‐targeted therapy (inhaled iloprost) to include patients with CTEPH. Key learnings from these studies include the need to evaluate CTEPH separately from other types of PH, the importance of prospective operability adjudication as part of the protocol, and the need for sufficient duration to allow treatment benefits to become apparent. The 16‐week Chronic Thromboembolic Pulmonary Hypertension Soluble Guanylate Cyclase‐Stimulator Study 1 (CHEST‐1) study was the first to operationalize these learnings, demonstrating a significant mean improvement in 6‐minute walk distance (+46 m) and improvements in hemodynamic endpoints with riociguat versus placebo. Findings from previous studies will inform the design of future studies to address key issues related to combination medical therapy. Data on combinations of macitentan with phosphodiesterase type 5 inhibitors or oral prostanoids are available from MERIT, the first study to allow such regimens. No data on combinations including riociguat, the only licensed medical therapy for CTEPH, are available. Studies are also needed for multimodality treatment, including medical therapy plus BPA, and medical therapy as a bridge to PEA in selected operable patients. To address these issues and improve patient outcomes, it is vital that we learn from current studies to improve future trial design.
Short Term Outcomes Following Open Reduction Internal Fixation Surgery for a Distal Radius Fracture: 2 Week Versus 4 Week Immobilization. A Retrospective Analysis
Authors: Toemen Angela , Collocott Shirley , Heiss-Dunlop Wolfgang
Published: March 2021

Study design:

The study was a retrospective cohort analysis for a 41 month period; from January 2013 to May 2016.

Introduction:

It is suggested that patients following a distal radius fracture (DRF) achieve a comparable outcome at 3 and 6 months post surgery regardless of the time they begin mobilization. In previous studies there has been limited analysis of outcomes within the initial 3 months: functional return, time taken from work and use of therapy resources are key outcomes which have not formally been investigated in previous studies.

Purpose of the study:

To analyze short term outcomes of patients following open reduction internal fixation (ORIF) for a DRF.

Methods:

A retrospective cohort analysis was conducted to determine primarily if there is a difference in time from work, number of therapy appointments, cost of therapy materials, time to discharge from therapy and secondarily range of motion (ROM) and grip strength (GS); when measured in patients who begin mobilization prior to 2 weeks compared to those who begin mobilization at 4 or greater weeks post surgery.

Results:

Patients mobilized early were discharged from hand therapy significantly quicker (p = 0.033) and returned to work significantly faster (p = 0.019) than those mobilized later. Patients who began mobilization at 2 weeks or earlier post surgery had significantly greater wrist extension/flexion arc at 4 weeks (p < 0.001) and 6 weeks (p < 0.001) and rotation at 4 weeks (p < 0.001).

Conclusions:

Patients who begin mobilization at 2 weeks or earlier following ORIF for a DRF will lose less time from work and will be discharged sooner from hand therapy. They will additionally have increased ROM in the early post surgery phase.
Is Burnout a Depressive Condition? A 14-Sample Meta-Analytic and Bifactor Analytic Study
Authors: Bianchi Renzo , Verkuilen Jay , Schonfeld Irvin S. , Hakanen Jari J. , Jansson-Fröjmark Markus , Manzano-García Guadalupe , Laurent Eric , Meier Laurenz L.
Published: March 2021

There is no consensus on whether burnout constitutes a depressive condition or an original entity requiring specific medical and legal recognition. In this study, we examined burnout–depression overlap using 14 samples of individuals from various countries and occupational domains ( N = 12,417). Meta-analytically pooled disattenuated correlations indicated (a) that exhaustion—burnout’s core—is more closely associated with depressive symptoms than with the other putative dimensions of burnout (detachment and efficacy) and (b) that the exhaustion–depression association is problematically strong from a discriminant validity standpoint ( r = .80). The overlap of burnout’s core dimension with depression was further illuminated in 14 exploratory structural equation modeling bifactor analyses. Given their consistency across countries, languages, occupations, measures, and methods, our results offer a solid base of evidence in support of the view that burnout problematically overlaps with depression. We conclude by outlining avenues of research that depart from the use of the burnout construct.
Validity of Single-item Versus Multiple-item Job Satisfaction Measures in Predicting Life: Satisfaction and Turnover Intention
Authors: Fakunmoju Sunday B.
Published: March 2021

