bluuebunny/crossref_metadata_2025 huggingface dataset:
Achieving Financial Inclusion for Persons With Disabilities: Exploring Preparedness and Accessibility of Financial Services for Persons With Disabilities in Malawi
Authors: Jiya Alex Nester , Opoku Maxwell Peprah , Nketsia William , Dogbe Joslin Alexei , Adusei Josephine Nkrumah
Published: July 2021

Deplorable living conditions among persons with disabilities and the need to improve their living conditions cannot be overemphasized. This has triggered international discussion on the need for deliberate social policies to bridge the poverty gap between persons with and without disabilities. In Malawi, expansion of financial services has been identified as an essential tool to accelerate economic and inclusive development. However, empirical studies are yet to explore the preparedness of financial institutions to extend their services to persons with disabilities. In this qualitative study, semi-structured interviews were conducted with managers from commercial banks in Malawi to understand their perspectives on extending financial services to persons with disabilities. Interviews were transcribed verbatim and a descriptive thematic analysis was performed. Although participants reiterated the need to provide persons with disabilities with financial services to improve their well-being, few initiatives have been undertaken to improve their participation. Particularly, participants stated that barriers, such as a lack of financial literacy and adaptive technologies, communication barriers, and high rates of unemployment, explained the reluctance of commercial banks to extend financial services to persons with disabilities. The limitations, recommendations for future research, and implications of the study for policymaking have been highlighted.
Safety of Rapid Infliximab Biosimilar Infusions in Patients With Inflammatory Bowel Disease
Authors: Kim Ji Yoon , Bhat Shubha
Published: July 2021

Background

The biosimilar landscape for inflammatory bowel disease (IBD) continues to grow, with several biosimilar products for originator infliximab now available. The rapid infusion of originator infliximab and infliximab-dyyb has been shown to be well tolerated; however, the tolerability of rapid infusion in patients receiving infliximab-abda, another infliximab biosimilar, or in those who have switched among originator infliximab and biosimilars remains unknown.

Objective

We aimed to evaluate the safety of rapid infusion in patients with IBD who received infliximab-abda or underwent switches with infliximab products.

Methods

We conducted a retrospective observational study of all infliximab-related infusion encounters for patients ≥18 years with IBD who received their infusion over 30 to 90 minutes at our institution between March 1, 2020, and September 30, 2020. Patient, disease, and treatment characteristics were collected. The primary outcome was infusion reactions.

Results

A total of 377 infusion encounters for 96 unique patients were evaluated. Within the study cohort, 16% of patients were treated with originator infliximab, 42% with infliximab-dyyb, and 2% with infliximab-abda. The remaining 41% of patients received at least 2 infliximab products during the study period, primarily infliximab-dyyb and infliximab-abda. Approximately 54% and 42% of infusions encounters included premedication and immunomodulator use. Within the 377 infusion encounters, no infusion reactions were noted.

Conclusion and Relevance

Rapid infusion of infliximab biosimilars (including infliximab-abda) and in patients who have switched among originator infliximab and biosimilars is well tolerated. Future studies should assess clinical impact and outcomes of rapid infusion with biosimilars.
Outcomes of Posterior Arthroscopic Subtalar Arthrodesis for Medial Facet Talocalcaneal Coalition
Authors: Saraiva Daniel , Knupp Markus , Rodrigues André Sá , Gomes Tiago Mota , Oliva Xavier Martin
Published: July 2021

Background:

Medial facet talocalcaneal coalition can be a painful condition. This study aimed to determine clinical and radiographic outcomes of posterior arthroscopic subtalar arthrodesis (PASTA) for adult patients presenting with symptomatic medial facet talocalcaneal coalition and normal hindfoot alignment, with a minimal follow-up of 18 months.

Methods:

Between June 2017 and July 2019, this procedure was performed on 8 feet (8 patients; mean age, 55 [42-70] years; mean BMI, 29.8 [24.4-45.0] kg/m2). Clinical assessment was performed using Visual Analog Scale for Pain (VAS-P), Foot and Ankle Outcome Score (FAOS) and the 36-Item Short-Form Health Survey (SF-36). Patient satisfaction was assessed at the last available follow-up as “very satisfied”, “satisfied” or “unsatisfied”. Radiographic analysis was performed using plain radiography, computed tomography (CT) scan and magnetic resonance imaging (MRI). The primary outcome was to determine both clinical and radiographic outcomes.

Results:

The mean follow-up was 25.1 (18.2-34.2) months. The authors found statistically significant improvement on all clinical scores (VASP-P, FAOS and SF-36). They registered 6 “very satisfied” patients, 2 “satisfied” patients and no “unsatisfied” patient. Fusion of the subtalar joint was observed in all patients by 12 weeks and in 5 of them as soon as 8 weeks postoperatively (mean, 9.5 [8-12] weeks). There were no cases of delayed fusion or nonunion of the subtalar joint, superficial or deep infection, neurovascular damage, thromboembolic event, screw breakage, need for hardware removal or revision surgery.

