bluuebunny/crossref_metadata_2025 huggingface dataset:
Colonic Adenocarcinoma Presenting as Splenic Abscess Secondary to Suspected Microperforation
Authors: Fitzsimmons Emily , Torrico Tyler J. , Bajaj Tushar , Ragland Alan Scott
Published: December 2020

Splenic abscesses are a rare infection that usually requires seeding from another primary source; however, direct contact of bacteria can occur with microperforation secondary to colon cancer leading to abscess formation. This occurrence is rare, and through literature review only 12 previous cases have been reported with associated bacteremia. Our patient is a 62-year-old female who presented with left upper quadrant pain with a history of tobacco and alcohol abuse that was febrile and hypoxic. Blood cultures were obtained that eventually grew Fusobacterium mortiferum. Computed tomography of the abdomen and the pelvis revealed 2 splenic abscesses that were cultured to grow Escherichia coli and β-hemolytic Streptococcus group C. Colonoscopy was performed, which identified 2 masses that were biopsied, and histopathology confirmed well-differentiated adenocarcinoma with possible muscular invasion. The patient had no other identifiable risk factors for bacterial seeding from another primary source. We present the first reported case report of splenic abscess secondary to colonic adenocarcinoma suspected microperforation associated with Fusobacterium mortiferum bacteremia.
Bone Marrow Concentrate Injection Treatment Improves Short-term Outcomes in Symptomatic Hip Osteoarthritis Patients: A Pilot Study
Authors: Whitney Kaitlyn E. , Briggs Karen K. , Chamness Carolyn , Bolia Ioanna K. , Huard Johnny , Philippon Marc J. , Evans Thos A.
Published: December 2020

Background:

Osteoarthritis (OA) is one of the leading causes of disability in the United States, the hip being the second most affected weightbearing joint. Autologous bone marrow concentrate (BMC) is a promising alternative therapy to conventional treatments, with the potential to mitigate inflammation and improve joint function.

Purpose:

To investigate the effectiveness of a single intra-articular BMC injection for patients with symptomatic hip OA.

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 24 patients diagnosed with symptomatic hip OA who elected to undergo a single BMC injection were prospectively enrolled in the study. Patients were excluded if they reported a preinjection Numeric Rating Scale (NRS) score for pain with activity of <6 points out of 10. The Western Ontario and McMaster Universities Arthritis Index (WOMAC), modified Harris Hip Score (mHHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), 12-Item Short Form Health Survey (SF-12), and NRS pain scores were collected before and after the procedure (6 weeks, 3 months, and 6 months). Joint space and Tönnis OA grade scores were recorded on preinjection anteroposterior pelvis radiographs.

Results:

A total of 18 hips from 16 patients (7 male and 9 female) (mean age, 57.6 ± 11; mean body mass index, 25.9 ± 3.6 kg/m2) were used in the final analysis. Significant improvements were observed in NRS pain with activity (from 8 to 4.5; P < .001) and without activity (from 5 to 1; P < .001), WOMAC (from 31 to 16; P = .006), mHHS (from 63 to 80; P = .004), and HOS-ADL (from 71 to 85; P = .014) over 6 months. At 6 months, all patients maintained their improvements and did not return to preprocedure status. BMI significantly correlated with baseline WOMAC scores ( P = .012) and inversely correlated with 6-month SF-12 Physical Component Summary ( P = .038). Tönnis grades 2 and 3 were inversely correlated with 6-week SF-12 Mental Component Summary ( P = .008) and 3-month pain with activity ( P = .032). No serious adverse events were reported from the BMC harvest or injection procedure.

Conclusion:

A single BMC injection can significantly improve subjective pain and function scores up to 6 months in patients with symptomatic hip OA. Further studies are warranted to evaluate BMC treatment against other therapeutics in a larger sample size and compare the biological signature profiles that may be responsible for the therapeutic effect.
Life History of an Omani Woman, Nursing Pioneer, and Nurse Leader
Authors: Emerson Christie
Published: December 2020

This study explored the lived experiences of an Omani nursing pioneer and nurse leader whose life and career have evolved amidst a time of rapid modernization in Oman that began in 1970, widely known as the Omani Renaissance. The life history method of qualitative research was used to examine personal and institutional facilitators and barriers to professional development, as well as aspects of the history of the nursing profession and healthcare in Oman during this time. This paper provides insight about the successes and challenges she faced in choosing nursing and along her career path. Inductive thematic analysis revealed three dominant themes: opportunity, visionary, and nurse; with subthemes: national identity, country building, nursing pioneer, leadership, perseverance, resilience, mentors, advocacy, caring, and fulfillment. Conclusions from this study are that opportunities, personal attributes, and motivations shaped decisions about employment and played a role in overcoming barriers to professional development in the workforce.
Exploring the Attendance and Potential Benefits of Reducing Sitting Time for Residents in a Canadian Long-Term Care Setting: A Pilot Study
Authors: Lee Amanda , Sénéchal Martin , Read Emily , Bouchard Danielle R.
Published: December 2020

