bluuebunny/crossref_metadata_2025 huggingface dataset:
In situ exfoliation and modification of graphite foil in supercapacitor devices: a facile strategy to fabricate high-performance supercapacitors
Authors: Jang Byungkwon , Kim Han , Park Si-Woo , Lim Minseob , Lee Jimin , Go Gwang-Myeong , Choa Yong-Ho
Published: January 2021

Simple fabrication for high performance supercapacitors.
Rapid synthesis of internal peptidyl α-ketoamides by on resin oxidation for the construction of rhomboid protease inhibitors
Authors: Van Kersavond Tim , Konopatzki Raphael , van der Plassche Merel A. T. , Yang Jian , Verhelst Steven H. L.
Published: January 2021

Rhomboid intramembrane serine proteases are involved in various biological processes. A solid phase synthesis of internal α-ketoamides reported here shows that primed site elements are crucial for rhomboid protease inhibition.
Designing caps for colloidal Au nanoparticles
Authors: Tian Xiaoli , Zong Jianpeng , Zhou Yusai , Chen Dapeng , Jia Jia , Li Shuaibin , Dong Xiaochen , Feng Yuhua , Chen Hongyu
Published: January 2021

We show that active surface growth is an effective method to create structural variety in the appending domain of Au seeds. The dynamic competition between the growth sites led to different Au hats on seeds.
Hybrid layered double hydroxides as multifunctional nanomaterials for overall water splitting and supercapacitor applications
Authors: Tomboc Gracita M. , Kim Jun , Wang Yunting , Son Yunchang , Li Jinghong , Kim Jin Young , Lee Kwangyeol
Published: January 2021

This review critically assessed the progress of hybrid LDHs nanostructure as competent multifunctional nanomaterials for energy conversion and storage systems.
Retraction: Melatonin protects spinal cord injury by up-regulating IGFBP3 through the improvement of microcirculation in a rat model
Authors: Fisher Laura
Published: January 2021

Retraction of ‘Melatonin protects spinal cord injury by up-regulating IGFBP3 through the improvement of microcirculation in a rat model’ by Kun Wang et al., RSC Adv., 2019, 32072–32080, DOI: 10.1039/C9RA04591K.
Retraction: Circular RNA hsa_circ_0000467 modulates SGK1 to facilitate cell migration, metastasis, and EMT while repressing apoptosis in colorectal cancer by sponging miR-383-5p
Authors: Fisher Laura
Published: January 2021

Retraction of ‘Circular RNA hsa_circ_0000467 modulates SGK1 to facilitate cell migration, metastasis, and EMT while repressing apoptosis in colorectal cancer by sponging miR-383-5p’ by Chong Liu et al., RSC Adv., 2019, 9, 39294–39303, DOI: 10.1039/C9RA07900A.
Retraction: Long non-coding RNA KCNQ1OT1 promotes osteosarcoma progression by increasing β-catenin activity
Authors: Fisher Laura
Published: January 2021

Retraction of ‘Long non-coding RNA KCNQ1OT1 promotes osteosarcoma progression by increasing β-catenin activity’ by Changsheng Zhang et al., RSC Adv., 2018, 8, 37581-37589, DOI: 10.1039/C8RA07209D.
Retraction: PVT1 knockdown alleviates vancomycin-induced acute kidney injury by targeting miR-124 via inactivation of NF-κB signaling
Authors: Fisher Laura
Published: January 2021

Retraction of ‘PVT1 knockdown alleviates vancomycin-induced acute kidney injury by targeting miR-124 via inactivation of NF-κB signaling’ by Xiaoguang Zhu et al., RSC Adv., 2018, 8, 31725–31734, DOI: 10.1039/C8RA05724A.
Positive Changes in Certified Nursing Assistants' Communication Behaviors With People With Dementia: Feasibility of a Coaching Strategy
Authors: Douglas Natalie F. , MacPherson Megan K.
Published: January 2021

Purpose

This study investigated whether a 6-week coaching strategy resulted in positive changes in self-perceived knowledge and efficacy (SPKE) and positive communication behaviors in certified nursing assistants (CNAs) working with people with dementia in a skilled nursing facility. It also assessed the impact of the coaching strategy on negative responsive behaviors of people with dementia, such as yelling out, hitting, or spitting.

Method

Seven CNAs and seven people with dementia completed this study. Pretesting and posttesting were conducted for CNAs' SPKE. A single-subject, multiple-baseline design across five communication behaviors, the positive communication approach checklist, was completed to assess CNA communication behaviors after completion of a coaching strategy. Pretesting and posttesting of responsive behaviors of people with dementia were completed with the Cohen–Mansfield Agitation Inventory.

Results

Six out of seven CNAs improved their SPKE from pre- to postcoaching; however, this difference was not statistically significant. Per the positive communication approach checklist, there was a statistically significant increase, from baseline to follow-up, in CNA positive communication behaviors when interacting with people with dementia. The frequency of overall responsive behaviors of people with dementia significantly decreased from pre- to postcoaching, per the Cohen–Mansfield Agitation Inventory.

Conclusions

There is preliminary evidence to support the feasibility of a coaching strategy for the implementation of positive communication behaviors by CNAs when communicating with people with dementia. Negative responsive behaviors of people with dementia also decreased. Speech-language pathologists should consider acting as coaches to support positive communication for people with dementia.

