bluuebunny/crossref_metadata_2025 huggingface dataset:
Methodology, Fake Learning, and Emotional Performativity
Authors: Macfarlane Bruce
Published: March 2021

Purpose:

Academics are at the forefront of criticisms about so-called “fake news” considered to undermine evidence-based approaches to the understanding of complex social, political, and economic issues. However, universities contribute to the production of fake news through the legitimization of measures that promote student performativity rewarding their academic non-achievements. This conceptual article will seek to illustrate how this can occur via the writing of methodology chapters by postgraduate students.

Design/Approach/Methods:

This article provides a critical analysis of the writing of methodology chapters in dissertations and theses in postgraduate education in the social sciences. In so doing, it applies the concept of performativity to student learning.

Findings:

It is argued that the pressures on students to comply with the requirements of emotional performativity in respect to ideology and method in close-up, qualitative research can lead to fake learning. This phenomenon may be exemplified by reference to a number of practices, namely, phony positionality, methodolatry, ethical cleansing, participatory posturing, and symbolic citation.

Originality/Value:

This article provides an illustration of the concept of student performativity. It demonstrates that emotional performativity plays a significant role in the way in which students are required to comply with expectations that give rise to inauthenticity in learning.
Happiness and Consumption: A Research Synthesis Using an Online Finding Archive
Authors: Veenhoven Ruut , Chiperi Felicia , Kang Xin , Burger Martijn
Published: March 2021

There is a considerable amount of research on the effect of income on happiness, but only a limited number of studies have considered how the spending of income works out on one’s happiness. In this article, we take stock of the scattered findings on the relation between consumption and happiness. We cover 379 research findings observed in 99 empirical studies. We use a new method of research synthesis, in which research findings are first described in a comparable format and then entered in an online “findings archive” (World Database of Happiness). This technique allows a condensed presentation of the many research findings, while providing readers access to the full results through hyperlinks from the text. Our systematic review reveals some unexpected findings, but does not provide a conclusive answer to the question of what patterns of consumption provide the most happiness for what type of people. Suggestions for further research are provided.
Uncertainty Avoidance as a Moderating Factor to the Self-Congruity Concept: The Development of a Conceptual Framework
Authors: Yang Shaohua , Isa Salmi Mohd , Ramayah T.
Published: March 2021

The aim of this article was to propose a framework based on the theory of self-congruity and on Hofstede’s uncertainty avoidance. The framework was to combine destination personality, self-congruity, uncertainty avoidance, and tourists’ revisit intention. The present conceptual paper proposed an integrated model of self-congruity which incorporates the effect of uncertainty avoidance. More importantly, the uncertainty avoidance was introduced as a moderator between self-congruity and revisit intention. Based on the theoretical framework proposed in this article, the estimated results affirmed the applicability of the theory of self-congruity for tourism research. Moreover, by extending the theoretical model through the incorporation of a variable of uncertainty avoidance in the context of tourism, this article offers a significant contribution to the tourism literature. It is important to understand how the theory of self-congruity applies across a broad cultural spectrum. This article also offers several implications for destination marketing organizations from a practical perspective.
Employee Engagement Among Millennial Workforce: Empirical Study on Selected Antecedents and Consequences
Authors: Sahni Jolly
Published: March 2021

Although employee engagement has been investigated by many scholars, there has been minimal research on this subject for millennial workforce. To bridge the research gap, the present study intends to examine employee engagement among millennial workforce of Saudi Arabia. In addition, the mediation effect of employee engagement on the relationship between antecedents; job characteristics, job satisfaction, and consequences; organizational commitment and intentions to quit is explored with social exchange theory (SET) as a theoretical underpinning. It tests the hypothesis by using data from 408 employees working in private sector companies located in Riyadh, Saudi Arabia through a self-administered questionnaire. SPSS Amos 25.0 was used to analyze the data. The results suggest that there exists a satisfactory condition of employee engagement among Saudi youth. Findings propose a significant positive relationship between job characteristics, job satisfaction, and organization commitment. Employee engagement was found to be a significant and partial mediator amid job characteristics, job satisfaction, and organization commitment. However, the results were not significant for the variable turnover intentions. There is a dearth of research on millennial workforce of Saudi Arabia, and this study would be perhaps, the first one to explore employee engagement in this context. It contributes to the current literature and theory development of employee engagement. Since the findings are based on limited millennial employees’ responses, there is no universal claim for generalization.
A Case of Intravascular Diffuse Large B-Cell Lymphoma Initially Suspected as Interstitial Pneumonia Associated With Systemic Scleroderma
Authors: Oguri Tomoyo , Sasada Shinji , Aramaki-Sumii Yuki , Tsuchiya Yumi , Ishioka Kota , Takahashi Saeko , Kunieda Hisako , Kimura Yoshifumi , Seki Reishi , Hirose Shigemichi , Nakamura Morio
Published: March 2021