Background: This study aimed to assess the attendance to a novel intervention aiming to reduce sitting time in a long-term care facility and exploring the potential functional benefits. Methods: The intervention consisted of research staff visiting a resident to promote standing for 10-minute sessions, three times per day (morning, afternoon and evening), 4 days per week (Monday-Wednesday-Friday and Sunday) over 10 weeks. The main outcome was attendance. Functional outcomes included walking speed, power, and strength. Results: A total of 28 participants agree to participate and 24 completed the trial. The average attendance averaged four sessions per week and averaged 45 minutes of standing weekly out of 120 minutes offered. Attendance was highest during the morning session ( p = .02) and weekdays ( p < .01). There was a significant improvement in the 30-second chair stand test ( p < .05). Conclusion: Although well accepted, the attendance was low. Based on the information gathered suggestions can be made to improve the intervention, attendance, and potential benefits of such intervention.
Assessment on Hand Hygiene Knowledge and Practices Among Pre-school Children in Klang Valley
Authors: Tengku Jamaluddin Tengku Zetty Maztura , Mohamed Nurul Azmawati , Mohd Rani Mohd Dzulkhairi , Ismail Zarini , Ramli Shalinawati , Faroque Habibah , Abd Samad Farishah Nur , Ariffien Abdul Rasyid , Che Amir Farid Aisyah Ar Redha , Isahak Ilina
Published: December 2020

Background. Pre-school children are at a higher risk to acquire infectious diseases such as hand, foot and mouth disease due to their immature immune system. Good hand hygiene prevents transmission of infectious diseases. This study aimed to determine the knowledge and practices of hand hygiene among pre-schoolers. Methods. In this prospective, multi-center study, the pre-schools were selected according to the selection criteria. A questionnaire consisting of socio-demographics, knowledge and practices of hand hygiene were administered via face-to-face interview during the pre- and post-intervention period. A total of 435 pre-schoolers aged 5 and 6 years old from 2 pre-schools within Klang Valley, School P (test group) and School C (control group) were involved in this study. The test group was provided with comprehensive hand hygiene education including video on proper handwashing technique during the 2 months intervention period, whereas the control group did not receive any form of intervention. The data were statistically analyzed using descriptive analysis and independent t-test. Results. Majority of pre-schoolers gained knowledge of handwashing from their parents. However, only 63% demonstrated good handwashing technique. Test group were significantly better ( P < 0.05) in handwashing technique and hand hygiene routine score. Conclusion. A comprehensive hand hygiene education program should include proper handwashing facilities, resources, and awareness of the care-givers in instilling and sustaining good hand hygiene behavior.
Sustainable Development Goals as a Framework for Postgraduate Future Research Following COVID-19 Pandemic: A New Norm for Developing Countries
Authors: Useh Ushotanefe
Published: December 2020

Purpose and Significance:

Education is regarded as the key to economic development, and COVID-19 has provided all universities the unique opportunity to urgently address their fitness for purpose. Universities can play a significant role in contributing to a more sustainable world by mainstreaming Sustainable Development Goals (SDGs) at postgraduate levels. The opportunity to utilize United Nation’s Sustainable Development Goals (UN SDGs) as the framework for postgraduate projects in solving real world’s challenges in our communities after the COVID-19 pandemic was explored.

Main Body:

One way of ensuring concomitant attainments of the SDGs with community development is that post-COVID-19 postgraduate projects should be purposively driven to address UN SDGs to make positive social impact in our communities. Through this, higher education institutions (HEIs) will be contributing in no little measures to human capital and social development with sustainable developments driven through interdisciplinary approach.

Conclusion:

The research products upon the completion of master’s and doctoral studies from our different universities should be purposively designed in accordance with the UN SDGs and universities’ visions to solve real-life challenges and therefore make social impacts in our communities. All HEIs should embrace an integrated approach by designing courses with learning objectives that are clearly focused on holistic approaches to sustainable societal development.
Mapping the Production and Mobilization Functions of Collective Action
Authors: Robbins Blaine G. , Matsueda Ross L. , Pfaff Steven J.
Published: December 2020

Collective action is a fundamental feature of human social life. If public goods are to materialize, social norms are to emerge, and social protests are to succeed, individuals must act jointly to achieve their collective ends. But how can collective action evolve when individuals receive the benefits of a common good without contributing to its production? According to theories of the critical mass, the success of collective action hinges on the type of production function required for the provision of a common good. Production functions and mobilization functions, however, have proven difficult to observe empirically in large groups. Here, the authors report results from a factorial survey experiment administered to a disproportionate stratified random sample of undergraduate students ( n = 880) that required respondents to rate their perceptions of and intentions to participate in a hypothetical student protest. Results show that the population-average production and mobilization functions are decelerating, but individual heterogeneity is observed around the population averages. Moreover, the experiment demonstrates that latent class trajectories of production and mobilization functions, rather than population-level consensus or complete individual heterogeneity, exist in the population. The authors show that the majority of latent class trajectories are decelerating, while a minority are linear or relatively constant. The authors find that subjective interest in the common good and attitudes toward protest predict membership in latent class trajectories. Importantly, the authors provide evidence for the predictive validity of their estimates. The authors discuss the implications of these results for theories of the critical mass and for promoting collective action.
The Vulnerability Paradox: Strengthening Trust in the Classroom
Authors: Romney Alexander C. , Holland Daniel V.
Published: December 2020