Supplemental Material

https://doi.org/10.23641/asha.13564811
Sensory Innervation of the Larynx and the Search for Mucosal Mechanoreceptors
Authors: Foote Alexander G. , Thibeault Susan L.
Published: January 2021

Purpose

The larynx is a uniquely situated organ, juxtaposed between the gastrointestinal and respiratory tracts, and endures considerable immunological challenges while providing reflexogenic responses via putative mucosal mechanoreceptor afferents. Laryngeal afferents mediate precise monitoring of sensory events by relay to the internal branch of the superior laryngeal nerve (iSLN). Exposure to a variety of stimuli (e.g., mechanical, chemical, thermal) at the mucosa–airway interface has likely evolved a diverse array of specialized sensory afferents for rapid laryngeal control. Accordingly, mucosal mechanoreceptors in demarcated laryngeal territories have been hypothesized as primary sources of sensory input. The purpose of this article is to provide a tutorial on current evidence for laryngeal afferent receptors in mucosa, the role of mechano-gated ion channels within airway epithelia and mechanisms for mechanoreceptors implicated in laryngeal health and disease.

Method

An overview was conducted on the distribution and identity of iSLN-mediated afferent receptors in the larynx, with specific focus on mechanoreceptors and their functional roles in airway mucosa.

Results/Conclusions

Laryngeal somatosensation at the cell and molecular level is still largely unexplored. This tutorial consolidates various animal and human researches, with translational emphasis provided for the importance of mucosal mechanoreceptors to normal and abnormal laryngeal function. Information presented in this tutorial has relevance to both clinical and research arenas. Improved understanding of iSLN innervation and corresponding mechanotransduction events will help shed light upon a variety of pathological reflex responses, including persistent cough, dysphonia, and laryngospasm.
A novel divergence measure–based routing algorithm in large‐scale satellite networks
Authors: Wang Zhonghao , Li Jinze , Chen Haiqiang , Qin Tuanfa
Published: January 2021

In recent years, large‐scale satellite networks have been studied emphatically due to its advantages in high throughput and low latency. Many companies and institutions are keen to build large‐scale low earth orbit satellite constellations to provide space‐based Internet services, which poses a great demand for the design of efficient and reliable routing schemes. Three attribute indexes to evaluate the performance of the satellites are proposed. With the Dempster–Shafer theory, the attributes can be fused for the routing decision‐making process. Based on the Message Identification divergence (M‐I divergence) measure method, a Belief Message Importance divergence based Routing algorithm is proposed. By adjusting the characteristic parameter, it can amplify the divergence between distance‐based evidence and others properly. In this way, Belief Message Importance divergence‐based Routing attempts to find the optimal shortest path according to the status of intermediate nodes. Compared with existing satellite routing schemes, the algorithm that is proposed can approach the optimal routing performance, increasing the throughput by 47.2% on average, and decreasing the total delay and packet drop rate by 59.5% and 42.1% on average, respectively.
Generative adversarial network for low‐light image enhancement
Authors: Li Fei , Zheng Jiangbin , Zhang Yuan‐fang
Published: January 2021

Low‐light image enhancement is rapidly gaining research attention due to the increasing demands of extreme visual tasks in various applications. Although numerous methods exist to enhance image qualities in low light, it is still undetermined how to trade‐off between the human observation and computer vision processing. In this work, an effective generative adversarial network structure is proposed comprising both the densely residual block (DRB) and the enhancing block (EB) for low‐light image enhancement. Specifically, the proposed end‐to‐end image enhancement method, consisting of a generator and a discriminator, is trained using the hyper loss function. The DRB adopts the residual and dense skip connections to connect and enhance the features extracted from different depths in the network while the EB receives unique multi‐scale features to ensure feature diversity. Additionally, increasing the feature sizes allows the discriminator to further distinguish between fake and real images from the patch levels. The merits of the loss function are also studied to recover both contextual and local details. Extensive experimental results show that our method is capable of dealing with extremely low‐light scenes and the realistic feature generator outperforms several state‐of‐the‐art methods in a number of qualitative and quantitative evaluation tests.
Multiwavelength constraints on the unidentified Galactic TeV sources HESS J1427−608, HESS J1458−608, and new VHE γ-ray source candidates
Authors: Devin J. , Renaud M. , Lemoine-Goumard M. , Vasileiadis G.
Published: January 2021

Aims. Among the γ-ray sources discovered at high and very-high energies, a large fraction still lack a clear identification. In particular, the H.E.S.S. Galactic Plane Survey (HGPS) revealed 78 TeV sources among which 47 are not clearly associated with a known object. Multiwavelength data can help identify the origin of the very-high energy γ-ray emission, although some bright TeV sources have been detected without clear counterparts. We present a multiwavelength approach to constrain the origin of the emission from unidentified HGPS sources.

Methods. We present a generic pipeline that explores a large database of multiwavelength archival data toward any region in the Galactic plane. Along with a visual inspection of the retrieved multiwavelength observations to search for faint and uncataloged counterparts, we derive a radio spectral index that helps disentangle thermal from nonthermal emission and a mean magnetic field through X-ray and TeV data in case of a leptonic scenario. We also search for a spectral connection between the GeV and the TeV regimes with the Fermi-LAT cataloged sources that may be associated with the unidentified HGPS source. We complete the association procedure with catalogs of known objects (supernova remnants, pulsar wind nebulae, H II regions, etc.) and with the source catalogs from instruments whose data are retrieved.