The use of single-item (SI) measures to operationalise a construct has endured extensive methodological critique, and its practical advantages over multiple-item (MI) measures pale in comparisons to the theoretical advantages of MI measures. Among constructs that have been operationalised with a single item, job satisfaction remains one of the favourites, although empirical knowledge about its validity is limited to data derived from management, marketing and human resources fields. Little is known about its validity among human service professionals. Using two cross-sectional surveys, the present article describes validity of SI versus MI measures of job satisfaction in predicting life satisfaction and turnover intention among social workers across organisations and professional specialisations, including supervisors, managers and administrators. Results in both studies suggested that SI measure of job satisfaction was methodologically and analytically suitable for examining job-related outcomes. It established convergent validity with MI job satisfaction measures and discriminant validity with job dissatisfaction measures. It demonstrated comparable demographic outcomes, association and predictive relationship with life satisfaction and turnover intention in the same magnitude as MI job satisfaction. It accounted for comparable variance in life satisfaction and turnover intention and generated bivariate, multivariate and mediation model outcomes that are systematically similar to those of MI job satisfaction measures. The article stipulates conditions for the use of SI job satisfaction measures, offers suggestions about how to resolve methodological impasse in choosing between SI and MI measures, and concludes with recommendations that include criteria for choosing between SI and MI measures for research.
Surgical Repair of Distal Biceps Femoris Avulsion Injuries in Professional Athletes
Authors: Thompson Joshua W. , Plastow Ricci , Kayani Babar , Moriarty Peter , Asokan Ajay , Haddad Fares S.
Published: March 2021

Background:

Understanding the optimal management of distal biceps femoris avulsion injuries is critical for restoring preinjury function, restoring hamstring muscle strength, increasing range of motion, and minimizing risk of complications and recurrence. Due to the rarity of these injuries, prognosis and outcomes within the literature are limited to case reports and small case series.

Purpose:

To assess the effect of surgical repair for acute distal avulsion injuries of the biceps femoris tendon on (1) return to preinjury level of sporting function and (2) time to return to preinjury level of sporting function, patient satisfaction, and complications.

Study Design:

Case series; Level of evidence, 4.

Methods:

This prospective single-surgeon study included 22 elite athletes (18 men [82%], 4 women [18%]; mean age, 26 years; age range, 17-35 years; mean body mass index, 25.3 ± 4.1 kg/m2) undergoing primary suture anchor repair of avulsion injuries of the distal biceps femoris confirmed on preoperative magnetic resonance imaging. Predefined outcomes relating to time for return to sporting activity, patient satisfaction, complications, and injury recurrence were recorded at regular intervals after surgery. Minimum follow-up time was 12 months (range, 12.0-26.0 months) from the date of surgery.

Results:

The mean time from injury to surgical intervention was 12 days (range, 2-28 days). All study patients returned to their preinjury level of sporting activity, predominately professional soccer or rugby. Mean time from surgical intervention to return to full sporting activity was 16.7 ± 8.7 weeks. At 1- and 2-year follow-up, all study patients were still participating at their preinjury level of sporting activity. There was no incidence of primary injury recurrence, and no patients required further operation to the biceps origin.

Conclusion:

Surgical repair of acute avulsion injuries of the distal biceps femoris facilitated early return to preinjury level of function with low risk of recurrence, low complication rate, and high patient satisfaction in elite athletes. Suture anchor repair of these injuries should be considered a reliable treatment option in athletes with high functional demands to permit an early return to sport with restoration of hamstring strength.
Concurrent Validity of Pictorial Fit-Frail Scale (PFFS) in Older Adult Male Veterans with Different Levels of Health Literacy
Authors: Ysea-Hill Otoniel , Sani Tesil Nedumkallel , Nasr Lubna A. , Gomez Christian J. , Ganta Nagapratap , Sikandar Sehrish , Theou Olga , Ruiz Jorge G.
Published: March 2021