Teachers often struggle with determining how vulnerable to make themselves in the classroom. Many teachers intuitively desire to exude strength and confidence in their teaching and view vulnerability as a hindrance to that aim. However, there exists a vulnerability paradox: the more vulnerable teachers make themselves, the stronger students’ trust in teachers becomes. Drawing upon research on trust, we provide important insights for teachers to consider regarding how vulnerability can generate trust and in turn improve student learning. We then introduce three pedagogical strategies that teachers can use to demonstrate vulnerability, thereby engendering greater trust in the classroom.
Mapping the Kansas City Cardiomyopathy Questionnaire (KCCQ) Onto EQ-5D-3L in Heart Failure Patients: Results for the Japanese and UK Value Sets
Authors: Hunger Matthias , Eriksson Jennifer , Regnier Stephane A. , Mori Katsuya , Spertus John A. , Cristino Joaquim
Published: December 2020

Background. Health technology assessment bodies in several countries, including Japan and the United Kingdom, recommend mapping techniques to obtain utility scores in clinical trials that do not have a preference-based measure of health. This study sought to develop mapping algorithms to predict EQ-5D-3L scores from the Kansas City Cardiomyopathy Questionnaire (KCCQ) in patients with heart failure (HF). Methods. Data from the randomized, double-blind PARADIGM-HF trial were analyzed, and EQ-5D-3L scores were calculated using the Japanese and UK value sets. Several different model specifications were explored to best fit EQ-5D data collected at baseline with KCCQ scores, including ordinary least square regression, two-part, Tobit, and three-part models. Generalized estimating equations models were also fitted to analyze longitudinal EQ-5D data. To validate model predictions, the data set was split into a derivation ( n = 4,465) from which the models were developed and a separate sample ( n = 1,892) for validation. Results. There were only small differences between the different model classes tested. Model performance and predictive power was better for the item-level models than for the models including KCCQ domain scores. R2 statistics for the item-level models ranged from 0.45 to 0.52. Mean absolute error in the validation sample was 0.10 for the models using the Japanese value set and 0.114 for the UK models. All models showed some underprediction of utility above 0.75 and overprediction of utility below 0.5, but performed well for population-level estimates. Conclusions. Using data from a large clinical trial in HF, we found that EQ-5D-3L scores can be estimated from responses to the KCCQ and can facilitate cost-utility analysis from existing HF trials where only the KCCQ was administered. Future validation in other HF populations is warranted.
Being There: The Importance of Direct Observation in Resident Assessment
Authors: Berkowitz Lee R
Published: December 2020

There are many methods to assess resident competency. In this report the author describes an experience that strongly suggests the superiority of direct observation compared to other methods. Literature comparing direct observation to other methods is cited. In addition ways to create time for direct observation and how to promote wider use of direct observation are discussed
Liberalization, Import of Capital Goods, and Industrial Exports: Evidence from Indian Manufacturing Sectors
Authors: Rijesh R.
Published: December 2020

This article examines the impact of capital goods import on Indian manufacturing exports at the sectoral level. Import of capital goods provides dynamic productivity gains through quality, variety, and cost-efficiency channels that further boost manufacturing exports. Since trade liberalization facilitates this process, we presumed that better access to capital inputs would enhance Indian exports for 15 major manufacturing sectors at the 3-digit level from 1997 to 2016. The panel regression analysis based on fixed effect(s) feasible generalized least squares (FGLS), and ordinary least squares (OLS) indicate that, after controlling for world demand, relative export prices, and in-house research and development (R&D), the capital goods import has a positive and statistically significant impact on the aggregate manufacturing sector. The OLS estimates at the sectoral level further confirm the positive impact across nine major sectors. In general, the engineering sectors such as metals, machinery and transport equipment, and traditional labor-intensive sectors like textiles show positive benefit from these technology imports.
How does leadership influence incident reporting intention in healthcare? A dual process model of leader–member exchange
Authors: Jungbauer Kevin-Lim , Loewenbrück Kai , Reichmann Heinz , Wendsche Johannes , Wegge Jürgen
Published: December 2020

Building on social exchange and social identity theory, we examined how leader–member exchange (LMX) influences intention to report incidents in healthcare organizations through two different mechanisms. Using survey data of 15 hospitals in Germany ( N = 480) and multilevel structural equation modelling, we found as expected that LMX positively related to reporting-specific trust and organizational identification of employees. However, only reporting-specific trust but not organizational identification was directly related to incident reporting intention. Furthermore, top management support for patient safety moderated the link between LMX and reporting-specific trust, indicating a compensatory mechanism of top management support for followers with a low-quality leadership relationship. In addition, codification of patient safety regulations moderated the link between organizational identification and incident reporting intention. As expected, the institutionalization of patient safety norms through a strong follow-through of the organization is related to increased reporting only for employees with high organizational identification. Results are discussed in terms of how safety leadership can be enacted at both the supervisory and top management level in order to promote safety behaviour in healthcare organizations.
Iatrogenic Subretinal Triamcinolone During Primary Surgical Repair of a Retinal Detachment With a Giant Retinal Tear
Authors: Xu Kunyong , Chin Eric K. , Almeida David R.P.
Published: December 2020

Purpose:

We describe the outcome of a 23-year-old man undergoing vitreoretinal surgery for a macula-off rhegmatogenous retinal detachment secondary to a giant retinal tear.

