bluuebunny/crossref_metadata_2025 huggingface dataset:
Loss or Theft of Controlled Substances Declared to Health Canada From 2014 to 2018: A Retrospective Study
Authors: Dubé Pierre-André , Morissette Tyler , Tessier Mélanie , Parent Marc , Tremblay Pierre-Yves
Published: May 2021

Theft of prescription drugs is nothing new for Canadian pharmacists. Recently, an increasing body of literature has covered the diversion of controlled substances from Canadian hospitals. However, little has been published in the scientific literature concerning the data collected by Health Canada’s Loss or Theft Report Program regulated under the Controlled Drugs and Substances Act. Data from January 1, 2014, to December 31, 2018, were obtained from Health Canada’s Office of Controlled Substances (OCS). Reports to the OCS are mostly provided by pharmacies and hospitals, by veterinarian, dental, and physician clinics, pharmaceutical distributors and producers, and federal establishments and organizations. Entries include information related to the date, province, and location type; type of loss or theft; and generic name of the product, its strength, dosage form, quantity, and drug identification number. During the studied period, 45,379 submissions to the OCS provided information to create 213,895 entries to the database. After exclusions, 212,317 reports were retained for analysis. Opioids count for 45% of reports, benzodiazepines for 29%, and psychostimulants for 21%. Approximately, 29 million individual doses were lost or stolen of which 7.7 million were opioids (26%), totalizing approximately 178 million oral morphine milligram equivalents with 95% having been lost or stolen in community pharmacies. Moreover, approximately four out of 10 individual doses lost in community pharmacies are unexplained losses, which represent about 4.6 million individual doses. Reporting lost or stolen controlled substances and precursors is essential to tracking the diversion of Canada’s prescription drugs. Pharmacists therefore have an important role to play when it comes to minimizing their potential diversion. A better understanding of the situation across Canada may help to increase health care professionals’ awareness, improve practices, enhance the quality of collected data, and prevent further losses and thefts.
Development and Validation of the Ableist Microaggression Impact Questionnaire
Authors: Aydemir-Döke Deniz , Herbert James T.
Published: May 2021

Microaggressions are daily insults to minority individuals such as people with disabilities (PWD) that communicate messages of exclusion, inferiority, and abnormality. In this study, we developed a new scale, the Ableist Microaggressions Impact Questionnaire (AMIQ), which assesses ableist microaggression experiences of PWD. Data from 245 PWD were collected using Amazon’s Mechanical Turk (MTurk) platform. An exploratory factor analysis of the 25-item AMIQ revealed a three-factor structure with internal consistency reliability ranging between .87 and .92. As a more economical and psychometrically sound instrument assessing microaggression impact as it pertains to disability, the AMIQ offers promise for rehabilitation counselor research and practice.
Characterization and ballistic performance of thin pre-damaged resin-starved aramid-fiber composite panels
Authors: Edwards Cerise A , Ogin Stephen L , Jesson David A , Oldfield Matthew , Livesey Rebecca L , James Bryn J , Boardman Richard P
Published: May 2021

Military personnel use protective armor systems that are frequently exposed to low-level damage, such as non-ballistic impact, wear-and-tear from everyday use, and damage during storage of equipment. The extent to which such low-level pre-damage could affect the performance of an armor system is unknown. In this work, low-level pre-damage has been introduced into a Kevlar/phenolic resin-starved composite panel using tensile loading. The tensile stress–strain behavior of this eight-layer material has been investigated and has been found to have two distinct regions; these have been understood in terms of the microstructure and damage within the composite panels investigated using micro-computed tomography and digital image correlation. Ballistic testing carried out on pristine (control) and pre-damaged panels did not indicate any difference in the V50 ballistic performance. However, an indication of a difference in response to ballistic impact was observed; the area of maximal local out-of-plane deformation for the pre-damaged panels was found to be twice that of the control panels, and the global out-of-plane deformation across the panel was also larger.
Spontaneous subcapsular renal haematoma in a diabetic patient with acute pyelonephritis
Authors: Nayyar Nishant , Sood Dinesh , Chauhan Narvir S , Kumar Neeraj , Thakur Manoj , Thakur Deepika
Published: May 2021

Spontaneous renal subcapsular haematoma is not a common clinical condition. It is mainly caused by renal tumours, vascular diseases, trauma, anticoagulation, and urological interventions. Patients present with sudden onset abdominal pain mainly in the flank region, haematuria, and abdominal tenderness. We report a case of 42-year-old diabetic patient who presented with a history of fever and left flank pain with clinical signs of pyelonephritis, on whom abdominal ultrasound and computed tomography demonstrated a subcapsular renal haematoma which was confirmed by percutaneous aspiration. Management with antibiotics and percutaneous nephrostomy proved successful.
Entrepreneurial Social Identity Management Through Language Use
Authors: Hajek Christopher
Published: May 2021