Introduction: Frailty is a state of vulnerability characterized by multisystemic physiological decline. The Pictorial Fit Frail Scale (PFFS) is a practical, image-based assessment that may facilitate the assessment of frailty in individuals with inadequate health literacy (HL). Objective: Determine the concurrent validity and feasibility of the PFFS in older Veterans with different levels of HL and cognition. Methods: Cross-sectional study in a geriatric clinic at a Veteran Health Administration (VHA) medical center. Veterans ≥65 years old completed a HL evaluation, PFFS, FRAIL scale and cognitive screening. We assessed the associations between PFFS, FRAIL scale, and VA-Frailty Index (VA-FI), and compared PFFS and FRAIL scale accuracy with a Receiver Operating Characteristic curve, Area Under the Curve (AUC) analysis, using the VA-FI as reference. Results: Eighty-three Veterans, mean age 76.20 ( SD = 6.02) years, 65.1% Caucasian, 69.9% had inadequate HL, 57.8% were frail and 20.5% had cognitive impairment. All participants completed the 43 PFFS items. There were positive correlations between PFFS and VA-FI, r = .55 (95% CI: 0.365–0.735, p < .001), and FRAIL scale, r = .673 (95% CI: 0.509–0.836, p < .001). Compared to the VA-FI, the PFFS (AUC = 0.737; 95% CI: 0.629–0.844) and FRAIL scale (AUC = 0.724;95% CI: 0.615–0.824; p < .001) showed satisfactory diagnostic accuracy. Conclusions: The PFFS is valid and feasible in evaluating frailty in older Veterans with different levels of HL and cognition.
Employee perceptions of their work environment, work passion, and work intentions: A replication study using three samples
Authors: Peyton Taylor , Zigarmi Drea
Published: March 2021

This study contributes to the emerging literature on the employee work passion appraisal (EWPA) model, by replicating structural equation modeling across three samples (total n = 4,613). We examine passion for work as a mediator of employees’ work environment characteristics and work intentions. Our data fit the structure of the EWPA model in three samples. As expected, work environment characteristics were strongly and positively correlated with harmonious passion, but contrary to our expectations, work environment characteristics were moderately and positively correlated with obsessive passion. Harmonious passion was positively correlated with work intentions, but the connection between obsessive passion and work intentions yielded mixed results. The overall results support harmonious passion, and less so obsessive passion, as partial mediators of employees’ perceptions of their work environment characteristics and favorable work intentions. This study has limitations in that it uses a cross-sectional, single-source, self-report design. Practical implications of the study are also presented.
‘Beyond the clash?’: Union–management partnership through social dialogue on sustainable HRM. Lessons from Belgium
Authors: De Prins Peggy
Published: March 2021

The purpose of this article is to explore the concept of intended versus real partnerships between unions and management in relation to social dialogue on sustainable HRM within a historically grown institutional context of dominant conflict thinking in Belgium. In-depth qualitative data was retrieved from unions and managers within leading companies in the Belgian chemistry and the life sciences sector. The central goal was to examine how sustainable HR issues can strengthen the partnership relationship between unions and management and what kind of paradoxical tensions they face in this regard. The data supports the idea of a hybrid, (neo)pluralistic approach, within which any polarizing ‘we are against them’ mindset cannot be fully ruled out and may even be fruitful in achieving win-win solutions.
Investigating the toxicology of intramuscular injected multiwalled carbon nanotubes conjugated antibody (CNT-Ab) in mice followed by microwave hyperthermia
Authors: Clark CE , Chall AF , Stagg JC , Sittaramane V , Quirino RL , Mixson AC , Gato WE
Published: March 2021