Conclusion:

This study found that PASTA is a safe and reliable technique for adult patients presenting with symptomatic medial facet talocalcaneal coalition and normal hindfoot alignment, demonstrating and maintaining clinical improvement at an average follow-up of 2 years.

Level of Evidence:

Level IV, case series.
Comparative effects of fluconazole, posaconazole, and isavuconazole upon tacrolimus and cyclosporine serum concentrations
Authors: Gu Tina M , Lewis James S , Le Henry , Bubalo Joseph S
Published: July 2021

Introduction

Calcineurin inhibitors are commonly used in hematopoietic stem cell transplant (HSCT) patients to prevent graft versus host disease, but as CYP3A4 substrates they are frequently involved in drug-drug interactions. The purpose of this study is to characterize the effects of isavuconazole, fluconazole, and posaconazole on tacrolimus and cyclosporine serum concentrations and dose adjustments in allogeneic HSCT patients.

Methods

This retrospective study included patients admitted to Oregon Health and Science University between April 2008 and December 2018 who underwent hematopoietic stem cell transplantation and received concomitant tacrolimus or cyclosporine and fluconazole, isavuconazole or posaconazole therapy. Data on patient characteristics, drug dosing, and serum drug concentrations were collected through chart review, and descriptive statistics were used to summarize the results.

Results

A total of 139 patients were included in this study. We found fluconazole initiation leads to a 25% reduction in both tacrolimus and cyclosporine doses in order to maintain goal serum concentrations. Posaconazole and isavuconazole initiation requires tacrolimus dose reductions by 53% and 21%, respectively.

Conclusions

Based on our experience, FLC, POS, and ISA initiation may require CNI dose reductions and close monitoring of CNI levels to ensure levels remain within goal serum concentrations. Larger studies are needed to fully quantify the percentage in CNI dose reductions and characterize differences among these antifungals.
Wear characterization under sliding–rolling contact using friction-induced vibration features
Authors: Xu Chan , Li Bo , Wu Tonghai
Published: July 2021

Skidding in rolling bearings often causes unexpected surface wear and early failures. Although vibration monitoring is widely used for bearing fault diagnosis, it is much less developed for wear analysis. This paper presents an investigation into characterizing the surface wear of a simplified sliding–rolling contact using friction-induced vibration features. The friction vibration mechanism under a rough sliding–rolling contact is explored by a mixed elastohydrodynamic lubrication model. It is found that the friction coefficient has a positive correlation with the surface roughness, which indicates that the friction behaviour can be used to track the wear state under the sliding–rolling contact. Furthermore, the vibration excited by different rough surfaces is studied experimentally on a roller–ring test rig. The friction-induced vibration signal is extracted and a feature parameter ( K) is defined for quantitative wear characterization. Results show that the friction-induced vibration can well reflect the surface wear under the sliding–rolling contact. Compared with traditional time-domain parameters, the proposed parameter has a better linear relationship with the surface roughness.
Tourism demand forecasting: An ensemble deep learning approach
Authors: Sun Shaolong , Li Yanzhao , Guo Ju-e , Wang Shouyang
Published: July 2021

The availability of tourism-related big data increases the potential to improve the accuracy of tourism demand forecasting but presents significant challenges for forecasting, including curse of dimensionality and high model complexity. A novel bagging-based multivariate ensemble deep learning approach integrating stacked autoencoder and kernel-based extreme learning machine (B-SAKE) is proposed to address these challenges in this study. By using historical tourist arrival data, economic variable data, and search intensity index (SII) data, we forecast tourist arrivals in Beijing from four countries. The consistent results of multiple schemes suggest that our proposed B-SAKE approach outperforms the benchmark models in terms of level accuracy, directional accuracy, and even statistical significance. Both bagging and stacked autoencoder can effectively alleviate the challenges brought by tourism big data and improve the forecasting performance of the models. The ensemble deep learning model we propose contributes to tourism demand forecasting literature and benefits relevant government officials and tourism practitioners.
Improvised active music therapy for clients with Parkinson’s disease: A feasibility study
Authors: Kogutek Demian , Holmes Jeffrey D , Grahn Jessica A , Ready Emily , Montero-Odasso Manuel
Published: July 2021

The purpose of this study was to test the feasibility of delivering Improvised Active Music Therapy sessions in measuring the impact of acquisition of rhythmic complexity levels on gait performance in individuals with Parkinson’s disease. In this single subject multiple baseline design, the study measured the ability of three right-handed participants with Parkinson’s disease to acquire greater density of syncopation, as a measure of rhythmic complexity levels, while playing uninterrupted improvised music on a simplified electronic drum-set. The music content of the sessions was transformed into digital music data in real-time using Musical Instrument Digital Interface. The Musical Instrument Digital Interface data were analyzed to determine the participants’ and the Music Therapist’s density of syncopation (on acoustic guitar) during baseline and treatment conditions. Results from visual analyses and Pearson’s correlations on the outcomes indicated conflicting and inconclusive outcomes about whether higher acquisition of rhythmic complexity levels improves gait performance in individuals with Parkinson’s disease. Despite this, evidence was found to support the overall value of Improvised Active Music Therapy sessions on gait performance. The study design, the intervention, and outcome measures were found to be feasible and could be scaled-up into a larger trial.
Intimate partner violence and its association with mental health problems: The importance of childhood violence – The SAMINOR 2 Questionnaire Survey
Authors: Eriksen Astrid M. A. , Melhus Marita , Jacobsen Bjarne K. , Schei Berit , Broderstad Ann-Ragnhild
Published: July 2021

Aims:

This study aims to estimate the prevalence of intimate partner violence (IPV) and its association with psychological distress and symptoms of post-traumatic stress (PTS) among Sami and non-Sami and to explore whether the association between IPV and mental health is modified by exposure to childhood violence (CV). These issues are scarcely studied among the Sami.