This study draws upon interview data and a grounded theoretical methodology to explore entrepreneurial social identity management. Interviews were conducted with forty-three entrepreneurs in several U.S. cities. The women and men discussed past conversations with (non)entrepreneurs, with foci on self- and other stereotyping, associated language use, prototypicality, and motivation. Open and axial coding of the interview content revealed a new model of entrepreneurial social identity management. The model’s implications for understanding entrepreneurs’ social identity and motivation were discussed.
The relationship between psychological distress and impairment of disease-specific quality-of-life compared between liquid sclerocompression therapy and invasive treatments in patients with superficial venous disease during a one-year follow-up
Authors: Krasznai Attila G , Catarinella Fabio S , Houtermans-Auckel Janine , Nieman FHM , Wittens IAJ , Mooij MC , Wittens Cees HA
Published: May 2021

Introduction

Superficial venous disease (SVD) is a very common disease and much research has been done towards finding the ideal treatment and discovering the pathophysiology of SVD. Not much is known about the psychological burden of SVD. Current guidelines and scientific publications tend to focus on clinical and physiological aspects of SVD. The aim of this study was to relate the changes in Quality-of-Life (QoL) after SVD treatment to possible changes in psychological distress (PD).

Methods

A prospective cohort was set up with the assistance of 5 specialized vein clinics in the Netherlands. Inclusion criteria were: 18 years of age or older, fluent in Dutch language, C1 to C6 (CEAP) class intended to be primary treated with either endovenous laser(LA), radiofrequency ablation (RFA) and phlebectomy(PHL) or sclerocompression therapy alone (SCT). Patients were divided in two groups: 1. C1-C3 patients treated by SCT 2. C1-C6 patients treated invasively (LA, RFA and PHL) Outcomes were a disease specific QoL questionnaire (CIVIQ-20) and a questionnaire to assess PD (Hospital Anxiety and Depression Scales (HADS)). This study was approved by the local institutional review board, following the principles outlines in the Declaration to Helsinki. This trial was registered in the ISRCTN registry with study ID ISRCTN12085308

Results

442 patients were included in the study and completed the T0 measurements. Mean age of these patients is 54.4 years (s.d. 12.9, 17-90). Number of females: 349 (79.0%), of males: 93 (21.0%). The mean baseline (T-0) HADS depression (0-3) scale scores is 2.54 (s.d. 0.51, n = 412). The mean one-year difference between T-12 HADS depression (0-3) scale scores and baseline T-0 scores is +0.06. The mean baseline (T-0) HADS anxiety (0-3) scale scores is 2.19 (s.d. 0.5, n = 283). The mean one-year difference between T-12 HADS anxiety (0-3) scale scores and baseline T-0 scores is +0.06. Controlled for baseline scores, gender, age, weight and length(BMI), patients in group 2 (receiving invasive treatment) show significantly higher one-year improvement in the QoL of their psychological state of mind than patients in group 1 (receiving SCT and having C1,2,3) (beta 0.158 p = 0.002).

Conclusions

The significant improvement in psychological, QoL and clinical scores that we observe after successful invasive treatment compared to no significant improvement after SCT and the lack of psychological distress in patients with “simple” SVD indicates that SCT is mainly performed for cosmetic reasons. One could thus argue that reimbursement of SCT as a stand-alone medical treatment is debatable.
Early intubation versus late intubation for COVID-19 patients: An in situ simulation identifying factors affecting performance and infection control in airway management
Authors: Lee Christopher P , Yip Yu-Yeung , Chan Albert KM , Ko Chun P , Joynt Gavin M
Published: May 2021

COVID-19 poses an infectious risk to healthcare workers especially during airway management. We compared the impact of early versus late intubation on infection control and performance in a randomised in situ simulation, using fluorescent powder as a surrogate for contamination. Twenty anaesthetists and intensivists intubated a simulated patient with COVID-19. The primary outcome was the degree of contamination. The secondary outcomes included the use of bag-valve-mask ventilation, the incidence of manikin cough, intubation time, first attempt success and heart rate variability as a measure of stress. The contamination score was significantly increased in the late intubation group, mean (standard deviation, SD) 17.20 (6.17), 95% confidence intervals (CI) 12.80 to 21.62 versus the early intubation group, mean (SD) 9.90 (5.13), 95% CI 6.23 to 13.57, P = 0.005. The contamination score was increased after simulated cough occurrence (mean (SD) 18.0 (5.09) versus 5.50 (2.10) in those without cough; P<0.001), and when first attempt laryngoscopy failed (mean (SD) of 17.1 (6.41) versus 11.6 (6.20) P = 0.038). The incidence of bag-mask ventilation was higher in the late intubation group (80% versus 30%; P=0.035). There was no significant difference in intubation time, incidence of failed first attempt laryngoscopy or heart rate variability between the two groups. Late intubation in patients with COVID-19 may be associated with greater laryngoscopist contamination and potential aerosol-generating events compared with early intubation. There was no difference in performance measured by intubation time and incidence of first attempt success. Late intubation, especially when resources are limited, may be a valid approach. However, strict infection control and appropriate personal protective equipment usage is recommended in such cases.
Is Dementia-Specific Caregiving Compared With Non-Dementia Caregiving Associated With Physical Difficulty Among Caregivers for Community-Dwelling Adults?
Authors: Parker Lauren J. , Fabius Chanee , Rivers Emerald , Taylor Janiece L.
Published: May 2021

Objective:

The purpose of this study is to identify whether dementia caregiving is associated with physical difficulty among informal caregivers.