Carbon nanotubes bound to tumor specific antibodies offer specific treatment for cancer cells without affecting surrounding tissue. The present study seeks to affirm the initial results of CNTs in cancer therapy by investigating the toxicological effect in mice injected with CNT-Ab followed by microwave hypothermia. We were particularly interested in evaluating the biodistribution, toxicity, and immune response that may be elicited from CNT-Ab exposure in mice. 4–5 week old mice (C57BL/6) were injected with various concentrations and combinations of multiwalled carbon nanotubes (MWCNT) conjugated with specific prostate-specific membrane antigen (PMSA) antibodies. After 1-week post-injection, mice were sacrificed followed by the collection of blood separated into serum, liver, kidney and other tissues for further analysis. Serum total protein concentration across the treatment groups was varied. No significant changes in albumin levels were detected when compared to the control group (No Treatment). Group YE (.125 mg/ml anti-PSMA-MWCNT + Microwave) was found to have consistently high blood serum analyte levels, indicating impaired liver and kidney function. Likewise, groups YB (Microwave only), YF [.5 mg/ml anti-PSMA-MWCNT (No Microwave)], and YG (.5 mg/ml plain MWCNT + Microwave) seemed to show indications of impaired liver function. Analysis of gene expression revealed a significant impact on the NF-KB inflammatory response pathway. NF-KB gene was up-regulated relative to controls in all treatment groups. These results seem to suggest marginal toxicity from the injection of CNT-Ab followed by microwave hyperthermia in mice subjects.
Road-mapping the Contradictions Around Premenstrual Syndrome: A Medico-legal Quandary
Authors: Gautam Upma , Sharma Sonali
Published: March 2021

Even though the term premenstrual syndrome has entered the common lexicon, yet it still remains a Gordian knot that needs to be untangled by not only the medical profession but also the legal profession. Resolving this conundrum requires a balancing of the dichotomy between ‘medicalizing’ women’s lives and a need to affirm women’s experiences. There exist several legal impediments while presenting evidence of this syndrome for diminishing the responsibility of a woman in a criminal trial. The present research is undertaken with an aim to determine the relationship between female criminality and premenstrual syndrome. The research further examines the credibility of utilizing the evidence of premenstrual syndrome to excuse a woman from criminal responsibility during a trial. This article is a step in the direction of pushing the envelope for spurring a holistic development of law, which is inclusive of the specific needs of women.
Essential properties and pitfalls of colorimetric Reverse Transcription Loop-mediated Isothermal Amplification as a point-of-care test for SARS-CoV-2 diagnosis
Authors: de Oliveira Coelho Bruna , Sanchuki Heloisa Bruna Soligo , Zanette Dalila Luciola , Nardin Jeanine Marie , Morales Hugo Manuel Paz , Fornazari Bruna , Aoki Mateus Nóbrega , Blanes Lucas
Published: March 2021

Background

SARS-CoV-2 Reverse Transcription Loop-mediated Isothermal Amplification (RT-LAMP) colorimetric detection is a sensitive and specific point-of-care molecular biology technique used to detect the virus in only 30 min. In this manuscript we have described a few nuances of the technique still not properly described in the literature: the presence of three colors clusters; the correlation of the viral load with the color change; and the importance of using an internal control to avoid false-negative results.

Methods

To achieve these findings, we performed colorimetric RT-LAMP assays of 466 SARS-CoV-2 RT-qPCR validated clinical samples, with color quantification measured at 434 nm and 560 nm.

Results

First we determinate a sensitivity of 93.8% and specificity of 90.4%. In addition to the pink (negative) and yellow (positive) produced colors, we report for the first time the presence of an orange color cluster that may lead to wrong diagnosis. We also demonstrated using RT-qPCR and RT-LAMP that low viral loads are related to Ct values > 30, resulting in orange colors. We also demonstrated that the diagnosis of COVID-19 by colorimetric RT-LAMP is efficient until the fifth symptoms day when the viral load is still relatively high.

Conclusion

This study reports properties and indications for colorimetric RT-LAMP as point-of-care for SARS-CoV-2 diagnostic, reducing false results, interpretations and optimizing molecular diagnostics tests application.
A source-sink model explains the difference in the metabolic mechanism of mechanical damage to young and senescing leaves in Catharanthus roseus
Authors: Chen Qi , Lu Xueyan , Guo Xiaorui , Xu Mingyuan , Tang Zhonghua
Published: March 2021

Background

Mechanical damage is an unavoidable threat to the growth and survival of plants. Although a wound to senescing (lower) leaves improves plant vitality, a wound to younger (upper) leaves often causes damage to or death of the whole plant. Source-sink models are often used to explain how plants respond to biotic or abiotic stresses. In this study, a source-sink model was used to explain the difference in the metabolic mechanism of mechanical damage to young and senescing leaves of Catharanthus roseus.

