bluuebunny/crossref_metadata_2025 huggingface dataset:
“Enjoy your experience”: Symbolic violence and becoming a tasteful state cannabis consumer in Canada
Authors: Cormack Patricia , Cosgrave James
Published: March 2021

This article explores the legalization and marketing of recreational cannabis in Canada, specifically the province of Nova Scotia, that has extended state monopoly over sales. Beginning with Howard Becker’s classic analysis of “becoming a marijuana user,” this ethnographic investigation of the first day of state cannabis sales utilizes and extends Bourdieusian analyses, particularly by showing how “symbolic violence” and “taste distinctions” work beyond overt class reproduction to establish state classifications and rituals. The practices we observe show state formation in action at the point of sale, including education, warning, prohibition, and promotion. As we demonstrate, the state marketing of cannabis works to invite emotional identification toward becoming the state consumer as an embodied habitus. The citizen is not just redeemed morally by the legal recategorization of cannabis but brought into a new subject position as good consumer citizen at the moment of ritual consumption, that is, brought into a “tasteful state.”
Fénelon, a conservative mind?
Authors: Rousselière Geneviève
Published: March 2021

In his excellent new book, Hanley presents an engaging interpretation of Fénelon’s political thought as modern and moderate. While I salute the revival of the work of this important and forgotten author, and I concur with Hanley to see him as a courageous opponent of absolute monarchy, tyranny, and political corruption, I argue that Fénelon’s worldview was conservative, in the sense that he endorsed social hierarchy, rejected democracy, and ultimately praised subjection to God rather than reason.
A bionic noise reduction strategy on the trailing edge of NACA0018 based on the central composite design method
Authors: Liu Haoran , Lu Yeming , Li Yingyue , Wang Xiaofang
Published: March 2021

New innovative approaches to reduce noise are of great significance in engineering. Taking the typical NACA0018 airfoil as the study target, the serrated treatment of the trailing edge is carried out with the bionic noise reduction technology. To boost the design efficiency and clarify the distributing laws between the design parameters and the noise performances, a special investigation about optimizing the NACA0018 airfoil’s serrated trailing edge is implemented here. Firstly, a united parametric approach to represent various design schemes is proposed. Then, with the integration of the Computational Fluid Dynamics/Computational Acoustics analysis, Central Composite Design, and the Respond Surface Method, a bionic noise reduction strategy is established. The findings can be gotten as: taking into account the existence of the casing or wall near the span-end of the airfoil, the newly defined install location adjustment factor has an influence on the reduction noise, and the install location adjustment factor mainly affects the near-wall flow field of the serrated trailing edge; the optimal design scheme is obtained successfully, which can reduce the overall sound pressure level by about 2 dB in relative to the target; through the mechanism analysis of noise reduction, it can be found that the serrated trailing edge can suppress the development of the laminar separation bubbles, so the noise is reduced.
Diagnostic accuracy of multichannel intraluminal impedance-pH monitoring for gastroesophageal reflux-induced chronic cough
Authors: Li Na , Chen Qiang , Wen Siwan , Zhang Mengru , Dong Ran , Xu Xianghuai , Yu Li , Qiu Zhongmin
Published: March 2021

Objectives:

To elucidate the accuracy and advantages of Multichannel intraluminal impedance-pH monitoring (MII-pH) in diagnosing gastroesophageal reflux-induced chronic cough (GERC).

Methods:

The patients with suspected GERC were recruited and underwent MII-pH, GERC was confirmed by subsequent anti-reflux treatment despite the findings of MII-pH. Its diagnostic accuracy in identifying GERC were evaluated by receiver operating characteristic (ROC) analysis and compared with that of 24-h esophageal pH monitoring.

Results:

Among 158 patients completing both MII-pH and anti-reflux therapy, GERC was diagnosed in 136 patients, including acid GERC in 96 patients (70.6%), non-acid GERC in 30 patients (22.0%), neither one of both GERC in 10 patients (7.4%). For the identification of GERC, MII-pH presented with the sensitivity of 92.6%, specificity of 63.6%, positive predictive value of 94.0%, negative predictive value of 58.3% and area under ROC curve of 0.863, which was totally superior to 24-h esophageal pH monitoring. As the essential criteria of MII-pH, esophageal acid exposure time and symptom associated probability had a limited diagnostic value when used alone, but improved greatly the diagnostic yield when used in combination, even with a suboptimal efficacy.

Conclusion:

MII-pH is a more sensitive test for identifying GERC, but with a suboptimal diagnostic efficacy.
Management of an Aortoenteric Fistula in a Patient with End Stage Renal and Liver Disease, Prior Endovascular Aortic Repair With Type II Endoleak
Authors: Stafforini Nicolas A. , Czerwonko Matias E. , Singh Niten , Quiroga Elina , Starnes Benjamin W.
Published: March 2021

Primary aortoenteric fistula (AEF) is an uncommon but life-threatening condition. We present a case of primary AEF in an octogenarian with previous endovascular aortic repair, type II endoleak and end stage liver and renal disease. He was successfully treated with accessory renal artery ligation, duodenojejunostomy, aneurysm sac debridement and irrigation and closure of the aneurysm sac over a drain. The patient made an excellent recovery and was discharged on POD #7, with no complications noted after over a year of follow up. This approach may represent a valuable option to manage primary AEF versus open endograft explant, particularly in severely ill patients.
Analysis of NOMA-OFDM 5G wireless system using deep neural network
Authors: Pandya Sharnil , Wakchaure Manoj Ashok , Shankar Ravi , Annam Jagadeeswara Rao
Published: March 2021