Intravascular large B-cell lymphoma (IVLBCL) is a rare form of diffuse LBCL. The patient was a 71-year-old female admitted to our hospital with hypoxia. On admission, chest computed tomography revealed a ground-glass opacity. Interstitial pneumonia associated with systemic scleroderma was suspected because of positive anti-centromere antibody. Thereafter, steroid pulse therapy and plasma exchange were performed. Although ground-glass opacity improved, bilateral pleural effusion appeared, so we performed a random skin biopsy because of her elevated serum lactate dehydrogenase and soluble interleukin-2 receptor levels. The patient was diagnosed with IVLBCL with symptoms improving after 6 cycles of rituximab plus chemotherapy treatment.
Comparison of Biomechanical Factors Before and After UCL Surgery in Baseball Athletes: A Systematic Review With Meta-analysis
Authors: Hamer Tyler J. , Chung Sunghoon , Rosen Adam B.
Published: March 2021

Background:

Ulnar collateral ligament (UCL) reconstruction (UCLR) and repair (UCLr) are the gold standards in the treatment of UCL injuries. Although return-to-play timelines after UCLR have been established, pitching biomechanical variables are speculated to change after surgical intervention.

Purpose/Hypothesis:

To synthesize the literature and investigate changes in pitching biomechanics in baseball pitchers after UCLR or UCLr. We hypothesized that differences in pitching biomechanics would be observed for both intra- and interpatient comparisons.

Study Design:

Systematic review; Level of evidence, 3.

Methods:

We searched 4 electronic databases (PubMed, Web of Science, SCOPUS, and Sports Medicine & Education Index) from inception to February 2020. Data extracted included author and year of publication, study design, sample size, study population, and primary outcome variables. Meta-analysis was performed to produce random pooled effect sizes (▵).

Results:

We identified 1010 original articles for inclusion. A total of 5 studies were included in the systematic review; of these, 3 studies were included in the meta-analysis. No differences were found in shoulder range of motion (ROM) between post-UCLR and control pitchers (dominant arm external rotation ▵, 0.13°; 95% CI, –0.15° to 4.02°; P = .36); dominant arm internal rotation ▵, –0.20°; 95% CI, –0.74° to 0.35°; P = .48). Mean fastball velocity as well as pitches thrown decreased after UCLR in professional pitchers. Significant differences in elbow extension, elbow extension velocity, and shoulder internal rotation velocity were found among amateur pitchers.

Conclusion:

The results of this systematic review and meta-analysis show that limited differences exist in pitchers before and after UCLR as well as in post-UCLR pitchers and healthy, age-matched controls. UCLR may influence throwing velocity, but it had no effect on either the throwing biomechanics or theROM of baseball pitchers. Although trends appear to be forming, further evidence is needed to understand the effect of UCLR on throwing biomechanics.
Instrumental Quality Predictions and Analysis of Auditory Cues for Algorithms in Modern Headphone Technology
Authors: Biberger Thomas , Schepker Henning , Denk Florian , Ewert Stephan D.
Published: March 2021

Smart headphones or hearables use different types of algorithms such as noise cancelation, feedback suppression, and sound pressure equalization to eliminate undesired sound sources or to achieve acoustical transparency. Such signal processing strategies might alter the spectral composition or interaural differences of the original sound, which might be perceived by listeners as monaural or binaural distortions and thus degrade audio quality. To evaluate the perceptual impact of these distortions, subjective quality ratings can be used, but these are time consuming and costly. Auditory-inspired instrumental quality measures can be applied with less effort and may also be helpful in identifying whether the distortions impair the auditory representation of monaural or binaural cues. Therefore, the goals of this study were (a) to assess the applicability of various monaural and binaural audio quality models to distortions typically occurring in hearables and (b) to examine the effect of those distortions on the auditory representation of spectral, temporal, and binaural cues. Results showed that the signal processing algorithms considered in this study mainly impaired (monaural) spectral cues. Consequently, monaural audio quality models that capture spectral distortions achieved the best prediction performance. A recent audio quality model that predicts monaural and binaural aspects of quality was revised based on parts of the current data involving binaural audio quality aspects, leading to improved overall performance indicated by a mean Pearson linear correlation of 0.89 between obtained and predicted ratings.
Evaluation of Cancer Patients with Older Adult for Awareness and Hospital Arrival Process of COVID-19 Pandemic During: A Cross-Sectional Study
Authors: Sipahi Karslı Zeynep , Kurt Berna , Karadağ İbrahim , Çakmak Öksüzoğlu Berna
Published: March 2021

The study aimed to evaluate the Coronavirus pandemic awareness of cancer patients ≥65 years of age, considered a vulnerable group, and their hospital arrival process, follow-ups and treatments during the pandemic. COVID-19 pandemic was found to increases the mortality and morbidity rates of individuals who aged 65 years and older. The research was conducted with a cross-sectional descriptive correlational design. The sample consist of 77 cancer patients aged 65 years and older adult. Participants were recruited through convenience sampling. In total, 77 patients from the Oncology Hospital located in Ankara from April 29, 2020 to May 20, 2020. Data were collected using a two-part form and a questionnaire. The study was undertaken in accordance with the STROBE checklist for observational studies. Of the participants, 59.7% were female, the mean age was 70 years, 79.2% resided in Ankara and 98.7% traveled to the hospital by car. Looking at the gender and the protective measures taken at home, female participants were found to perform a statistically significant higher level of protective measures. In conclusion, the study results suggest that the restrictions for older adult oncology patients during the pandemic did not negatively affect the delivery of health care.
Effectiveness of Deworming with Single-Dose Albendazole for Preschool-Aged Children in the Dominican Republic
Authors: Japa Ingrid , Ancha Bhavya , Custodio Antonio , Ohrenschall Rachel , Cordero Ramona , Deverlis Adriana , Chapman Jennifer , Hickson Meredith R. , Steenhoff Andrew P. , Lowenthal Elizabeth D.
Published: March 2021