Methods:

This study was based on the cross-sectional SAMINOR 2 Questionnaire Survey, a part of the Population-based Study on Health and Living Conditions in Regions with Sami and Norwegian Populations (SAMINOR). Chi-square tests and two-sample t-tests were used to test differences between groups. Multiple linear regression analysis was applied to explore the association between IPV/CV and continuous scores of psychological distress and symptoms of post-traumatic stress.

Results:

Experiences of IPV (emotional, physical, and/or sexual) were reported by 12.8% of women and 2.0% of men. A significantly higher proportion of Sami women reported exposure to emotional (12.4 v. 9.5%, p = 0.003), physical (11.6 v. 6.9%, p < 0.001), and any IPV (17.2 v. 11.8%, p < 0.001) compared to non-Sami women. There were no ethnic differences in sexual IPV among women (2%). Exposure to IPV was associated with a higher score of psychological distress and PTS and was highest among those exposed to both IPV and CV.

Conclusions:

Sami women reported the highest prevalence of IPV. The association between IPV/CV and mental health problems did not differ by ethnicity or gender. The most severe mental health problems were observed for those who were exposed to both IPV and CV.
Communication privacy management for smart speaker use: Integrating the role of privacy self-efficacy and the multidimensional view
Authors: Kang Hyunjin , Oh Jeeyun
Published: July 2021

Smart speakers can transform interactions with users into retrievable data, posing new challenges to privacy management. Privacy management in smart speakers can be more complex than just making decisions about disclosure based on the risk–benefit analysis. Hence, this study attempts to integrate privacy self-efficacy and the multidimensional view of privacy management behaviors into the privacy calculus model and proposes an extended privacy calculus model for smart speaker usage. The study explicates three types of privacy management strategies in smart speaker usage: privacy disclosure, boundary linkage, and boundary control. A survey of smart speaker users ( N = 474) finds that perceived benefits are positively associated with privacy disclosure and boundary linkage, whereas perceived privacy risks are negatively related to these two strategies. Also, perceived privacy risks are positively related to boundary control. Finally, privacy self-efficacy promotes all three strategies while mitigating the impact of perceived privacy risks and boosting the impact of perceived benefits on privacy management.
Comparing expert versus general public rationale for death penalty support and opposition: Is expert perspective on capital punishment consistent with “disciplined retention”?
Authors: Griffin Timothy
Published: July 2021

The author compared American criminologists’ stated reasons for death penalty support or opposition with those of the general public as reported by Gallup pollsters. While experts were overwhelmingly more likely to oppose capital punishment, the rationale for opposition or support were largely comparable for both groups, albeit with some potentially informative differences. As is the case with the general public, the most common reasons for experts' opposition are moral beliefs, concerns about system errors, and the unfair application of the death penalty. Similarly, among the small minority of experts who expressed (often qualified) support for the death penalty, the favored rationale is simple retributive justice—exactly as is the case with the general public. The results show that, not only is opposition to the death penalty among experts not absolute, but the underlying rationale of expert dissenters is arguably a partial bridge to greater public-expert symbiosis on this highly contentious and divisive issue. The radical “newsmaking criminology” contribution of these findings and their ramifications is that the entirety of expert perspective is arguably as consistent with disciplined retention of the death penalty as it is with strict abolition. Future research could reveal even more expert sympathy for retributive thinking, and thus greater affinity with public views, than might be assumed.
Waste cooking oils as processing aids for eco-sustainable elastomeric compounding
Authors: Cherubini Valeria , Lamastra Francesca Romana , Bragaglia Mario , Nanni Francesca
Published: July 2021

This work focuses on the replacement of mineral oils with bio-based waste cooking oils in rubber compounding. Two different waste cooking oils from potatoes and chicken frying process were analyzed by means of chemical and rheological tests to evaluate the chemical composition, the oxidative stability and the viscosity. Waste oils have been introduced in elastomeric compounds as substitute for typical processing aids (i.e. lubricants). Cure kinetics of rubber compounds was studied by rheological characterization. Mechanical properties of vulcanized samples were determined by means of tensile tests, hardness tests and dynamic mechanical analysis. The waste oils showed a rheological behavior very similar to the mineral oils conventionally employed in rubber manufacturing leading to almost the same processability of the resulting compound. The waste oils did not significantly affect the vulcanization kinetics of the rubber compound, as expected for conventional lubricants. Waste cooking oils and mineral oil show analogous influence on mechanical properties of cured compounds. At increasing oil content, the elongation at break and the tensile strength increased whereas the values of Elastic Modulus at 100% strain, the Storage Modulus and Shore A Hardness decreased with respect to the oil-free sample. These results are very promising, confirming the possibility to replace the mineral oils, in a good practice of circular economy.
E-learning experiences of adults during Covid-19 outbreak: The moderating effect of gender
Authors: Kwapong Olivia Adwoa Tiwaah Frimpong
Published: July 2021