Methods:

Patient underwent combined 25- gauge 3-port pars plana vitrectomy with scleral buckle, perfluorocarbon liquid, and perfluoropropane gas tamponade. During surgery, triamcinolone inadvertently entered the subretinal space and was retained.

Results:

The subretinal triamcinolone deposits spontaneously absorbed over a 2-month period. No adverse sequelae were associated with this complication.

Conclusion:

This may support avoiding aggressive mechanical removal of iatrogenic subretinal triamcinolone in the context of retinal detachment repair.
What is the role of technology in improving patient safety? A French, German and UK healthcare professional perspective
Authors: Astier Alain , Carlet Jean , Hoppe-Tichy Torsten , Jacklin Ann , Jeanes Annette , McManus Steve , Pletz Mathias W , Seifert Harald , Fitzpatrick Ray
Published: December 2020

Patient safety in hospitals can be compromised by preventable adverse events (AE). Among the preventable AEs, hospital-acquired infections (HAIs) are one of the most burdensome, contributing to not only poorer patient outcomes but institutional burden through direct financial losses and increased patient length of stay.

 Technological innovations can enhance patient safety by automating tasks, introducing medication alerts, clinical reminders, improved diagnostic and consultation reports, facilitating information sharing, improving clinical decision-making, intercepting potential errors, reducing variation in practice, and managing workforce shortages as well as making complete patient data available.

 A multidisciplinary working group from three European countries was convened to discuss how to optimise the use of technology to reduce preventable AEs in acute care hospitals. The working group identified examples where they felt there were opportunities to streamline patient pathways, including antimicrobial stewardship, point of care testing, microbiology test reporting to streamline time from sample-taking to clinical decision and mobile automated dispensing systems, which can reduce the burden on overworked staff. The working group also discussed key factors that were critical to ensuring different stakeholders, both within and outside the hospital, could meaningfully contribute to improving patient safety. They agreed that technological approaches and advances would have limited impact without meaningful cultural changes at all levels of healthcare infrastructure to implement the benefits offered by current or future technologies.
Strategizing Under Economic Uncertainties: Lessons from the COVID-19 Pandemic for the Indian Auto Sector
Authors: Bhatt Pratyush , Varghese Sumeet
Published: December 2020

Formulating business strategies in times of economic uncertainty can be a challenging exercise because of rapid changes in market assumptions, projections, and conditions. Studies have shown that the repertory of strategic choices that businesses explore, to handle uncertain economic environments, is not highly varied. This article reviews the strategic responses that leading Indian auto manufacturers have adopted in order to handle the dip in demand post COVID-19. Given that the Indian automobile industry has been facing headwinds since 2018, the COVID-19 pandemic could not have hit the sector at a more inopportune time. This article aims to review how firms in the sector ride through an economic slump and also sheds light on strategic decision-making patterns

The article exclusively focuses on leading automobile firms and does not analyze actions taken by comparatively smaller players to stay afloat. Hence, this article does not delve into the actions that suppliers and dealers are exploring. Most importantly, this article contains a comprehensive analysis of the financial performance of a few auto majors. This article seeks to piece together a picture of firm-level strategies on the basis of publicly accessible financial statements and news reports.
Corporate Crime and the Use of Science in the Case of Asbestos: Producing Harm Through Discursive Shields
Authors: de Nardin Budó Marília
Published: December 2020

This article focuses on the normalization of victimization and harms caused by asbestos, a carcinogenic mineral fiber. To understand the role played by science in hiding the wounds and deaths caused by corporations, the article starts presenting the example of Brazil, where scientific discourse of foreign experts with industry ties are influencing regulation. From there, I examine the disputes for truth in six different medical journals through grounded theory. The results show that authors use some strategies to achieve credibility: avoiding to acknowlegde industry funding; constructing a specific meaning for the controversy about asbestos risks; and reflecting about the consequences os research misconducts. The ways of thinking about asbestos riks and harms are migrating through the international division of scientific labor, both to spread harm and to avoid liability of powerful agents.
Describing the end-of-life doula role and practices of care: perspectives from four countries
Authors: Krawczyk Marian , Rush Merilynne
Published: December 2020

Background:

End-of-life doulas are emerging as a potentially important new form of community-based caregiving in the global North, yet we know little about this form of care. The aim of our study was to solicit the perspective of key stakeholders and early innovators in community-based end-of-life care about the development and practices of end-of-life doulas.

