bluuebunny/crossref_metadata_2025 huggingface dataset:
Labor unions and institutional corruption: The case of Kazakhstan
Authors: Akhmetzharov Slyamzhar , Orazgaliyev Serik
Published: August 2021

In this study, we used the institutional corruption framework to analyze the evolution of labor unions in Kazakhstan. As a research method, we conducted a case study by combining document analysis with survey data covering (n)1,200 respondents across all 14 regions of the country. Our findings suggest that external and internal influences weakened labor unions and diverted from fulfilling their primary purpose of promoting interests of their members. External influences, represented by restrictive regulatory framework and state intervention, create conditions of limited independence of labor unions leaving them extremely narrow scope to operate in. Internal influences are represented by disagreements and conflicts between national-level labor unions. This article stipulates that dysfunctional and institutionally corrupt labor unions in Kazakhstan serve as an indicator of state fragility. The findings confirmed that institutional corruption of labor unions has an adverse impact on public trust, while a frequent occurrence of labor conflicts might impact political risk factors, contributing to increased state fragility.
Unique enlarging cavernous malformation secondary to abnormal arteriovenous shunting through an associated developmental venous anomaly
Authors: Parikh Nimisha , Williamson Richard , Kulzer Matthew , Sohn Albert , Chang Warren M , Li Charles Q
Published: August 2021

Cavernous malformations are angiographically occult vascular malformations. They are often associated with a developmental venous anomaly through poorly understood mechanisms. We present an unusual case of a gradually enlarging cavernous malformation associated with a developmental venous anomaly with arteriovenous shunting, suggesting venous hypertension or reflux as a potential cause of progressive growth.
Experimental investigations of the response of a portable container to blast, fragmentation, and thermal effects of energetic materials detonation
Authors: Ahmed Khurshid , Malik Abdul Qadeer
Published: August 2021

The detonation of an energetic material (EM) is manifested in the form of blast wave, fragmentation of casing material, and thermal effects. These effects are very destructive and cause injuries-being fatal-and structural damage as well. The attenuation of these effects is a prime focus. C4 explosive weighing 104 g was tested as surface burst. Peak overpressures of 1362 kPa and fireball radius of 0.65 m were measured. A multi-layer container comprised steel liner, Kevlar woven fabric, and laminated glass fiber reinforced polymer (GFRP) was developed and investigated to counter the combined blast, fragmentation, and thermal effects of EM detonation. Commercially available shaving foam was characterized and used as filling material inside the container. The foam bubbles have shown a good stability with time. The shaving foam quenched the fireball and afterburning reactions owing to rapid heat and momentum transfer mechanism. The containment system provided more than 80% overpressure reduction with respect to an equivalent open-air detonation and also restricted any escape to lateral directions. Coupled Euler-ALE (Arbitrary Lagrangian-Eulerian) approach was employed to numerically simulate the blast wave parameters. A good agreement is obtained between the simulation and experimental results.
Ubiquitin‐specific protease 7 mediates platelet‐derived growth factor‐induced pulmonary arterial smooth muscle cells proliferation
Authors: Zhu Yanting , Zhang Qianqian , Yan Xin , Liu Lu , Zhai Cui , Wang Qingting , Chai Limin , Li Manxiang
Published: August 2021

Pulmonary arterial hypertension is a devastating pulmonary vascular disease, in which the pathogenesis is complicated and unclear. Pulmonary arterial smooth muscle cells (PASMCs) proliferation is a key pathological feature of pulmonary arterial hypertension. It has been shown that ubiquitin‐specific protease 7 (USP7) is involved in cancer cell proliferation via deubiquitinating and stabilizing E3 ubiquitin ligase mouse double minute 2 (MDM2). However, the effect of USP7 and MDM2 on platelet‐derived growth factor (PDGF)‐induced PASMCs proliferation is uncertain. This study aims to explore this issue. Our results indicated that PDGF up‐regulated USP7 protein expression and stimulated PASMCs proliferation; this was accompanied with the increase of MDM2, forkhead box O4 (FoxO4) reduction and elevation of CyclinD1. While prior transfection of USP7 siRNA blocked PDGF‐induced MDM2 up‐regulation, FoxO4 down‐regulation, increase of CyclinD1 and cell proliferation. Pre‐depletion of MDM2 by siRNA transfection reversed PDGF‐induced reduction of FoxO4, up‐regulation of CyclinD1 and PASMCs proliferation. Furthermore, pre‐treatment of cells with proteasome inhibitor MG‐132 also abolished PDGF‐induced FoxO4 reduction, CyclinD1 elevation and cell proliferation. Our study suggests that USP7 up‐regulates MDM2, which facilitates FoxO4 ubiquitinated degradation, and subsequently increases the expression of CyclinD1 to mediate PDGF‐induced PASMCs proliferation.
Direct application of ropivacaine-soaked gauze to sciatic nerve after necrotizing fasciitis exposes underlying muscles and nerves
Authors: Ratto Christina , Ji Yisi D , McDowell Joseph
Published: August 2021

Background:

Necrotizing fasciitis is a rapidly progressive infection of the subcutaneous tissue and fascia with significant morbidity and mortality. There is a paucity of literature published on the benefits of regional anaesthesia in patients with necrotizing fasciitis of the extremities.

