bluuebunny/crossref_metadata_2025 huggingface dataset:
Characteristics of Micro/Nano Pores and Hydrocarbon Accumulation in a Continental Shale Oil Reservoir—A Case Study of the Lucaogou Formation in the Jimsar Sag, Junggar Basin, Northwest China
Authors: Jin Jun , Yang Zhao , Chen Xuekun , Li Lulu , Yang Hongxia , Ju Yiwen , Qiao Peng , Sun Ying
Published: November 2020

This paper comprehensively studies the micro- and nanometer-scale pore characteristics and structure of the Lucaogou Formation shale oil reservoir in the Jimsar Sag using high-pressure mercury analysis, field emission scanning electron microscopy and nano-CT scanning technology. In
addition, the occurrence states of crude oil in pores are analyzed combined with macro–micro characteristics. The results show that there are various reservoir types; the main reservoir pore structure is on the micron and nanometer levels, with other void spaces including intergranular
pores, interparticle dissolution pores, intercrystalline pores and microfissures. Nanopores are generally oil-bearing and mostly in the adsorption state, which changes the traditional understanding that micron pores are the only microscopic pores in the reservoir and confirms that shale oil
exists in ‘sweet spots’ and mud-shale sections of the Lucaogou Formation.
Women, wellbeing and the city: A model of participatory health research exploring physical activity in Black, Asian and minority ethnic communities
Authors: Peerbhoy Denise , Minou Masoumeh , Stratton Gareth
Published: November 2020

Objective:

The aim of this project was to document a partnership working process from a cross-sectoral and cross-cultural participatory health research study focused on promoting physical activity among women from Black, Asian and minority ethnic (BAME) backgrounds.

Design:

A participatory health research paradigm was used to support this pilot feasibility study into partnership working for health promotion. Action research and community development principles underpinned the design, delivery and interpretation of findings from a community-based survey, data from four focus groups and bespoke interventions.

Setting:

Community groups from education, leisure, health and religious community sectors, and charity sectors, in the City of Liverpool, met in different venues representing those sectors.

Method:

Reflection on the process of community engagement in a research study guided by socio-ecological model, community development and action research principles.

Results:

Seven emerging collaborative processes based on effective partnership working, capacity-building practice and sustaining health and wellbeing evolved from a partnership between a Community Researchers Advisory Group and a Partners Advisory Group. BAME ‘community connectors’ were key to obtaining feedback from 213 women from 16 ethnic groups, which influenced the development of bespoke interventions and local sport and physical activity long-term policy, as one means of reducing social inequalities for women from BAME backgrounds.

Conclusion:

This feasibility study demonstrates the effectiveness and limitations of partnership working as a public health tool. The local Sport and Physical Activity Alliance and council department worked together to promote the sustainability of BAME-focused programmes as part of their governance and policy frameworks.
Innovative COVID-19 Programs to Rapidly Serve New Mexico
Authors: Katzman Joanna G. , Tomedi Laura E. , Thornton Karla , Menking Paige , Stanton Michael , Sosa Nestor , Harkins Michelle , Katzman Neil , Liu Jinyang , Archer Gaelyn R.D. , Arora Sanjeev
Published: November 2020

Project ECHO (Extension for Community Healthcare Outcomes) at the University of New Mexico is a telementoring program that uses videoconferencing technology to connect health care providers in underserved communities with subject matter experts. In March 2020, Project ECHO created 10 coronavirus disease 2019 (COVID-19) telementoring programs to meet the public health needs of clinicians and teachers living in underserved rural and urban regions of New Mexico. The newly created COVID-19 programs include 7 weekly sessions (Community Health Worker [in English and Spanish], Critical Care, Education, First-Responder Resiliency, Infectious Disease Office Hours, and Multi-specialty) and 3 one-day special sessions. We calculated the total number of attendees, along with the range and standard deviation, per session by program. Certain programs (Critical Care, Infectious Disease Office Hours, Multi-specialty) recorded the profession of attendees when available. The Project ECHO research team collected COVID-19 infection data by county from March 11 through May 31, 2020. During that same period, 9765 health care and general education professionals participated in the COVID-19 programs, and participants from 31 of 35 (89%) counties in New Mexico attended the sessions. Our initial evaluation of these programs demonstrates that an interprofessional clinician group and teachers used the Project ECHO network to build a community of practice and social network while meeting their educational and professional needs. Because of Project ECHO’s large reach, the results of the New Mexico COVID-19 response suggest that the rapid use of ECHO telementoring could be used for other urgent national public health problems.
A school-based soil-transmitted helminths survey in the Guadalcanal Province, the Solomon Islands
Authors: Lee June-Der , Yen Chuan-Min , Wang Jiun-Jye , Lin Rong-Jyh , Chung Li-Yu
Published: November 2020