Results. The method is applied on two unidentified sources, namely HESS J1427−608 and HESS J1458−608, for which the multiwavelength constraints favor the pulsar wind nebula (PWN) scenario. We model their broadband nonthermal spectra in a leptonic scenario with a magnetic field B ≲ 10 μG, which is consistent with that obtained from ancient PWNe. We place both sources within the context of the TeV PWN population to estimate the spin-down power and the characteristic age of the putative pulsar. We also shed light on two possibly significant γ-ray excesses in the HGPS: the first is located in the south of the unidentified source HESS J1632−478 and the second is spatially coincident with the synchrotron-emitting supernova remnant G28.6−0.1. The multiwavelength counterparts found toward both γ-ray excesses make these promising candidates for being new very-high energy γ-ray sources.
Possible substellar companions in dwarf eclipsing binaries
Authors: Wolf M. , Kučáková H. , Zasche P. , Hornoch K. , Kára J. , Merc J. , Zejda M.
Published: January 2021

We present the new results of our long-term observational project to detect the small variations in the orbital periods of low-mass and short-period eclipsing binaries. About 120 new precise mid-eclipse times were obtained for three relatively well-known dwarf eclipsing binaries: SDSS J143547.87+373338.5 (P = 0.126 d), NSVS 07826147 (0.162 d), and NSVS 14256825 (0.110 d). Observed-minus-calculated diagrams of these systems were analyzed using all accurate timings, and, where possible, new parameters of the light-time effect were calculated. For the first time, we derive (or improve upon previous findings with regard to) the short orbital periods of 13 and 10 years of possible third bodies for SDSS J143547.87+373338.5 and NSVS 07826147, respectively. In these binaries, our data show that period variations can be modeled simply on the basis of a single circumbinary object. For the first two objects, we calculated the minimum mass of the third components to be 17 MJup and 1.4 MJup respectively, which corresponds to the mass of a brown dwarf or a giant planet. For NSVS 14256825, the cyclical period changes caused by a single additional body cannot be confirmed by our recent eclipse time measurements. More complex behavior connected with two orbiting bodies, or yet unknown effects, should be taken into account.
A simplified analysis of the Chernobyl accident
Authors: Mercier Bertrand , Yang Di , Zhuang Ziyue , Liang Jiajie
Published: January 2021

We show with simplified numerical models, that for the kind of RBMK operated in Chernobyl:

The core was unstable due to its large size and to its weak power counter-reaction coefficient, so that the power of the reactor was not easy to control even with an automatic system.

Xenon oscillations could easily be activated.

When there was xenon poisoning in the upper half of the core, the safety rods were designed in such a way that, at least initially, they were increasing (and not decreasing) the core reactivity.

This reactivity increase has been sufficient to lead to a very high pressure increase in a significant amount of liquid water in the fuel channels thus inducing a strong propagating shock wave leading to a failure of half the pressure tubes at their junction with the drum separators.

The depressurization phase (flash evaporation) following this failure has produced, after one second, a significant decrease of the water density in half the pressure tubes and then a strong reactivity accident due to the positive void effect reactivity coefficient.

We evaluate the fission energy released by the accident
Preparation of an “Information booklet for returnees” – Building trust through collaboration with local communities
Authors: Kuroda Y. , Koyama Y. , Yoshida H. , Naito W.
Published: January 2021

This paper describes an exercise in helping scientific experts find common ground with local residents following the 2011 Fukushima nuclear accident. The first section discusses the effects of the accident in Iitate Village, which was fully evacuated after the accident, and the village’s sociocultural background, and presents a case study of a collaboration between experts and villagers in preparing an information booklet for the villagers. The second section discusses the potential for collaborations of experts in different disciplines to connect science and people, clarifies what experts learned from such a collaboration, and explains that cross-disciplinary collaboration is essential to avoiding confusion among residents. Concerns and questions from local residents were specific to their situation; residents needed specific information and advice on specific situations at specific times. The residents considered those concerns important and needed answers that would allow them to regain control over their lives. An information booklet was prepared to help local experts to build trust with the residents by providing them with the information they sought. The experts considered the process of developing the booklet to be a good example of collaboration with residents. Understanding the social values of residents, sharing those values, and making a commitment to the community were significant steps in building trust.
Implementing eHealth with radiation records: a new support package for evacuees returning to areas around the Fukushima Daiichi nuclear power station
Authors: Ohba T. , Goto A. , Nakano H. , Nollet K.E. , Murakami M. , Yoshida K. , Yumiya Y. , Honda K. , Kuroda Y. , Kumagai A. , Ohira T. , Tanigawa K.
Published: January 2021

Following the 2011 Fukushima Daiichi nuclear power station (FDNPS) accident, numerous initiatives emerged to address the needs of evacuees, including those eligible to return home. These came from multiple channels, timely in many cases, but in retrospect, needing better coordination. By embracing eHealth, we are attempting to coordinate efforts in Fukushima intended to link returnees with health information and care providers, not only for radiological protection in particular, but also for health promotion in general. We aim to establish a comprehensive support system for residents in municipalities around the FDNPS by developing a digital application for interactive communication regarding radiation and health promotion and to link the tool to other resources provided by local health care providers and radiation specialists. This paper explains the progress of our innovative trial to introducing eHealth in areas affected by the FDNPS accident. Based on international recommendations for developing a digital tool in response to a nuclear accident, we designed a comprehensive support package including development and implementation of the application, data management, and health counselling and ethical considerations arising from such outreach. Our trial of connecting disaster-affected citizens to health services using informatics could serve as a model eHealth program for long-term restoration after a nuclear accident.
Chalandise ou expertise(s) : le développement économique des clubs professionnels de sport indoor. Étude de cas de trois clubs du Nord
Authors: Terrien Mickael , Valin Guillaume , Jugé Raphaël
Published: January 2021