Case Presentation:

This study demonstrates novel approaches to management of pain in a patient with necrotizing fasciitis of the lower extremity. A 47-year-old male with polysubstance use disorder was found to have necrotizing fasciitis of the lower extremity. Surgical debridement included 15% of his total body surface area and resultant exposure of his sciatic nerve. A ropivacaine-soaked gauze was applied directly to the exposed sciatic nerve. Femoral and lateral cutaneous nerve blocks were performed to facilitate necessary surgical dressing changes and physical therapy.

Conclusion:

This report details techniques used in postoperative pain management to facilitate surgical dressing changes after extensive debridement of an extremity for necrotizing fasciitis. The use of local anaesthetic-soaked gauze may be a useful adjunct in certain scenarios.
Groin abscess, a rare complication of strangulated femoral hernia: Case report
Authors: Ahmad Khaled S , Alenazi Naif A , Essa Mohamed S
Published: August 2021

Femoral hernias account for 8%–11% of all groin hernias and 3%–5% of all anterior abdominal wall hernias. While groin hernias are more common in males, femoral hernias are developed more commonly in female, accounting for 22%–34% of all groin hernias compared with 1.1% in male. The lifetime risk of developing groin hernia in male is approximately 25% but in female less than 5%, so in all female patients with groin hernias, femoral hernias should be included in the differential diagnosis until proven otherwise. The main concern of a femoral hernia is the higher risk of bowel strangulation, presenting emergently in 32%–39% of patients. We report a case of strangulated femoral hernia in a 78-year-old female who was presented to emergency department with groin abscess based on ultrasound image; patient was then diagnosed as having strangulated femoral hernia and taken to the operating theater, where she was found having strangulated segment of small intestine, so the patient underwent bowel resection and anastomosis with repair of the defect extraperitoneally, and ultimately, the patient improved and discharged from the hospital. Strangulated femoral hernia can present with groin abscess. Furthermore, femoral hernia should be ruled out in elderly patient presented with groin abscess, especially female patients.
A case of bleomycin-induced flagellate dermatitis: A case report
Authors: Cullingham Kyle , Kost Gregory
Published: August 2021

The article description and significance to dermatologists: bleomycin flagellate dermatitis is a rare cutaneous manifestation, believed to be due to the lack of bleomycin hydrolase enzyme in the skin, which inactivates bleomycin, resulting in its accumulation. This is thought to be a dose-dependent reaction, and doses over 200 U and higher may increase risk. This case describes a male developing a pruritic, erythematous linear flagellated dermatitis to the lower back after his third cycle of bleomycin, etoposide and cisplatin for a stage 3 seminoma. Pruritis resolved and erythema improved with the treatment of bilastine and desoximetasone cream. It is important to recognize this condition because untreated pruritis may lead to increased impairment of the skin barrier in already immunocompromised patient populations. This may also give further evidence to having ongoing and continuing collaboration between Dermatology and Medical Oncology for any patients presenting with a new rash undergoing chemotherapy treatments.
Successful treatment with crizotinib after alectinib-induced interstitial lung disease
Authors: Zhu Ning , Lin Shanhong , He Lei , Wang Linfeng , Kong Weiliang , Cao Chao
Published: August 2021

Although alectinib is a well-tolerated and highly effective inhibitor of a second-generation anaplastic lymphoma kinase, special attention should be paid to the possibility of potentially severe and fatal adverse events such as interstitial pneumonia. We report a case of a patient with advanced non-small cell lung cancer treated with alectinib who developed immunohistochemically positive anaplastic lymphoma kinase (ALK(IHC +)) . However, due to the rapid emergence of drug-induced interstitial lung disease, alectinib treatment was halted. Once the interstitial lung disease had been successfully treated, we reluctantly chose crizotinib as a second-line treatment for ALK + NSCLC in this patient as he refused all other available treatments. Contrary to expectation, crizotinib performed well both in terms of its safety and efficacy. Our results suggest that crizotinib may provide a promising therapy option for patients with ALK + NSCLC accompanied by alectinib-induced interstitial lung disease. To our knowledge, this is a rare report of successful treatment of ALK + NSCLC with crizotinib after alectinib-induced interstitial lung disease.
A review of techniques for difficult catheterisation and their costs
Authors: Healy Rion , Dyer James Edward
Published: August 2021

Objective:

Awareness of departmental expenditure gives surgeons the ability to make cost-effective decisions. We reviewed the available techniques for difficult catheterisation and assessed the cost of each method.

Methods:

A literature search was undertaken using EMBASE and Medline databases. Seven techniques for difficult catheterisation were identified, and a cost analysis was performed. All items required for a technique were costed per unit, including VAT, and can be referenced to the NHS supply chain.

Results:

Techniques were divided into three broad categories: simple urethral techniques – increased lubrication with different catheter sizes (£5.05) or types (£8.83 Tiemann tip, £10.65 Coude tip); complex urethral techniques – blind hydrophilic guidewire (£27.31), S-dilators (£244.62) and flexible cystoscopy (£38.78); and percutaneous techniques – suprapubic catheterisation (£117.38).

Conclusion:

This paper demonstrates a progression in cost and specialist input required when moving from simple urethral techniques to complex and percutaneous techniques. It is clear that clinicians should consider these cost implications and exhaust all simple techniques before moving to the more complex options. We would advocate the use of a national evidence-based difficult catheter algorithm to guide management based on both effectiveness and cost.