Covid-19 has brought surprises in the educational landscape. Educational institutions had to hurriedly migrate all teaching, learning and assessment activities to online platforms. Such was the case of adult learners who had signed on to the access course for entrance into the University of Ghana. This study sought to find out how the e-learning experiences of adult learners differed across gender as they studied English language, Logic and Mathematics online. From a quantitative analysis of the data, the online experience of students with regard to Mathematics learning did not differ along gender lines. Therefore, the experiences of males and females were similar. Though, there were differences across gender groups regarding Logic and English language experiences, those of Logic experience were much bigger, where males provided overall more positive ratings than females. Specifically, for Logic experience, instructors’ show of respect to students, understanding of the learning needs of students and effective communication were rated generally better among males than females. Going forward, Logic instructors should pay equal attention to both groups irrespective of their gender to identify their learning needs and support them accordingly. Furthermore, all the instructors irrespective of their course could continue to improve their delivery of the courses as well as their relationships with the students in order to enhance future experience of the students.
A retrospective observational study on the types of anaesthesia in hip fracture surgery
Authors: Nawi Siti N Mohd , Wong Bianca , Edwards Suzanne , Loh Xiang , Maddison John
Published: July 2021

Background

There is no specific recommendation regarding the type of anaesthesia in hip fracture surgery.

Objectives

This study sought to examine the current local anaesthetic practice (general anaesthesia versus regional anaesthesia (RA)) in hip fracture surgery and to analyse their associations with perioperative outcomes.

Methodology

A retrospective observational study of hip fracture patients from April to December 2017 was undertaken. Patient characteristics and perioperative outcomes were analysed against the types of anaesthesia using multiple logistic regression.

Results

One hundred and twelve out of 154 patients (72.7%) had a general anaesthesia. Patients from residential care facilities were more likely to receive general anaesthesia (OR = 2.9, 95% CI: 1.1, 7.4; P = 0.03). There was no significant association between type of anaesthesia and specific postoperative outcomes; however, patients with postoperative delirium and hypotension were more likely to have received general anaesthesia [OR = 1.7, 95% CI: 0.68, 4.38; P = 0.25] and [OR = 1.6, 95% CI: 0.67, 4.04; P = 0.27] respectively). Subgroup analysis showed increased length of stay with patients who underwent general anaesthesia (OR = 1.26, 95% CI:1.04, 1.54; P = 0.02).

Conclusion

Regional anaesthesia may be considered in patients without contraindications in view of increased risk of postoperative delirium and hypotension, and longer length of stay with general anaesthesia. A larger prospective study is needed to confirm these findings.
Survey of laceration injuries experienced by US adolescent and young adult alpine skier racers during the 2018–2019 ski season
Authors: Bielmeier Christie M , Man Jessica
Published: July 2021

Recently during ski racing competitions, a few high-profile accidents resulted in severe life-threatening laceration injuries. Ski-laceration injuries are caused by metal ski edges cutting through skin/muscles/arteries during falls and range in severity. There is a desire by the racing community to better protect skiers. However, current laceration injury research does not provide detailed information about laceration injuries or focus on adolescent and young adult ski racers. Therefore, the Self-Report Slash Injury Survey (Slash Survey) was conducted to (a) measure the frequency, severity, and body location of laceration injuries during skiing and (b) identify the skiing environment and ski maintenance level during laceration injuries. The Slash Survey was an online survey that asked participants ages 10–24, who are enrolled in US ski race programs, to report whether they experienced a laceration injury and what ski maintenance was used during the 2018–2019 ski season. The Slash Survey results suggest that the laceration injury rate during the 2018–2019 ski season was 6.8% and almost half the lacerations reported were considered slight (i.e. <1 day of absence from the sport). For respondents of the survey, no correlation was found between laceration injuries and (a) slope surface conditions, (b) outside temperature, (c) weather, (d) skiing activity, and (e) ski maintenance (tuning). From the survey, the most common ski tuning method was using a file guide by hand (29%), automated ski tune at a ski shop (20%), stone grind (17%), and cup wheel grinder (17%). Furthermore, open-ended responses suggest that a ski community narrative may be amplifying the awareness of laceration injuries. The aim of this survey was to establish detailed information about ski laceration injuries among adolescent and young adult US ski racers for the development of mitigation strategies.
A cross-sectional national questionnaire survey assessing the views of members of the British Menopause Society on the management of patients with unscheduled bleeding on hormone replacement therapy
Authors: Abdullahi Idle Salwa , Panay Nick , Hamoda Haitham
Published: July 2021

Objective

To explore the views of members of the British Menopause Society on the management of women with unscheduled bleeding on hormone replacement therapy.