Methods:

We conducted 22 semi-structured interviews with participants in four countries where end-of-life doulas are most active: Australia, Canada, the United States, and the United Kingdom.

Findings:

This article focuses on participants’ description of the end-of-life doula role and attendant practices, and our findings provide the first detailed taxonomy of the end-of-life doula role and specific services on the basis of the perspective of subject experts in four countries. We situate our findings within literature on the professionalization of caregiving, with particular attention to nomenclature, role flexibility and boundary blurring, and explicit versus tacit knowledge. We also discuss the importance of jurisdictional considerations as the end-of-life doula movement develops.

Discussion:

We speculate that the end-of-life doula role is potentially experiencing common developmental antecedents similar to other now-professionalized forms of caregiving. Our findings contribute substantial new information to the small body of empirical research about the end-of-life doula role and practices, provide critical firsthand insight as the movement develops, and are the first research to explore end-of-life doulas from a comparative international perspective.
Promoting advance care planning in African American faith communities: literature review and assessment of church-based programs
Authors: McDonnell Jenny , Idler Ellen
Published: December 2020

Advance care planning is under-used among Black Americans, often because of experiences of racism in the health care system, resulting in a lower quality of care at the end of life. African American faith communities are trusted institutions where such sensitive conversations may take place safely. Our search of the literature identified five articles describing faith-based advance care planning education initiatives for Black Americans that have been implemented in local communities. We conducted a content analysis to identify key themes related to the success of a program’s implementation and sustainability. Our analysis showed that successful implementation of advance care planning programs in Black American congregations reflected themes of building capacity, using existing ministries, involving faith leadership, exhibiting cultural competency, preserving a spiritual/Biblical context, addressing health disparities, building trust, selectively using technology, and fostering sustainability. We then evaluated five sets of well-known advance care planning education program materials that are frequently used by pastors, family caregivers, nurse’s aides, nurses, physicians, social workers, and chaplains from a variety of religious traditions. We suggest ways these materials may be tailored specifically for Black American faith communities, based on the key themes identified in the literature on local faith-based advance care planning initiatives for Black churches. Overall, the goal is to achieve better alignment of advance care planning education materials with the African American faith community and to increase implementation and success of advance care planning education initiatives for all groups.
Seismic collapse performance of steel special moment frames designed using different analysis methods
Authors: Kim Taeo , Han Sang Whan
Published: December 2020

Building structures designed according to current seismic design codes should satisfy the seismic performance objectives specified in codes during big earthquake events. ASCE 7-16 specifies that risk category I and II structures should have a probability of collapse less than 10% against the maximum considered earthquake (MCE) shaking hazard. ASCE 7-16 provides four analysis methods to calculate the seismic demands on structures. In this study, 4-, 8-, 12-, and 16-story steel special moment frames (SMFs) are designed using the two most popular elastic analysis methods: the equivalent lateral force (ELF) method and the modal response spectrum analysis (RSA) method. The collapse probabilities of these structures are estimated against MCE shaking hazards according to FEMA P695. It is observed that the collapse probabilities of these structures vary according to analysis methods used for design. To improve the seismic collapse performance of SMFs, a modified method is proposed.
Constitutive activation of Lyn kinase enhances BCR responsiveness, but not the development of CLL in Eµ-TCL1 mice
Authors: Kohlhas Viktoria , Hallek Michael , Nguyen Phuong-Hien
Published: December 2020

The treatment of chronic lymphocytic leukemia (CLL) has been improved dramatically by inhibitors targeting B-cell receptor (BCR)–associated kinases. The tyrosine kinase Lyn is a key modulator of BCR signaling and shows increased expression and activity in CLL. To evaluate the functional relevance of Lyn for CLL, we generated a conditional knockin mouse model harboring a gain-of-function mutation of the Lyn gene (LynY508F), which was specifically expressed in the B-cell lineage (Lynup-B). Kinase activity profiling revealed an enhanced responsiveness to BCR stimulation in Lynup-B B cells. When crossing Lynup-B mice with Eµ-TCL1 mice (TCL1tg/wt), a transgenic mouse model for CLL, the resulting TCL1tg/wt Lynup-B mice showed no significant change of hepatomegaly, splenomegaly, bone marrow infiltration, or overall survival when compared with TCL1tg/wt mice. Our data also suggested that TCL1 expression has partially masked the effect of the Lynup-B mutation, because the BCR response was only slightly increased in TCL1tg/wt Lynup-B compared with TCL1tg/wt. In contrast, TCL1tg/wt Lynup-B were protected at various degrees against spontaneous apoptosis in vitro and upon treatment with kinase inhibitors targeting the BCR. Collectively, and consistent with our previous data in a Lyn-deficient CLL model, these data lend further suggest that an increased activation of Lyn kinase in B cells does not appear to be a major driver of leukemia progression and the level of increased BCR responsiveness induced by Lynup-B is insufficient to induce clear changes to CLL pathogenesis in vivo.
Persistent, mobile and toxic (PMT) and very persistent and very mobile (vPvM) substances pose an equivalent level of concern to persistent, bioaccumulative and toxic (PBT) and very persistent and very bioaccumulative (vPvB) substances under REACH
Authors: Hale Sarah E. , Arp Hans Peter H. , Schliebner Ivo , Neumann Michael
Published: December 2020