Methods:

This cross-sectional retrospective cohort study design used data from the 2015 National Health and Aging Trends Study and the National Study of Caregiving. Binary logistic regression was used to examine the association between substantial physical difficulty and dementia caregiving among 1,871 caregivers.

Results:

Nearly 14% of the caregivers reported substantial physical difficulty. Dementia caregivers were 1.5 times more likely to report caregiving-related substantial physical difficulty (adjusted odds ratio [AOR] = 1.58, p = .04) than non-dementia caregivers. Factors associated with substantial physical difficulty included caregiver gender, self-rated health, depressive symptoms, pain, and caring for someone receiving assistance with three or more self-care or mobility activities.

Discussion:

Future studies should identify strategies to mitigate the physical demands on dementia caregivers. Early monitoring of caregivers’ self-rated health, depressive symptoms, and pain may identify those more likely to experience physical difficulty.
The Creation of a Mental Health Policy in Higher Education
Authors: Pilato Kelly A. , Law Madelyn P. , Narushima Miya , Moore Shannon A. , Hay John A.
Published: May 2021

The mental wellness of university students can be critical for their success. In an attempt to minimize stress for students, many universities have implemented a policy for a fall break with limited evidence to support its intended outcomes. This case study offers a critical appraisal of the formation of the fall break policy at one medium sized comprehensive university using qualitative and quantitative forms of evidence triangulated from (1) University Student Union survey, (2) document analysis and; (3) informant interview. The lack of uniformity on how the fall break is labelled, the timing of the break and its evaluation emerged as design flaws in the creation stage that perhaps, could have been mitigated if faculty and student voices were included in policy creation decisions.
Study of the rollers geometry effects in rotary tube piercing and wear analyses of mandrel according to the finite element method
Authors: Darki Saeed , Raskatov Evgeniy Y
Published: May 2021

The rotary tube piercing (RTP) is the first process of making the seamless tube after producing the desired alloy ingot. There are several approaches to manufacture a seamless tube, but one of the most common types is RTP. This approach covers a wide range of processes that are categorized according to the number and shape of the rollers. On the other hand, each of these types has designed guides in the output and input of the piercing process. In this paper, a new design of the input guide for four types of rollers have been examined and simulated. Thus, four specimens including Diescher and Conical rollers were considered, with the different number of rollers. Results including torque, total force, mandrel wear, temperature distribution, and strain were extracted using FEM simulation. In order to the validation of simulation, the total force and oscillations of applied force within the process have been compared with the experimental results. The results obtained through this simulation, are more in line with the empirical results obtained from previous research. As well as, the FEM simulation confirmed the performance accuracy of the output and input guides of the RTP process. On the other hand, the results indicate that the three-roller Diescher type with 17° feed angle, has the most suitable arrangement for production of seamless tube.
Undetected Neurodegenerative Disease Biases Estimates of Cognitive Change in Older Adults
Authors: Harrington Karra D. , Aschenbrenner Andrew J. , Maruff Paul , Masters Colin L. , Fagan Anne M. , Benzinger Tammie L. S. , Gordon Brian A. , Cruchaga Carlos , Morris John C. , Hassenstab Jason
Published: May 2021

Neurodegenerative disease is highly prevalent among older adults and, if undetected, may obscure estimates of cognitive change among aging samples. Our aim in this study was to determine the nature and magnitude of cognitive change in the absence of common neuropathologic markers of neurodegenerative disease. Cognitively normal older adults (ages 65–89 years, N = 199) were classified as normal or abnormal using neuroimaging and cerebrospinal-fluid biomarkers of β-amyloid, tau, and neurodegeneration. When cognitive change was modeled without accounting for biomarker status, significant decline was evident for semantic memory, processing speed, and working memory. However, after adjusting for biomarker status, we found that the rate of change was attenuated and that the biomarker-normal group demonstrated no decline for any cognitive domain. These results indicate that estimates of cognitive change in otherwise healthy older adults will be biased toward decline when the presence of early neurodegenerative disease is not accounted for.
Vaccination with Rift Valley fever virus live attenuated vaccine strain Smithburn caused meningoencephalitis in alpacas
Authors: Anthony Tasneem , van Schalkwyk Antoinette , Romito Marco , Odendaal Lieza , Clift Sarah J. , Davis A. Sally
Published: May 2021