Background. The World Health Organization recommends biannual deworming with single-dose albendazole for all children over 1 year in regions where soil-transmitted helminths (STH) are endemic. There are limited data from the Dominican Republic (DR) on the effectiveness of deworming programs. Methods. Between January and June 2019, we enrolled 63 preschool-aged children at a community clinic in the DR. Participants received albendazole at enrollment. Stool samples were collected and examined for parasites at enrollment, 2 to 4 and 12 to 16 weeks post-albendazole. Caregivers were surveyed on home hygiene practices and children’s symptoms. Findings. At enrollment, 1 or more parasites were noted in 89% of samples. Ascaris lumbricoides (68%) was the most common species, followed by Entamoeba histolytica (35%) and Giardia intestinalis (8%). Two-to-four weeks post-albendazole, fewer than half of those with A. lumbricoides infections at baseline had cleared the infection. STH symptoms significantly improved between enrollment and 2 to 4 weeks. By 12 to 16 weeks after treatment, A. lumbricoides infections were as high as baseline. Interpretation. Although limited by size and available technology, our study contributes data on STH in the DR. Single-dose deworming with albendazole did not reduce Ascaris lumbricoides infections in our sample. As STH are the most common neglected tropical diseases and negatively impact children’s health globally, further studies on both effective deworming programs and interventions to prevent STH are needed.
Feasibility and Clinical Utility of Ultra-Widefield–Navigated Swept-Source Optical Coherence Tomography Imaging
Authors: Kovacs Kyle D. , Mahrous M. Abdallah , Gonzalez Luis , Botsford Benjamin E. , Lenis Tamara L. , Ryan Michael C. , Orlin Anton , Papakostas Thanos D. , D’Amico Donald J. , Kiss Szilárd
Published: March 2021

Purpose:

This work aims to evaluate the clinical utility and feasibility of a novel scanning laser ophthalmoscope-based navigated ultra-widefield swept-source optical coherence tomography (UWF SS-OCT) imaging system.

Methods:

A retrospective, single-center, consecutive case series evaluated patients between September 2019 and October 2020 with UWF SS-OCT (modified Optos P200TxE, Optos PLC) as part of routine retinal care. The logistics of image acquisition, interpretability of images captured, nature of the peripheral abnormality, and clinical utility in management decisions were recorded.

Results:

Eighty-two eyes from 72 patients were included. Patients were aged 59.4 ± 17.1 years (range, 8-87 years). During imaging, 4.4 series of images were obtained in 4.1 minutes, with 86.4% of the image series deemed to be diagnostic of the peripheral pathology on blinded image review. The most common pathologic findings were chorioretinal scars (18 eyes). In 31 (38%) eyes, these images were meaningful in supporting clinical decision-making with definitive findings. Diagnoses imaged included retinal detachment combined with retinoschisis, retinal hole with overlying vitreous traction and subretinal fluid, vitreous inflammation overlying a peripheral scar, Coats disease, and peripheral retinal traction in sickle cell retinopathy.

Conclusions:

Navigated UWF SS-OCT imaging was clinically practical and provided high-quality characterization of peripheral retinal lesions for all eyes. Images directly contributed to management plans, including laser, injection or surgical treatment, for a clinically meaningful set of patients (38%). Future studies are needed to further assess the value of this imaging modality and its role in diagnosing, monitoring, and treating peripheral lesions.
Evaluating the Feasibility of the Incredible Years Attentive Parenting Program as Universal Prevention for Racially Diverse Populations
Authors: Zhou Xiang , Lee Richard M. , Ohm Judy
Published: March 2021

Parenting training (PT) can be implemented as a prevention program to effectively address children’s behavioral and psychosocial problems. In the current feasibility study, we implemented the Incredible Years (IY) Attentive Parenting Program as universal/primary prevention in a community mental health setting with racially diverse families. We evaluated the attendance and treatment outcomes in a one-group pre–post design. A total of 152 parents (88% mothers; 81% non-White) participated in the IY Attentive Parenting Program. Parents who completed the program reported a significant decrease in conduct problems and an increase in prosocial behaviors in their children. Minimal differences among race and gender were found in parents’ attendance, parenting stress, and children’s internalizing and externalizing symptoms and prosocial behaviors. However, pretreatment child externalizing behaviors predicted parents’ attendance. The study provides preliminary support for the feasibility of the recently developed IY Attentive Parenting Program as a universal prevention program for behavioral and psychosocial problems in children.
Persistent short-term imprisonment: Belonging as a lens to understand its shifting meanings over the life course
Authors: Schinkel Marguerite ,   Lives Sentenced Participants
Published: March 2021