Cet article s’intéresse au développement économique des clubs de première division masculine de basketball, de handball et de volley-ball. Différents facteurs exogènes contraignent le développement économique de ces clubs sportifs professionnels. Évoluant dans des zones de chalandises restreintes, la marge de manœuvre semble réduite pour ces organisations. Néanmoins, une analyse documentaire permet de mettre à jour la transformation du modèle économique des clubs de handball. Les résultats montrent l’importance des facteurs endogènes et plus particulièrement le rôle de l’expertise commerciale dans cette mutation. L’arrivée d’un magnat dans cette ligue a en effet obligé les autres clubs à mieux se structurer pour rester concurrentiel. Une étude de cas multiple auprès d’un club dans chacune de ces ligues permet de vérifier ces résultats. Lorsque les clubs adaptent leurs stratégies commerciales, ils s’avèrent capables d’attirer de nouvelles sources de financement permettant de réduire leur dépendance aux subventions.
Focal Autoimmune Pancreatitis: A Simple Flow Chart for a Challenging
Diagnosis
Authors: Conti Clara Benedetta , Cereatti Fabrizio , Drago Andrea , Grassia Roberto
Published: January 2021

Autoimmune pancreatitis is a chronic fibroinflammatory autoimmune mediated
disease of the pancreas. Clinically, obstructive painless jaundice and upper
abdominal pain are the main symptoms. Focal AIP is characterized by
segmental involvement of pancreatic parenchyma and it is often
radiologically represented by a pancreatic mass. In these cases, the
diagnosis can be very challenging, since it may be easily confused with
pancreatic cancer. Therefore, we suggest a combined approach of imaging
tests as the diagnostic workup. EUS study combined with CEUS and
elastography, if available, increases the accuracy of the method to rule out
cancer. Moreover, the lesion should always be sampled under EUS guidance to
obtain a cyto/histological diagnosis. The diagnostic workup should
also include the use of diagnostic clinical criteria (extrapancreatic
lesions, steroid response) and laboratory findings (CA 19.9 and IgG4
evaluations).
Stigma als Behandlungsbarriere bei ehemaligen DDR-Heimkindern – Eine qualitative Studie am Beispiel der Mitglieder der „Betroffeneninitiative Missbrauch in DDR-Kinderheimen“
Authors: Gfesser Tobias , Rechenberg Theresia , Glaesmer Heide , Schomerus Georg
Published: January 2021

Ziel der Studie Explorative Untersuchung zu Stigma als Behandlungsbarriere bei ehemaligen DDR-Heimkindern mit traumatischen Erfahrungen.

Methodik Besprechung des Themas „Stigmatisierung“ innerhalb der Selbsthilfegruppe der „Betroffeneninitiative Missbrauch in DDR-Kinderheimen“ anhand eines Interviewleitfadens. Thematische Analyse der Besprechung.

Ergebnisse Betroffene berichten Stigmatisierung in der Öffentlichkeit, in der Familie und strukturell. Dies geht mit Hilfesuchbarrieren bezüglich somatischer und psychosozialer Versorgung einher.

Schlussfolgerung Es ist wichtig, die Hilfesuchbarrieren der Betroffenen wahrzunehmen und ihnen Raum zu geben, traumatische Erfahrungen und deren Folgen anzusprechen.
A novel endoscopic purse-string suture technique, “loop 9”, for gastrointestinal defect closure: a pilot study
Authors: Inoue Haruhiro , Tanabe Mayo , Shimamura Yuto , Rodriguez de Santiago Enrique , Fujiyoshi Yusuke , Toshimori Akiko , Abad Mary Raina Angeli , Nishikawa Yohei , Nashida Kosuke , Sumi Kazuya , Ikeda Haruo , Onimaru Manabu , Uragami Naoyuki
Published: January 2021

Background This study aimed to assess the feasibility and efficacy of the novel loop 9 method of gastrointestinal (GI) defect closure.

Methods 20 patients underwent a GI procedure that required defect closure. Loop 9 can be delivered through a single instrument channel (3.2 mm) and released at the defect site. After it has been anchored by two clips positioned on opposite sides of the defect edge, the loop 9 is tightened by pulling the end of the suture intraluminally using biopsy forceps. Additional clips are placed to achieve complete closure. The primary outcome was complete closure rate. The secondary outcomes were closure time, sustained closure rate, and adverse events.

Results Complete closure was achieved in 100 % of cases. The mean size of the mucosal defects was 17.5 mm (range 10–55 mm). The median closure time was 14 minutes. The sustained closure rate was 90 %. No adverse events were noted.

Conclusions The loop 9 technique is feasible and effective in achieving complete and sustained closure of therapeutic endoscopy-related GI defects.
“Part of the Ritual”: Exploring Patient and Physician Decision Making Regarding Anticoagulation Use in Obstetric Antiphospholipid Syndrome
Authors: Skeith Leslie , Rodger Marc A. , Bates Shannon M. , Gonsalves Carol , Karovitch Alan , Taylor Taryn S.
Published: January 2021

Background Antiphospholipid syndrome is associated with recurrent pregnancy loss. Low-molecular-weight heparin (LMWH) and/or aspirin (ASA) prophylaxis during pregnancy to prevent future loss is based on limited trial data with mixed results.

Objectives Given the clinical equipoise, we sought to understand how patients and physicians navigate the decision-making process for use of LMWH and/or ASA in pregnancy.