Results

In our study, GC-MS and LC-QTOF-MS metabolomics techniques were used to explore the differences in source-sink allocation and metabolic regulation in different organs of Catharanthus roseus after mechanical damage to the upper/lower leaves (WUL/WLL). Compared with that of the control group, the energy supplies of the WUL and WLL groups were increased and delivered to the secondary metabolic pathway through the TCA cycle. The two treatment groups adopted different secondary metabolic response strategies. The WLL group increased the input to the defense response after damage by increasing the accumulation of phenolics. A source-sink model was applied to the defensive responses to local (damaged leaves) and systemic (whole plant) damage. In the WUL group, the number of sinks increased due to damage to young leaves, and the tolerance response was emphasized.

Conclusion

The accumulation of primary and secondary metabolites was significantly different between the two mechanical damage treatments. Catharanthus roseus uses different trade-offs between tolerance (repair) and defense to respond to mechanical damage. Repairing damage and chemical defenses are thought to be more energetically expensive than growth development, confirming the trade-offs and allocation of resources seen in this source-sink model.
Appropriate utilization of cardiac computed tomography for the assessment of stable coronary artery disease
Authors: Hammer Michael , Mian Muhtashim , Elhadad Levi , Li Mary , Roifman Idan
Published: March 2021

Background

Appropriate use criteria (AUC) have been developed in response to growth in cardiac imaging utilization and concern regarding associated costs. Cardiac computed tomography angiography (CCTA) has emerged as an important modality in the evaluation of coronary artery disease, however its appropriate utilization in actual practice is uncertain. Our objective was to determine the appropriate utilization of CCTA in a large quaternary care institution and to compare appropriate utilization pre and post publication of the 2013 AUC guidelines. We hypothesized that the proportion of appropriate CCTA utilization will be similar to those of other comparable cardiac imaging modalities and that there would be a significant increase in appropriate use post AUC publication.

Methods

We employed a retrospective cohort study design of 2577 consecutive patients undergoing CCTA between January 1, 2012 and December 30, 2016. An appropriateness category was assigned for each CCTA. Appropriateness classifications were compared pre- and post- AUC publication via the chi-square test.

Results

Overall, 83.5% of CCTAs were deemed to be appropriate based on the AUC. Before the AUC publication, 75.0% of CCTAs were classified as appropriate whereas after the AUC publication, 88.0% were classified as appropriate (p < 0.001). The increase in appropriate utilization, when extrapolated to the Medicare population of the United States, was associated with potential cost savings of approximately $57 million per year.

Conclusions

We report a high rate of appropriate use of CCTA and a significant increase in the proportion of CCTAs classified as appropriate after the AUC publication.
The incidence and prevalence of inflammatory bowel disease in UK primary care: a retrospective cohort study of the IQVIA Medical Research Database
Authors: Freeman Karoline , Ryan Ronan , Parsons Nicholas , Taylor-Phillips Sian , Willis Brian H. , Clarke Aileen
Published: March 2021

Background

Our knowledge of the incidence and prevalence of inflammatory bowel disease (IBD) is uncertain. Recent studies reported an increase in prevalence. However, they excluded a high proportion of ambiguous cases from general practice. Estimates are needed to inform health care providers who plan the provision of services for IBD patients. We aimed to estimate the IBD incidence and prevalence in UK general practice.

Methods

We undertook a retrospective cohort study of routine electronic health records from the IQVIA Medical Research Database covering 14 million patients. Adult patients from 2006 to 2016 were included. IBD was defined as an IBD related Read code or record of IBD specific medication. Annual incidence and 12-month period prevalence were calculated.

Results

The prevalence of IBD increased between 2006 and 2016 from 106.2 (95% CI 105.2–107.3) to 142.1 (95% CI 140.7–143.5) IBD cases per 10,000 patients which is a 33.8% increase. Incidence varied across the years. The incidence across the full study period was 69.5 (95% CI 68.6–70.4) per 100,000 person years.