Study design

An electronic cross-sectional questionnaire survey.

Main outcome measures

Investigations, treatment options and preferences for the management of women with unscheduled bleeding on hormone replacement therapy.

Results

A total of 91/178 (51%) clinicians investigate patients with unscheduled bleeding within three to six months of starting sequential hormone replacement therapy (seq-HRT) versus 83/178 (47%) for continuous combined hormone replacement therapy (con-HRT). A total of 52/178 (29%) versus 54/178 (30%) would investigate unscheduled bleeding continuing beyond six months while 18/178 (10%) versus 26/178 (15%) would investigate within three months. Assessment is requested as urgent by 88/176 (50%) clinicians, routine by 47/176 (27%) and a two-week-wait-suspected cancer referral by 41/176 (23%). A total of 97/178 (55%) clinicians would continue seq-HRT and refer versus 117/178 (66%) for con-HRT. A total of 46/178 (26%) clinicians would change the progestogen preparation in women with unscheduled bleeding on seq-HRT. For women on con-HRT, 12/178 (7%) clinicians would change to seq-HRT and 8/178 (5%) to the Mirena IUS. The Mirena IUS is the preferred progestogen for 81/178 (45%) of clinicians when prescribing hormone replacement therapy.

Conclusions

There is a varied approach in the practise amongst British Menopause Society members to managing women with unscheduled bleeding on hormone replacement therapy. Further research is needed to determine the optimal assessment pathways for women with unscheduled bleeding on hormone replacement therapy.
The effects of US–China competing strategies in Asia-Pacific on India and Pakistan rivalry in the South Asian region
Authors: Khan Zafar
Published: July 2021

This article primarily focuses on how the increasing US–China competing strategies in Asia-Pacific affect the policies of South Asian rivals India and Pakistan when, on the one hand, the US as part of its offshore balancing grand strategy has been increasing its strategic partnership with India through the transfer of emerging technologies in terms of military modernization process, and on the other hand, China and Pakistan have improved their geo-economic and geostrategic partnership as part of the Chinese grand strategy via the Belt and Road Initiative while enabling Pakistan to produce effective countermeasures against its potential adversary. The article presumes that, in doing so, such competing strategies frame a quadrangle setting comprising of US and India to deter and contain China on the one hand and China and Pakistan to produce countermeasures and try to create a balance to potentially prevent the risk of conflict in South Asia out of such competing strategies at the quadrangle order conceived here. However, in fact, neither the US nor rising China would desire such a possibility of conflict otherwise unintendedly occurring from the intense US–China competing strategies while affecting the policies of the South Asian rivals. The article concludes that the shaping of this quadrangle framework may bring both opportunities and challenges for the South Asian rivals. It also concludes that the more intense the competition between the US and China becomes, the more intense its implications could be on the South Asian rivals, while the reduced tension between China and the US, although unlikely, would have reduced pressure on India and Pakistan relations as well.
Understanding Factors That Influence Consumer Intention to Use Mobile Money Services: An Application of UTAUT2 With Perceived Risk and Trust
Authors: Penney Emmanuel Kofi , Agyei James , Boadi Eric Kofi , Abrokwah Eugene , Ofori-Boafo Richmond
Published: July 2021

Mobile money is an attractive alternative that has boomed in recent times due to the advancement in mobile and telecommunication technology. Although there are copious benefits of such a great mobile technology, the adoption rate is far from expectations. This study examines the factors that predict users’ behavioral intention (BI) to adopt and use mobile money. The study adopts the unified theory of acceptance and usage of technology as a reference and builds an extended model by taking into account “perceived risk” and “trust.” Data collected from 373 mobile money users in Ghana via a questionnaire survey were analyzed using the structural equation modeling approach. The findings reveal that performance expectancy, effort expectancy, social influence, habit, price value, perceived risk, and trust substantially affect users’ BI. However, facilitating conditions and hedonic motivation showed no pertinent effect on users’ BI. Implications for both theory and practice are also discussed.
Spine Treatment Appraisal Report (STAR): Return-to-Play in Elite Athletes After Symptomatic Lumbar Disc Herniation: Surgery or Non-Surgical Treatment?
Authors: Dettori Joseph R.
Published: July 2021

Citation: Sedrak P, Shahbaz M, Gohal C, Madden K, Aleem I, Khan M. Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: A Systematic Review and Meta-analysis of Operative Versus Nonoperative Treatment. Sports Health. Feb 10 2021:1 941 738 121 991 782.
International Consortium for Social Development: Members’ Views and Future Directions
Authors: Pawar Manohar , Androff David
Published: July 2021