Level of evidence:

Not applicable.
Territorial wars and absolute outcomes
Authors: Crisher Brian Benjamin
Published: August 2021

Why do some wars end with an absolute outcome, with state death or regime change? I argue that we are more likely to see absolute outcomes when we have territorial disputes with the potential for credible commitment problems and asymmetric disputants. In the absence of credible commitment problems, disputes are less likely to recur, and states are unlikely to seek to absorb the opponent state or remove its government. Among more symmetric disputants, states cannot impose an absolute outcome, and we are more likely to see recurrent disputes in the face of credible commitment problems. Only in very asymmetric dyads are we likely to have both the required willingness and opportunity to impose absolute outcomes to attempt to solve a credible commitment problem over territorial conflict.
High Frequency Words Produced by Typically Developing Mandarin-Speaking Children Between 3 and 6 Years of Age
Authors: Wu Shang-Yu , Lin Shanju , Huang Rei-Jane , Tsai I-Fang
Published: August 2021

The purpose of this study was to provide high frequency word lists for Mandarin-speaking children between 3 and 6 years of age and to explore the differences between each part of speech (POS) category among different age groups. Participants were 209 typically developing native Mandarin speakers aged between 3 and 6 years, born in Taiwan, and recruited from Mandarin-language preschools in Taipei, New Taipei City, and Miaoli. Language samples were collected through conversations, free play, and story retelling. The researchers then transcribed the samples, segment utterances, and words, tagging the POS corresponding to each word. The frequencies of word occurrences were then analyzed and ranked to generate a high frequency word list. The mean frequency of each POS category was calculated to identify significant differences between age groups. The results showed high frequency word lists, including the corresponding POS tagging. Significant differences were found in 10 of the 11 POS categories among age groups. The results of this study presented preliminary information concerning high frequency words produced by Mandarin-speaking children aged between 3 and 6 years and the development of their use of each POS category.
Decreasing the Abnormal Internally Rotated Talus After Lateral Ankle Stabilization Surgery
Authors: Li Hong-Yun , Cao Li , Li Hong , Hua Ying-Hui , Chen Shi-Yi
Published: August 2021

Background:

Increased internal rotation of the talus has been found in patients with mechanical ankle instability (MAI).

Purpose/Hypothesis:

To evaluate and compare the talar rotation position before and after lateral ankle lateral stabilization surgery in patients with MAI. We hypothesized that the abnormal internal talus rotation in patients with MAI will decrease after surgery for ankle lateral instability and that there will be no significant difference in internal talus rotation between the ligament repair and reconstruction groups.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

We retrospectively studied 56 patients with MAI who underwent ankle lateral stabilization surgery after arthroscopic evaluation (repair, 36 cases; reconstruction, 20 cases). Before and after the operation, magnetic resonance images of all the participants were reviewed. The rotated position of the talus was measured and calculated by the Malleolar Talus Index at the magnetic resonance axial plane.

Results:

The internal rotation of the talus decreased significantly after ankle lateral stabilization surgery in patients with MAI as compared with before surgery (mean ± SD, 83.3° ± 3.3° vs 86.7° ± 3.9°; P < .01). However, there was no statistically significant difference between the ligament repair and reconstruction groups before or after the operation.

Conclusion:

Abnormal internal rotation of the talus in patients with MAI was decreased after ankle lateral stabilization surgery.
Arthroscopic Bankart Repair Versus Open Latarjet for First-Time Dislocators in Athletes
Authors: Hurley Eoghan T. , Davey Martin S. , Montgomery Connor , O’Doherty Ross , Gaafar Mohamed , Pauzenberger Leo , Mullett Hannan
Published: August 2021

Background:

In athletes with a first-time shoulder dislocation, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are the most commonly utilized surgical procedures to restore stability and allow them to return to play (RTP).

Purpose:

To compare the outcomes of ABR and OL in athletes with a first-time shoulder dislocation.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

We performed a retrospective review of patients with first-time shoulder dislocation who underwent primary ABR and OL and had a minimum 24-month follow-up. Indications for OL over ABR in this population were those considered at high risk for recurrence, including patients with glenohumeral bone loss. Patients who underwent ABR were pair-matched in a 2:1 ratio with patients who underwent OL by age, sex, sport, and level of preoperative play. The rate, level, and timing of RTP, as well as the Shoulder Instability–Return to Sport after Injury (SIRSI) score were evaluated. Additionally, we compared recurrence, visual analog scale pain score, Subjective Shoulder Value, Rowe score, satisfaction, and whether patients would undergo the surgery again.

Results:

Overall, 80 athletes who underwent ABR and 40 who underwent OL were included, with a mean follow-up of 50.3 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, or recurrent dislocation rate. There were also no differences between ABR and OL in patient-reported outcome scores or patient satisfaction. When collision athletes were compared between ABR and OL, there were no differences in RTP, SIRSI score, or redislocation rate.

Conclusion:

ABR and OL resulted in excellent clinical outcomes, with high rates of RTP and low recurrence rates. Additionally, there were no differences between the procedures in athletes participating in collision sports.
Knowledge, Attitudes, and Beliefs of Parents of Youth Basketball Players Regarding Sport Specialization and College Scholarship Availability
Authors: Post Eric G. , Rosenthal Michael D. , Root Hayley J. , Rauh Mitchell J.
Published: August 2021

Background:

Previous surveys of youth sport parents have revealed that while parents believe early sport specialization is beneficial for improving sport ability, they also overestimate their child’s chances of receiving a college scholarship.