Conclusions

In this large study we found higher estimates of IBD incidence and prevalence than previously reported. Estimates are highly dependent on definitions of disease and previously may have been underestimated.
Dorsal approach with Glissonian approach for laparoscopic right anatomic liver resections
Authors: Wang Shaohe , Yue Yang , Zhang Wenjie , Liu Qiaoyu , Sun Beicheng , Sun Xitai , Yu Decai
Published: March 2021

Background

Laparoscopic anatomic hepatectomy (LAH) has gradually become a routine surgical procedure. However, how to expose the whole hepatic vein and avoid the hepatic vein laceration is still a challenge because of the caudate lobe, particularly in right hepatectomy. We adopted a dorsal approach combined with Glissionian appraoch to perform laparoscopic right anatomic hepatectomy (LRAH).

Methods

Twenty patients who underwent LRAH from January 2017 to November 2018 were retrospectively analysed. Of these patients, seven patients underwent laparoscopic right hemihepatectomy (LRH group), seven patients who underwent laparoscopic right posterior hepatectomy (LRPH group), and six patients who underwent laparoscopic hepatectomy for segment 7 (LS7 group). The paracaval portion of caudate lobe could be transected firstly through dorsal approach and the corresponding major hepatic vein could be exposed from its root to the peripheral branches safely. Due to exposure along the major hepatic vein trunk, the remaining liver parenchyma could be quickly transected from dorsal to cranial side.

Results

The mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 ± 58.2 min and the mean estimated volume of blood loss was 412.5 ± 255.4 mL. The mean duration of postoperative hospital stay was 10.2 days. The mean Pringle maneuver time was 64.8 ± 27.7 min. Five patients received transfusion of 2–4 U of red blood cells. Two patients suffered from transient hepatic dysfunction and one suffered from pleural effusion. None of the patients underwent conversion to an open procedure. The operative duration, volume of the blood loss, Pringle maneuver time, and postoperative hospital stay duration did not differ significantly among the LRH, LRPH, and LS7 groups (P > 0.05).

Conclusions

Dorsal approach combined with Glissonian approach for right lobe is feasible and effective in laparoscopic right anatomic liver resections.
Comparison of bone single-photon emission computed tomography (SPECT)/CT and bone scintigraphy in assessing knee joints
Authors: An Young-Sil , Park Do Young , Min Byoung-Hyun , Lee Su Jin , Yoon Joon-Kee
Published: March 2021

Background

This study attempted to compare the radiopharmaceutical uptake findings of planar bone scintigraphy (BS) and single photon emission computed tomography (SPECT)/computed tomography (CT) performed on knee joints.

Methods

We retrospectively included 104 patients who underwent bone SPECT/CT and BS 4 h after the intravenous administration of technetium-99m-hydroxymethylene diphosphonate (99mTc-HDP) for pain in the knee joint. The uptake degree of each of the knee regions (medial femoral, lateral femoral, medial tibial, lateral tibial, and patellar area) in planar images and SPECT/CT were evaluated by visual (grades 0 to 2) and quantitative analyses (uptake counts for planar image and standardized uptake values [SUVs] for SPECT/CT).

Results

The uptake grades assessed visually on the planar images differed significantly from the uptake grades on SPECT/CT images in all areas of the knee (all p < 0.001), and SPECT/CT imaging revealed a larger number of uptake lesions than those noted in planar imaging for each patient (3.3 ± 2.0 vs 2.4 ± 2.3, p < 0.0001). In all regions of the knee, all of the quantitative values, including uptake counts obtained from the planar image as well as the maximum SUV (SUVmax) and mean SUV (SUVmean) obtained from SPECT/CT, showed statistically higher values as their visual grades increased (all p < 0.001). However, when analyzed for each area, only the SUVmax showed a significant difference by grade in all knee regions. Quantitative uptake values obtained from planar images were moderately correlated with SUVs of SPECT/CT images (r = 0.58 for SUVmean and r = 0.53 for SUVmax, all p < 0.001) in the total knee regions. Looking at each area, there was a significant but low correlation between the uptake counts of the planar images and the SUVs on SPECT/CT in the right lateral tibial region (r = 0.45 for SUVmean, r = 0.31 for SUVmax, all p < 0.001).