This article takes a life-course perspective to the meaning of persistent short-term imprisonment and introduces the significance of ‘penal careers’. Examining a total of 62 interviews with men and women in Scotland with long careers of (progression through) criminal punishment, it uses to the concept of belonging as a lens to interpret their experiences. While some participants already felt early on in their career that they belonged in prison because of their shared characteristics with other prisoners, the repetition of imprisonment meant that they increasingly felt displaced from life outside and saw life in prison as ‘easier’ and ‘safer’. Nevertheless, looking back on their many sentences, they felt their cumulative meaning was ‘a waste of life’. The article concludes by considering steps towards tackling the conditions that create this sense of belonging in a place of punishment.
Inclusive Growth in Maharashtra: A Dual Narrative
Authors: Suryanarayana M. H.
Published: March 2021

This study seeks to show how disaggregate profiles of welfare dimension of ‘inclusive growth’ could provide useful public policy insights in formulating development strategies. The disaggregate profile is defined with respect to regions and social groups. The study proposes concepts and illustrates with empirical estimates of measures of inclusion/exclusion and mainstreaming/marginalization for the six National Sample Survey (NSS) regions, and four social groups in rural and urban Maharashtra. The information base is the NSS estimates of household per capita consumer expenditure distribution for the two periods 2004–2005 and 2011–2012, respectively. The findings on outcomes show that the development experience of Maharashtra does not hold much promise on the inclusive growth front.
Role of authentic leadership and personal mastery in predicting employee creative behavior: a self-determination perspective
Authors: Fateh Adnan , Mustamil Norizah , Shahzad Fakhar
Published: March 2021

Personality dispositions and their role in inducing employee creative behavior are well documented in the literature. However, much is unexplored about the collective and relative contribution of personality orientations and environmental factors in explaining creative behavior. This study used a framework based on self-determination theory (SDT) to measure the combined and relative contribution of personal mastery orientation and authentic leadership in predicting employee creative behavior as mediated by autonomous motivation. A self-reported survey was conducted among software developers working in software houses. The results of the study show that both personal mastery and authentic leadership are significant predictors of employee creative behavior. In addition, autonomous motivation significantly mediates the relationship between personal mastery, authentic leadership, and creative behavior. The findings of the study lend support to the combined effect of personality orientation and environmental factors in predicting employee creative behavior and test the SDT framework’s efficacy in predicting creative behavior.
Differential microRNAs expression profiles in liver from three different lifestyle modification mice models
Authors: Gong Huan , Zhang Ming , Han Yiwen , Zhang Ying , Pang Jing , Zhao Yanyang , Chen Beidong , Wu Wei , Qi Ruomei , Zhang Tiemei
Published: March 2021

Background

MicroRNAs play an important role in many fundamental biological and pathological processes. Defining the microRNAs profile underlying the processes by beneficial and detrimental lifestyles, including caloric restriction (CR), exercise and high-fat diet (HF), is necessary for understanding both normal physiology and the pathogenesis of metabolic disease. We used the microarray to detect microRNAs expression in livers from CR, EX and HF mice models. After predicted potential target genes of differentially expressed microRNAs with four algorithms, we applied GO and KEGG to analyze the function of predicted microRNA targets.

Results

We describe the overall microRNAs expression pattern, and identified 84 differentially expressed microRNAs changed by one or two or even all the three lifestyle modifications. The common and different enriched categories of gene function and main biochemical and signal transduction pathways were presented.

Conclusions

We provided for the first time a comprehensive and thorough comparison of microRNAs expression profiles in liver among these lifestyle modifications. With this knowledge, our findings provide us with an overall vision of microRNAs in the molecular impact of lifestyle on health as well as useful clues for future and thorough research of the role of microRNAs.
A two-year review of adult emergency department mortality at Tikur Anbesa specialized tertiary hospital, Addis Ababa, Ethiopia
Authors: Yosha Hanna Daniel , Tadele Achamyelesh , Teklu Sisay , Melese Kidest Getu
Published: March 2021

Background

Adult emergency department mortality remains high in resource-limited lower-income countries. The majority of deaths occur within the first 24 h of presentation to the emergency department. Many of these mortality’s can be alleviated with appropriate interventions. This study was aimed to assess the magnitude, cause, and factors related to very early mortality in patients presented to the emergency department of Tikur Anbesa Specialized Tertiary Hospital, Ethiopia from March 2018 to 2020.

Methods

This is a cross-sectional retrospective chart review. Retrospective data were collected from the records of all patients who died within 72 h of emergency department presentation from March 2018 to 2020. Data entered using Epi data 4.2.1 and analyzed using SPSS Version 23. Using the Chi-square test, binary and multiple logistic regression analysis were carried out to measure the association of variables of interest and very early emergency mortality. P-value < 0.05, odds ratio with 95% CI were used to identify the significant factors.

Results

Between March 2018 to 2020, 30,086 patients visited the ED and 604 patients died within 72 h of presentation (274 died within 24 h and 232 within > 24–72 h). Shock (36.7%) and road traffic accidents (3.16%) were the major causes of death. Triage category red AOR 0.23 95% CI 0.1–0.55 and duration of illness 4–24 h AOR 0.47 95% CI 0.26–0.87 were significantly associated with decreased very early emergency department mortality. Meanwhile, co-morbid disease HIV AIDS AOR 2.72 95% CI 1.01–7.30 and residence Addis Ababa AOR 2.78 95% CI 1.36–5.68 and Oromia AOR 3.23 95% CI 1.58–6.54 were found significantly associated with increased very early emergency department mortality.