Purpose:

To (1) describe knowledge, attitudes, and beliefs of parents of youth basketball players regarding sport specialization and college scholarships and (2) examine potential differences in child basketball participation characteristics based on parent income.

Study Design:

Cross-sectional study.

Methods:

A total of 805 parents (mean age, 39.9 ± 7.1 years; 353 female [43.9%]) of youth basketball players (mean age, 12.9 ± 2.5 years; 241 female [29.9%]) were recruited via Qualtrics Online Panels to complete an anonymous online questionnaire. Participants were required to be a parent of a child between 8 and 18 years of age who participated in organized youth basketball (ie, school, club, or recreational/local league). Participants were recruited to be nationally representative with regard to race/ethnicity (White, 62.7%; Hispanic/Latino of any race, 15.3%; African American/Black, 13.3%; Asian, 4.6%; ≥2 races, 2.9%; American Indian/Alaskan Native, 1.1%; Native Hawaiian/other Pacific Islander, 0.1%). The questionnaire was adapted from previous research on parent knowledge, attitudes, and beliefs and consisted of 3 sections: (1) parent and child characteristics; (2) child basketball participation information (months per year of basketball participation, sport specialization status, receiving private coaching, traveling regularly for basketball competitions, participating on multiple teams at the same time); and (3) parent attitudes, beliefs, and knowledge regarding sport specialization and college basketball scholarships.

Results:

Most parents believed specialization increased their child’s chances of making a high school (71.4%) or college team (69.7%). Parents underestimated the availability of college basketball scholarships at the National Collegiate Athletics Association (NCAA) Division I and II levels (8.9 ± 5.1 vs reality of 13-15 per team) but overestimated availability at the Division III level (8.6 ± 5.7 vs reality of 0 per team). High-income parents spent significantly more money ($4748 USD [$1214-$10,246]) than middle-income ($2250 USD [$727-$5079]; P < .001) and low-income ($1043 USD [$368-$2444]; P < .001) parents.

Conclusion:

Parents believed specialization was important for sport success, but they underestimated college scholarship availability at the NCAA Division I and II levels while overestimating scholarship availability at the Division III level.
Effect of Baseline Mental Health on 1-Year Outcomes After Hip Arthroscopy: A Prospective Cohort Study
Authors: Lynch T. Sean , Oak Sameer R. , Cossell Charles , Strnad Gregory , Zajichek Alexander , Goodwin Ryan , Jones Morgan H. , Spindler Kurt P. , Rosneck James
Published: August 2021

Background:

Patient factors, including mental health, sex, and smoking, have been found to be more predictive of preoperative hip pain and function than intra-articular findings during hip arthroscopy for femoroacetabular impingement (FAI); however, little is known about how these factors may influence patients’ postoperative outcomes.

Hypothesis:

We hypothesized that lower patient-reported mental health scores would be significant risk factors for worse patient-reported outcomes (PROs) 1 year after arthroscopic hip surgery for FAI and that baseline intra-articular pathology would fail to demonstrate an association with outcomes 1 year after FAI surgery.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

A prospective cohort of patients undergoing hip arthroscopy for FAI were electronically enrolled. Baseline and 1-year follow-up PROs were collected, including Hip disability and Osteoarthritis Outcome Score for pain (HOOS-Pain), HOOS–Physical Function Short Form (HOOS-PS), and Veterans RAND 12-Item Health Survey–Mental Component Score (VR-12 MCS). Intra-articular operative findings and treatment were documented at the time of surgery. Proportional odds logistic regression models were built for 1-year outcomes (HOOS-Pain, HOOS-PS, and VR-12 MCS). Risk factors included patient characteristics and intraoperative anatomic and pathologic findings.

Results:

Overall, 494 patients underwent hip arthroscopy for FAI, and 385 (78%) were evaluated at 1 year with at least 1 PRO. The median patient age was 33 years, mean body mass index was 25.5 kg/m2, and 72% were female. Multivariable analysis demonstrated that better baseline HOOS-Pain, HOOS-PS, and VR-12 MCS were significantly associated with improvement in the 1-year scores for each PRO. Higher VR-12 MCS was significantly associated with better 1-year HOOS-Pain and HOOS-PS, while current and former smokers had worse 1-year outcomes than those who never smoked. In ranking each variable’s relative importance, baseline HOOS-Pain and HOOS-PS and baseline VR-12 MCS were identified as the strongest predictors of 1-year HOOS-Pain and HOOS-PS in our multivariable model.

Conclusion:

During hip arthroscopy for FAI, patient factors, including baseline hip pain and function, mental health, and smoking, were independently associated with 1-year PROs of hip pain and function, while intra-articular pathology such as the presence of labral tear and its treatment, tear size, tear location, and anchors placed were not independently associated.
A Systematic Review of Current Clinical Practice Guidelines on Intra-articular Hyaluronic Acid, Corticosteroid, and Platelet-Rich Plasma Injection for Knee Osteoarthritis: An International Perspective
Authors: Phillips Mark , Bhandari Mohit , Grant John , Bedi Asheesh , Trojian Thomas , Johnson Aaron , Schemitsch Emil
Published: August 2021

Background:

There are many clinical practice guidelines (CPGs) for the prevention, diagnosis, and treatment of knee osteoarthritis (OA). They differ by region, considering local health care systems, along with cultural and economic factors. Currently, there are conflicting CPG recommendations across the various publications, which makes it difficult for clinicians to fully understand the optimal treatment decisions for knee OA management.