Infections by soil-transmitted helminths are a major public health problem worldwide, especially among schoolchildren in low-income countries. Little information is described about their prevalence in the Solomon Islands. From 2017 to 2018, a school-based soil-transmitted helminths survey in the Guadalcanal Province was conducted. A total of 454 schoolchildren were selected; the Merthiolate–iodine–formaldehyde concentration and stain was used. The prevalence was 17% of one or more parasites, including hookworm (8.8%), Strongyloides stercoralis (5.7%), Ascaris lumbricoides (4.2%) and Trichuris trichiura (3.5%). STH infection was significantly correlated with parents' occupations, hand washing, shoe wearing as well as gastrointestinal symptoms. To prevent STH transmission for schoolchildren in the Solomon Islands completely, combined preventive strategies seem necessary.
Vestibular Function in Psoriasis Patients
Authors: Kınar Abdullah , Bucak Abdulkadir , Ulu Şahin , Duman Nilay , Baştuğ Nur Betül
Published: November 2020

Introduction:

Psoriasis is an inflammatory skin disease that is characterized by T-cell-mediated hyperproliferation of the keratinocytes. It develops through immune-mediated mechanisms and is defined as an immune-mediated inflammatory disease. The inner ear is susceptible to inflammatory attacks, and vertigo and dizziness can occur as a complication. There is little information about psoriasis and the vestibular system.

Objective:

This study aimed to investigate the cervical vestibular-evoked myogenic potential (cVEMP) results of psoriasis patients and the effect of psoriasis on the vestibular system.

Materials and Methods:

Randomly selected and included in the study were patients who had been admitted to the Dermatology Outpatient Clinic of the Afyon Kocatepe University Medical Faculty, between November 15, 2017, and March 15, 2018, with the diagnosis of psoriasis, in addition to a healthy control group. This research was designed as cross-sectional study. Ethics committee permission was received. Both cVEMP and distortion product otoacoustic emission (DPOAE) tests were administered to all of the participants. Values were compared between the control group and psoriasis patients.

Results:

The study included 43 psoriasis patients and 40 controls. The duration of treatment of the patients and the drugs that they were using were noted. The psoriasis patients had lower p13–n23 amplitude differences in their cVEMP tests ( P < .05). These patients also had lower signal to noise ratio values, at 4 and 6 kHz, on their DPOAE tests ( P < .05).

Conclusion:

Psoriasis is an immune-mediated inflammatory disease that can be associated with vestibulocochlear dysfunction.
Sexual Behavior Problems Among Sexually Abused Children: Associations With Co-Occurring Symptoms
Authors: Wamser-Nanney Rachel , Campbell Claudia L.
Published: November 2020

Sexual behavior problems (SBPs) and interpersonal SBPs (ISBPs) among sexually abused children often occur alongside a variety of other clinical difficulties, such as externalizing problems, attentional difficulties, social concerns, and posttraumatic stress symptoms (PTSS). Yet, as few studies have examined these links in a multivariate manner, it is unclear which symptoms are most strongly related to SBPs and ISBPs. Research regarding children’s reports of their difficulties and SBPs and ISBPs is also very limited. The current study investigated the relations between both caregiver- and child-reported trauma-related symptoms and SBPs and ISBPs among 248 treatment-seeking sexually abused children (ages 6–12; M = 8.06, SD = 2.52; 64.5% female; 55.6% white). Children’s caregiver-reported trauma-related sexual concerns and anger were associated with SBPs. For ISBPs, only caregiver-reported sexual concerns were related to ISBPs. Surprisingly, none of the child-reported symptoms were associated with either SBPs or ISBPs. Trauma-related sexual concerns and anger may be tied to SBPs, whereas other clinical difficulties may be less strongly implicated. Trauma-related sexual concerns may be most important in understanding interpersonally focused SBPs. Children’s self-reported difficulties may be unrelated to caregiver-reported SBPs, or these results may be a function of a low degree of caregiver and child symptom concordance.
Double Glomerulonephritis in a Patient with Ankylosing Spondylitis Treated with Biologic Agent: Extrarticolar Involvement or Anti-Tumor Necrosis Factor Alpha Injury? A Case-Based Review
Authors: Diena Davide , Priora Marta , Barreca Antonella , Parisi Simone , Colla Loredana , Biancone Luigi , Fusaro Enrico
Published: November 2020

With the widespreading use of biologic drugs, reports of renal injury are increasing, most of which belong to the spectrum of secondary autoimmune syndromes. We present the case of a young man affected by Ankylosing Spondylitis, treated with tumor necrosis factor alpha inhibitors (Anti-TNF) that develop a peculiar renal damage: a coexistence of 2 glomerulonephritis due to different noxae, an IgA nephropaty with a Membranous nephropathy. The first one probably related to the rheumatologic disease, the second one related to Anti-TNF. Despite the underlying mechanisms, the renal involvement both related to Ankylosing Spondylitis and secondary to biologic treatment are currently rare and not predictable. Regular control of renal function and urinalysis during treatment with anti-TNF is mandatory. A concomitant treatment with Disease Modifying Anti Rheumatic Drugs or eventually a low dose of steroids may prevent the formation of anti-drug antibodies and could limit the renal damage related to this phenomenon.
Salvaging adulthood at youth work: Dignity, social disrespect, and the micro-politics of recognition in a polarized world
Authors: Mao Jina , Xue Y. Alex
Published: November 2020