Conclusions

In assessing knee joints, the findings of planar images and SPECT/CT images differ both visually and quantitatively, and more lesions can be found in SPECT/CT than in the planar images. The SUVmax could be a reliable value to evaluate knee joint uptake activity.
Chlorhexidine for facility-based umbilical cord care: EN-BIRTH multi-country validation study
Authors:   EN-BIRTH Study Group, Zaman Sojib Bin , Siddique Abu Bakkar , Ruysen Harriet , KC Ashish , Peven Kimberly , Ameen Shafiqul , Thakur Nishant , Rahman Qazi Sadeq-ur , Salim Nahya , Gurung Rejina , Tahsina Tazeen , Rahman Ahmed Ehsanur , Coffey Patricia S. , Rawlins Barbara , Day Louise T. , Lawn Joy E. , Arifeen Shams El
Published: March 2021

Background

Umbilical cord hygiene prevents sepsis, a leading cause of neonatal mortality. The World Health Organization recommends 7.1% chlorhexidine digluconate (CHX) application to the umbilicus after home birth in high mortality contexts. In Bangladesh and Nepal, national policies recommend CHX use for all facility births. Population-based household surveys include optional questions on CHX use, but indicator validation studies are lacking. TheEvery NewbornBirth Indicators Research Tracking in Hospitals (EN-BIRTH) was an observational study assessing measurement validity for maternal and newborn indicators. This paper reports results regarding CHX.

Methods

The EN-BIRTH study (July 2017–July 2018) included three public hospitals in Bangladesh and Nepal where CHX cord application is routine. Clinical-observers collected tablet-based, time-stamped data regarding cord care during admission to labour and delivery wards as the gold standard to assess accuracy of women’s report at exit survey, and of routine-register data. We calculated validity ratios and individual-level validation metrics; analysed coverage, quality and measurement gaps. We conducted qualitative interviews to assess barriers and enablers to routine register-recording.

Results

Umbilical cord care was observed for 12,379 live births. Observer-assessed CHX coverage was very high at 89.3–99.4% in all 3 hospitals, although slightly lower after caesarean births in Azimpur (86.8%), Bangladesh. Exit survey-reported coverage (0.4–45.9%) underestimated the observed coverage with substantial “don’t know” responses (55.5–79.4%). Survey-reported validity ratios were all poor (0.01 to 0.38). Register-recorded coverage in the specific column in Bangladesh was underestimated by 0.2% in Kushtia but overestimated by 9.0% in Azimpur. Register-recorded validity ratios were good (0.9 to 1.1) in Bangladesh, and poor (0.8) in Nepal. The non-specific register column in Pokhara, Nepal substantially underestimated coverage (20.7%).

Conclusions

Exit survey-report highly underestimated observed CHX coverage in all three hospitals. Routine register-recorded coverage was closer to observer-assessed coverage than survey reports in all hospitals, including for caesarean births, and was more accurately captured in hospitals with a specific register column. Inclusion of CHX cord care into registers, and tallied into health management information system platforms, is justified in countries with national policies for facility-based use, but requires implementation research to assess register design and data flow within health information systems.
Survey of women’s report for 33 maternal and newborn indicators: EN-BIRTH multi-country validation study
Authors:   EN-BIRTH Study Group, Ameen Shafiqul , Siddique Abu Bakkar , Peven Kimberly , Rahman Qazi Sadeq-ur , Day Louise T. , Shabani Josephine , KC Ashish , Boggs Dorothy , Shamba Donat , Tahsina Tazeen , Rahman Ahmed Ehsanur , Zaman Sojib Bin , Hossain Aniqa Tasnim , Ahmed Anisuddin , Basnet Omkar , Malla Honey , Ruysen Harriet , Blencowe Hannah , Arnold Fred , Requejo Jennifer , Arifeen Shams El , Lawn Joy E.
Published: March 2021

Background

Population-based household surveys, notably the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), remain the main source of maternal and newborn health data for many low- and middle-income countries. As part of the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study, this paper focuses on testing validity of measurement of maternal and newborn indicators around the time of birth (intrapartum and postnatal) in survey-report.

Methods

EN-BIRTH was an observational study testing the validity of measurement for selected maternal and newborn indicators in five secondary/tertiary hospitals in Bangladesh, Nepal and Tanzania, conducted from July 2017 to July 2018. We compared women’s report at exit survey with the gold standard of direct observation or verification from clinical records for women with vaginal births. Population-level validity was assessed by validity ratios (survey-reported coverage: observer-assessed coverage). Individual-level accuracy was assessed by sensitivity, specificity and percent agreement. We tested indicators already in DHS/MICS as well as indicators with potential to be included in population-based surveys, notably the first validation for small and sick newborn care indicators.