Purpose:

To summarize the current published CPG recommendations for the role of injections in the nonoperative management of knee OA, specifically with the use of intra-articular hyaluronic acid (IA-HA), intra-articular corticosteroids (IA-CS), and platelet-rich plasma (PRP).

Study Design:

Systematic review.

Methods:

A comprehensive search identified all nonoperative knee OA CPGs within the ECRI (formerly Emergency Care Research Institute) Guidelines Trust database, the Guidelines International Network database, Google Scholar, and the Trip (formerly Turning Research Into Practice) database. Guideline recommendations were categorized into strong, conditional, or uncertain recommendations for or against the use of IA-HA, IA-CS, or PRP. Guideline recommendations were summarized and depicted graphically to identify trends in recommendations over time.

Results:

The search strategy identified 27 CPGs that provided recommendations. There were 20 recommendations in favor of IA-HA use, 21 recommendations in favor of IA-CS use, and 9 recommendations that were uncertain or unable to make a formal recommendation for or against PRP use based on current evidence. Most recommendations considered IA-HA and IA-CS use for symptom relief when other nonoperative options are ineffective. IA-CS were noted to provide fast and short-acting symptom relief for acute episodes of disease exacerbation, while IA-HA may demonstrate a relatively delayed but prolonged effect in comparison. The CPGs concluded that PRP recommendations currently lack evidence to definitively recommend for or against use.

Conclusion:

Available CPGs provide recommendations on injectables for knee OA treatment. General guidance from a global perspective concluded that IA-CS and IA-HA are favored for different needed responses and can be utilized within the knee OA treatment paradigm, while PRP currently has insufficient evidence to make a conclusive recommendation for or against its use.
Validating Coding for the Identification of Pediatric Treatment Resistant Epilepsy Patients
Authors: Freedman Daniel A. , Grinspan Zachary , Glynn Peter , Mittlesteadt Jackson , Dawes Alex , Patel Anup D.
Published: August 2021

The International Classification of Diseases (ICD) system includes sub codes to indicate that an individual with epilepsy is treatment resistant. These codes would be a valuable tool to identify individuals for quality improvement and population health, as well as for recruitment into clinical trials. However, the accuracy of these codes is unclear. We performed a single center cross sectional study to understand the accuracy of ICD codes for treatment resistant epilepsy. We identified 344 individuals, roughly half with treatment resistant epilepsy The ICD code had a sensitivity of 90% (147 of 164) and specificity of 86% (155 of 180). The miscoding of children with refractory epilepsy was attributed to the following reasons: 5 patients had epilepsy surgery, 4 had absence epilepsy, 4 patients were seen by different providers, and 1 patient was most recently seen in movement disorders clinic. ICD codes accurately identify children with treatment resistant epilepsy.
Writing Apprehension in the Online Classroom: The Limits of Instructor Behaviors
Authors: Gaytan Jorge , Kelly Stephanie , Brown Wiley S.
Published: August 2021

In response to COVID-19, educational stakeholders are transferring traditional, face-to-face instruction to the online learning environment. The purpose of this study was to determine if business instructors’ use of immediate behaviors and clarity, which have been found to help business students overcome their writing apprehension in the face-to-face learning environment, can also be used to help business students to overcome their writing apprehension in an online learning environment. Findings indicated that instructor immediate behaviors and clarity are not interventions for writing apprehension in the online learning environment. The instructional strategies business instructors rely on in the face-to-face classroom did not have the same meaning or effect on the online classroom.
Association Between Racial Disparities in Hospital Length of Stay and the Hospital Readmission Reduction Program
Authors: Ghosh Arnab K. , Soroka Orysya , Shapiro Martin , Unruh Mark A.
Published: August 2021

Background:

On average Black patients have longer LOS than comparable White patients. Longer hospital length of stay (LOS) may be associated with higher readmission risk. However, evidence suggests that the Hospital Readmission Reduction Program (HRRP) reduced overall racial differences in 30-day adjusted readmission risk. Yet, it is unclear whether the HRRP narrowed these LOS racial differences.

Objective:

We examined the relationship between Medicare-insured Black-White differences in average, adjusted LOS (ALOS) and the HRRP’s implementation and evaluation periods.

Methods:

Using 2009-2017 data from State Inpatient Dataset from New York, New Jersey, and Florida, we employed an interrupted time series analysis with multivariate generalized regression models controlling for patient, disease, and hospital characteristics. Results are reported per 100 admissions.

Results:

We found that for those discharged home, Black-White ALOS differences significantly widened by 4.15 days per 100 admissions (95% CI: 1.19 to 7.11, P < 0.001) for targeted conditions from before to after the HRRP implementation period, but narrowed in the HRRP evaluation period by 1.84 days per 100 admissions for every year-quarter (95% CI: −2.86 to −0.82, P < 0.001); for those discharged to non-home destinations, there was no significant change between HRRP periods, but ALOS differences widened over the study period. Black-White ALOS differences for non-targeted conditions remained unchanged regardless of HRRP phase and discharge destination.