In this work, a multiple user deep neural network-based non-orthogonal multiple access (NOMA) receiver is investigated considering channel estimation error. The decoding of the symbol in the case of the NOMA system follows the sequential order and decoding accuracy depends on the detection of the previous user. Without estimating the throughput, a deep neural network-based NOMA orthogonal frequency division multiplexing (OFDM) system is proposed to decode the symbols from the users. Firstly, the deep neural network is trained. Secondly, the data are trained and lastly, the data are tested for various users. In this work, for various values of signal to noise ratio, the performance of the deep neural network is investigated, and the bit error rate (BER) is calculated on a per subcarrier basis. The simulation results show that the deep neural network is more robust to symbol distortion due to inter-symbol information and will obtain knowledge of the channel state information using data testing.
Isiris™ for Ureteric Stent Removal in Renal Transplantation: An Initial Single-Centre Experience of 150 Cases
Authors: Doherty Daniel T. , Moinuddin Zia , Grey Ben R. , van Dellen David
Published: March 2021

Background. Ureteric stent insertion is performed at the time of renal transplant to minimise the risk of post-operative urological complications, including anastomotic leak and ureteric stenosis or obstruction. Transplant ureteric stent removal (TUSR) has historically been performed via flexible cystoscopy, predominantly in a theatre setting. Isiris™ is a single-use cystoscope with integrated grasper designed for removal of ureteric stents. We report our initial experience. Methods. A retrospective analysis of a contemporaneously maintained database was performed with review of case notes from October 2017 to September 2018. TUSR was performed by surgical middle grades with a single nurse assistant. Results. One hundred and fifty ureteric stents were removed in transplant recipients (mean age 50.2 years, SD ± 15.2; 61.3% male). 91.3% ( n = 137) of cases were performed in the outpatient clinic. Median time to TUSR was 42 days (IQR 30-42). 147 attempts at removal were successful. One urinary tract infection (UTI) was reported following TUSR. Use of the Isiris™ for TUSR corresponds to a £63,480 saving in this cohort compared to conventional practice. This value is conservative and does not include income that has been gained from the reallocation of operating theatre capacity. Conclusion. Isiris™ can safely be employed for the timely performance of non-complicated TUSR. Isiris™ releases this procedure from the confines of the operating theatre to the outpatient clinic. This reduces the resource burden for healthcare providers and may result in improved patient satisfaction. The environmental implications of disposable healthcare equipment require consideration. Evaluation of Isiris™ TUSR for encrustation is required.
Optimal parameter selection in Weeks’ method for numerical Laplace transform inversion based on machine learning
Authors: Kano Patrick O , Brio Moysey , Bailey Jacob
Published: March 2021

The Weeks method for the numerical inversion of the Laplace transform utilizes a Möbius transformation which is parameterized by two real quantities, σ and b. Proper selection of these parameters depends highly on the Laplace space function F( s) and is generally a nontrivial task. In this paper, a convolutional neural network is trained to determine optimal values for these parameters for the specific case of the matrix exponential. The matrix exponential eA is estimated by numerically inverting the corresponding resolvent matrix [Formula: see text] via the Weeks method at [Formula: see text] pairs provided by the network. For illustration, classes of square real matrices of size three to six are studied. For these small matrices, the Cayley-Hamilton theorem and rational approximations can be utilized to obtain values to compare with the results from the network derived estimates. The network learned by minimizing the error of the matrix exponentials from the Weeks method over a large data set spanning [Formula: see text] pairs. Network training using the Jacobi identity as a metric was found to yield a self-contained approach that does not require a truth matrix exponential for comparison.
Evaluation of Transient Ischemic Attack and Minor Stroke: A Rapid Outpatient Model for the COVID-19 Pandemic and Beyond
Authors: Wechsler Paul M. , Parikh Neal S. , Heier Linda A. , Ruiz Evelyn , Fink Matthew E. , Navi Babak B. , White Halina
Published: March 2021

The grim circumstances of the COVID-19 pandemic have highlighted the need to refine and adapt stroke systems of care. Patients’ care-seeking behaviors have changed due to perceived risks of in-hospital treatment during the pandemic. In response to these challenges, we optimized a recently implemented, novel outpatient approach for the evaluation and management of minor stroke and transient ischemic attack, entitled RESCUE-TIA. This modified approach incorporated telemedicine visits and remote testing, and proved valuable during the pandemic. In this review article, we provide the evidence-based rationale for our approach, describe its operationalization, and provide data from our initial experience.
Increased serum calcium levels are associated with carotid atherosclerotic plaque in normocalcaemic individuals with type 2 diabetes
Authors: Zhu Huijing , Wang Huili , Jia Yuqing , Cheng Lin , Cheng Xingbo
Published: March 2021

Background:

Patients with type 2 diabetes mellitus (T2DM) have an elevated risk of atherosclerotic cardiovascular disease. Although previous data have suggested that serum calcium levels could be involved in T2DM and cardiovascular disease, whether this applies in T2DM patients with atherosclerosis remains unclear. This study therefore aimed to investigate the relationship between serum calcium levels within the physiological ranges and carotid atherosclerotic plaque in T2DM patients.