Methods We interviewed 10 patients and 10 thrombosis physicians in Ottawa, Canada from January 2017 to March 2018. Patients who had ≥1 late pregnancy loss or ≥2 early losses and persistently positive antiphospholipid antibodies based on the revised Sapporo/Sydney criteria were identified in the a Thrombosis Clinic. Patients were also identified by the TIPPS Study screening logs of excluded patients. Data collection and analysis occurred iteratively, in keeping with constructivist grounded theory methodology.

Results Our analysis generated three themes, present across both patient and physician interviews, which captured a patient-led decision-making experience: (1) managing high stakes, (2) accepting uncertainty, and (3) focusing on safety. Patients and physicians acknowledged the high emotional burden and what was at stake: avoiding further pregnancy loss. Patients responded to their situation by taking action (i.e., using LMWH injections became a “ritual”), whereas physicians reacted by removing themselves from the final decision by “[leaving] it up to the patient.”

Conclusion Our findings should be considered when designing future research on studying the role for LMWH/ASA in this population, as it suggests that the perceived benefits of treatment go beyond improving pregnancy rates. Rather, patients described potential benefit from the process of taking action, even in the absence of a guaranteed good outcome.
Malignant Uterine Neoplasms Attended at a Brazilian Regional Hospital: 16-years Profile and Time Elapsed for Diagnosis and Treatment
Authors: Candido Elaine Cristina , Veiga Junior Nelio Neves , Minari Monique Possari , Toledo Maria Carolina Szymanski , Yela Daniela Angerame , Teixeira Julio Cesar
Published: January 2021

Objective The present study aims to evaluate the profile of endometrial carcinomas and uterine sarcomas attended in a Brazilian cancer center in the period from 2001 to 2016 and to analyze the impact of time elapsed from symptoms to diagnoses or treatment in cancer stage and survival.

Methods This observational study with 1,190 cases evaluated the year of diagnosis, age-group, cancer stage and histological type. A subgroup of 185 women with endometrioid histology attended in the period from 2012 to 2017 was selected to assess information about initial symptoms, diagnostic methods, overall survival, and to evaluate the influence of the time elapsed from symptoms to diagnosis and treatment on staging and survival. The statistics used were descriptive, trend test, and the Kaplan-Meier method, with p-values < 0.05 for significance.

Results A total of 1,068 (89.7%) carcinomas (77.2% endometrioid and 22.8% non-endometrioid) and 122 (10.3%) sarcomas were analyzed, with an increasing trend in the period (p < 0.05). Histologies of non-endometrioid carcinomas, G3 endometrioid, and carcinosarcomas constituted 30% of the cases. Non-endometrioid carcinomas and sarcomas were more frequently diagnosed in patients over 70 years of age and those on stage IV (p < 0.05). The endometrioid subgroup with 185 women reported 92% of abnormal uterine bleeding and 43% diagnosis after curettage. The average time elapsed between symptoms to diagnosis was 244 days, and between symptoms to treatment was 376 days, all without association with staging (p = 0.976) and survival (p = 0.160). Only 12% of the patients started treatment up to 60 days after diagnosis.

Conclusion The number of uterine carcinoma and sarcoma cases increased over the period of 2001 to 2016. Aggressive histology comprised 30% of the patients and, for endometrioid carcinomas, the time elapsed between symptoms and diagnosis or treatment was long, although without association with staging or survival.
Factors Associated with Exclusive Breastfeeding in a Maternity Hospital Reference in Humanized Birth
Authors: Brandt Gabriela Pinheiro , Britto Alan Messala A. , Leite Camila Carla De Paula , Marin Luciana Garangau
Published: January 2021

Objective To analyze the factors associated with the prevalence of exclusive breastfeeding (EBF) for up to six months in mother/infant binomials cared for at a usual-risk maternity hospital.

Methods The present is a descriptive, longitudinal, prospective, quantitative study. Socioeconomic, obstetric and perinatal variables from 101 mother/infant binomials in a Public Maternity Hospital in the city of Curitiba, state of Paraná, Brazil, were investigated during hospitalization after delivery and 6 months after birth. For the statistical analysis, the Chi-squared test was used. The variables that showed values of p < 0.25 for the Chi-squared test were also submitted to an odds ratio (OR) analysis.

Results The prevalence (42.6%) of EBF was observed. Most women (93.1%) had had more than 6 prenatal consultations, and the variables maternity leave and support to breastfeeding were associated with EBF. Support to breastfeeding by professionals and family members increased 4-fold the chance of maintenance of EBF (OR = 0.232; 95% confidence intercal [95%CI]: 0.079 to 0.679; p = 0.008). Cracked nipples were the biggest obstacle to breastfeeding, and low milk production was the main responsible factor for weaning.

Conclusion The encouragement of breastfeeding and the mother's stay for a longer period with the child contributed to the maintenance of EBF until the sixth month of life of the infant.
User-Centered Design in Pediatric Acute Care Settings Antimicrobial Stewardship
Authors: Ward Michael J. , Chavis Bryson , Banerjee Ritu , Katz Sophie , Anders Shilo
Published: January 2021

Background Antibiotic prescribing in ambulatory care centers is increasing. Previous research suggests that 20 to 50% of antibiotic prescriptions are either unnecessary or inappropriate. Unnecessary antibiotic consumption can harm patients by increasing antibiotic resistance and drug-associated toxicities, and the reasons for such use are multifactorial. Antimicrobial Stewardship Programs (ASP) were developed to guide better use of antibiotics. A core element of ASP is to provide feedback to clinical providers. To create clinically meaningful feedback, user-center design (UCD) is a robust approach to include end-users in the design process to improve systems.