This article aims to discuss members’ views about the past and current engagements and activities of the International Consortium for Social Development (ICSD), and the future directions and strategies. A survey method was used to collect data from the ICSD members by using the Survey Monkey software. Quantitative data analysis was limited to frequency distributions, and responses to open-ended questions were analysed by using the qualitative content analysis method. Further, these results were presented in a workshop to generate ideas for the future directions and strategies. Overall, the analysis showed that the members had positive perceptions of the ICSD in terms of meeting their expectations and conduct of activities according to its mission. Some of the critical issues and the future directions for the ICSD included relooking at the leadership, finance, membership, social development vision and knowledge building by research and scholarly activities and networking, education/curriculum programmes, conferences and practice projects, and activism and increasing visibility. The article argues that addressing these and similar issues is critical in maintaining and sustaining consortiums/professional bodies such as the ICSD. The findings and analysis have implications for improving and strengthening the ICSD and similar professional bodies.
Essential role for Gata2 in modulating lineage output from hematopoietic stem cells in zebrafish
Authors: Gioacchino Emanuele , Koyunlar Cansu , Zink Joke , de Looper Hans , de Jong Madelon , Dobrzycki Tomasz , Mahony Christopher B. , Hoogenboezem Remco , Bosch Dennis , van Strien Paulina M. H. , van Royen Martin E. , French Pim J. , Bindels Eric , Gussinklo Kirsten J. , Monteiro Rui , Touw Ivo P. , de Pater Emma
Published: July 2021

The differentiation of hematopoietic stem cells (HSCs) is tightly controlled to ensure a proper balance between myeloid and lymphoid cell output. GATA2 is a pivotal hematopoietic transcription factor required for generation and maintenance of HSCs. GATA2 is expressed throughout development, but because of early embryonic lethality in mice, its role during adult hematopoiesis is incompletely understood. Zebrafish contains 2 orthologs of GATA2: Gata2a and Gata2b, which are expressed in different cell types. We show that the mammalian functions of GATA2 are split between these orthologs. Gata2b-deficient zebrafish have a reduction in embryonic definitive hematopoietic stem and progenitor cell (HSPC) numbers, but are viable. This allows us to uniquely study the role of GATA2 in adult hematopoiesis. gata2b mutants have impaired myeloid lineage differentiation. Interestingly, this defect arises not in granulocyte-monocyte progenitors, but in HSPCs. Gata2b-deficient HSPCs showed impaired progression of the myeloid transcriptional program, concomitant with increased coexpression of lymphoid genes. This resulted in a decrease in myeloid-programmed progenitors and a relative increase in lymphoid-programmed progenitors. This shift in the lineage output could function as an escape mechanism to avoid a block in lineage differentiation. Our study helps to deconstruct the functions of GATA2 during hematopoiesis and shows that lineage differentiation flows toward a lymphoid lineage in the absence of Gata2b.
Wild-type HIV infection after treatment with lentiviral gene therapy for β-thalassemia
Authors: Hongeng Suradej , Anurathapan Usanarat , Songdej Duantida , Phuphuakrat Angsana , Jongrak Kesinee , Parsons Geoffrey , Deary Briana , Bonner Melissa , Veres Gabor , Asmal Mohammed
Published: July 2021

Betibeglogene autotemcel (beti-cel) gene therapy (GT) for patients with transfusion-dependent β-thalassemia uses autologous CD34+ cells transduced with BB305 lentiviral vector (LVV), which encodes a modified β-globin gene. BB305 LVV also contains select HIV sequences for viral packaging, reverse transcription, and integration. This case report describes a patient successfully treated with beti-cel in a phase 1/2 study (HGB-204; #NCT01745120) and subsequently diagnosed with wild-type (WT) HIV infection. From 3.5 to 21 months postinfusion, the patient stopped chronic red blood cell transfusions; total hemoglobin (Hb) and GT-derived HbAT87Q levels were 6.6 to 9.5 and 2.8 to 3.8 g/dL, respectively. At 21 months postinfusion, the patient resumed transfusions for anemia that coincided with an HIV-1 infection diagnosis. Quantitative polymerase chain reaction assays detected no replication-competent lentivirus. Next-generation sequencing confirmed WT HIV sequences. Six months after starting antiretroviral therapy, total Hb and HbAT87Q levels recovered to 8.6 and 3.6 g/dL, respectively, and 3.5 years postinfusion, 13.4 months had elapsed since the patient’s last transfusion. To our knowledge, this is the first report of WT HIV infection in an LVV-based GT recipient and demonstrates persistent long-term hematopoiesis after treatment with beti-cel and the ability to differentiate between WT HIV and BB305-derived sequences.
Comorbidities are risk factors for hospitalization and serious COVID-19 illness in children and adults with sickle cell disease
Authors: Mucalo Lana , Brandow Amanda M. , Dasgupta Mahua , Mason Sadie F. , Simpson Pippa M. , Singh Ashima , Taylor Bradley W. , Woods Katherine J. , Yusuf Fouza I. , Panepinto Julie A.
Published: July 2021