Methods:

A total of 594 normocalcaemic in-patients with T2DM were recruited, of whom 231 had carotid atherosclerotic plaque. Serum calcium levels were measured and carotid ultrasonography was performed.

Results:

Patients with plaque had significantly higher serum albumin-corrected calcium than those without plaque [9.02 (8.78–9.34) mg/dL versus 8.86 (8.66–9.06) mg/dL, p < 0.001]. As serum albumin-corrected calcium levels increased across tertiles, the percentage of plaque increased (27.6%, 35.5%, and 55.7%; p < 0.001). Logistic regression showed that serum albumin-corrected calcium levels were independently and positively correlated with the presence of plaque, but not parathyroid hormone levels. Compared with patients in the lowest serum calcium tertiles, the odds ratio for plaque in patients in the upper quartile was 2.47 (95% confidence interval 1.51–4.03, p < 0.001) after adjustment for potential confounders.

Conclusion:

Serum albumin-corrected calcium levels are elevated in patients with T2DM and carotid atherosclerotic plaques.
Early postoperative straight leg raise is associated with shorter length of stay after unilateral total knee arthroplasty
Authors: Suh Jimin , Liow Ming Han Lincoln , Pua Yong Hao , Chew Eleanor Shu-Xian , Chia Shi-Lu , Lo Ngai Nung , Yeo Seng-Jin , Chen Jerry Yongqiang
Published: March 2021

Purpose:

Shorter length of stay (LOS) after total knee arthroplasty (TKA) is cost-effective. Straight leg raise (SLR) is a common exercise prescribed after TKA, but the significance of early postoperative SLR is unknown. The primary aim of this study is to evaluate the association between early postoperative SLR and LOS. Secondary aims are to explore associations among early postoperative SLR, time to ambulation, and time to stairs climbing and identify factors related to postoperative SLR.

Methods:

888 TKAs (888 knees, 865 patients) performed at a tertiary hospital in 2016 were included for this retrospective study. All TKAs were performed with medial parapatellar approach and tourniquet. Time to events (SLR, ambulation, stair climbing), LOS and factors influencing these events were analysed using a multivariate Poisson regression model and logistic regression.

Results:

Patients who performed SLR on postoperative day 1 (POD1) had shorter LOS than those who did not (adjusted Mean Ratio (aMR) = 0.846, p < 0.001), with estimated mean LOS being 3.5 days and 4.1 days, respectively. Performing SLR on POD1 was also associated with shorter time to ambulation (aMR = 0.789; p < 0.001) and stair climbing (aMR = 0.811, p < 0.001). Female gender and higher rest pain on POD1 were associated with delayed postoperative SLR.

Conclusion:

Performing SLR on POD1 after TKA is associated with shorter LOS, time to ambulation, and time to stair climbing. Early postoperative SLR can prognosticate early recovery and discharge. Optimization of preoperative muscle strength and postoperative pain may be important in early recovery after TKA.
Relationship Between Anterior Knee Laxity and General Joint Laxity During the Menstrual Cycle
Authors: Maruyama Sae , Yamazaki Tomomi , Sato Yuuki , Suzuki Yukako , Shimizu Sohei , Ikezu Masahiro , Kaneko Fumiya , Matsuzawa Kanta , Hirabayashi Ryo , Edama Mutsuaki
Published: March 2021

Background:

Anterior cruciate ligament (ACL) injury has been reported to have a higher incidence in women than in men.

Purpose/Hypothesis:

The purpose was to examine the relationship of anterior knee laxity (AKL), stiffness, and generalized joint laxity (GJL) with respect to the menstrual cycle. It was hypothesized that AKL and GJL would increase during the ovulation phase, when estrogen levels are high.

Study Design:

Descriptive laboratory study.

Methods:

A total of 15 female university students aged >20 years and with normal menstrual cycles were evaluated. AKL was measured as anterior tibial displacement of the femur after application of 44-, 89-, and 133-N loads to the tibia. Stiffness was calculated as Δ force/Δ displacement at loads between 44 and 89 N and between 89 and 133 N. The University of Tokyo joint laxity test was used for evaluation of GJL. The participants’ menstrual cycle was divided into the early follicular, late follicular, ovulation, and luteal phases using the basal body temperature method and an ovulation kit; AKL and GJL were measured once during each phase. Participants were also stratified according to the presence or absence of genu recurvatum (GR).

Results:

There was no significant difference in AKL, stiffness, or GJL among the menstrual phases. In the GR group, AKL values at 89 N and 133 N were significantly higher in the ovulation phase than in the early follicular phase ( P = .025 and P =.018, respectively); there were no significant differences in AKL among the phases in the non-GR group. In addition, the GR group in the ovulation phase had significantly higher AKL values at 44 N, 89 N, and 133 N compared with the non-GR group ( P = .013, P = .005, and P = .010, respectively). There were no significant differences in GJL among the phases in the GR or non-GR groups.

Conclusion:

Women with GR may have increased AKL in the ovulation phase when compared with the early follicular phase, which may be a risk factor for ACL injury.