Conclusion:

Increased LOS for Black patients may have played a role in reducing Black-White disparities in 30-day readmission risks for targeted conditions among patients discharged to home.
The genetically modified organism shall not be refused? Talking back to the technosciences
Authors: Van Dyck Barbara , Kenis Anneleen , Stirling Andy
Published: August 2021

Starting from Marcel Mauss’ observation that “one has no right to refuse a gift”, this paper explores the politics of refusal in the context of field trials with genetically modified organisms in Flanders (Belgium). Based on a decade of activist research, and focusing on the genetically modified organism field trials of the Flemish Institute for Biotechnology, we show that the business model of this strategic research center – with its triple mission of carrying biotechnology research, technology transfer, and the promotion of biotechnology through communication and lobby activities – fosters a climate in which innovations in the technosciences have to “be accepted”. The future is laid out without including the possibility of refusal. Consternation is great when this is exactly what happens. Irrational fears and lack of understanding or lack of familiarity are invoked to explain refusal. Language of precision, innovation, safety, and control are deployed to re-assure the public. Refusal is not considered a legitimate option. Yet, if farmers and grassroots initiatives would accept the gift of genetically modified organisms, it would mean the acceptance of their dispossession and the impossibility of diverse food sovereignties. Starting from theoretical work on “the gift” and “the politics of refusal”, we argue that recognizing innovation as the intrinsically plural and divergent process it is, entails including options to refuse particular pathways as a first step to open up others. As we will argue, saying no to genetically modified organisms is part of saying yes to peasant autonomy, agrobiodiversity, and peoples’ food sovereignties.
Gendered Work and Barriers in Employment Increase Unjust Work–Life Imbalance for Women: The Need for Structural Responses
Authors: Israni Monisha , Kumar Vikash
Published: August 2021

As COVID-19 pandemic has disproportionately and negatively impacted women, structural responses are needed to prevent and address work–life imbalance issues experienced by women every day. Gendered work and barriers in gaining employment have reduced women’s participation in paid work/employment. Most of those who are employed, experience unfair work–life imbalance as they end up working for paid job and as well as in their homes. The consequences of COVID-19 pandemic lockdowns have further worsened their work–life imbalance. Most of those who have lost paid jobs have been experiencing significant financial and psychological stress and are doing more work than usual in their homes. To address these issues appropriate structural responses are warranted.
Access to Institutional Credit by Farmers in Eastern India
Authors: Haque T. , Goyal Ankita
Published: August 2021

The supply of institutional credit plays an important role in promoting agricultural growth and also saving the farmers from the clutches of private moneylenders who charge exorbitantly high rates of interest and force them to live in perpetual debt trap. There has been a phenomenal increase in the flow of institutional credit to agriculture in the recent years but this has been quite uneven between regions. As of 2018–2019, the Southern Region had the highest share (43.0 %) in the institutional credit followed by Northern Region (21.0 %), Central Region (13.6 %), Western Region (12.0 %), Eastern Region (9.0 %) and North Eastern Region (0.9 %) respectively. Despite so much talk about the need for green revolution in Eastern India, the institutional credit to agriculture in almost all the Eastern and North Eastern states has been very poor. Based on various standard criteria such as credit–deposit ratio, credit absorption capacity, level of agricultural diversification and untapped potentials for higher agricultural growth and poverty reduction, farmers in the eastern states deserve a better deal in terms of access to institutional credit. Besides, the article explodes the myth of low credit absorption of farmers in Eastern India.
IAP and HDAC inhibitors interact synergistically in myeloma cells through noncanonical NF-κB– and caspase-8–dependent mechanisms
Authors: Zhou Liang , Zhang Yu , Meads Mark B. , Dai Yun , Ning Yanxia , Hu Xiaoyan , Li Lin , Sharma Kanika , Nkwocha Jewel , Parker Rebecca , Bui Danny , McCarter Jacquelyn , Kramer Lora , Purcell Cullen , Sudalagunta Praneeth R. , Canevarolo Rafael R. , Coelho Siqueira Silva Maria D. , De Avila Gabriel , Alugubelli Raghunandan Reddy , Silva Ariosto S. , Kmeiciak Maciej , Ferreira-Gonzalez Andrea , Shain Kenneth H. , Grant Steven
Published: August 2021

Interactions between the inhibitor of apoptosis protein antagonist LCL161 and the histone deacetylase inhibitor panobinostat (LBH589) were examined in human multiple myeloma (MM) cells. LCL161 and panobinostat interacted synergistically to induce apoptosis in diverse MM cell lines, including those resistant to bortezomib (PS-R). Similar interactions were observed with other histone deacetylase inhibitors (MS-275) or inhibitors of apoptosis protein antagonists (birinapant). These events were associated with downregulation of the noncanonical (but not the canonical) NF-κB pathway and activation of the extrinsic, caspase-8–related apoptotic cascade. Coexposure of MM cells to LCL161/LBH589 induced TRAF3 upregulation and led to TRAF2 and NIK downregulation, diminished expression of BCL-XL, and induction of γH2A.X. Ectopic expression of TRAF2, NIK, or BCL-XL, or short hairpin RNA TRAF3 knock-down, significantly reduced LCL161/LBH589 lethality, as did ectopic expression of dominant-negative FADD. Stromal/microenvironmental factors failed to diminish LCL161/LBH589–induced cell death. The LCL161/LBH589 regimen significantly increased cell killing in primary CD138+ cells (N = 31) and was particularly effective in diminishing the primitive progenitor cell–enriched CD138–/19+/20+/27+ population (N = 23) but was nontoxic to normal CD34+ cells. Finally, combined LCL161/LBH589 treatment significantly increased survival compared with single-agent treatment in an immunocompetent 5TGM1 murine MM model. Together, these findings argue that LCL161 interacts synergistically with LBH589 in MM cells through a process involving inactivation of the noncanonical NF-κB pathway and activation of the extrinsic apoptotic pathway, upregulation of TRAF3, and downregulation of TRAF2/BCL-XL. Notably, this regimen overcomes various forms of resistance, is active against primary MM cells, and displays significant in vivo activity. This strategy warrants further consideration in MM.
Long term outcome of Hyper-CVAD-R for Burkitt leukemia/lymphoma and high-grade B-cell lymphoma: focus on CNS relapse
Authors: Samra Bachar , Khoury Joseph D. , Morita Kiyomi , Ravandi Farhad , Richard-Carpentier Guillaume , Short Nicholas J , El Hussein Siba , Thompson Philip A , Jain Nitin , Kantarjian Hagop M , Jabbour Elias J
Published: August 2021