Objective The study aimed to take a UCD approach to developing antibiotic prescribing feedback through input from clinicians in two ambulatory care settings.

Methods We conducted two group prototyping sessions with pediatric clinicians who practice in the emergency department and urgent care settings at a tertiary care children's hospital. Participants received background on the problem of antibiotic prescribing and then were interviewed about their information needs, perceived value, and desired incentives for a prescribing feedback system. Sessions concluded with their response and recommendations to sample sections of an antibiotic feedback report including orienting material, report detail, targeted education, and resources.

Results A UCD approach was found to be highly valuable in the development of a feedback mechanism that is viewed as desirable by clinicians. Clinicians preferred interpreting the data themselves with aids such as diagrams and charts over the researcher concluded statements about the clinician's behavior. Specific feedback that clinicians considered redundant were removed from the model if preexisting alerts were established.

Conclusion Integrating a UCD approach in developing ASP feedback identified desirable report characteristics that substantially modified preliminary wireframes for feedback. Future research will evaluate the clinical effectiveness of our feedback reports in outpatient settings.
Temporal Trend of Near Miss and its Regional Variations in Brazil from 2010 to 2018
Authors: Herdt Maria Carolina Wensing , Magajewski Flávio Ricardo Liberal , Linzmeyer Andressa , Tomazzoni Rafaela Rodolfo , Domingues Nicole Pereira , Domingues Milla Pereira
Published: January 2021

Cases of maternal near miss are those in which women survive severe maternal complications during pregnancy or the puerperium. This ecological study aimed to identify the temporal trend of near-miss cases in different regions of Brazil between 2010 and 2018, using data from the Hospital Information System (HIS) of the Unified Brazilian Health System (SUS, in the Portuguese acronym). Hospital admission records of women between 10 and 49 years old with diagnosis included in the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and codes indicating near-miss events were selected. From 20,891,040 admissions due to obstetric causes, 766,249 (3.66%) near-miss cases were identified, and 31,475 women needed admission to the intensive care unit (ICU). The cases were found to be more predominant in black women over 35 years old from the North and Northeast regions. There was a trend of increase in near-miss rates of ~ 13.5% a year during the period of the study. The trend presented a different behavior depending on the level of development of the region studied. The main causes of near miss were preeclampsia (47%), hemorrhage (24%), and sepsis (18%).
Switching of Hormone Therapies in Breast Cancer Women
Authors: Medeiros Luana Moreira de , Stahlschmidt Rebeca , Ferracini Amanda Canato , Souza Cinthia Madeira de , Juliato Cassia Raquel Teatin , Mazzola Priscila Gava
Published: January 2021

Objective The objective of the present study was to analyze the reasons that led to hormone therapies (HTs) regimen changes in women with breast cancer.

Methods This was a retrospective cross-sectional study from a single-institution Brazilian cancer center with patient records diagnosed with breast cancer between January 2012 and January 2017.

Results From 1,555 women who were in treatment with HT, 213 (13.7%) women had HT switched, either tamoxifen to anastrozole or vice-versa. Most women included in the present study who switched HT were > 50 years old, postmenopausal, Caucasian, and had at least one comorbidity. From the group with therapy change, ‘disease progression’ was reason of change in 124 (58.2%) cases, and in 65 (30.5%) patients, ‘presence of side effects’ was the reason. From those women who suffered with side effects, 24 (36.9%) had comorbidities.

Conclusion The present study demonstrated a low rate of HT switch of tamoxifen to anastrozole. Among the reasons for changing therapy, the most common was disease progression, which includes cancer recurrence, metastasis or increased tumor. Side effects were second; furthermore, age and comorbidities are risk factors for side effects.
Gestational Diabetes Mellitus and Obesity are Related to Persistent Hyperglycemia in the Postpartum Period
Authors: Rehder Patricia Moretti , Borovac-Pinheiro Anderson , de Araujo Raquel Oliveira Mena Barreto , Diniz Juliana Alves Pereira Matiuck , Ferreira Nathalia Lonardoni Crozatti , Branco Ana Claudia Rolim , Dias Aline de Fatima , Pereira Belmiro Gonçalves
Published: January 2021

Objective To evaluate the obstetric and sociodemographic characteristics of gestational diabetic women who maintained hyperglycemia in the postpartum period (6–12 weeks postpartum).

Methods This is a longitudinal cohort study with women who have had gestational diabetes and/or macrosomic children between March 1st, 2016 and March 1st, 2017. Between 6 and 12 weeks after birth, women who had gestational diabetes collected fasting glycemia, glucose tolerance test, and glycated hemoglobin results. The data were collected from medical records and during an interview in the first postpartum consultation. A statistical analysis was performed using frequency, percentage, Chi-Squared test, Fisher exact test, Mann-Whitney test, and multivariate Poisson regression. The significance level adopted for the statistical tests was 5%.

Results One hundred and twenty-two women were included. Most of the women were younger than 35 years old (70.5%), white, multiparous, and with no history of gestational diabetes. Thirteen percent of the participants developed persistent hyperglycemia. A univariate analysis showed that maternal age above 35 years, being overweight, having grade 1 obesity and weight gain under 5 kg was related to the persistence of hyperglycemia in the postpartum period.