Grounded in an ethnographic study of a US fast food chain, this paper explores how the rising employment polarization under neoliberalism may pose a threat to dignity via the predicament of adults doing youth work. We draw on Axel Honneth’s theory of recognition to develop a tripartite framework of the micro-politics of recognition, aimed as a middle-range construct for guiding empirical studies of work through the lens of dignity. We argue that a study of dignity at work, with the everyday human struggle for recognition as the focal point, may help to illuminate the realities of contemporary work and enable a humanistic critique of contemporary capitalism. We also highlight adulthood as the underarticulated yet morally laden identity signifier in organizational inquiry, which may gain added importance as more adults enter occupations where few institutional supports of adulthood exist.
Dispersion stability and rheology study of canola oil containing TiO2 nanoadditives for tribological applications: An experimental approach
Authors: Dhanola Anil , Garg HC
Published: November 2020

Recently, the biodegradable lubricants developed from vegetable oils are gaining popularity concerning biodegradability and sustainability. Moreover, the stabilized suspension of nanoparticles in the base lubricant is a crucial requirement of any nanolubricant for the long term. To evaluate the aggregation behaviour of nanoparticles in base lubricant and rheological properties of nanolubricants are important as other properties. Keeping in view of these, the aim of the present study has been categorized into two parts. Firstly, the dispersion stability of nanofluids in terms of the aggregation behaviour of nanoadditives with the standing time has been investigated under three non-ionic surfactants and one anionic surfactant with several TiO2- to-surfactant mass ratios utilizing dynamic light scattering (DLS) technique. The outcomes demonstrated that the TiO2- to-Triton X-100 mass ratio of 1:3 has long term stability. Secondly, the rheological behaviour of canola oil containing a varying range of nanoadditives has been conducted for various temperatures and shear rates. The results indicated that all the nanofluids exhibit Newtonian behaviour and the viscosity of canola oil increases as nanoadditives concentration increases. The experimental results are also compared and validated with the existing viscosity models, and a new regression model has been suggested.
Thermo-hydrodynamic simulation study of twin-groove elliptical (two-lobe) journal bearing of steam turbine with experimental investigations
Authors: Kumar Navin , Shukla Akash , Bansal Sanjay , Khatri Chandra B , Thakre Gannath D , Yadav Saurabh K , Sharma Satish C , Harsha Suraj P
Published: November 2020

The present paper reports an experimental and theoretical investigation on performance behaviour of twin-groove elliptical (two-lobe) white metal hydrodynamic journal bearing used in steam turbines. The experiments are performed on a fully automatic journal bearing test rig with provisions to various operating conditions (i.e. load, speed, and lubricant temperature). The performance behaviour in terms of coefficient of friction, lubricant inlet temperature, load carrying capacity, journal displacement, weight loss etc. has been presented. In addition to this, numerical investigations have also been performed with the numerical solution of governing Reynolds equation using FEM (finite element method) technique and Jakobsson-Floberg-Olsson (JFO) boundary condition. The experimentally obtained and theoretical results have been correlated.
A 4-DOF dynamic model for ball bearing with multiple defects on raceways
Authors: Gao Xianghong , Yan Changfeng , Liu Yaofeng , Yan Pengfei , Yang Junbao , Wu Lixiao
Published: November 2020

Localized defects in ball bearing components would cause additional vibration and it is imperative to reveal the vibration mechanism. The relationship between fault characteristic frequency (fBPFI and fBPFO) and multiple defect parameters of ball bearing were given in this paper. Considering elastohydrodynamic lubrication (EHL), radial clearance, time-varying displacement and excitation force generated from multiple defects, a 4 degree-of-freedom (DOF) dynamic model for ball bearing with multiple defects on inner or outer raceway was established, and the model has been verified by experiments. Vibration signals of ball bearing with different defects parameters were simulated, the effects of the angle between two defects ( θIAD and θOAD), the number of defects ( NDI and NDO) and the location of defects on outer raceway on dynamic response were studied. Comparing simulated signals with experimental results, it is shown that more impulses of acceleration signals are generated by multiple defects than that by single defect, meanwhile time delay due to two defects on raceways could also be found, fault characteristic frequency and their harmonics frequencies appeared in the envelope spectrums. Harmonics frequencies of fBPFI are modulated mainly by 2 fs instead of fs in frequency domain for multiple defects on inner raceway. The amplitudes of fBPFO and fBPFI change as Fourier curve when θOAD and θIAD varied within a certain range, and a series of Fourier function are given to describe the mathematic relationship.
Local Improvement Districts as Political Participation Signals
Authors: Ziebarth Dan
Published: November 2020

A significant amount of literature has inspected the relationship between public–private partnerships and state and local government. This literature has focused primarily on how these agreements shape financing, economic development, and public policy measures. There is little research, however, on how improvement districts may affect political participation. There are many reasons to believe that these districts may raise levels of political participation, as they deeply affect state and local politics and shape the socioeconomic development of local communities. This article fills this gap in the literature by exploring the relationship between the establishment of local improvement districts and voter participation rates. An original data set is constructed from 18 state assembly districts and 22 local improvement districts in New York City across nine elections between 2002 and 2018, resulting in 198 unique observations across time. Empirical results reflect how the development of improvement districts can serve as signals for rising political participation in surrounding areas, marked by increasing rates of voter turnout across midterm and presidential-year election cycles. These findings are compelling, providing insight into how local organizations designed and sustained through issue ownership and community collaboration have the ability to raise political participation through electoral activity.
Systematic review of research on educational leadership and management in Muslim societies
Authors: Ahmed Eman I
Published: November 2020