Conclusions and recommendations

The mortality burden of a road traffic accident and shock in the TASTH is significant and the magnitude of ED mortality differs between these groups. Residence Addis Ababa and Oromia, triage category red, co-morbid disease HIV AIDS, and duration of symptom 4–24 h were significantly associated with early emergency department mortality. Early detection and intervention are required to minimize emergency mortality.
Group testing can improve the cost-efficiency of prospective-retrospective biomarker studies
Authors: Zhang Wei , Zhang Zhiwei , Krushkal Julia , Liu Aiyi
Published: March 2021

Background

Cancer treatment is increasingly dependent on biomarkers for prognostication and treatment selection. Potential biomarkers are frequently evaluated in prospective-retrospective studies in which biomarkers are measured retrospectively on archived specimens after completion of prospective clinical trials. In light of the high costs of some assays, random sampling designs have been proposed that measure biomarkers for a random sub-sample of subjects selected on the basis of observed outcome and possibly other variables. Compared with a standard design that measures biomarkers on all subjects, a random sampling design can be cost-efficient in the sense of reducing the cost of the study substantially while achieving a reasonable level of precision.

Methods

For a biomarker that indicates the presence of some molecular alteration (e.g., mutation in a gene), we explore the use of a group testing strategy, which involves physically pooling specimens across subjects and assaying pooled samples for the presence of the molecular alteration of interest, for further improvement in cost-efficiency beyond random sampling. We propose simple and general approaches to estimating the prognostic and predictive values of biomarkers with group testing, and conduct simulation studies to validate the proposed estimation procedures and to assess the cost-efficiency of the group testing design in comparison to the standard and random sampling designs.

Results

Simulation results show that the proposed estimation procedures perform well in realistic settings and that a group testing design can have considerably higher cost-efficiency than a random sampling design.

Conclusions

Group testing can be used to improve the cost-efficiency of biomarker studies.
The efficacy and safety of itopride in feeding intolerance of critically ill patients receiving enteral nutrition: a randomized, double-blind study
Authors: Elmokadem Eman Mohamed , EL Borolossy Radwa Maher , Bassiouny Ahmed M. , Hanna Maha Gamil , Darweesh Ebtissam Abdel Ghaffar , Sabri Nagwa A.
Published: March 2021

Background

Enteral feeding intolerance (EFI) is a frequent problem in the Intensive care unit (ICU) and is associated with poor clinical outcomes leading to worse prognosis in terms of mortality and ICU stay. Nowadays, prokinetic drugs are the mainstay of therapy in EFI. However, available prokinetics have uncertain efficacy and safety profiles. Itopride, is a prokinetic agent which is different and unique from the available prokinetics because of its dual mode of action as well as its tolerability and safety. The current study compared the efficacy and safety of Itopride against metoclopramide for EFI in critically ill patients. Moreover, it tested the utility and applicability of ultrasonography to measure gastric residual volume (GRV) in this population.

Methods

This randomized, double-blind study included 76 EFI patients who were randomly assigned to either Itopride or metoclopramide group. The primary outcome was to measure GRV by ultrasonography. Secondary outcomes included the percentage ratio of enteral feed volume, energy and protein received by patients over 7 days of treatment, ICU length of stay, safety parameters and occurrence of infectious complications or vomiting.

Results

Thirty-five patients of each group completed the study. At day 7, itopride significantly decreased GRV compared with metoclopramide group (p = 0.001). Moreover, there was a significant increase in the ratios of received enteral nutrition feed volume, calories, and protein after the one-week therapy in the itopride group more than the metoclopramide group (p = 0.001), (p = 0.002), (p = 0.01), respectively and there were no differences in any secondary outcomes or adverse events between the two groups.

Conclusion

In critically ill patients with EFI, itopride was well tolerated with superior efficacy to metoclopramide. In addition, we demonstrated that ultrasonography is a simple, non-invasive, inexpensive, and undemanding method for GRV measurements and can offer reliable assessments in the gastric emptying modality.

Trial registration

The trial was registered in ClinicalTrials.gov (NCT03698292). Date: October 5, 2018
Risk factors for measles deaths among children during a Nationwide measles outbreak – Romania, 2016–2018
Authors: Donadel Morgane , Stanescu Aurora , Pistol Adriana , Stewart Brock , Butu Cassandra , Jankovic Dragan , Paunescu Bogdan , Zimmerman Laura
Published: March 2021

Background

Case fatality ratio (CFR) among all age groups during the 2016–2018 measles outbreak in Romania was increased compared with previous outbreaks. To identify risk factors for measles death, we conducted a case-control study among infants and children hospitalized for measles.

Methods

National surveillance data were used to identify hospitalized cases of laboratory-confirmed or epidemiologically linked measles in infants and children aged< 59 months with rash onset from January 2016 to July 2018. We abstracted medical records of 50 fatal cases (“cases”) and 250 non-fatal cases (“controls”) matched by age, sex, district of residence, and urban/rural place of residence. We calculated univariable and multivariable matched odds ratios (OR) and 95% confidence intervals (CIs) for risk factors.