Rift Valley fever (RVF) is a zoonotic, viral, mosquito-borne disease that causes considerable morbidity and mortality in humans and livestock in Africa and the Arabian Peninsula. In June 2018, 4 alpaca inoculated subcutaneously with live attenuated RVF virus (RVFV) Smithburn strain exhibited pyrexia, aberrant vocalization, anorexia, neurologic signs, and respiratory distress. One animal died the evening of inoculation, and 2 at ~20 d post-inoculation. Concern regarding potential vaccine strain reversion to wild-type RVFV or vaccine-induced disease prompted autopsy of the latter two. Macroscopically, both alpacas had severe pulmonary edema and congestion, myocardial hemorrhages, and cyanotic mucous membranes. Histologically, they had cerebral nonsuppurative encephalomyelitis with perivascular cuffing, multifocal neuronal necrosis, gliosis, and meningitis. Lesions were more severe in the 4-mo-old cria. RVFV antigen and RNA were present in neuronal cytoplasm, by immunohistochemistry and in situ hybridization (ISH) respectively, and cerebrum was also RVFV positive by RT-rtPCR. The virus clustered in lineage K (100% sequence identity), with close association to Smithburn sequences published previously (identity: 99.1–100%). There was neither evidence of an aberrant immune-mediated reaction nor reassortment with wild-type virus. The evidence points to a pure infection with Smithburn vaccine strain as the cause of the animals’ disease.
Interventions to Improve Medication Adherence in Ethnically Diverse Patients: A Narrative Systematic Review
Authors: Singh Pavneet , LeBlanc Pamela , King-Shier Kathryn
Published: May 2021

Introduction:

Ethnically diverse patients often have lower medication adherence relative to Whites. Certain ethnic groups are also more susceptible to cardiovascular and related diseases. It is critical to develop culturally tailored interventions to improve medication adherence in these ethnically diverse patients. Thus, the aim of this systematic review was to identify what interventions have been developed and tested to improve medication adherence in ethnically diverse patients with cardiovascular-related diseases.

Method:

A systematic search of peer-reviewed literature (MEDLINE, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane Central Register of Controlled Trials) was conducted to identify relevant articles. The narrative synthesis was performed based on elements offered by Popay et al. The mixed methods appraisal tool was used to appraise the quality of the included studies.

Results:

A total of 11,294 records were retrieved, and 34 articles met the inclusion criteria for this systematic review. Synthesis of the literature revealed four overarching intervention strategies used to improve medication adherence: pharmacist-mediated, primarily nurse-led, community-based and community-health worker led, and text-message and phone-based.

Discussion:

Several approaches can be used to improve medication adherence in ethnically diverse patients, although details on the approaches and conditions to produce optimal improvements for particular ethnic groups need to be determined in future studies. How does this affect culturally congruent health care?
Forecasting Posttreatment Outcome of Hallux Valgus Surgery Patients
Authors: Sawah Amjad , Zemenova Stepanka , Haque Russel , Ridley David , Abboud Rami J. , Wang Weijie , Harrold Fraser
Published: May 2021

Background:

Despite advancements in operative techniques and the extraordinary number of procedures described for correcting hallux valgus (HV), there is still uncertainty as to why some patients thrive postoperatively whereas others do not. This study aimed to investigate whether the postoperative outcome of HV surgery could be predicted from patient demographics or functional impairment at the time of referral.

Methods:

The prospectively collected data, from 92 patients, were analyzed to determine whether patient demographics significantly influenced outcome 52 weeks after surgery. Potential relationships between socioeconomic deprivation and the outcome, as well as between preoperative functional impairment and postoperative improvement, were examined. The Manchester Oxford Foot Questionnaire (MOXFQ) and Scottish Index of Multiple Deprivation (SIMD) were used in this evaluation.

Results:

None of the demographics studied were found to be statistically significant determinants of outcome. Preoperative MOXFQ scores for patients from the most deprived areas were significantly worse at the time of referral. Patients living in the least deprived postcodes experienced the lowest improvement in MOXFQ scores. Patients from the most deprived SIMD quintile achieved significantly higher improvement in MOXFQ–walking and standing compared to those from the least deprived quintile. A strong positive correlation was found between the preoperative MOXFQ scores and the improvement in the scores postoperatively.

Conclusion:

In this patient cohort, demographics could not be used to predict the postoperative outcome at week 52. Socioeconomic disparities seem to influence the timing of patients seeking surgery. Lower preoperative MOXFQ scores strongly correlate with a lesser degree of postoperative improvement.

Level of Evidence:

Level III, retrospective study with prospective arm.
Latinx immigrants raising children in the land of the free: Parenting in the context of persecution and fear
Authors: Cross Fernanda Lima , Rivas-Drake Deborah , Aramburu Jasmin
Published: May 2021

Anti-immigrant rhetoric generated by the sociopolitical climate under the current U.S. presidential administration has exacerbated the fear of deportation and family separation within the unauthorized Latinx community. Consequently, millions of families, including U.S. citizen children living in mixed-status households, are experiencing stressful environments as they adapt and respond to their social context. This study explored how harsh immigration discourse impacts mixed-status families living in a new-immigrant destination. Twenty-two unauthorized mothers participated in semi-structured interviews regarding their experiences as immigrants raising children in the U.S. Two main themes arose from this analysis: (1) ever-present fear and stress and (2) obeying the law and avoiding others. Parents explained how they had been living in fear since the elections took place, and the different scenarios they had to prepare for in case of deportation. Moreover, some parents choose to minimize conversations around incidents happening in their community to avoid additional stress for children, whereas others addressed children’s concerns to reassure them and placate their apprehension. Participants also reported avoiding unnecessary trips outside of the home to prevent interactions with others, especially law enforcement. These results provide important insights regarding the experiences of unauthorized Latinx immigrant parents in the context of sociopolitical adversity. Due to the limited resources often available in new immigrant destinations, social workers must leverage their networks to support families undergoing difficult transitions with special attention to altered family structures and parenting practices. As unauthorized parents attempt to withstand the double burden of basic survival and effective parenting, it is imperative that practitioners provide tools for parents to effectively engage with their children to sustain healthy environments.
A Risk Appraisal Framework for Injury Etiology
Authors: Barton Benjamin K. , Davis Shane J. , Pugliese Brian J.
Published: May 2021