This article reports the results of a systematic review of research on educational leadership and management (EDLM) in Muslim societies. Quantitative methods were employed to examine 362 articles published in eight core international EDLM journals. This review examined general patterns of knowledge production, as well as research topics, conceptual models, and methods employed by scholars in Muslim societies. The results show that 44% of the articles had been published in the past 4 years, and 67% in the past 8 years. Turkey, Malaysia, and the United Arab Emirates (UAE) qualified as the largest producers of knowledge production (45.6%). Almost 88.4% of the literature consisted of empirical studies with topical foci focused on leadership in K-12, principals, organizational behavior, climate, and culture. Recommendations were provided to advance the development of knowledge production in the field.
Physical Examination of the Hip
Authors: Wichman Daniel , Rasio Jonathan P. , Looney Austin , Nho Shane J.
Published: November 2020

The hip and pelvis have a complex anatomy and are a common source of pain and injury in the athletic population. The clinical examination of the hip requires a systematic approach to differentially diagnose hip problems with overlapping pain referral patterns. Because of the complex anatomy of the hip, the physical examination is a comprehensive evaluation of the 4 main pain generators of the hip from deep to superficial: the osteochondral, capsulolabral, musculotendinous, and neurovascular elements of the hip. The hip examination begins with the standing examination and gait analysis followed by a seated, supine, lateral, and prone examination. A targeted physical examination used in conjunction with a layered understanding of the hip and pelvis can help guide diagnostic testing, distinguish hip-specific diagnoses from similar presenting pathologies, and inform treatment.
Barriers to the Implementation of the Ward-Based Outreach Team Program in Mpumalanga Province: Results From Process Evaluation
Authors: Nelson Cheryl , Madiba Sphiwe
Published: November 2020

Background:

South Africa adopted the ward-based outreach team (WBOT) program as one aspect of the three-stream approach to primary health care (PHC) re-engineering. PHC re-engineering seeks to modify the hospicentric and curative approach into a more preventive and promotive approach to improve health outcomes. There has not been an evaluation of the implementation of the WBOTs in Nkangala District since its inception in 2012.

Methods:

A process evaluation approach using qualitative methods was used to examine and describe the contextual, organizational, health provider, and program-related barriers considered to affect the implementation of the WBOTs 3 sub-districts in one of the health districts in Mpumalanga Province, South Africa. The framework for this evaluation was informed by the logic model framework developed by the Center for Disease Control as well as the 3 domains of evaluation recommended by the Medical Research Council Guidance on process evaluation. Data were collected through in-depth interviews with multiple data sources directly involved in the implementation of the WBOTs. A thematic analysis was done using NVivo 11.

Results:

The key critical barriers identified by the evaluation include the inadequate provision of resources, the lack of supervision, the heavy workload for outreach teams, the inadequate and irregular payment of stipends, threats to the safety of the CHWs, and the cultural beliefs and practices of the communities who are to receive the services. The lack of adequate financial resources was the main challenge, and will continue to pose a risk to the successful implementation of the WBOTs.

Conclusions:

Although the barriers are being reported as separate contextual factors, the internal and external contexts are interdependent, interact with one each other, and should not be considered in isolation. The need to improve stakeholder engagement on the WBOT program underscores the importance of the external context in the successful implementation of WBOTs.
Effect of Workload After ACL Reconstruction on Rerupture Rates in NBA Players
Authors: Khalil Lafi S. , Matar Robert N. , Rahman Tahsin , Franovic Sreten , Abbas Muhammad J. , Hessburg Luke , Mehran Nima , Okoroha Kelechi R.
Published: November 2020

Background:

Rupture of the anterior cruciate ligament (ACL) is a common and potentially career-altering injury sustained by players in the National Basketball Association (NBA). Strategies have been employed by the league to prevent reinjury of players after ACL reconstruction (ACLR), including minute restrictions and rest games; however, it remains unknown whether workload metrics after ACLR influence the risk for reinjury and revision surgery.

Purpose:

To evaluate whether workload changes after return to play (RTP) from primary ACLR influences the risk of rerupture in NBA players.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

We identified NBA players from 1975 to 2018 who underwent primary ACLR as well as those who required revision ACLR. Primary outcomes included workload measures such as games played, games started, and minutes per game. Secondary outcomes included in-game performance statistics. Statistical analysis was used to compare relative workload and performance 3 years before and 3 years after undergoing primary ACLR. Workload was also compared between the control group of NBA players who underwent primary ACLR and those who required revision ACLR.