Patients with sickle cell disease (SCD) are at high risk of developing serious infections, therefore, understanding the impact that severe acute respiratory syndrome coronavirus 2 infection has on this population is important. We sought to identify factors associated with hospitalization and serious COVID-19 illness in children and adults with SCD.We established the international SECURE-SCD Registry to collect data on patients with SCD and COVID-19 illness. We used multivariable logistic models to estimate the independent effects of age, sex, genotype, hydroxyurea, and SCD-related and -nonrelated comorbidities on hospitalization, serious COVID-19 illness, and pain as a presenting symptom during COVID-19 illness. As of 23 March 2021, 750 COVID-19 illness cases in patients with SCD were reported to the registry. We identified history of pain (relative risk [RR], 2.15; P < .0001) and SCD heart/lung comorbidities (RR, 1.61; P = .0001) as risk factors for hospitalization in children. History of pain (RR, 1.78; P = .002) was also a risk factor for hospitalization in adults. Children with history of pain (RR, 3.09; P = .009), SCD heart/lung comorbidities (RR, 1.76; P = .03), and SCD renal comorbidities (RR, 3.67; P < .0001) and adults with history of pain (RR 1.94, P = .02) were at higher risk of developing serious COVID-19 illness. History of pain and SCD renal comorbidities also increased risk of pain during COVID-19 in children; history of pain, SCD heart/lung comorbidities, and female sex increased risk of pain during COVID-19 in adults. Hydroxyurea showed no effect on hospitalization and COVID-19 severity, but it lowered the risk of presenting with pain in adults during COVID-19.
Glucocorticoid toxicity reduction with mepolizumab using the Glucocorticoid Toxicity Index
Authors: McDowell P. Jane , Stone John H. , Zhang Yuqing , Honeyford Kirsty , Dunn Louise , Logan R. Jayne , McGarvey Lorcan P.A. , Butler Claire A. , Heaney Liam G.
Published: July 2021

Background

Reduction in glucocorticoid exposure is the primary benefit of new biologic treatments in severe asthma, but there is currently no evidence that reduction in glucocorticoid exposure corresponds to a proportionate reduction in associated toxicity.

Objectives

To use the validated Glucocorticoid Toxicity Index (GTI) to assess change in glucocorticoid toxicity after 12 months treatment with mepolizumab, and compare toxicity change to glucocorticoid reduction and change in patient-reported outcome measures (PROMs).

Methods

A longitudinal, real-world prospective cohort of 101 consecutive patients with severe asthma commenced on mepolizumab in a specialist UK regional severe asthma clinic. GTI toxicity assessment, cumulative glucocorticoid exposure and PROMs were recorded on commencing mepolizumab (V1), and after 12 months treatment (V2).

Results

There was significant reduction in oral glucocorticoid exposure (V1 median 4280 mg prednisolone per year (interquartile range 3083–5475 mg)versusV2 2450 mg prednisolone per year (1243–3360 mg), p<0.001). Substantial improvements in individual toxicities were observed, but did not correlate with oral glucocorticoid reduction. Mean±sdGTI aggregate improvement score (AIS) was −35.7±57.8 with a wide range in toxicity change at individual patient level (AIS range −165 to +130); 70% (71 out of 101) had a reduction in toxicity (AIS <0); 3% (three out of 101) had no change (AIS=0); and 27% (27 out of 101) an increase in overall toxicity. 62% (62 out of 101) of patients met the AIS minimally clinically important difference of ≤−10, but AIS did not correlate with glucocorticoid reduction or change in PROMs.

Conclusion

Mepolizumab resulted in substantial oral glucocorticoid reduction, but this did not correlate with reduction in oral glucocorticoid toxicity, which varies widely at the individual patient level. Oral glucocorticoid reduction is not a comprehensive measure of response to mepolizumab.
Cardiopulmonary exercise capacity and limitations 3 months after COVID-19 hospitalisation
Authors: Skjørten Ingunn , Ankerstjerne Odd Andre Wathne , Trebinjac Divna , Brønstad Eivind , Rasch-Halvorsen Øystein , Einvik Gunnar , Lerum Tøri Vigeland , Stavem Knut , Edvardsen Anne , Ingul Charlotte Björk
Published: July 2021

Background

This study aimed to describe cardiopulmonary function during exercise 3 months after hospital discharge for COVID-19 and compare groups according to dyspnoea and intensive care unit (ICU) stay.

Methods

Participants with COVID-19 discharged from five large Norwegian hospitals were consecutively invited to a multicentre, prospective cohort study. In total, 156 participants (mean age 56.2 years, 60 females) were examined with a cardiopulmonary exercise test (CPET) 3 months after discharge and compared with a reference population. Dyspnoea was assessed using the modified Medical Research Council (mMRC) dyspnoea scale.

Results

Peak oxygen uptake (V′O2 peak) <80% predicted was observed in 31% (n=49). Ventilatory efficiency was reduced in 15% (n=24), while breathing reserve <15% was observed in 16% (n=25). Oxygen pulse <80% predicted was found in 18% (n=28). Dyspnoea (mMRC ≥1) was reported by 47% (n=59). These participants had similarV′O2 peak(p=0.10) but lower mean±sdV′O2 peak·kg−1% predicted compared with participants without dyspnoea (mMRC 0) (76±16%versus89±18%; p=0.009) due to higher body mass index (p=0.03). For ICU-versusnon-ICU-treated participants, mean±sdV′O2 peak% predicted was 82±15% and 90±17% (p=0.004), respectively. Ventilation, breathing reserve and ventilatory efficiency were similar between the ICU and non-ICU groups.