Unintentional injury is a significant worldwide health concern. Researchers have called on several occasions for conceptual frameworks to guide work on unintentional injury. Using conceptual approaches to organize our inquiry is one way to advance our knowledge of injury etiology. To this end, we suggest a risk appraisal framework for examining enactment or avoidance of injury risk behaviors. Our framework comprises broad antecedents, focusing on the evaluative stage preceding behaviors. Four categories influencing efficacy related to injury risk behavior are included: environmental context, experience, social context, and strategy. In this article, we explain the categories and concepts in our framework, discuss each in terms of etiology, briefly discuss interrelations between the categories, and suggest future paths using the framework.
Analysis of the dynamic characteristics of downsized aerostatic thrust bearings with different pressure equalizing grooves at high or ultra-high speed
Authors: Yan Ruzhong , Zhang Haojie
Published: May 2021

This study adopts the DMT(dynamic mesh technology) and UDF(user defined functions) co-simulation method to study the dynamic characteristics of aerostatic thrust bearings with equalizing grooves and compare with the bearing without equalizing groove under high speed or ultra high speed for the first time. The effects of air film thicness, supply pressure, rotation speed, perturbation amplitude, perturbation frequency, and cross section of the groove on performance characteristics of aerostatic thrust bearing are thoroughly investigated. The results show that the dynamic stiffiness and damping coefficient of the bearing with triangular or trapezoidal groove have obvious advantages by comparing with that of the bearing without groove or with rectangular groove for the most range of air film thickness, supply pressure, rotation speed, perturbation amplitude, especially in the case of high frequency, which may be due to the superposition of secondary throttling effect and air compressible effect. While the growth range of dynamic stiffness decreases in the case of high or ultra-high rotation speed, which may be because the Bernoulli effect started to appear. The perturbation amplitude only has little influence on the dynamic characteristic when it is small, but with the increase of perturbation amplitude, the influence becomes more obvious and complex, especially for downsized aerostatic bearing.
Impact of a “Pharmacist First” innovative workflow plan in patients with hypertension and/or diabetes
Authors: So Randy , Al Hamarneh Yazid N. , Oleksyn Carlene , Purschke Mary , Tsuyuki Ross T.
Published: May 2021

Usual community pharmacy workflow, whereby patients might see a pharmacist at the end of the dispensing process, is not conducive to proactive patient-centred care. The objective of this study was to evaluate the impact of the “Pharmacist First” (P1st) workflow model on blood pressure and glycemic control in patients with hypertension and/or diabetes. This retrospective review was set in 2 community pharmacies that use the P1st model in the Greater Edmonton Region. The population entailed patients with hypertension and/or type 1 or 2 diabetes who received care via the P1st workflow model. The P1st workflow model places the patient in immediate contact with the pharmacist. The pharmacist first assesses prescription appropriateness, reviews relevant laboratory tests, discusses chronic disease control and addresses any questions or concerns the patient has before passing the prescription to be filled by a technician. This allows issues or concerns to be identified and addressed up front, rather than waiting until the prescription is filled and the patient is ready to leave the pharmacy. The primary outcome assessed in this study was change in blood pressure and/or A1C from baseline to the last follow-up visit. We reviewed 215 patient records. The mean age was 69.4 years (standard deviation 12.5), 51.2% of patients were male, 57.7% had hypertension, 5.6% had diabetes, and 36.7% had both. Median follow-up time was 4.2 months (interquartile range 2.5 -9.3). In 203 patients with hypertension, systolic blood pressure was reduced from 139.83 mmHg to 131.26 mmHg ( p < 0.001) and diastolic blood pressure from 80.26 mmHg to 76.86 mmHg ( p < 0.001). In 87 patients with diabetes, A1C changed from 7.4% to 7.2% ( p = ns). The P1st workflow model demonstrated significant improvements in blood pressure. Further investigation is needed to evaluate the effectiveness of this model with a control group, longer follow-up and evaluation of the patient experience.
An Elusive Seizure
Authors: Han Harry J. , Parks Anna L. , Shah Maulik P. , Hsu Gerald , Santhosh Lekshmi
Published: May 2021