Results:

A total of 68 players who underwent primary ACLR were included, 8 of whom subsequently required revision ACLR. In their first season upon RTP, control players (primary ACLR) demonstrated a significant reduction in all workload metrics relative to the season before injury ( P < .001), while the revision group demonstrated an unchanged to increased workload. In a comparison between the primary and revision groups during the first season after RTP, the primary group demonstrated significantly fewer games started (mean ± SD, 22.2 ± 3.0 vs 35.8 ± 8.3; P = .039) and minutes per game (20.5 ± 1.1 vs 27.0 ± 3.1; P = .048) than revision players. The primary ACLR group demonstrated reduced cumulative workload trends for the first 3 years after RTP relative to 3 years before injury, which was not demonstrated in the revision ACLR group, albeit statistically insignificant.

Conclusion:

Our study found that after ACLR, a reduction in workload parameters relative to preinjury baseline was associated with players who did not sustain rerupture. Further study is required to determine if workload measures following RTP from primary ACLR should be individualized relative to preinjury baseline.
Analysis of Shortening and Elevation of the First Ray With Instrumented Triplane First Tarsometatarsal Arthrodesis
Authors: Hatch Daniel J. , Dayton Paul , DeCarbo William , McAleer Jody P. , Ray Justin J. , Santrock Robert D. , Smith W. Bret
Published: November 2020

Background:

The Lapidus procedure using planar saw resection has often been criticized for complications related to excessive shortening and elevation of the first ray. The goal of this study was to assess the amount of shortening that occurs when using a cutting guide for controlled saw resection of the first tarsometatarsal (TMT) joint surfaces, along with assessment of deformity correction in all 3 anatomic planes.

Methods:

A prospective multicenter study with IRB approval included 35 hallux valgus subjects evaluated at baseline and 6 months following instrumented triplane first TMT arthrodesis without lesser metatarsal osteotomies.

Results:

The average first ray bone segment length loss was 3.1 mm (95% confidence interval [CI] 2.4-3.7) in the anteroposterior (AP) radiographic assessment and 2.4 mm (95% CI 1.7-3.1) in the sagittal plane. The mean preoperative radiographic measurements were 1.7 degrees (dorsiflexion) for sagittal plane angle, 13.8 degrees for intermetatarsal angle (IMA), and 5.1 for tibial sesamoid position (TSP). Improvements were seen postoperatively for all measures with a mean difference of –0.2 degrees (95% CI –1.0 to 0.6) for sagittal plane angle, –9.2 degrees (95% CI –10.1 to –8.3 degrees) for IMA, and –3.5 (95% CI –4.0 to –3.1) for TSP. Five of the patients reported lesser metatarsal pain preoperatively, and no patients complained of lesser metatarsalgia at 6-month follow-up.

Conclusions:

Minimal length loss of the first ray can be expected following instrumented triplane TMT arthrodesis while achieving full 3-dimensional deformity correction and reducing the risk of lesser metatarsalgia.

Level of Evidence:

Level II, prospective comparative study.
Monitoring of a rehabilitated building in soft soil in Mexico and structural response to September 2017 earthquakes: Part 2: Numerical simulation
Authors: Murià-Vila David , Arnau Delgado Oriol , Aguilar Silva Guillermo G , Arias Lara Damaris , Pérez-Liévana Karen
Published: November 2020

This article deals with the proper numerical simulation of the response presented by an instrumented damaged-retrofitted building using a low computational cost linear-elastic model, using effective stiffness for its reinforced concrete structural members. The purpose is to identify the most appropriate criteria and considerations and to validate them against the actual behavior of the building registered during real earthquakes. Relevant structural aspects like concrete elastic modulus and soil–structure interaction effects are determined experimentally. Special attention is paid to select appropriate techniques to model the complex geometry of the North-South facades wall elements and their related coupling beams. Finally, time-history analyses of 20 March 2012 earthquake (service conditions demand) and 19 September 2017 earthquake (design conditions demand) are performed, both considering and ignoring the soil–structure interaction effects. Results point out that commonly adopted simplifications in numerical models of buildings must be correctly implemented to satisfactorily simulate their earthquake response.
Analysis of multidimensional factors in attempts to quit using tobacco by Korean adolescents
Authors: Kang Mi-Jung , Lee Hyunjin , Jo Mirae
Published: November 2020

Background

This study aims to understand the extent of adolescents’ attempts to quit using tobacco and the factors influencing such attempts in Korea, using a descriptive, cross-sectional design and secondary data analysis with the 2019 Youth Health Behavior Survey.

Methods

The participants were 4028 adolescent tobacco users who had used tobacco for 1 day or more in the past 30 days. The data analysis was performed using IBM SPSS/WIN 26.0 program, and multivariable logistic regression analysis was conducted using the complex sampling method module.

Results

A total of 68.2% of the participants attempted to quit using tobacco. We analyzed the factors for adolescents’ attempts to quit using tobacco by dividing them into psychological, physical, behavioral, and environmental dimensions. The factors influencing adolescents’ attempts to quit using tobacco, identified through multivariable logistic regression analysis, are as follows: participation in sports activities (OR = 1.20, 95% CI 1.01–1.41), vigorous physical activity (OR = 1.24, 95% CI 1.06–1.46), and type of tobacco product used (OR = 1.65, 95% CI 1.24–2.21) in the behavioral dimension; pictorial cigarette pack warnings (perceived smoking as unhealthy) (OR = 1.91, 95% CI 1.56–2.36), and the presence of secondhand smoking at home (OR = 1.18, 95% CI 1.01–1.38) in the environmental dimension.