Clinical Relevance:

The results of this study suggest that the ovulation phase may be related to the greater incidence of ACL injuries in women.
miR-29modulates CD40 signaling in chronic lymphocytic leukemia by targeting TRAF4: an axis affected by BCR inhibitors
Authors: Sharma Sonali , Pavlasova Gabriela Mladonicka , Seda Vaclav , Cerna Katerina Amruz , Vojackova Eva , Filip Daniel , Ondrisova Laura , Sandova Veronika , Kostalova Lenka , Zeni Pedro F. , Borsky Marek , Oppelt Jan , Liskova Kvetoslava , Kren Leos , Janikova Andrea , Pospisilova Sarka , Fernandes Stacey M. , Shehata Medhat , Rassenti Laura Z. , Jaeger Ulrich , Doubek Michael , Davids Matthew S. , Brown Jennifer R. , Mayer Jiri , Kipps Thomas J. , Mraz Marek
Published: March 2021

B-cell receptor (BCR) signaling and T-cell interactions play a pivotal role in chronic lymphocytic leukemia (CLL) pathogenesis and disease aggressiveness. CLL cells can use microRNAs (miRNAs) and their targets to modulate microenvironmental interactions in the lymph node niches. To identify miRNA expression changes in the CLL microenvironment, we performed complex profiling of short noncoding RNAs in this context by comparing CXCR4/CD5 intraclonal cell subpopulations (CXCR4dimCD5bright vs CXCR4brightCD5dim cells). This identified dozens of differentially expressed miRNAs, including several that have previously been shown to modulate BCR signaling (miR-155, miR-150, and miR-22) but also other candidates for a role in microenvironmental interactions. Notably, all 3 miR-29 family members (miR-29a, miR-29b, miR-29c) were consistently down-modulated in the immune niches, and lower miR-29(a/b/c) levels associated with an increased relative responsiveness of CLL cells to BCR ligation and significantly shorter overall survival of CLL patients. We identified tumor necrosis factor receptor–associated factor 4 (TRAF4) as a novel direct target of miR-29s and revealed that higher TRAF4 levels increase CLL responsiveness to CD40 activation and downstream nuclear factor-κB (NF-κB) signaling. In CLL, BCR represses miR-29 expression via MYC, allowing for concurrent TRAF4 upregulation and stronger CD40–NF-κB signaling. This regulatory loop is disrupted by BCR inhibitors (bruton tyrosine kinase [BTK] inhibitor ibrutinib or phosphatidylinositol 3-kinase [PI3K] inhibitor idelalisib). In summary, we showed for the first time that a miRNA-dependent mechanism acts to activate CD40 signaling/T-cell interactions in a CLL microenvironment and described a novel miR-29–TRAF4–CD40 signaling axis modulated by BCR activity.
EHEC O111:H8 strain and norovirus GII.4 Sydney [P16] causing an outbreak in a daycare center, Brazil, 2019
Authors: Spano Liliana Cruz , Guerrieri Caroline Gastaldi , Volpini Lays Paula Bondi , Schuenck Ricardo Pinto , Goulart Jaqueline Pegoretti , Boina Elizabeth , Recco Celia Regina Nascimento , Ribeiro-Rodrigues Rodrigo , dos Santos Luís Fernando , Fumian Tulio Machado
Published: March 2021

Background

This study describes the investigation of an outbreak of diarrhea, hemorrhagic colitis (HC), and hemolytic uremic syndrome (HUS) at a daycare center in southeastern Brazil, involving fourteen children, six staff members, six family members, and one nurse. All bacterial and viral pathogens detected were genetically characterized.

Results

Two isolates of a strain of enterohemorrhagicEscherichia coli(EHEC) serotype O111:H8 were recovered, one implicated in a case of HUS and the other in a case of uncomplicated diarrhea. These isolates had a clonal relationship of 94% and carried thestx2aandeaevirulence genes and the OI-122 pathogenicity island. The EHEC strain was determined to be a single-locus variant of sequence type (ST) 327. EHEC isolates were resistant to ofloxacin, doxycycline, tetracycline, ampicillin, and trimethoprim-sulfamethoxazole and intermediately resistant to levofloxacin and ciprofloxacin. Rotavirus was not detected in any samples, and norovirus was detected in 46.7% (14/30) of the stool samples, three of which were from asymptomatic staff members. The noroviruses were classified as the recombinant GII.4 Sydney [P16] by gene sequencing.

Conclusion

In this outbreak, it was possible to identify an uncommonstx2a + EHEC O111:H8 strain, and the most recent pandemic norovirus strain GII.4 Sydney [P16]. Our findings reinforce the need for surveillance and diagnosis of multiple enteric pathogens by public health authorities, especially during outbreaks.
The Articulated Oral Airway as an aid to mask ventilation: a prospective, randomized, interventional, non-inferiority study
Authors: Abrons Ron O. , Ten Eyck Patrick , Sheffield Isaac D.
Published: March 2021

Background

Oropharyngeal airways are used both to facilitate airway patency during mask ventilation as well as conduits for flexible scope intubation, though none excel at both. A novel device, the Articulated Oral Airway (AOA), is designed to facilitate flexible scope intubation by active displacement of the tongue. Whether this active tongue displacement also facilitates mask ventilation, thus adding dual functionality, is unknown. This study compared the AOA to the Guedel Oral Airway (GOA) in regards to efficacy of mask ventilation of patients with factors predictive of difficult mask ventilation. The hypothesis was that the AOA would be non-inferior to the GOA in terms of expiratory tidal volumes by a margin of 1 ml/kg, thus demonstrating dual functionality.