We present a case of a healthy 62-year-old woman who developed recurrent seizures preceded by subacute cognitive slowing, ataxia, night sweats, and weight loss. She was found to have cytopenias, multifocal T2/FLAIR hyperintensities on magnetic resonance imaging (MRI), and magnetic susceptibility artifact lesions on susceptibility weighted imaging (SWI). Her symptoms, imaging and laboratory abnormalities all improved with high-doses of steroids and intravenous immunoglobulin (IVIG). But recurred several weeks after completing treatment. Despite extensive work-up, she required multiple hospitalizations and repeat diagnostic studies to arrive at a diagnosis. With an expert discussant in hematology and oncology, we review the differential diagnosis and stepwise approach of unexplained neuro-inflammatory syndromes with cytopenias and systemic symptoms. Our case highlights how time, empiric treatment response, and repeated diagnostic studies refine differential diagnoses and subsequent evaluation. After revealing the diagnosis, we discuss the heterogenous clinical manifestations of this disease process.
Pulmonary arterial hypertension associated with congenital heart disease: lessons learnt from the large Turkish Nationwide Registry (THALES)
Authors: Kücükoglu Serdar M. , Kaymaz Cihangir , Alehan Dursun , Kula Serdar , Akcevin Atıf , Celiker Alpay , Cicek Sertac M. , Tokgözoglu Lale S. , Kentli Suleyman ,   THALES Registry Investigators
Published: May 2021

Pulmonary hypertension is a group of diseases, including pulmonary arterial hypertension associated with congenital heart disease (APAH‐CHD), characterized by progressive deterioration in pulmonary hemodynamics associated with substantial morbidity and mortality risk. THALES is a national multicenter, prospective observational registry, providing data on patients with APAH‐CHD. The study comprised APAH‐CHD patients (>3 months of age) with confirmed diagnosis of right heart catheterization or echocardiographic findings. Initial and follow‐up data were collected via regular hospital visits. Descriptive statistics are used for definitive purposes. Overall, 1034 patients aged 3 months–79 years (median 11.2 [Q1–Q3: 2.2–24.3] years) with APAH‐CHD were enrolled at 61 centers, 50.3% being retrospectively enrolled. Most had either Eisenmenger's syndrome (49.2%) or systemic‐to‐pulmonary shunts (42.7%). Patients were mostly in functional class I–II at the time of diagnosis (46.6%). Mean 6‐min walk distance (6MWD) was 369 ± 120 m. Mean pulmonary arterial pressure was 54.7 ± 22.2 mmHg for the whole group, and was highest in patients with Eisenmenger's syndrome. Targeted therapies were noted in 398 (38.5%) patients (monotherapy in 80.4%). Follow‐up data were available in 506 patients. Survival at 140 months was 79% and was associated with baseline 6MWD >440 m (p = 0.009), brain natriuretic peptide level < 300 ng/L (p < 0.001). Follow‐up 6MWD >165 m (p < 0.0001), brain natriuretic peptide level <300 ng/L (p = 0.031), and targeted therapies (p = 0.004) were also predictive of survival. THALES is the largest registry dedicated to APAH‐CHD to date and provides important contributions on demographics, clinical characteristics, and gaps in disease management.
Studying Reddit: A Systematic Overview of Disciplines, Approaches, Methods, and Ethics
Authors: Proferes Nicholas , Jones Naiyan , Gilbert Sarah , Fiesler Casey , Zimmer Michael
Published: May 2021

This article offers a systematic analysis of 727 manuscripts that used Reddit as a data source, published between 2010 and 2020. Our analysis reveals the increasing growth in use of Reddit as a data source, the range of disciplines this research is occurring in, how researchers are getting access to Reddit data, the characteristics of the datasets researchers are using, the subreddits and topics being studied, the kinds of analysis and methods researchers are engaging in, and the emerging ethical questions of research in this space. We discuss how researchers need to consider the impact of Reddit’s algorithms, affordances, and generalizability of the scientific knowledge produced using Reddit data, as well as the potential ethical dimensions of research that draws data from subreddits with potentially sensitive populations.
Chiming In: A Computer-Assisted Analysis of Popular Musicians’ Political Engagement on Twitter
Authors: Lukito Josephine , Loya Luis , Dávalos Carlos , Li Jianing , Tong Chau , McLeod Douglas M.
Published: May 2021

While music as an artistic form is well studied, the individuals behind the art receive relatively less attention. In this article, we provide evidence of celebrity advocacy with a systematic examination of musicians’ political engagement on Twitter. This study estimates the extent to which musicians use Twitter for political purposes, with particular attention to whether such engagement varies across music genres. Through a computational-assisted analysis of 2,286,434 tweets, we group 881 musicians into three categories of political engagement on Twitter: not engaged (comprising the majority of artists), circumstantial engagement, and active political engagement. We examine the latter categories in detail with two qualitative case studies. The findings indicate that musicians from different genres have distinct patterns of political engagement. The Christian music genre shows the most engagement as a whole, especially in philanthropy. On the contrary, the most active accounts are rock and hip-hop artists, some of whom discuss political issues and call for mobilization. We conclude with suggestions for future research.
Strategies for Effective Home Modification in Older Adults
Authors: Kato Yuki , Muramatsu Ken , Yamamoto Yoshinori , Suzuki Yoshie , Momosaki Ryo
Published: May 2021