Burkitt leukemia/lymphoma (BL) and high-grade B-cell lymphoma (HGBL) have a high incidence of central nervous system (CNS) involvement, which is associated with poor prognosis. The Hyper-CVAD-R regimen includes systemic and intrathecal CNS-directed therapy to treat and prevent CNS disease. We report herein the long-term safety and efficacy of the Hyper-CVAD-R regimen in adults with BL and HGBL, focusing on its efficacy to prevent CNS relapse. Among 79 adults (54 BL, 25 HGBL), the median age was 44 years (25% ≥ 60 years old), 73% had bone marrow (BM) involvement and 28% had CNS involvement. The complete remission rate was 91% (BL 96%; HGBCL 79%; p=0.16). The 5-year relapse-free survival (RFS) and overall survival (OS) rates were 58% and 52%, respectively. The cumulative incidence of relapse (CIR) was 21% (BL 14%; HGBCL 37%, p=0.06) and was associated with baseline BM (27% vs 0%; p=0.02) and CNS (42% vs 12%; p<0.01) involvement. In multivariate analyses, age and CNS involvement were independent predictors for OS and RFS. The 5-year CNS CIR was 6% (BL 4%; HGBL 11%, p=0.31); 16% with baseline CNS involvement (p=0.03). Our data support the use of Hyper-CVAD-R in preventing CNS relapse, especially among high-risk patients with BM or CNS involvement.
Genome-wide screening identifies cell-cycle control as a synthetic lethal pathway with SRSF2P95H mutation
Authors: Xu Jane Jialu , Chalk Alistair M. , Nikolic Iva , Simpson Kaylene J. , Smeets Monique F. , Walkley Carl R.
Published: August 2021

Current strategies to target RNA splicing mutant myeloid cancers proposes targeting the remaining splicing apparatus. This approach has only been modestly sensitizing and is also toxic to non-mutant-bearing wild-type cells. To explore potentially exploitable genetic interactions with spliceosome mutations, we combined data mining and functional screening for synthetic lethal interactions with an Srsf2P95H/+ mutation. Analysis of missplicing events in a series of both human and murine SRSF2P95H mutant samples across multiple myeloid diseases (acute myeloid leukemia, myelodysplastic syndromes, chronic myelomonocytic leukemia) was performed to identify conserved missplicing events. From this analysis, we identified that the cell-cycle and DNA repair pathways were overrepresented within the conserved misspliced transcript sets. In parallel, to functionally define pathways essential for survival and proliferation of Srsf2P95H/+ cells, we performed a genome-wide Clustered regularly interspaced short palindromic repeat loss-of-function screen using Hoxb8 immortalized R26-CreERki/+Srsf2P95H/+ and R26-CreERki/+Srsf2+/+ cell lines. We assessed loss of single guide RNA representation at 3 timepoints: immediately after Srsf2P95H/+ activation, and at 1 week and 2 weeks after Srsf2P95H/+ mutation. Pathway analysis demonstrated that the cell-cycle and DNA damage response pathways were among the top synthetic lethal pathways with Srsf2P95H/+ mutation. Based on the loss of guide RNAs targeting Cdk6, we identified that palbociclib, a CDK6 inhibitor, showed preferential sensitivity in Srsf2P95H/+ cell lines and in primary nonimmortalized lin−cKIT+Sca-1+ cells compared with wild-type controls. Our data strongly suggest that the cell-cycle and DNA damage response pathways are required for Srsf2P95H/+ cell survival, and that palbociclib could be an alternative therapeutic option for targeting SRSF2 mutant cancers.
A new murineRpl5(uL18) mutation provides a unique model of variably penetrant Diamond-Blackfan anemia
Authors: Yu Lei , Lemay Philippe , Ludlow Alexander , Guyot Marie-Claude , Jones Morgan , Mohamed Fatma F. , Saroya Ghazi-Abdullah , Panaretos Christopher , Schneider Emily , Wang Yu , Myers Greggory , Khoriaty Rami , Li Qing , Franceschi Renny , Engel James Douglas , Kaartinen Vesa , Rothstein Thomas L. , Justice Monica J. , Kibar Zoha , Singh Sharon A.
Published: August 2021