Results

33 maternal and newborn indicators were evaluated. Amongst nine indicators already present in DHS/MICS, validity ratios for baby dried or wiped, birthweight measured, low birthweight, and sex of baby (female) were between 0.90–1.10. Instrumental birth, skin-to-skin contact, and early initiation of breastfeeding were highly overestimated by survey-report (2.04–4.83) while umbilical cord care indicators were massively underestimated (0.14–0.22). Amongst 24 indicators not currently in DHS/MICS, two newborn contact indicators (kangaroo mother care 1.00, admission to neonatal unit 1.01) had high survey-reported coverage amongst admitted newborns and high sensitivity. The remaining indicators did not perform well and some had very high “don’t know” responses.

Conclusions

Our study revealed low validity for collecting many maternal and newborn indicators through an exit survey instrument, even with short recall periods among women with vaginal births. Household surveys are already at risk of overload, and some specific clinical care indicators do not perform well and may be under-powered. Given that approximately 80% of births worldwide occur in facilities, routine registers should also be explored to track coverage of key maternal and newborn health interventions, particularly for clinical care.
Waterbirth: a national retrospective cohort study of factors associated with its use among women in England
Authors: Aughey H. , Jardine J. , Moitt N. , Fearon K. , Hawdon J. , Pasupathy D. , Urganci I. ,   NMPA Project Team, Harris T.
Published: March 2021

Background

Waterbirth is widely available in English maternity settings for women who are not at increased risk of complications during labour. Immersion in water during labour is associated with a number of maternal benefits. However for birth in water the situation is less clear, with conclusive evidence on safety lacking and little known about the characteristics of women who give birth in water.

This retrospective cohort study uses electronic data routinely collected in the course of maternity care in England in 2015–16 to describe the proportion of births recorded as having occurred in water, the characteristics of women who experienced waterbirth and the odds of key maternal and neonatal complications associated with giving birth in water.

Methods

Data were obtained from three population level electronic datasets linked together for the purposes of a national audit of maternity care. The study cohort included women who had no risk factors requiring them to give birth in an obstetric unit according to national guidelines. Multivariate logistic regression models were used to examine maternal (postpartum haemorrhage of 1500mls or more, obstetric anal sphincter injury (OASI)) and neonatal (Apgar score less than 7, neonatal unit admission) outcomes associated with waterbirth.

Results

46,088 low and intermediate risk singleton term spontaneous vaginal births in 35 NHS Trusts in England were included in the analysis cohort. Of these 6264 (13.6%) were recorded as having occurred in water. Waterbirth was more likely in older women up to the age of 40 (adjusted odds ratio (adjOR) for age group 35–39 1.27, 95% confidence interval (1.15,1.41)) and less common in women under 25 (adjOR 18–24 0.76 (0.70, 0.82)), those of higher parity (parity ≥3 adjOR 0.56 (0.47,0.66)) or who were obese (BMI 30–34.9 adjOR 0.77 (0.70,0.85)). Waterbirth was also less likely in black (adjOR 0.42 (0.36, 0.51)) and Asian (adjOR 0.26 (0.23,0.30)) women and in those from areas of increased socioeconomic deprivation (most affluent versus least affluent areas adjOR 0.47 (0.43, 0.52)).

There was no association between delivery in water and low Apgar score (adjOR 0.95 (0.66,1.36)) or incidence of OASI (adjOR 1.00 (0.86,1.16)). There was an association between waterbirth and reduced incidence of postpartum haemorrhage (adjOR 0.68 (0.51,0.90)) and neonatal unit admission (adjOR 0.65 (0.53,0.78)).

Conclusions

In this large observational cohort study, there was no association between waterbirth and specific adverse outcomes for either the mother or the baby. There was evidence that white women from higher socioeconomic backgrounds were more likely to be recorded as giving birth in water. Maternity services should focus on ensuring equitable access to waterbirth.