Conclusions

Schools and public healthcare providers must consider multidimensional factors when providing support for successful tobacco cessation in adolescents and focus particularly on elements relating to physical activity and environmental factors.
Framing the process in the implementation of care for people with generalized anxiety disorder in primary care: a qualitative evidence synthesis
Authors: Toledo-Chávarri Ana , Ramos-García Vanesa , Torres-Castaño Alezandra , Trujillo-Martín María M , Peñate Castro Wenceslao , Del Cura-Castro Isabel , Serrano-Aguilar Pedro , Perestelo-Pérez Lilisbeth
Published: November 2020

Background

Generalized anxiety disorder (GAD) is one of the most common mental disorders in primary care (PC). GAD has low remission and high relapse rates over long follow-up periods. Qualitative evidence was synthesized to understand the implementation of care and treatment options for people with GAD in PC.

Methods

Research published from 2008 to September 2020 was searched in five databases (MEDLINE, EMBASE, CINAHL, WOS and PsycArticles). Studies that used qualitative methods for data collection and analysis to investigate the implementation of care and treatment options for people with GAD in PC and outpatient settings were included. Non-qualitative studies, mixed methods studies that did not separately report qualitative findings and studies in languages other than English or Spanish were excluded. We used the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) framework to assess the overall confidence in the findings.

Results

The results with a moderate level of confidence showed that the trajectory of care for people with GAD in PC and outpatient settings is long and fluctuates over time, involving multiple difficulties in accessing and maintaining initial treatment or successive treatment options. In addition, there are wide variations in the preferences for and acceptability of different treatment options. The results with a high level of confidence indicated that more information on GAD and its treatment options is needed for PC practitioners, GAD patients and their carers. The results with a low level of confidence suggested that patients use antidepressants for longer than recommended and that the interruption of treatment is not usually planned.

Conclusions

Initial resistance to new treatments among people with GAD can make access and adherence to treatment difficult. Improving care may require patients to be informed of possible trajectories in stepped care pathways before the initiation of treatment so they are aware that they may need to try a number of options until the most effective treatment for them is found. Increased awareness of and information materials on GAD may facilitate both appropriate diagnosis and long-term care.
Evaluation of two family-based intervention programs for children affected by rare disease and their families – research network (CARE-FAM-NET): study protocol for a rater-blinded, randomized, controlled, multicenter trial in a 2x2 factorial design
Authors: Boettcher Johannes , Filter Bonnie , Denecke Jonas , Hot Amra , Daubmann Anne , Zapf Antonia , Wegscheider Karl , Zeidler Jan , von der Schulenburg J.-Matthias Graf , Bullinger Monika , Rassenhofer Miriam , Schulte-Markwort Michael , Wiegand-Grefe Silke
Published: November 2020

Background

Families of children with rare diseases (i.e., not more than 5 out of 10,000 people are affected) are often highly burdened with fears, insecurities and concerns regarding the affected child and its siblings. Although families caring for children with rare diseases are known to be at risk for mental disorders, the evaluation of special programs under high methodological standards has not been conducted so far. Moreover, the implementation of interventions for this group into regular care has not yet been accomplished in Germany. The efficacy and cost-effectiveness of a family-based intervention will be assessed.

Methods/design

The study is a 2x2 factorial randomized controlled multicenter trial conducted at 17 study centers throughout Germany. Participants are families with children and adolescents affected by a rare disease aged 0 to 21 years. Families in the face-to-face intervention CARE-FAM, online intervention WEP-CARE or the combination of both will be treated over a period of roughly 6 months. Topics discussed in the interventions include coping, family relations, and social support. Families in the control condition will receive treatment as usual. The primary efficacy outcome is parental mental health, measured by the Structured Clinical Interview for DSM-IV (SCID-I) by blinded external raters. Further outcomes will be assessed from the parents’ as well as the children’s perspective. Participants are investigated at baseline, 6, 12 and 18 months after randomization. In addition to the assessment of various psychosocial outcomes, a comprehensive health-economic evaluation will be performed.

Discussion

This paper describes the implementation and evaluation of two family-based intervention programs for Children Affected by Rare Disease and their Family’s Network (CARE-FAM-NET) in German standard care. A methodologically challenging study design is used to reflect the complexity of the actual medical care situation. This trial could be an important contribution to the improvement of care for this highly burdened group.

Trial registration

German Clinical Trials Register: DRKS00015859 (registered 18 December 2018) and ClinicalTrials.gov: NCT04339465 (registered 8 April 2020).

Protocol Version: 15 August 2020 (Version 6.1).

Trial status: Recruitment started on 1 January 2019 and will be completed on 31 March 2021.
Epidermoid cyst in an intrapancreatic accessory spleen in the pancreas head: a case report
Authors: Ko Hyo Jung , Shim Jae Ryong , Lee Tae Beom , Choi Byung Hyun , Lee Jung-Hee , Ryu Je Ho , Yang Kwangho
Published: November 2020

Background

An epidermoid cyst in an intrapancreatic accessory spleen (ECIPAS) in the pancreas head is an extremely rare condition. The natural course of this condition is not well known, and it is difficult to diagnose before surgery due to the lack of specific imaging findings.