Methods

In this randomized controlled clinical trial, fifty-eight patients with factors predictive of difficult mask ventilation were mask ventilated with both the GOA and the AOA. Video of the anesthetic monitors were evaluated by a blinded member of the research team, noting inspiratory and expiratory tidal volumes and expiratory CO2 waveforms.

Results

The AOA was found to be non-inferior to the GOA at a margin of 1 ml/kg with a mean weight-standardized expiratory tidal measurement 0.45 ml/kg lower (CI: 0.34–0.57) and inspiratory tidal measurement 0.109 lower (CI: − 0.26-0.04). There was no significant difference in expiratory waveforms (p = 0.2639).

Conclusions

The AOA was non-inferior to the GOA for mask ventilation of patients with predictors of difficult mask ventilation and there was no significant difference in EtCO2 waveforms between the groups. These results were consistent in the subset of patients who were initially difficult to mask ventilate.

Trial registration

ClinicalTrials.gov, NCT03144089, May 2017.
Role of interleukin 6 as a predictive factor for a severe course of Covid-19: retrospective data analysis of patients from a long-term care facility during Covid-19 outbreak
Authors: Sabaka P. , Koščálová A. , Straka I. , Hodosy J. , Lipták R. , Kmotorková B. , Kachlíková M. , Kušnírová A.
Published: March 2021

Background

Covid-19 is a disease with high morbidity and mortality among elderly residents of long-term care facilities (LTCF). During an outbreak of SARS-CoV-2 infection in the LTCF an effective screening tool is essential to identify the patients at risk for severe disease. We explored the role of interleukin 6 (IL-6) as a predictor for severe disease during the outbreak of Covid-19 in one LTCF in Slovakia.

Methods

We conducted a retrospective data analysis of cases of COVID-19, diagnosed during the outbreak in one LTCF in Slovakia between April 11, 2020, and May 5, 2020. Within 24 h after the diagnosis of Covid-19, clinical and laboratory screening was performed in the LTCF to identify patients in need of hospitalization. Patients with oxygen saturation below 90% were immediately referred to the hospital. Patients staying in the LFTC were monitored daily and those that developed hypoxemia were transferred to the hospital. We analyzed the association between the IL-6 at the initial assessment and development of hypoxemia during follow up and determined the cut-off of the IL-6 able to predict the development of hypoxemia requiring oxygen therapy.

Results

Fifty-three patients (11 men, 42 women) with diagnosed Covid-19 were included in the analysis. 19 (53%) patients developed hypoxemia during the disease. Patients with hypoxemia had significantly higher concentrations of IL-6, C-reactive protein, procalcitonin, fibrinogen, total bilirubin, aspartate aminotransferase and alanine aminotransferase at initial screening. ROC analyses identified IL-6 as the most robust predictor of hypoxemia. The concentration of IL-6 > 24 pg/mL predicted the development of hypoxemia with the sensitivity of 100% and specificity of 88.9%. The positive and negative predictive values were 76.9, and 100% respectively.

Conclusions

The concentration of IL-6 > 24 pg/mL at initial assessment predicted the development of hypoxemia requiring hospitalization with excellent sensitivity and good specificity. IL-6 appears as a potential predictor for the development of the severe Covid-19 and might serve for early identification of patients in need of hospitalization. Further studies are needed to evaluate the robustness of the use of IL-6 as an effective screening tool for the severe course of Covid-19.
The association between food insecurity and mental health during the COVID-19 pandemic
Authors: Fang Di , Thomsen Michael R. , Nayga Rodolfo M.
Published: March 2021

Objective

To explore the association between food insecurity and mental health outcomes among low-income Americans during the COVID-19 pandemic.

Methods

We conducted a survey of 2714 low-income respondents nationwide from June 29, 2020 to July 21, 2020. A proportional odds logit model was employed to estimate the associations between food insecurity and anxiety and between food insecurity and depression.

Results

Food insecurity is associated with a 257% higher risk of anxiety and a 253% higher risk of depression. Losing a job during the pandemic is associated with a 32% increase in risk for anxiety and a 27% increase in risk for depression.

Conclusions

Food insecurity caused by the pandemic was associated with increased risk of mental illness. The relative risk of mental illness from being food insecure is almost three-fold that of losing a job during the pandemic. Public health measures should focus on getting direct subsidies of food purchases to poor families, especially families with children. They should also reduce the stigma and shame that is associated with accepting charitable foods.
Urdu version of Oswestry disability index; a reliability and validity study
Authors: Amjad Fareeha , Mohseni-Bandpei Mohammad A. , Gilani Syed Amir , Ahmad Ashfaq , Waqas Muhammad , Hanif Asif
Published: March 2021

Background

Oswestry Disability Index (ODI) is broadly used in clinical and research settings for assessing the disability level in patients with lumbar radiculopathy but it has not been translated into Urdu language according to the pre-established translation guidelines as well as the validity and reliability of ODI Urdu version has not been tested yet. The aim of this study was to translate ODI in native Urdu language (ODI-U) according to recommended guidelines and to measure its psychometric properties in Urdu speaking patients suffering from lumber radiculopathy.