Background

Under the EU chemicals regulation REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals EC 1907/2006), registrants are not obliged to provide information related to intrinsic substance properties for substances that pose a threat to the drinking water resources. In 2019, perfluorobutane sulfonic acid (PFBS) and 2,3,3,3-tetrafluoro-2-(heptafluoropropoxy)-propanoic acid (HFPO-DA trade name GenX) were demonstrated to have an equivalent level of concern (ELoC) to persistent, bioaccumulative and toxic or very persistent and very bioaccumulative (PBT/vPvB) substances owing to their persistent, mobile and toxic (PMT) substance properties and very persistent and very mobile (vPvM) substance properties, respectively. They were both subsequently identified as substances of very high concern (SVHC) applying Article 57(f) in REACH. This work follows up on this regulatory decision by presenting a science based, conceptual level comparison that all PMT/vPvM substances pose an ELoC to PBT/vPvB substances. Using the two cases named above, as well as 1,4-dioxane, 16 categories were developed to evaluate a) serious effects on human health, b) serious effects on the environment and c) additional effects. 1,4-dioxane has recently been proposed to be classified as Carcinogenic 1B by the Committee for Risk Assessment (RAC). The aim was to enable an objective and scientifically justified conclusion that these classes of substances have an equivalent level of concern for the environment and human health.

Results

In all of the categories related to human health, the environment and other effects, the PMT/vPvM case study substances exhibited comparable effects to PBT/vPvB substances. A difference in the human and environmental exposure pathways of PMT/vPvM and PBT/vPvB substances exists as they vary temporally and spatially. However, effects and impacts are similar, with PMT/vPvM substances potentially accumulating in (semi-)closed drinking water cycles and pristine aquatic environments, and PBT/vPvB substances accumulating in humans and the food chain. Both PMT/vPvM and PBT/vPvB substances share the common difficulty that long term and long-range transport and risk of exposure is very difficult to determine in advance and with sufficient accuracy.

Conclusion

The registration process of substances under REACH should reflect that PMT/vPvM substances pose an equivalent level of concern to PBT/vPvB substances.
NIMO-CKD-UK: a real-world, observational study of iron isomaltoside in patients with iron deficiency anaemia and chronic kidney disease
Authors: Kalra Philip A. , Bhandari Sunil , Spyridon Michael , Davison Rachel , Lawman Sarah , Mikhail Ashraf , Reaich David , Pritchard Nick , McCafferty Kieran , Moore Jason
Published: December 2020

Background

Intravenous iron is often used to treat iron deficiency anaemia in non-dialysis chronic kidney disease (ND-CKD), but the optimal dosing regimen remains unclear. We evaluated the impact of high- versus low-dose intravenous iron isomaltoside on the probability of retreatment with intravenous iron in iron-deficient ND-CKD patients.

Methods

This real-world, prospective, observational study collected data from 256 ND-CKD patients treated for anaemia in the UK. Following an initial course of iron isomaltoside, patients were followed for ≥12 months. Iron dose and the need for retreatment were determined at the investigators’ discretion. The primary study outcome was the need for retreatment at 52 weeks compared between patients who received >1000 mg of iron during Course 1 and those who received ≤1000 mg. Safety was evaluated through adverse drug reactions.

Results

The probability of retreatment at Week 52 was significantly lower in the >1000 mg iron group (n = 58) versus the ≤1000 mg group (n = 198); hazard ratio (95% confidence interval [CI]): 0.46 (0.20, 0.91); p = 0.012. Mean (95% CI) haemoglobin increased by 6.58 (4.94, 8.21) g/L in the ≤1000 mg group and by 10.59 (7.52, 13.66) g/L in the >1000 mg group (p = 0.024). Changes in other blood and iron parameters were not significantly different between the two groups. Administering >1000 mg of iron isomaltoside saved 8.6 appointments per 100 patients compared to ≤1000 mg. No serious adverse drug reactions were reported. Of the patients who received ≤1000 mg of iron in this study, 82.3% were eligible for a dose >1000 mg.

Conclusions

The >1000 mg iron isomaltoside regimen reduced the probability of retreatment, achieved a greater haemoglobin response irrespective of erythropoiesis-stimulating agent treatment, and reduced the total number of appointments required, compared to the ≤1000 mg regimen. Many of the patients who received ≤1000 mg of iron were eligible for >1000 mg, indicating that there was considerable underdosing in this study.