Conclusion Maternal age above 35 years, obesity and overweight, and the diagnosis of gestational diabetes in the first trimester of pregnancy are associated with hyperglycemia during the postpartum period.
The Influence of Hospital Volume on the Outcomes of Nasopharyngeal, Sinonasal, and Skull-Base Tumors: A Systematic Review of the Literature
Authors: Flukes Stephanie , Sharma Rahul K. , Lohia Shivangi , Cohen Marc A.
Published: January 2021

Objective The center of excellence model of health care hypothesizes that increased volume in a specialized center will lead to better and more affordable care. We sought to characterize the volume-outcome data for surgically treated sinonasal and skull base tumors and (chemo) radiation-treated nasopharyngeal malignancy.

Design  Systematic review of the literature.

Setting This review included national database and multi-institutional studies published between 1990 and 2019.

Participants PubMed was interrogated for keywords “hospital volume,” “facility volume,” and outcomes for “Nasopharyngeal carcinoma,” “Sinonasal carcinomas,” “Pituitary Tumors,” “Acoustic Neuromas,” “Chordomas,” and “Skull Base Tumors” to identify studies. Single-institution studies and self-reported surveys were excluded.

Main outcome measures The main outcome of interest in malignant pathologies was survival; and in benign pathologies it was treatment-related complications.

Results A total of 20 studies met inclusion criteria. The average number of patients per study was 4,052, and ranged from 394 to 9,950 patients. Six of seven studies on malignant pathology demonstrated improved survival with treatment in high volume centers and one showed no association with survival. Ten of thirteen studies on benign disease showed reduced risk of complications, while one study demonstrated both an increased and decreased association of complications. Two studies showed no volume-outcome associations.

Conclusion This systematic review demonstrates that a positive volume–outcome relationship exists for most pathologies of the skull base, with some exceptions. The relative dearth of literature supports further research to understand the effect of centralization of care on treatment outcomes.
The Effectiveness of Melissa Officinalis L. versus Citalopram on Quality of Life of Menopausal Women with Sleep Disorder: A Randomized Double-Blind Clinical Trial
Authors: Shirazi Mahboobeh , Jalalian Mohamad Naser , Abed Masoumeh , Ghaemi Marjan
Published: January 2021

Objective The present study aimed to assess the effect of Melissa Officinalis L. (a combination of lemon balm with fennel fruit extract) compared with citalopram and placebo on the quality of life of postmenopausal women with sleep disturbance.

Methods The present study is a randomized, double-blind, placebo clinical trial among 60 postmenopausal women with sleep disturbance who were referred to a university hospital from 2017 to 2019. The participants were randomized to receive M. Officinalis L. (500 mg daily), citalopram (30 mg) or placebo once daily for 8 weeks. The Menopause-Specific Quality of Life (MENQOL) questionnaire was self-completed by each participant at baseline and after 8 weeks of the intervention and was compared between groups.

Results The mean for all MENQOL domain scores were significantly improved in the M. Officinalis L. group compared with citalopram and placebo (p < 0.001). The mean ± standard deviation (SD) after 8 weeks in the M. Officinalis L., citalopram and placebo groups was 2.2 ± 0.84 versus 0.56 ± 0.58 versus 0.36 ± 0.55 in the vasomotor (p < 0.001), 1.02 ± 0.6 versus 0.28 ± 0.2 versus 0.17 ± 0.1 in the psychomotor-social (p < 0.001), 0.76 ± 0.4 versus 0.25 ± 0.1 versus 0.11 ± 0.1 in the physical and 2.3 ± 1.0 versus 0.35 ± 0.5 versus 0.41 ± 0.5 in the sexual domain, respectively.

Conclusions The results revealed that M. Officinalis L. may be recommended for improving the quality of life of menopausal women with sleep disturbance.

Trial registration The present study was registered by the name “Comparison of the efficacy of citalopram and compound of Asperugo procumbens and foeniculum vulgare in treatment of menopausal disorders” with the code IRCT2013072714174N1 in the Iranian Registry of Clinical Trials (IRCT).
Smell Regions in Patients with Vitamin D Deficiency: An MRI Evaluation
Authors: Şencan Ziya , Bayar Muluk Nuray , Şahan Mehmet Hamdi
Published: January 2021

Objective We investigated the effects of vitamin D deficiency in the peripheral and central smell regions by magnetic resonance imaging (MRI).

Methods This retrospective study included 29 patients (12 males, 17 females) with 25-dihydroxy vitamin D3 [25(OH)2D3] deficiency (group 1) and 34 subjects without 25(OH)2D3 deficiency (14 males, 20 females) (group 2). Using cranial MRIs, the peripheral (olfactory bulb [OB] volume and olfactory sulcus [OS] depth) and central (insular gyrus and corpus amygdala) smell regions were evaluated.

Results The OB volume and OS depth values of the 25(OH)2D3 deficiency group were significantly lower than those of the control group (p < 0.05). For the central smell regions, the insular gyrus and corpus amygdala areas of the 25(OH)2D3 deficiency group were nonsignificantly lower than those in the control group (p > 0.05). There were positive correlations between OB volumes, OS depths, and insular gyrus and corpus amygdala areas bilaterally in the 25(OH)2D3 deficiency group separately and in all subjects (groups 1 and 2) (p < 0.05). In the 25(OH)2D3 deficiency group, as the 25(OH)2D3 values became lower, the insular gyrus area values decreased bilaterally (p < 0.05). In females, the corpus amygdala area values were lower than in males (p < 0.05).