Results

Ninety-three percent of case-patients and controls had not received a valid dose of a measles-containing vaccine; only 5 % received Vitamin A supplementation once diagnosed with measles. In the univariable analysis, cases were more likely than controls to have had a healthcare-related exposure to measles manifesting as inpatient admission for pneumonia during the 7 to 21 day measles incubation period (OR: 3.0; 95% CI [1.2, 7.2]), to have had a history of malnutrition (OR: 3.4; 95% CI [1.1, 9.9]), and to have had pneumonia as a complication of measles (OR:7.1; 95% CI [2.0–24.8]). In the multivariable analysis, pneumonia as a measles complication remained a risk for death (OR: 7.1; 95% CI [1.4–35.3]).

Conclusions

Implementing infection prevention and control practices, ensuring immunization of healthcare workers, and hospitalizing only severe measles cases may minimize the risk of nosocomial measles transmission. Implementing World Health Organization (WHO) recommendations for Vitamin A supplementation, improving immunization of children to prevent influenza, pneumococcal, and other bacterial respiratory diseases may decrease complications and deaths due to measles in Romania.
Brain activation patterns in medicated versus medication-naïve adults with attention-deficit hyperactivity disorder during fMRI tasks of motor inhibition and cognitive switching
Authors: Berberat Jatta , Huggenberger Ruth , Montali Margherita , Gruber Philipp , Pircher Achmed , Lövblad Karl-Olof , Killer Hanspeter E. , Remonda Luca
Published: March 2021

Background

Adult-attention-deficit-hyperactive-disorder (ADHD) is often unrecognized condition. FMRI examination along with neuropsychological testing might strengthen the diagnosis. We hypothesized that ADHD-adults with and without medication would show different fMRI pattern compared to healthy controls while testing tasks of motor inhibition and cognitive switching.

Methods

45 subjects in three age-matched groups: (1) controls, (2) ADHD-adults under medication (ADHD+) and (3) medication-naïve adults with ADHD (ADHD−) underwent fMRI and neuropsychological testing. Group analysis and population-based statistics were performed.

Results

DTVP-A, intellectual ability as well as attention capability, visual-perceptual and visual-motor abilities showed no significant differences between the groups. However, fMRI revealed statistically significant differences between the ADHD+, ADHD− and control groups on tasks of motor inhibition and cognitive switching on adults in bilateral fronto-striatal brain regions, inferior fronto-frontal, fronto-cingulate and fronto-parietal networks as well as in the parietal lobe (p < 0.05).

Conclusions

fMRI offers the potential to differentiate between the ADHD+, ADHD− and control groups. FMRI possibly opens a new window for monitoring the therapeutic effect of ADHD medication.

Trial registration

NCT02578342, registered at August 2015 to clinical trial registry (https://ichgcp.net/clinical-trials-registry/NCT02578342).
Diffusion tensor imaging revealed different pathological processes of white matter hyperintensities
Authors: Min Zhi-gang , Shan Hai-rong , Xu Long , Yuan Dai-hai , Sheng Xue-xia , Xie Wen-chao , Zhang Ming , Niu Chen , Shakir Tahir Mehmood , Cao Zhi-hong
Published: March 2021

Background

Although increasing evidence showed the correlations between white matter hyperintensities (WMHs) and cognitive impairment, the relationship between them is still modest. Many researchers began to focus on the variation caused by the heterogeneity of WMH. We tried to explore the pathological heterogeneity in WMH by using diffusion tensor imaging (DTI), so as to provide a new insight into the future research.

Methods

Diffusion weighted images (DWIs) of the brain were acquired from 73 patients with WMH and 18 healthy controls, which were then modeled by DTI. We measured fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) of white matter of the periventricular frontal lobe (pFL), periventricular occipital lobe (pOL), periventricular parietal lobe (pPL) and deep centrum ovales (dCO), and grouped these measures according to the Fazekas scale. Then we compared the DTI metrics of different regions with the same Fazekas scale grade.

Results

Significantly lower FA values (all p < 0.001), and higher MD (all p < 0.001) and RD values (all p < 0.001) were associated with WMH observed in the periventricular frontal lobe (pFL) compared to all other regions with the same Fazekas grades. The AD of WMH in the pFL was higher than that of pPL and dCO, but the differences between groups was not as high as of MD and RD, as indicated by the effect size. In the normal control group, DTI metrics between pFL and other regions were not significantly different or less significant different. The difference of DTI metrics of WMH between pPL, pOL and dCO was lower than that of normal white matter, as indicated by the effect size.

Conclusion

Distinct pathological processes can be revealed by DTI between frontal periventricular WMH and other regions. These processes may represent the effects of severe demyelination within the frontal periventricular WMH.
“Enhanced recovery after surgery – ERAS in elective craniotomies-a non-randomized controlled trial”
Authors: Elayat Anirudh , Jena Sritam S. , Nayak Sukdev , Sahu R. N. , Tripathy Swagata
Published: March 2021

Background

Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care bundle aimed at the early recovery of patients. Well accepted in gastric and pelvic surgeries, there is minimal evidence in neurosurgery and neurocritical care barring spinal surgeries. We wished to compare the length of intensive care unit (ICU) or high dependency unit (HDU) stay of patients undergoing elective craniotomy for supratentorial neurosurgery: ERAS protocol versus routine care. The secondary objective was to compare the postoperative pain scores, opioid use, glycemic control, and the duration of postoperative hospital stay between the two groups.