Case presentation

A tumor was found in the head of the pancreas in a 68-year-old man with abdominal distension and discomfort. Magnetic resonance imaging (MRI) suggested a malignant tumor, such as a colloid cancer. The tumor was removed surgically, with pathologic examination showing that it was an ECIPAS.

Conclusion

ECIPAS cannot be easily distinguished from other pancreatic cystic tumors, making it necessary to include ECIPAS in the differential diagnosis of these tumors. Unnecessary surgical resection may be avoided by more accurate preoperative diagnosis based on clinical and imaging characteristics.
Characteristics and outcomes of frail patients with suspected infection in intensive care units: a descriptive analysis from a multicenter cohort study
Authors:   for the JAAM SPICE Study Group, Komori Akira , Abe Toshikazu , Yamakawa Kazuma , Ogura Hiroshi , Kushimoto Shigeki , Saitoh Daizoh , Fujishima Seitaro , Otomo Yasuhiro , Kotani Joji , Sakamoto Yuichiro , Sasaki Junichi , Shiino Yasukazu , Takeyama Naoshi , Tarui Takehiko , Tsuruta Ryosuke , Nakada Taka-aki , Hifumi Toru , Iriyama Hiroki , Naito Toshio , Gando Satoshi
Published: November 2020

Background

Frailty is associated with morbidity and mortality in patients admitted to intensive care units (ICUs). However, the characteristics of frail patients with suspected infection remain unclear. We aimed to investigate the characteristics and outcomes of frail patients with suspected infection in ICUs.

Methods

This is a secondary analysis of a multicenter cohort study, including 22 ICUs in Japan. Adult patients (aged ≥16 years) with newly suspected infection from December 2017 to May 2018 were included. We compared baseline patient characteristics and outcomes among three frailty groups based on the Clinical Frailty Scale (CFS) score: fit (score, 1–3), vulnerable (score, 4), and frail (score, 5–9). We conducted subgroup analysis of patients with sepsis defined as per Sepsis-3 criteria. We also produced Kaplan–Meier survival curves for 90-day survival.

Results

We enrolled 650 patients with suspected infection, including 599 (92.2%) patients with sepsis. Patients with a median CFS score of 3 (interquartile range [IQR] 3–5) were included: 337 (51.8%) were fit, 109 (16.8%) were vulnerable, and 204 (31.4%) were frail. The median patient age was 72 years (IQR 60–81). The Sequential Organ Failure Assessment scores for fit, vulnerable, and frail patients were 7 (IQR 4–10), 8 (IQR 5–11), and 7 (IQR 5–10), respectively (p = 0.59). The median body temperatures of fit, vulnerable, and frail patients were 37.5 °C (IQR 36.5 °C–38.5 °C), 37.5 °C (IQR 36.4 °C–38.6 °C), and 37.0 °C (IQR 36.3 °C–38.1 °C), respectively (p < 0.01). The median C-reactive protein levels of fit, vulnerable, and frail patients were 13.6 (IQR 4.6–24.5), 12.1 (IQR 3.9–24.9), 10.5 (IQR 3.0–21.0) mg/dL, respectively (p < 0.01). In-hospital mortality did not statistically differ among the patients according to frailty (p = 0.19). Kaplan–Meier survival curves showed little difference in the mortality rate during short-term follow-up. However, more vulnerable and frail patients died after 30-day than fit patients; this difference was not statistically significant (p = 0.25). Compared with the fit and vulnerable groups, the rate of home discharge was lower in the frail group.

Conclusion

Frail and vulnerable patients with suspected infection tend to have poor disease outcomes. However, they did not show a statistically significant increase in the 90-day mortality risk.
Solitary juxtacortical lesion associated with anti-N-methyl-D-aspartate receptor encephalitis: a case report
Authors: Gao Rupan , Zhang Xiang , Bhekharee Abhijeet Kumar , Zhang Yue
Published: November 2020

Background

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a severe autoimmune encephalitis mediated by anti-NMDA receptor antibodies. Brain MRI manifestations vary and are non-specific. If there are any lesions, they tend to be diffusely or multifocally distributed. Solitary lesion is relatively rare.

Case presentation

We report a 16-year-old girl who initially presented with focal seizures but developed severe psychiatric and extrapyramidal symptoms later on. Brain MRI revealed a solitary juxtacortical demyelinating lesion in the left frontal lobe. No enhancement was noted. Electroencephalogram captured epileptiform discharges in the same region. NMDAR IgGs were tested positive in the serum and cerebrospinal fluid. Corticosteroid and intravenous IgG were administered and the patient completely recovered. Brain MRI revealed a fainter lesion in the left frontal lobe.

Conclusion

In very rare instances, anti-NMDA receptor encephalitis can present with a solitary brain lesion. A full panel of antibodies for autoimmune encephalitis is the key leading to the diagnosis.
Identification and functional analysis of a novel missense mutation in GJA8, p.Ala69Thr
Authors: Li Dandan , Xu Chenjia , Huang Dandan , Guo Ruru , Ji Jian , Liu Wei
Published: November 2020

Background

To explore the molecular genetic cause of a four-generation autosomal dominant congenital cataract family in China.