Methods

Out of 108 participants, 54 were healthy (who filled ODI-U) and 54 were patients of lumber radiculopathy. The patients were administered through ODI-U, visual analogue scales for disability (VAS disability), pain intensity (VAS pain) and SF-36 at baseline and after 3 days. Reliability was investigated through test-retest method, internal consistency, standard error of measurement (SEM) and smallest detectable change (SDC). ODI-U was assessed for exploratory factor analysis, construct (convergent and discriminative) validity and content validity. Alpha level < 0.05 was considered statistically significant and psychometric standards were evaluated contrary to priori hypothesis.

Results

ODI-U revealed excellent test-retest reliability for total score (ICC2,1 = 0.95) and for all item (ICC2,1 = 0.72–0.98). Cronbach’s alpha of 0.89 showed excellent internal consistency and moderate correlation between ODI-U total score and each item through spearman’s correlation coefficient (r = 0.51–0.76). One factor structure was created, explaining 52.5% variance. There was no floor and ceiling effect of total ODI-U score. Content validity was assessed through conducting interviews with patients and incorporating expert’s opinions. The discriminative validity was measured by independent sample t-test, where significant difference between healthy and patients (P < 0.001) was observed. The convergent validity was evaluated through Pearson’s correlation showing moderate positive correlation of ODI-U with VAS pain (r = 0.49) and VAS disability (r = 0.51) but moderate negative correlation with all SF-36 domains (r = − 0.43to − 0.63).

Conclusion

ODI-U showed adequate psychometric properties. ODI-U was found to be a reliable and a valid tool to measure the level of disability in Urdu-speaking patients with lumber radiculopathy.
Multidisciplinary team meetings for patients with complex extremity defects: a retrospective analysis of treatment recommendations and prognostic factors for non-implementation
Authors: Kotsougiani-Fischer Dimitra , Fischer Sebastian , Warszawski Jan , Gruetzner Paul A. , Reiter Gregor , Hirche Christoph , Kneser Ulrich
Published: March 2021

Background

This study aimed to assess a multidisciplinary team (MDT) meeting approach for the management of patients with complex extremity defects, analyze treatment recommendations, and evaluate factors influencing non-implementation.

Methods

All patients introduced to an MDT meeting for complex extremity defects from 2015 to 2017 were included in a retrospective cohort study. Patients’ characteristics and defect causes were evaluated. Treatment recommendations (TR) of MDT meetings and subsequent implementation were reviewed (cohort with implementation of TR versus cohort with non-implementation of TR), and factors associated with non-adherence to recommendations were statistically analyzed using logistic regression.

Results

Fifty-one patients (41 male) with a mean age of 54 years were presented in 27 MDT meetings. Most of the patients (70%) suffered from reconstructive challenging or combined bone- and soft tissue defects, primarily located at the lower extremity (88%). Large skeletal defects, chronic osteomyelitis, and multi-fragmented fractures were present in 65% of cases. Forty-five percent of the patients suffered from peripheral vascular disease, necessitating surgical optimization. Of the 51 MDT decisions, 40 were implemented (78%; (32/40) limb salvage versus 22%; (8/40) limb amputation). Limb salvage was successfully achieved in 91% (29/32) of the cases. Failed limb salvages were due to flap failure (33%; 1/3), recurring periprosthetic joint infections (66%; 2/3) and concomitant reconstructive failure. Patients who underwent limb amputation, as recommended, showed proper stump healing and regained mobility with a prosthesis. Overall the MDT treatment plan was effective in 92.5% (37/40) of the patients, who adhered to the MDT treatment recommendation. In eleven patients (22%; 11/51), the MDT treatment was not implemented. MDT decisions were less likely to be implemented, if amputation was recommended (p = 0.029).

Conclusions

MDT meetings represent a valid tool to formulate individualized treatment plans, avoiding limb amputation in most patients with severe extremity defects. Recommendation for limb amputation is less likely to be implemented than plans for limb salvage.

Trial registration:Retrospectively registered
Acacetin ameliorates insulin resistance in obesity mice through regulating Treg/Th17 balance via MiR-23b-3p/NEU1 Axis
Authors: Wei Yan , Jing Jianhong , Peng Zhiping , Liu Xiaoqian , Wang Xueyang
Published: March 2021

Background

The role of miR-23b-3p in insulin resistance (IR) remained poorly understood.

Methods

After acacetin injection, obesity-induced IR model was constructed with or without miR-23b-3p upregulation and Neuraminidase 1 (NEU1) overexpression in mice. Body weight, serum metabolite and fat percent of the mice were measured. Tests on oral glucose and insulin tolerance were performed, and inflammatory cytokines C-reactive protein (CRP), Interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and monocyte chemoattractant protein 1 (MCP1) levels were quantified with enzyme-linked immunosorbent assay (ELISA). The binding sites between miR-23b-3p and NEU1 were predicted by TargetScan, and verified using dual-luciferase reporter assay. Relative expressions were detected with quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot. Proportion of Treg and Th17 cells in total CD4+ T cells was detected with flow cytometry.

Results

MiR-23b-3p offset the effects of acacetin on body weight, fat percent, inflammatory cytokines levels and expressions of markers of regulatory T cells (Treg cells) and T helper 17 cells (Th17 cells), NEU1 and miR-23b-3p. NEU1 was a target of miR-23b-3p, and overexpressed NEU1 reversed the effects of upregulated miR-23b-3p on reducing Treg cells but increased body weight, fat percent and inflammatory cytokines levels, percentage of Th17 cells, and upregulated NEU1 expression.