Methods

In this pragmatic non-randomized controlled trial (CTRI/2017/07/015451), consenting adult patients scheduled for elective supratentorial intracranial tumor excision were enrolled prospectively after institutional ethical clearance and consent. Elements-of-care in the ERAS group were- Preoperative –family education, complex-carbohydrate drink, flupiritine; Intraoperative – scalp blocks, limited opioids, rigorous fluid and temperature regulation; Postoperative- flupiritine, early mobilization, removal of catheters, and initiation of feeds. Apart from these, all perioperative protocols and management strategies were similar between groups. The two groups were compared with regards to the length of ICU stay, pain scores in ICU, opioid requirement, glycemic control, and hospital stay duration. The decision for discharge from ICU and hospital, data collection, and analysis was by independent assessors blind to the patient group.

Results

Seventy patients were enrolled. Baseline demographics – age, sex, tumor volume, and comorbidities were comparable between the groups. The proportion of patients staying in the ICU for less than 48 h after surgery, the cumulative insulin requirement, and the episodes of VAS scores > 4 in the first 48 h after surgery was significantly less in the ERAS group – 40.6% vs. 65.7%, 0.6 (±2.5) units vs. 3.6 (±8.1) units, and one vs. ten episodes (p = 0.04, 0.001, 0.004 respectively). The total hospital stay was similar in both groups.

Conclusion

The study demonstrated a significant reduction in the proportion of patients requiring ICU/ HDU stay > 48 h. Better pain and glycemic control in the postoperative period may have contributed to a decreased stay. More extensive randomized studies may be designed to confirm these results.

Trial registration

Clinical Trial Registry of India (CTRI/2018/04/013247), registered retrospectively on April 2018.
Wilms’ tumor gene 1 is an independent prognostic factor for pediatric acute myeloid leukemia following allogeneic hematopoietic stem cell transplantation
Authors: Deng Dao-Xing , Wen Juan-Juan , Cheng Yi-Fei , Zhang Xiao-Hui , Xu Lan-Ping , Wang Yu , Yan Chen-Hua , Chen Yu-Hong , Chen Huan , Han Wei , Wang Feng-Rong , Wang Jing-Zhi , Qin Ya-Zhen , Liu Kai-Yan , Huang Xiao-Jun , Zhao Xiao-Su , Mo Xiao-Dong
Published: March 2021

Background

Sequential monitoring of Wilms’ tumor gene 1 (WT1) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) could predict relapse in adult acute myeloid leukemia (AML). However, the prognostic role of WT1 in pediatric AML after allo-HSCT is unclear. Thus, we determined to see whether sequential monitoring of WT1 after allo-HSCT could predict relapse in AML children.

Methods

Pediatric AML patients receiving allo-HSCT from January 21, 2012 to December 20, 2018 at the Peking University Institute of Hematology were included in this study. WT1 expression level was determined by TaqMan-based reverse transcription-polymerase chain reaction. WT1 sequential monitoring was performed 1, 2, 3, 4.5, 6, 9, and 12 months post-transplantation and at 6-month intervals thereafter. The primary end point was relapse. The secondary end points included disease-free survival (DFS), overall survival (OS), and non-relapse mortality (NRM). Kaplan–Meier analysis was used for DFS and OS estimates, while competing risk analysis was used for estimating relapse and NRM.

Results

Of the 151 consecutive patients included, the median age was 10 years (range, 1–17). The optimal cutoff value of WT1 within 1 year after allo-HSCT to predict relapse was 0.8% (80 WT1 copies/104 ABL copies), with a sensitivity of 60% and specificity of 79%. Compared with WT1 expression < 0.8%, WT1 expression ≥0.8% indicated significantly higher 5-year cumulative incidence of relapse (CIR, 35.1% vs. 11.3%; P = 0.001), lower 5-year disease-free survival (DFS, 60.4% vs. 80.8%; P = 0.009), and lower 5-year overall survival (OS, 64.9% vs. 81.6%; P = 0.038) rates. Multivariate analyses showed that WT1 was an independent risk factor for relapse (HR 2.89; 95% confidence interval (CI), 1.25–6.71; P = 0.014). Both the CIR (5-year CIR: 8.3% vs. 11.3%; P = 0.513) and DFS (5-year DFS: 91.7% vs. 80.8%; P = 0.208) were comparable between patients achieving minimal residual disease (MRD) negativity after preemptive interferon-α (IFN-α) treatment and those without MRD after allo-HSCT, which were better than those of MRD-positive patients without preemptive therapies.

Conclusions

Sequential monitoring of WT1 could predict relapse in pediatric AML after allo-HSCT. WT1-directed immunotherapy may have the potential to prevent relapse and improve survival.
Minimize the extent and morbidity of axillary dissection for node-positive breast cancer patients: implementation of axillary lymph node dissection based on breast lymphatics level
Authors: Yuan Qianqian , Hou Jinxuan , He Yukun , Liao Yiqian , Zheng Lewei , Wu Gaosong
Published: March 2021

Background

Breast cancer-related lymphedema (BCRL) is associated with extensive axillary dissection. Axillary lymph node dissection (ALND) based on breast lymphatics level (BLL) was proposed to minimize the surgical extent for node-positive breast cancer patients.