Conclusions

One-third of participants experiencedV′O2 peak<80% predicted 3 months after hospital discharge for COVID-19. Dyspnoeic participants were characterised by lower exercise capacity due to obesity and lower ventilatory efficiency. Ventilation and ventilatory efficiency were similar between ICU- and non-ICU-treated participants.
Latent tuberculosis infection among contacts of patients with multidrug-resistant tuberculosis in New South Wales, Australia
Authors: Chang Vicky , Ling Raphael Hongxi , Velen Kavindhran , Fox Greg J.
Published: July 2021

Background

Contacts of an individual with active tuberculosis (TB) disease have a higher risk of developing latent TB infection (LTBI) or active TB disease. Contact tracing is a public health measure that seeks to identify exposed contacts, screen them for co-prevalent TB and consider prophylactic treatment to prevent progression from LTBI to active TB disease. The investigators sought to determine the prevalence of LTBI and active TB disease among contacts of patients with multidrug-resistant (MDR)-TB in New South Wales, Australia.

Methodology

A retrospective cohort study was performed among the contacts of patients diagnosed with MDR-TB between 2000 and 2016, inclusive, at seven chest clinics. Medical records were used to identify eligible contacts. Outcomes of screening and prophylactic treatment regimens offered to MDR-TB contacts with LTBI were characterised. Collected data included demographic information, screening tests results and initial management.

Results

In total, 247 contacts of 55 MDR-TB patients were identified. LTBI was identified in 105 contacts (42.5%). Preventive treatment was received by 20 contacts with LTBI (32.3%) in the form of various regimens, ranging from one to three antimicrobials, with various doses and durations. One contact with LTBI who was untreated progressed to active TB disease during the study period, according to clinic notes.

Conclusion

Contacts of MDR-TB patients have a high prevalence of LTBI. Management of these contacts varies substantially in New South Wales, reflecting a lack of definitive evidence for preventive therapy. Further research is required to determine the optimal management of this population.
Verification of the shear performance of mortise and tenon joints with top and bottom notches at the beam end
Authors: Okamoto Shigefumi , Nakatani Makoto , Akiyama Nobuhiko , Tanaka Kei , Mori Takuro
Published: July 2021

Shear experiments on mortise and tenon joints with top and bottom notches in the beam end were conducted with the length of the tenon as a variable. In addition, material experiments were performed to investigate the structural performance of the fracture modes of the joint. The experimental results show that when the lower notch at the beam end experiences splitting, the shear forces were identical for different tenon lengths and did not decrease. In addition, the deformation performance of the joint up to yielding was largely due to the compressive deformation perpendicular to the grain of the wood on the sides of the tenon. Based on the theory of the calculation method of the splitting strength of a notched beam, a formula for the splitting strength when the end of the beam is moment-resisting was proposed. It was confirmed that the proposed formula could estimate the shear force that caused the splitting fracture of the lower notch. In addition, the increase in shear force after the lower notch experienced splitting fracture was due to the increase in clamping force of the beam end due to rotational deformation.
Recent Advances on Immune Targeted Therapy of Colorectal Cancer Using bi-Specific Antibodies and Therapeutic Vaccines
Authors: Azadi Ali , Golchini Alireza , Delazar Sina , Abarghooi Kahaki Fatemeh , Dehnavi Seyed Mohsen , Payandeh Zahra , Eyvazi Shirin
Published: July 2021

Colorectal cancer (CRC) is a universal heterogeneous disease that is characterized by genetic and epigenetic alterations. Immunotherapy using monoclonal antibodies (mAb) and cancer vaccines are substitute strategies for CRC treatment. When cancer immunotherapy is combined with chemotherapy, surgery, and radiotherapy, the CRC treatment would become excessively efficient. One of the compelling immunotherapy approaches to increase the efficiency of CRC therapy is the deployment of therapeutic mAbs, nanobodies, bi-specific antibodies and cancer vaccines, which improve clinical outcomes in patients. Also, among the possible therapeutic approaches for CRC patients, gene vaccines in combination with antibodies are recently introduced as a new perspective. Here, we aimed to present the current progress in CRC immunotherapy, especially using Bi-specific antibodies and dendritic cells mRNA vaccines. For this aim, all data were extracted from Google Scholar, PubMed, Scopus, and Elsevier, using keywords cancer vaccines; CRC immunotherapy and CRC mRNA vaccines. About 97 articles were selected and investigated completely based on the latest developments and novelties on bi-specific antibodies, mRNA vaccines, nanobodies, and MGD007.
Primary care teams’ experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study
Authors: Ashcroft Rachelle , Donnelly Catherine , Dancey Maya , Gill Sandeep , Lam Simon , Kourgiantakis Toula , Adamson Keith , Verrilli David , Dolovich Lisa , Kirvan Anne , Mehta Kavita , Sur Deepy , Brown Judith Belle
Published: July 2021

Background

Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams’ delivery of mental health care.

Methods

A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis.

Results

We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers.

Conclusions

From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care’s capacity for mental health care for the duration of the pandemic and beyond.