Conclusion Since vitamin D3 deficiency affected the peripheral and central smell regions negatively, we recommend evaluating patients' vitamin D levels as a health policy to prevent vitamin D3 deficiency-related cranial smell region problems. Moreover, sunlight exposure is very important to increase vitamin D levels, and the public should be informed about this topic.
Intrahepatic Cholestasis of Pregnancy: Natural History and Current Management
Authors: Roediger Rebecca , Fleckenstein Jaquelyn
Published: January 2021

Intrahepatic cholestasis of pregnancy (ICP) is a common disorder in the second half of pregnancy characterized by pruritus and elevated serum bile acids (BAs) with spontaneous resolution after delivery. ICP carries a risk of adverse effects on the fetus which correlates with the degree of BA elevation. ICP occurs in genetically susceptible women as the reproductive hormones increase during pregnancy. Ursodeoxycholic acid is still considered the first-line treatment for ICP though it is of unproven benefit in preventing adverse effects on the fetus. Fetal complications, such as stillbirth, increase with gestational age, so preterm delivery is generally performed in cases of severe ICP, defined as BA levels above 40 μmol/L. ICP may recur in future pregnancies and is associated with an increased risk for future hepatobiliary, immune mediated, and cardiovascular diseases. Children born of mothers with ICP have normal development but may have a risk for subsequent metabolic disease.
Thrombocytopenia and Bloodstream Infection: Incidence and Implication on Length of Stay in the Pediatric Intensive Care Unit
Authors: Kassif Lerner Reut , Levinkopf Dana , Zaslavsky Paltiel Inna , Sadeh Tal , Rubinstein Marina , Pessach Itai M. , Keller Nathan , Lerner-Geva Liat , Paret Gideon
Published: January 2021

The incidence and prognosis of thrombocytopenia in critically ill patients with bloodstream infection (BSI) is not well delineated in the pediatric intensive care unit (PICU) setting. We assessed these variables in our PICU and sought to determine whether thrombocytopenia could serve as a prognostic marker for length of stay (LOS). The study was conducted at the medical PICU of a university hospital, on all critically ill pediatric patients consecutively admitted during a 3-year period. Patient surveillance and data collection have been used to identify the risk factors during the study period. The main outcomes were BSI incidence and implication on morbidity and LOS. Data from 2,349 PICU patients was analyzed. The overall incidence of BSI was 3.9% (93/2,349). Overall, 85 of 93 patients (91.4%) with BSI survived and 8 patients died (8.6% mortality rate). The overall incidence of thrombocytopenia among these 93 patients was 54.8% (51/93) and 100% (8/8) for the nonsurvivors. Out of the 85 survivors, 27 thrombocytopenic patients were hospitalized for >14 days versus 14 of nonthrombocytopenic patients (p = 0.007). Thrombocytopenia was associated with borderline significance with an increased LOS (adjusted odds ratio = 3.00, 95% confidence interval: 0.93–9.71, p = 0.066). Thrombocytopenia is common in critically ill pediatric patients with BSI and constitutes a simple and readily available risk marker for PICU LOS.
Typical Orbital Pathologies: Hemangioma
Authors: Low Christopher M. , Stokken Janalee K.
Published: January 2021

Orbital hemangiomas are the most common primary neoplasm of the orbit and manifest as two distinct pathologic entities: infantile hemangiomas and cavernous hemangiomas. In this article, both infantile and cavernous hemangiomas are reviewed, with special attention paid to the natural history, clinical presentation, and management teams and approaches involved. An example case of each type of hemangioma is presented along with pearls and tips a reader can take away after reading this article.
Mechanical Alignment in Knee Replacement Homogenizes Postoperative Coronal Hip–Knee–Ankle Angle in Varus Knees: A Navigation-Based Study
Authors: Larrainzar-Garijo Ricardo , Molanes-Lopez Elisa M. , Murillo-Vizuete David , Garcia-Bogalo Raul , Escobar-Anton David , Lopez-Fernandez Jesus , Diez-Rodriguez Angel , Corella-Montoya Fernando
Published: January 2021

After knee replacement, postoperative lower limb alignment is influenced by the geometry of the prosthesis position and surrounding soft tissue that contributes to the hip–knee–ankle (HKA) angle. The purpose of this study is to determine the dynamic coronal HKA angle after mechanical alignment in total knee replacement using computer navigation. We conducted a pre–post design study of 71 patients with varus osteoarthritic knees on which total knee arthroplasty was performed. The HKA was measured before and at the end of the surgical procedure with the patient in the supine position using a navigation system at 30, 60, and 90 degrees of knee flexion. Postoperative implant position and flexion and extension gaps were assessed. HKA was clustered in three preoperative dynamic patterns (PDPs; Varus-Neutral, Varus-Valgus, and Varus-Varus). There were statistically significant differences in the dynamic coronal HKA between the preoperative and postoperative statuses after mechanically aligned knee replacement (with p < 0.0001) Before the surgical procedure, statistically significant differences were found between patterns at any angle of flexion confirming a well-differentiated preoperative dynamic behavior between the three groups. Postoperatively, 98.6% (71 out of 72) of the knees were within ± 3 degrees of the HKA at full extension. Fifty-eight knees (80.6%) were assessed to a “within-range” postoperative dynamic alignment at any grade of flexion considered. There are differences between the preoperative and postoperative status of the dynamic coronal HKA angle after mechanically aligned knee replacement. We proposed that an excellent dynamic HKA alignment is achieved not only at full extension within the range of 0 ± 3 degrees but also when this alignment is maintained at 30, 60, and 90 degrees.