Trial registration

ClinicalTrials.gov NCT02546154, 10 September 2015.
Rare concurrent ocular myasthenia gravis and Graves’ ophthalmopathy in a man with Poland syndrome: a case report
Authors: Tang Jingqun , Qin Chao
Published: December 2020

Background

Ocular myasthenia gravis and Graves’ ophthalmopathy are autoimmune diseases that are mediated by membrane receptors and share many identical clinical processes. Poland syndrome is a rare congenital deformity characterized by defects of the ipsilateral hand and the chest wall, and it is usually associated with hypoplasia of ipsilateral pectoral muscles and homolateral breast. However, to the best of our knowledge, the co-occurrence of these diseases has never been reported. In this study, we present a man with Poland syndrome who was diagnosed with Graves’ ophthalmopathy and ocular myasthenia gravis in succession.

Case presentation

A 43-year-old man presented with bilateral upper eyelid ptosis, bilateral eye protrusion, bilateral eye movement disorder and malformation of the right hand. Asymmetrical malformation of the chest wall and ipsilateral hand deformity were shown as Poland syndrome. He was diagnosed with ocular myasthenia gravis and Graves’ ophthalmopathy on the basis of clinical manifestations and laboratory examinations, including bilateral exophthalmos and progressive asymmetrical ophthalmoparesis without pupillary dysfunction, positive autoantibody tests, repetitive nerve stimulation tests, and computed tomography scans. Treatments with pyridostigmine bromide, thymectomy, and prednisone led to partial clinical improvement. After 13 months of follow-up, the symptoms of drooping eyelids were partially improved, but the eyeball protrusion and right hand deformity remained unchanged.

Conclusions

We report the first case of co-occurrence of ocular myasthenia gravis, Graves’ ophthalmopathy, and Poland syndrome. Genetic predisposition and immune dysregulation might be the pathogenesis of the association.
The global, regional, and national burden of pancreatitis in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
Authors: Ouyang Guoqing , Pan Guangdong , Liu Qiang , Wu Yongrong , Liu Zhen , Lu Wuchang , Li Shuai , Zhou Zheng , Wen Yu
Published: December 2020

Background

Pancreatitis is a critical public health problem, and the burden of pancreatitis is increasing. We report the rates and trends of the prevalence, incidence, and years lived with disability (YLDs) for pancreatitis at the global, regional, and national levels in 195 countries and territories from 1990 to 2017, stratified by sex, age, and sociodemographic index (SDI).

Methods

Data on pancreatitis were available from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. Numbers and age-standardized prevalence, incidence, and YLDs’ rates per 100,000 population were estimated through a systematic analysis of modeled data from the 2017 GBD study. Both acute and chronic pancreatitis are being modeled separately in the GBD 2017; however, our data show acute and chronic pancreatitis together. Estimates were reported with uncertainty intervals (UIs).

Results

Globally, in 2017, the age-standardized rates were 76.2 (95% UIs 68.9 to 83.4), 20.6 (19.2 to 22.1), and 4.5 (2.3 to 7.6) per 100,000 population for the point prevalence, incidence, and YLDs, respectively. From 1990 to 2017, the percent changes in the age-standardized prevalence and YLDs rates increased, whereas the age-standardized incidence rate decreased. The global prevalence increased with age up to 60–64 years and 44–49 years in females and males, respectively, and then decreased, with no significant difference between females and males. The global prevalence rate increased with age, peaking in the 95+ age group, with no difference between sexes. Generally, positive correlation between age-standardized YLDs and SDIs at the regional and national levels was observed. Slovakia (297.7 [273.4 to 325.3]), Belgium (274.3 [242.6 to 306.5]), and Poland (266.7 [248.2 to 284.4]) had the highest age-standardized prevalence rates in 2017. Taiwan (Province of China) (104.2% [94.8 to 115.2%]), Maldives (72.4% [66.5 to 79.2%]), and Iceland (64.8% [57.2 to 72.9%]) had the largest increases in age-standardized prevalence rates from 1990 to 2017.

Conclusions

Pancreatitis is a major public health issue worldwide. The age-standardized prevalence and YLDs rates increased, but the age-standardized incidence rate decreased from 1990 to 2017. Improving the quality of pancreatitis health data in all regions and countries is strongly recommended for better monitoring the burden of pancreatitis.
Hypoxic exosomes orchestrate tumorigenesis: molecular mechanisms and therapeutic implications
Authors: Jafari Reza , Rahbarghazi Reza , Ahmadi Mahdi , Hassanpour Mehdi , Rezaie Jafar
Published: December 2020

The solid tumor microenvironment possesses a hypoxic condition, which promotes aggressiveness and resistance to therapies. Hypoxic tumor cells undergo broadly metabolic and molecular adaptations and communicate with surrounding cells to provide conditions promising for their homeostasis and metastasis. Extracellular vesicles such as exosomes originating from the endosomal pathway carry different types of biomolecules such as nucleic acids, proteins, and lipids; participate in cell-to-cell communication. The exposure of cancer cells to hypoxic conditions, not only, increases exosomes biogenesis and secretion but also alters exosomes cargo. Under the hypoxic condition, different signaling pathways such as HIFs, Rab-GTPases, NF-κB, and tetraspanin are involved in the exosomes biogenesis. Hypoxic tumor cells release exosomes that induce tumorigenesis through promoting metastasis, angiogenesis, and modulating immune responses. Exosomes from hypoxic tumor cells hold great potential for clinical application and cancer diagnosis. Besides, targeting the biogenesis of these exosomes may be a therapeutic opportunity for reducing tumorigenesis. Exosomes can serve as a drug delivery system transferring therapeutic compounds to cancer cells. Understanding the detailed mechanisms involved in biogenesis and functions of exosomes under hypoxic conditions may help to develop effective therapies against cancer.
Designing architecture of soothing labor–delivery–recovery–postpartum unit: a study protocol
Authors: Esfeh Behnam Kazemi , Kazemi Ashraf , Shamsaie Aida
Published: December 2020