Ribosome dysfunction is implicated in multiple abnormal developmental and disease states in humans. Heterozygous germline mutations in genes encoding ribosomal proteins are found in most individuals with Diamond-Blackfan anemia (DBA), whereas somatic mutations have been implicated in a variety of cancers and other disorders. Ribosomal protein-deficient animal models show variable phenotypes and penetrance, similar to human patients with DBA. In this study, we characterized a novel ENU mouse mutant (Skax23m1Jus) with growth and skeletal defects, cardiac malformations, and increased mortality. After genetic mapping and whole-exome sequencing, we identified an intronic Rpl5 mutation, which segregated with all affected mice. This mutation was associated with decreased ribosome generation, consistent with Rpl5 haploinsufficiency. Rpl5Skax23-Jus/+ animals had a profound delay in erythroid maturation and increased mortality at embryonic day (E) 12.5, which improved by E14.5. Surviving mutant animals had macrocytic anemia at birth, as well as evidence of ventricular septal defect (VSD). Surviving adult and aged mice exhibited no hematopoietic defect or VSD. We propose that this novel Rpl5Skax23-Jus/+ mutant mouse will be useful in studying the factors influencing the variable penetrance that is observed in DBA.
Distribution and diversity of dimetal-carboxylate halogenases in cyanobacteria
Authors: Eusebio Nadia , Rego Adriana , Glasser Nathaniel R. , Castelo-Branco Raquel , Balskus Emily P. , Leão Pedro N.
Published: August 2021

Background

Halogenation is a recurring feature in natural products, especially those from marine organisms. The selectivity with which halogenating enzymes act on their substrates renders halogenases interesting targets for biocatalyst development. Recently, CylC – the first predicted dimetal-carboxylate halogenase to be characterized – was shown to regio- and stereoselectively install a chlorine atom onto an unactivated carbon center during cylindrocyclophane biosynthesis. Homologs of CylC are also found in other characterized cyanobacterial secondary metabolite biosynthetic gene clusters. Due to its novelty in biological catalysis, selectivity and ability to perform C-H activation, this halogenase class is of considerable fundamental and applied interest. The study of CylC-like enzymes will provide insights into substrate scope, mechanism and catalytic partners, and will also enable engineering these biocatalysts for similar or additional C-H activating functions. Still, little is known regarding the diversity and distribution of these enzymes.

Results

In this study, we used both genome mining and PCR-based screening to explore the genetic diversity of CylC homologs and their distribution in bacteria. While we found non-cyanobacterial homologs of these enzymes to be rare, we identified a large number of genes encoding CylC-like enzymes in publicly available cyanobacterial genomes and in our in-house culture collection of cyanobacteria. Genes encoding CylC homologs are widely distributed throughout the cyanobacterial tree of life, within biosynthetic gene clusters of distinct architectures (combination of unique gene groups). These enzymes are found in a variety of biosynthetic contexts, which include fatty-acid activating enzymes, type I or type III polyketide synthases, dialkylresorcinol-generating enzymes, monooxygenases or Rieske proteins. Our study also reveals that dimetal-carboxylate halogenases are among the most abundant types of halogenating enzymes in the phylum Cyanobacteria.

Conclusions

Our data show that dimetal-carboxylate halogenases are widely distributed throughout the Cyanobacteria phylum and that BGCs encoding CylC homologs are diverse and mostly uncharacterized. This work will help guide the search for new halogenating biocatalysts and natural product scaffolds.
Prediction of postoperative nausea and vomiting by point-of-care gastric ultrasound: can we improve complications and length of stay in emergency surgery? A cohort study
Authors: Cozza Valerio , Barberis Lorenzo , Altieri Gaia , Donatelli Mario , Sganga Gabriele , La Greca Antonio
Published: August 2021

Background

Postoperative nausea and vomiting and postoperative ileus are common after major digestive surgery and represent one of the significant problems in Acute Care Surgery.

The delivery model of emergency surgery needs to be improved in order to foster a patient-centered care.

The multimodal approach suggested by Enhanced Recovery After Surgery (ERAS®) Guidelines is gaining widespread acceptance but is difficult to apply to emergency surgery.

Ultrasound examination of the gastric antrum allows a reliable assessment of gastric contents and volume and might help contribute to improve perioperative care in the emergency setting.

Methods

Gastric ultrasound examinations were performed preoperatively and postoperatively on forty-one patients undergoing emergency abdominal surgery. Gastric cross-sectional area (CSA) was measured, in order to estimate the gastric volume. The data obtained were used to evaluate a possible relationship between delayed gastric emptying and postoperative adverse event.

Results

Gastric antrum detection rate varied from 31.8% in open up to 78.9% in laparoscopic surgeries (p = 0.003). Six patients experienced adverse outcomes, had an antiemetic therapy administered and/or a nasogastric tube inserted. Mean CSA was significantly higher in this group (12.95 cm2 vs 6.12 cm2; p = 0.040).

Conclusions

Sensitivity of gastric ultrasound varies depending on surgical technique. A dilated gastric antrum is significantly related to postoperative adverse outcomes and a careful ultrasound follow-up might help tailor postoperative nutrition and antiemetic therapy. In patients who experienced adverse events, antral CSA showed an average increase of more than 50% over a period of 72 h after surgery. A relative measure could be used to predict the risk of postoperative ileus. Overall, gastric ultrasound seems to be a promising diagnostic tool and a useful way to integrate ERAS® protocol in emergency abdominal surgery.