Methods

Targeted region sequencing was performed to screen for the potential mutation, and Sanger sequencing was used to confirm the mutation. The homology model was constructed to identify the protein structural change, PolyPhen-2 and Provean were used to predict the mutation impact. Functional and cellular analysis of the wild and mutant GJA8 were performed in DF-1 cells by western blotting, dye uptake assay, immunofluorescence, Annexin V-FITC staining.

Results

A novel heterozygous mutation (c.205G > A; p.Ala69Thr) was identified within GJA8, which cosegregated with congenital cataract phenotype in this family. Bioinformatics analysis showed the mutation was located in a highly conserved region, and the mutation was predicted to be pathogenic. Function analysis indicated that the mutation inhibited GJA8 hemichannel activity, reduced cell tolerance to oxidative stress, changed the protein distribution pattern and inhibited the cell growth.

Conclusions

We have identified a novel missense mutation in GJA8 (c.205G > A, p.Ala69Thr) in a four-generation Chinese family and our results will further broaden the gene mutation spectrum of GJA8.
Household presentation of influenza and acute respiratory illnesses to a primary care sentinel network: retrospective database studies (2013–2018)
Authors: de Lusignan Simon , Sherlock Julian , Akinyemi Oluwafunmi , Pebody Richard , Elliot Alex , Byford Rachel , Yonova Ivelina , Zambon Maria , Joy Mark
Published: November 2020

Background

Direct observation of the household spread of influenza and respiratory infections is limited; much of our understanding comes from mathematical models. The study aims to determine household incidence of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections within a primary care routine data and identify factors associated with the diseases’ incidence.

Methods

We conducted two five-year retrospective analyses of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections using the England Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care sentinel network database; a cross-sectional study reporting incident rate ratio (IRR) from a negative binomial model and a retrospective cohort study, using a shared gamma frailty survival model, reporting hazard ratios (HR). We reported the following household characteristics: children < 5 years old, each extra household member, gender, ethnicity (reference white), chronic disease, pregnancy, and rurality.

Results

The IRR where there was a child < 5 years were 1·62 (1·38–1·89, p < 0·0001), 2·40 (2.04–2.83, p < 0·0001) and 4·46 (3.79–5.255, p < 0·0001) for ILI, LRTI and URTI respectively. IRR also increased with household size, rurality and presentations and by female gender, compared to male. Household incidence of URTI and LRTI changed little between years whereas influenza did and were greater in years with lower vaccine effectiveness.

The HR where there was a child < 5 years were 2·34 (95%CI 1·88–2·90, p < 0·0001), 2·97 (95%CI 2·76–3·2, p < 0·0001) and 10·32 (95%CI 10.04–10.62, p < 0·0001) for ILI, LRTI and URTI respectively. HR were increased with female gender, rurality, and increasing household size.

Conclusions

Patterns of household incidence can be measured from routine data and may provide insights for the modelling of disease transmission and public health policy.
Role of fibrocytes and endothelial progenitor cells among low-differentiated CD34+ cells in the progression of lung sarcoidosis
Authors: Elżbieta Rutkowska , Iwona Kwiecień , Joanna Bednarek , Karina Jahnz-Różyk , Piotr Rzepecki
Published: November 2020

Background

Sarcoidosis is a multisystemic granulomatous disease with still unknown etiology. Our previous studies showed a significantly higher percentage of CD34 + cells in the peripheral blood in patients with sarcoidosis (SA) compared to the control group. The objective of the present study was to characterized of the CD34 + cell population in peripheral blood in patients with SA with reference to the control group. Moreover in patients with SA, fibrocytes and endothelial cells were analysed and their relationship to the fibrosis process based on assessment of diffusing capacity for carbon monoxide (DLCO).

Methods

Data from patients diagnosed with SA at Military Institute of Medicine (Warsaw, Poland) between January 2018 and December 2019 were collected and analysed ongoing basis. Peripheral blood was collected from 26 patients with newly diagnosed pulmonary SA and 16 healthy subjects. The immunomagnetic method and flow cytometry were used. Among the CD34+ progenitor cells were assessed: low-differentiated cells, hematopoietic progenitor cells and endothelial progenitor cells. The Statistica 12.0 software was used for a statistical analysis.

Results

We observed a significantly higher percentage of low-differentiated cells (13.8 vs. 2.3, P = 0.001) and endothelial cells (0.3 vs. 0.0, P = 0.001) in patients with SA compared to the control group. In the study group the median proportion of fibrocytes was 1.877% (0.983–2.340) in patients with DLCO< 80%, while in patients with DLCO> 80% was 0.795% (0.139–1.951) (P = 0.72). The median proportion of endothelial progenitor cells was higher in patients with DLCO< 80%: 0.889% (0.391–1.741), than in patients with DLCO> 80%: 0.451% (0.177–0.857) (P = 0.44).

Conclusions

In conclusion we demonstrated for the first time the immunophenotype of peripheral CD34 + cells with the degree of their differentiation. The study confirmed the involvement of low differentiated cells and endothelial cells in patients with SA.