Methods

A total of 156 consecutive sentinel lymph node-positive (SLN+) or clinically node-positive (cN+) patients underwent sentinel lymph node biopsy (SLNB) with indocyanine green and methylene blue (MB). The SLNs were injected with 0.1 ml MB before removal, and a standard ALND was subsequently performed. The nodes adjacent to the blue-stained axillary lymph nodes from the breast (bALNs) were sent for pathological examination separately by resecting serial tissue every 0.5 cm away from the marginal blue-stained bALNs. Then, a pilot study comparing ALND based on BLL and standard ALND was performed.

Results

BLL were successfully identified in 20 SLN+ (100%) and 134 cN+ (98.5%) patients. The median number of BLL was four, ranging from three to six. A horizontal line 1.0 cm away from the superior blue-stained bALN and a vertical line 1.0 cm away from the medial blue-stained bALN formed BLL II, III, and IV. All of the additional positive nodes were within 1.0 cm of the blue-stained bALNs. The minimized axillary dissection should resect upwards from the lowest BLL that contains the first confirmed negative blue-stained bALNs. In the pilot study, no patient developed axillary recurrence.

Conclusion

The ALND surgical procedure based on BLL could minimize the surgical extent for pathological node-positive breast cancer patients and potentially reduce the BCRL rate.

Trial registration

ChiCTR1800014247.
Sampling trabecular meshwork using TrabEx+
Authors: Ramjiani Vipul , Mudhar Hardeep-Singh , Julian Thomas , Auger Graham
Published: March 2021

Background

To report sampling of the trabecular meshwork using the TrabEx+ (MicroSurgical Technology, Redmond, Washington, USA) device in ab interno trabeculectomy. Specifically, this series focusses upon preservation of the trabecular meshwork architecture for assessment of glaucomatous features using common histopathological techniques.

Patients

This series features six glaucomatous eyes undergoing TrabEx+ with or without cataract surgery. Three patients had primary open angle glaucoma and the remaining had pigment dispersion glaucoma, ocular hypertension or uveitic glaucoma. Four eyes had simultaneous cataract surgery.

Methods

Trabecular meshwork was excised using the TrabEx+ device and retrieved using vitreoretinal forceps. The samples were then processed into formalin-fixed paraffin-embedded 4 micron tissue segments and stained with haematoxylin and eosin, periodic acid–Schiff and elastin Van Gieson. Collagen IV was labelled using immunohistochemistry for the purpose of identifying the basement membrane of trabecular beams.

Results

Presence of trabecular meshwork was confirmed in five of the six samples taken. One of six samples consisted of blood only, but this was expected following early termination of the procedure due to patient restlessness. In the five positive cases trabecular beams with associated trabecular meshwork cells were identified on hematoxylin-eosin and periodic acid–Schiff staining. The beams retained their lamellar structure. The basement membrane underlying the trabecular cells was evident in three specimens, whilst two specimens were of insufficient size for collagen IV labelling.

Conclusions

This case series illustrates that TrabEx+ can be utilised to successfully retrieve trabecular meshwork samples with sufficient architectural perseveration of the tissue to enable histopathological and laboratory analysis.
Cognitive insight is associated with perceived body weight in overweight and obese adults
Authors: Suliman Sharain , L. van den Heuvel Leigh , Kilian Sanja , Bröcker Erine , Asmal Laila , Emsley Robin , Seedat Soraya
Published: March 2021

Background

Accurate perception of body weight is necessary for individuals with a high body mass index (BMI) to initiate strategies to improve their health status. Furthermore, identifying factors that influence accurate body weight perception can assist in designing appropriate educational and weight management programs. We therefore aimed to investigate whether levels of cognitive functioning and insight influence the ability to correctly judge body weight.

Methods

One hundred and eighty four overweight and obese adults who participated in a cross- sectional case-control study and were controls in the aforementioned study were included. The study was conducted in Cape Town, South Africa. Demographic, weight-related, neuropsychiatric, neurocognitive and cognitive insight measures were administered. Regression analysis was conducted to determine the factors associated with correct weight perception.

Results

The final regression model explained 52.3% of variation in accurate perception of body weight and was significant (p ≤ 0. 001). The model correctly classified 79.3% of individuals who were able to correctly and incorrectly judge their weight. Adults with higher BMI, and lower self-certainty, those who reported that they had gained weight in the previous year and those who were told by a healthcare professional to lose or maintain a healthy weight were more likely to correctly judge their weight.

Conclusion

Some aspects of cognitive insight (self-certainty) but not cognitive functioning were associated with perception of body weight in this sample. Awareness of recent weight changes, higher BMI and advice from of health care professionals were also significantly associated with perception of body weight, while demographic variables were not. Understanding the factors that contribute to the correct perception of weight is important in identifying appropriate health interventions that may address the burden of associated non-communicable diseases in overweight and obese individuals.