Background

The physical environment profoundly affects women's well-being during childbirth in family-centered unit. A LDRP, which is an acronym for labor, delivery, recovery, and postpartum that describes a maternity unit designed for family-centered care. This study aimed to design soothing LDRP healing architecture based on recognizing the emotional elements of Iranian women.

Methods

This study will be conducted in four consecutive phases; including review of literature to provide documentation based on architectural knowledge and the effects of each architectural component on the parturient psychological conditions, qualitative study to extract women's needs and suggestions for physiological childbirth, architectural designing of the soothing LDRP based on the results of the first and second phases and qualitative study for evaluation of the designed program.

Discussion

Designing soothing LDRP architecture based on safe child birth unit standards and favorable psychological environment will provide a positive childbirth experience for Iranian women and their family. But, the preferences and demands of families will be based on Iranian socio-cultural context, therefore the using of this design will be limited in other societies with different cultures.
CD83 expression regulates antibody production in response to influenza A virus infection
Authors: Akauliya Madhav , Gautam Avishekh , Maharjan Sony , Park Byoung Kwon , Kim Jinsoo , Kwon Hyung-Joo
Published: December 2020

Background

CD83 is known to regulate lymphocyte maturation, activation, homeostasis, and antibody response to immunization and infection. While CD83 has a major part in B cell function, its role in influenza A virus infection has not yet been investigated.

Methods

We investigated the role of CD83 using C57BL/6J wild type mice and CD83 knockout (KO) mice after intraperitoneal administration of the influenza A/WSN/1933 virus. We analyzed cells of the peritoneal cavity, splenocytes, and cells of the bone marrow with FACS to investigate CD83 expression and cell population change in response to the virus infection. ELISA was performed with sera and peritoneal cavity fluids to detect A/WSN/1933 virus-specific IgG and the subclasses of IgG.

Results

FACS analysis data showed a transient but distinct induction of CD83 expression in the peritoneal B cells of wild type mice. CD83 KO mice exhibited a delayed recovery of B cells in the bone marrow after influenza virus infection and overall, a smaller T cell population compared to wild type mice. The peritoneal cavity and serum of the wild type mice contained a high titer of IgG within 14 days after infection, whereas the CD83 KO mice had a very low titer of IgG.

Conclusions

These results show the importance of CD83 in lymphocytes homeostasis and antibody production during influenza A virus infection.
A systematic review of surgical procedures on thoracic myelopathy
Authors: Zhu Shiqi , Wang Yu , Yin Peng , Su Qingjun
Published: December 2020

Purpose

The surgical treatment of thoracic myelopathy is still controversial and also a challenge for spine surgeons. Therefore, the objective of this study was to review the related literature on the surgical treatment of thoracic myelopathy and try to define treatment guidelines for spine surgeons on thoracic myelopathy.

Methods

Relevant literatures were searched based on the PubMed, EMBASE, and Cochrane Library between January 2008 and December 2018. Some data on the characteristics of patients were extracted, including number of patients, mean age, surgical procedures, blood loss, complications, and pre-/post-operation modified JOA score. Recovery rate was used to assess the effect of surgery outcome, and the safety was evaluated by blood loss and incidence of complications.

Results

Thirty-five studies met the inclusion criteria and were retrieved. A total of 2183 patients were included in our systematic review, with the average age of 55.2 years. There were 69.8% patients diagnosed as ossification of ligamentum flavum (OLF), 20.0% as ossification of posterior longitudinal ligament (OPLL), 9.3% as disk herniation (DH), and 0.9% as others including diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS). The volume of blood loss was more in the treatment of circumferential decompression (CD) than posterior decompression (PD), and the incidence of complications was higher in CD (P < 0.05). The volume of blood loss in minimally invasive surgery (MIS) was lowest and the incidence of complications was 19.2%. Post-operation recovery rate was 0.49 in PD, 0.35 in CD, and 0.29 in MIS while the recovery rate was 0.54 in PD, 0.55 in CD, and 0.49 in MIS at the last follow-up. When focusing on the OLF specifically, incidence of complications in PD was much lower than CD, with less blood loss and higher recovery rate. Focusing on the OPLL specifically, incidence of complications in PD was much lower than CD, with less blood loss while there was no statistical difference in recovery rate between these two methods.

Conclusions

This systematic review showed that posterior decompression for thoracic myelopathy is safer and better than circumferential decompression according to the complication rate and surgical outcome. And we should also consider the location of compression before the operation.