Conclusion

Upregulation of miR-23b-3p offset the effects of acacetin on obesity-induced IR through regulating Treg/Th17 cell balance via targeting NEU1.The present findings provide a possible prevention strategy for obesity-induced IR.
Psychosocial-spiritual interventions among Muslims undergoing treatment for cancer: an integrative review
Authors: Abu Khait Abdallah , Lazenby Mark
Published: March 2021

Background

Cancer is a global disease that affects all populations, including Muslims. Psychological and spiritual care of Muslim patients with cancer includes psychosocial and spiritual techniques that help to improve their mental health and spiritual well-being. Although these techniques are available to cancer patients worldwide, they are poorly studied among Muslim patients. This review aims to integrate the literature on the psychosocial-spiritual outcomes and perspectives of Muslim patients with cancer who have undergone psychotherapy.

Method

We used the Whittemore and Knafl five-step methodology. We conducted a comprehensive search of PubMed, CINAHL, and PsycINFO using relevant keywords. Studies that focused on adult patients with cancer and on published evidence of using psychosocial and spiritual interventions among Muslim patients were included. Each study was reviewed, evaluated, and integrated.

Results

A systematic search produced 18 studies that were thematically analyzed. Results showed different psychosocial and spiritual approaches currently used to care for Muslim patients with cancer that target mainly patients’ mental health, quality of life, and spiritual well-being. Four major themes emerged: (1) Treating Psychological Distress Without Psychopharmacologic Agents, (2) Improving Knowledge of Cancer for Improving QOL, (3) Depending on Faith for Spiritual Well-being, and (4) Relying on Religious and Spiritual Sources: Letting Go, Letting God.

Conclusions

The rigor of psychosocial and spiritual studies that target psychosocial-spiritual outcomes of Muslim cancer patients needs to be improved to reach conclusive evidence about their efficacy in this population.
Cutaneous melanoma: cost of illness under Brazilian health system perspectives
Authors: da Veiga Cassia Rita Pereira , da Veiga Claudimar Pereira , Souza Alceu , Wainstein Alberto Julius Alves , de Melo Andreia Cristina , Drummond-Lage Ana Paula
Published: March 2021

Background

The landscape of cutaneous melanoma (CM) diagnosis, staging, prognosis, and treatment has undergone fundamental changes in the past decade. While the benefits of new health resources are recognized, there is a distinct lack of accurate cost-of-illness information to aid healthcare decision makers.

Methods

The cost-of-illness study for CM was conducted from the perspective of two health systems in Brazil: the public health system (Unified Health System, SUS) and the private health system (Health Management Organization, HMO). The study considered the direct medical cost in a bottom-up analysis, using melanoma incidence, knowledge of the disease’s progression, and the overall survival rates. The executional costs for the complete healthcare delivery cycle were investigated considering different disease stages and possible clinical course variations. The structural cost was assessed qualitatively considering the health value chain in Brazil.

Results

CM represents a critical financial burden in Brazil, and the cost of illness varied according to the health system and by stage at diagnosis. HMO patient costs are approximately 10-fold and 90-fold more than a SUS patient in the early-stage and advanced disease, respectively. Overall, spending on advanced disease patients can be up to 34-fold (SUS) or 270-fold (HMO) higher than that required for the early-stage disease. Given the massive amount of resources spent by the SUS and HMO, significant efforts must be made to improve the health value chain to deliver the right mix of medical care goods and services using available resources.

Conclusion

The cost-of-illness study for CM has the potential to inform policymakers and decision-makers regarding the economic burden that melanoma impose on a society in terms of the use of health care services, assisting them in making projections of future health care costs and resource allocation decisions. We believe that cost-of-illness analysis from a strategic perspective could be of help in assessing executional costs and be used to support the change in structural costs required for long-term strategies related to the health value chain.
The consequences of declining population access to insecticide-treated nets (ITNs) on net use patterns and physical degradation of nets after 22 months of ownership
Authors: Mboma Zawadi M. , Festo Charles , Lorenz Lena M. , Massue Dennis J. , Kisinza William N. , Bradley John , Moore Jason D. , Mandike Renata , Akim Ikupa , Lines Jo , Overgaard Hans J. , Moore Sarah J.
Published: March 2021

Background

As insecticide-treated nets (ITNs) wear out and are disposed, some household members are prioritized to use remaining ITNs. This study assessed how nets are allocated within households to individuals of different age categories as ITNs are lost or damaged and as new ITNs are obtained. The study also explored how ITN allocation affects ITN durability.

Methods

A cross-sectional household survey and ITN durability study was conducted among 2,875 households across Tanzania to determine the proportion of nets that remain protective (serviceable) 22 months after net distribution aiming for universal coverage. Allocation of study nets within houses, and re-allocation of ITNs when new universal replacement campaign (URC) nets arrived in study households in Musoma District, was also assessed.