There are various barriers to home modifications to prevent falls among the older population. Several strategies may be necessary to overcome these barriers and implement effective home modifications. The need for home modification should be assessed, which requires a home evaluation by a specialist. In Japan, welfare housing environment coordinators have been trained to provide advice on home modifications suitable for people with disabilities. In addition, in Japan, home assessment and advice on home modification before discharge from acute care hospitals for older people is allowed as a medical reimbursement, and a system for effective home modification is well established. Human resource training and medical policy arrangements on home modifications could improve the cost-effectiveness. In Japan, a system has been established to support the costs of home modification and environmental maintenance. Financial support has reduced the barrier to home modification. Fixed grab bars or shower chairs can be rented, which may be more cost-effective than purchasing them and may shorten the time required for installation. There may be psychological barriers to home modification for older population. Since many older people do not recognize the importance of home modification, promotion to convey the value of home modification may be necessary. Training of staff to engage in home modification, public financial support for modification, and ideas for reducing psychological hesitation may help to reduce the barriers for home modification and to enable effective home modification.
The Disclosure Decision of Foreign Clinical Trials in China: Moderating Effects of Firms’ Contingencies
Authors: Malik Tariq H. , Huo Chunhui
Published: May 2021

Result disclosure of clinical trial posts a conflicting logic between private secrecy and public interest. Despite ethical and legal requirements for disclosing clinical trial results, clinical trials’ sponsors tend to withhold the results. We explored the location, timing, and rationale behind the withheld clinical trial results. Based on the entrepreneurial orientation (EO) perspective, we propose that organizational EO contingencies moderate the disclosure decision. We used the completed clinical trial projects in China by foreign and domestic sponsors. First, we found that a unit increase in the sponsor’s experience can increase the disclosure about 1.01 times. Second, we found that industrial enterprises disclose results about 3.7 times more than universities do. Third, we found that foreign clinical trial projects in China tend to disclose 3.9 times more than domestic projects. We link these findings to two types of audience. First, we inform the academic community on the theory and empirics regarding risk-taking behavior in the biopharmaceutical industry’s clinical trial activity. Second, we address the general audiences concerned about the ethical and socioeconomic wellbeing of the public.
Promoting Female Entrepreneurship: The Impact of Gender Gap Beliefs and Perceptions
Authors: Ilie Camelia , Monfort Abel , Fornes Gaston , Cardoza Guillermo
Published: May 2021

Perceptions and institutional frameworks can be barriers or facilitators to the development of female entrepreneurship policies. Institutions rely on factual data on the gender gap to evaluate their policies. However, the literature shows that the research and institutions should also analyze the impact of social beliefs on the success of these policies and initiatives. This study focuses on the impact of these perceptions in promoting female entrepreneurship. Data were collected from 287 responses to a questionnaire from Spanish women and men and were analyzed using multivariate regression analysis. The results show that the perception of lack of equality increases the gender gap even if there are specific and effective policies in a society that attempt to eliminate the gender gap in terms of the role of women in the home or positions of power. The main result is that these perceptions ultimately affect women’s entrepreneurial intentions. The results have policy implications for companies and public institutions willing to change the gender narrative about entrepreneurship and design policies and initiatives that help women overcome cultural barriers and effectively promote female entrepreneurship.
Utilization of partograph and its associated factors among obstetric caregivers in public health institutions of Southwest Ethiopia
Authors: Tilahun Abel Girma , Gebeyehu Dawit Getachew , Adinew Yayehyirad Yemaneh , Mengstu Fekede Woldekidan
Published: May 2021

Background

Partographs should be used universally to monitor the mother and fetus’s conditions during delivery. However, its application in different parts of the world, including Ethiopia, is inconsistent. Moreover, its magnitude has not been determined in study area. As a result, the aim of this study was to investigate the utilization of partograph and associated factors among obstetric caregivers in public health institutions of Southwest Ethiopian.

Methods

An institutional-based cross-sectional study was conducted in Southwest Ethiopia from March 1st to June 30th, 2018. A simple random sampling technique was used to select study participants. A self-administered questionnaire was used to gather data on background characteristics, knowledge of partograph, and partograph utilization. The collected data were entered into an EPI Info and analysed using SPSS Version 22. We used bivariate and multivariate logistic regression analysis. Frequencies, tables, and graphs were used to present the final results. To determine statistical significance, a P-value of less than 0.05 was used.

Result

The response rate of this study was 393(92.2 %). The magnitude of utilization of partograph was 43 % with (95 % CI: 38.4, 48.1). According to the multivariate analysis being nurse or health officer [AOR = 0.37(0.21, 0.66)], degree level educational qualification [AOR = 0.32 (0.17, 0.60)], being trainined on partograph [Adjusted OR = 7.83 (95 % CI: (4.54, 13.50)], good knowledge about partograph [AOR = 5.84 (95 % CI: (3.27, 10.44)] and working at health center [AOR = 1.99 (95 % CI: (1.12, 3.52)] were found as determinants of partograph utilization.

Conclusions

The magnitude of partograph utilization among obstetric caregivers was found to be low in this study. Partograph utilization was determined by the type of profession, qualification level, knowledge of partograph, in-service training, and type of institution. To ensure its regular, obstetric caregivers must receive training and gain knowledge about it.
Relationships between age at first substance use and persistence of cannabis use and cannabis use disorder
Authors: Millar Seán R. , Mongan Deirdre , Smyth Bobby P. , Perry Ivan J. , Galvin Brian
Published: May 2021

Background

From a secondary prevention perspective, it is useful to know who is at greatest risk of progressing from substance initiation to riskier patterns of future use. Therefore, the aim of this study was to determine relationships between age at first use of alcohol, tobacco and cannabis and patterns of cannabis use, frequency of use and whether age of substance use onset is related to having a cannabis use disorder (CUD).