Results

Some 57.0% (95% CI 53.9–60.1%) of households had sufficient ITNs for every household member, while 84.4% (95% CI 82.4–86.4%) of the population had access to an ITN within their household (assuming 1 net covers every 2 members). In households with sufficient nets, 77.5% of members slept under ITNs. In households without sufficient nets, pregnant women (54.6%), children < 5 years (45.8%) and adults (42.1%) were prioritized, with fewer school-age children 5–14 years (35.9%), youths 15–24 years (28.1%) and seniors > 65 years (32.6%) sleeping under ITNs. Crowding ($$\ge$$
≥
3 people sleeping under nets) was twice as common among people residing in houses without sufficient nets for all age groups, apart from children < 5. Nets were less likely to be serviceable if: $$\ge$$
≥
3 people slept under them (OR 0.50 (95% CI 0.40–0.63)), or if nets were used by school-age children (OR 0.72 (95% CI 0.56–0.93)), or if the net product was Olyset®. One month after the URC, only 23.6% (95% CI 16.7–30.6%) of the population had access to a URC ITN in Musoma district. Householders in Musoma district continued the use of old ITNs even with the arrival of new URC nets.

Conclusion

Users determined the useful life of ITNs and prioritized pregnant women and children < 5 to serviceable ITNs. When household net access declines, users adjust by crowding under remaining nets, which further reduces ITN lifespan. School-age children that commonly harbour gametocytes that mediate malaria transmission are compelled to sleep under unserviceable nets, crowd under nets or remain uncovered. However, they were accommodated by the arrival of new nets. More frequent ITN delivery through the school net programme in combination with mass distribution campaigns is essential to maximize ITN effectiveness.
Democratic South Africa at 25 – a conceptual framework and narrative review of the social and structural determinants of adolescent health
Authors: Jacobs Tanya , George Asha
Published: March 2021

Twenty-five years into South Africa’s constitutional democracy provides an opportunity to take stock of the social and structural determinants of adolescent health. Those born in democratic South Africa, commonly known as the ‘Born Frees’, are perceived to be able to realise equal rights and opportunities, yet many factors constrain their lives. In bringing together approaches to understanding context in health policy and systems research and the social determinants of health, the paper develops a conceptual framework to guide the narrative review examining the key contextual social and structural determinants of adolescent health in South Africa. Illustrative examples drawing from 65 papers from public health and the social sciences describe and link these determinants across micro, meso and macro levels of society, their global determinants, and their intersections with compounding axes of power and inequality.

At a micro level individual adolescent sexual and gender identities are expressed through multiple and evolving forms, while they experience growing autonomy and agency, they do so within a broader context characterised by regressive social norms, gender inequality and other intersecting power relationships. At the meso level, organisational and sectoral determinants shape adolescents health and rights, both in being supportive, but they also replicate the biases and inequalities that characterise South African society. In addition, the macro level national and global determinants, such as the structural colonial and apartheid legacies, shape adolescents' health. Despite constitutional and other legislative rights, these determinants and compound economic, geographic, gender and other intersecting inequalities.

A key finding is that current experiences and health of adolescents is shaped by past social and structural determinants and power relations, with apartheid inequalities still echoing in the lives of the adolescents, 25 years into democracy. More research and work is needed to provide insights into determinants of adolescent health beyond just the micro level, but also at the interrelated and dynamic meso and macro levels, nested in global determinants. The findings raise critical considerations and implications for understanding the social and structural determinants in the South African context and what this means for adolescent health in the SDG era.
Does the medical insurance system play a real role in reducing catastrophic economic burden in elderly patients with cardiovascular disease in China? Implication for accurately targeting vulnerable characteristics
Authors: Ma Meiyan , Tian Wanxin , Kang Jian , Li Yuze , Xia Qi , Wang Nianshi , Miao Wenqing , Zhang Xiyu , Zhang Yiyun , Shi Baoguo , Gao Han , Sun Tao , Fu Xuelian , Hao Yanhua , Li Heng , Shan Linghan , Wu Qunhong , Li Ye
Published: March 2021

Background

The vulnerability of cardiovascular disease (CVD) patients’ health abilities, combined with the severity of the disease and the overlapping risk factors, leads such people to bear the economic burden of the disease due to the medical services. We estimated the economic burden of CVD and identified the weak link in the design of the medical insurance.

Methods

Data from 5610 middle-aged and elderly with CVD were drawn from the 2015 wave of “China Health and Retirement Longitudinal Study” (CHARLS). The recommended method of the “World Health Organization” (WHO) was adopted to calculate “catastrophic health expenditure” (CHE), “impoverishment by medical expenses” (IME), and applied the treatment-effect model to analyze the determinants of CHE.

Results

The incidence of CHE was 19.9% for the elderly families with CVD members, which was 3.6% higher than for uninsured families (16.3%). Families with CVD combined with > 3 other chronic diseases (38.88%) were the riskiest factor for the high CHE in the new rural cooperative medical system (NCMS). Moreover, families with members > 75 years old (33.33%), having two chronic disease (30.74%), and families having disabled members (33.33%), hospitalization members (32.41%) were identified as the high risky determinants for the high CHE in NCMS.

Conclusions

Elderly with physical vulnerabilities were more prone to CHE. The medical insurance only reduced barriers to accessing health resources for elderly with CVD; however it lacked the policy inclination for high-utilization populations, and had poorly accurate identification of the vulnerable characteristics of CVD, which in turn affects the economic protection ability of the medical insurance. The dispersion between the multiple medical security schemes leads to the existence of blind spots in the economic risk protection of individuals and families.