Methods

We analysed data from Ireland’s 2010/11 and 2014/15 National Drug Prevalence Surveys, which recruited 5134 and 7005 individuals respectively, aged 15 years and over, living in private households. We included only those people who reported lifetime cannabis use. Multinomial, linear and binary logistic regression analyses were used to determine relationships between age of substance use onset and patterns of cannabis use, frequency of use and having a CUD.

Results

When compared to former users, the odds of being a current cannabis user were found to be reduced by 11% (OR = 0.89; 95% CI: 0.83, 0.95) and 4% (OR = 0.96; 95% CI: 0.92, 1.00) for each year of delayed alcohol and cannabis use onset, respectively. Among current users, significant inverse linear relationships were noted, with increasing age of first use of tobacco (β = − 0.547; P < .001) and cannabis (β = − 0.634; P < .001) being associated with a decreased frequency of cannabis use within the last 30 days. The odds of having a CUD were found to be reduced by 14% (OR = 0.86; 95% CI: 0.78, 0.94) and 11% (OR = 0.89; 95% CI: 0.82, 0.98) for each year of delayed tobacco and cannabis use onset respectively in analyses which examined survey participants aged 15–34 years.

Conclusions

Among people who report past cannabis use, it is those with a more precocious pattern of early use of substances, including alcohol, and especially tobacco and cannabis, who are more likely to report ongoing, heavy and problematic cannabis use. Secondary prevention initiatives should prioritise people with a pattern of very early onset substance use.
Hyperlactatemia associated with diabetic ketoacidosis in pediatric intensive care unit
Authors: Liu Jingwei , Yan Haibo , Li Yumei
Published: May 2021

Background

Children with diabetic ketoacidosis often have elevated lactate. In this study, we investigated the clinical variables associated with hyperlactatemia in children with diabetic ketoacidosis.

Methods

We designed a single-center retrospective descriptive study of children with diabetic ketoacidosis in a pediatric intensive care unit.

Results

Of the 107 patients with diabetic ketoacidosis included in the analysis, 61 developed hyperlactatemia. Multivariate logistic regression analysis showed that heart rate (p = 0.003),diastolic blood pressure (p = 0.001) and stage of severity (p = 0.042) were independently associated with the development of hyperlactatemia in diabetic ketoacidosis. We found that lactate level was not significantly associated with length of hospital stay (p = 0.115) or the length of time to diabetic ketoacidosis resolution (p = 0.143).

Conclusions

Children with diabetic ketoacidosis presenting with severer stage, elevated heart rate and higher diastolic blood pressure may be prone to hyperlactatemia. Hyperlactatemia was not associated with length of time to DKA resolution and length of hospital stay.
The definition of major trauma using different revisions of the abbreviated injury scale
Authors:   Dutch Trauma Registry Southwest, Van Ditshuizen Jan C. , Sewalt Charlie A. , Palmer Cameron S. , Van Lieshout Esther M. M. , Verhofstad Michiel H. J. , Den Hartog Dennis
Published: May 2021

Background

A threshold Injury Severity Score (ISS) ≥ 16 is common in classifying major trauma (MT), although the Abbreviated Injury Scale (AIS) has been extensively revised over time. The aim of this study was to determine effects of different AIS revisions (1998, 2008 and 2015) on clinical outcome measures.

Methods

A retrospective observational cohort study including all primary admitted trauma patients was performed (in 2013–2014 AIS98 was used, in 2015–2016 AIS08, AIS08 mapped to AIS15). Different ISS thresholds for MT and their corresponding observed mortality and intensive care (ICU) admission rates were compared between AIS98, AIS08, and AIS15 with Chi-square tests and logistic regression models.

Results

Thirty-nine thousand three hundred seventeen patients were included. Thresholds ISS08 ≥ 11 and ISS15 ≥ 12 were similar to a threshold ISS98 ≥ 16 for in-hospital mortality (12.9, 12.9, 13.1% respectively) and ICU admission (46.7, 46.2, 46.8% respectively). AIS98 and AIS08 differed significantly for in-hospital mortality in ISS 4–8 (χ2 = 9.926, p = 0.007), ISS 9–11 (χ2 = 13.541, p = 0.001), ISS 25–40 (χ2 = 13.905, p = 0.001) and ISS 41–75 (χ2 = 7.217, p = 0.027). Mortality risks did not differ significantly between AIS08 and AIS15.

Conclusion

ISS08 ≥ 11 and ISS15 ≥ 12 perform similarly to a threshold ISS98 ≥ 16 for in-hospital mortality and ICU admission. This confirms studies evaluating mapped datasets, and is the first to present an evaluation of implementation of AIS15 on registry datasets. Defining MT using appropriate ISS thresholds is important for quality indicators, comparing datasets and adjusting for injury severity.

Level of evidence

Prognostic and epidemiological, level III.