bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative nutritional status impacts clinical outcome and hospital length of stay in pelvic exenteration patients – a retrospective study
Authors: Hogan Sophie , Steffens Daniel , Vuong Kenneth , Rangan Anna , Solomon Michael , Carey Sharon
Published: April 2021

Background:

Preoperative malnutrition is common in surgical oncology patients and can have negative effects on postoperative outcomes. Pelvic exenteration is major surgery associated with high morbidity rates. Associations between preoperative malnutrition, determined using the patient-generated subjective global assessment, and postoperative outcomes in this patient cohort has not yet been investigated.

Aim:

To determine if preoperative nutritional status is associated with postoperative surgical and quality of life (QoL) outcomes after pelvic exenteration surgery.

Methods:

A retrospective cohort study was conducted at a quaternary hospital investigating 123 patients who had pelvic exenteration surgery from January 2017 to August 2019. Preoperative nutritional status and postoperative surgical and QoL outcomes were collected and analysed to determine any associations.

Results:

Overall, 49.6% of patients were female with a median age of 59 years. Forty patients (32.5%) were malnourished and 83 (67.5%) were well nourished before surgery. Well-nourished patients had a shorter length of hospital stay ( p = 0.034) and at 6 months post-surgery, presented with a significantly better physical and mental QoL score ( p = 0.038 and p = 0.001 respectively). The regression analyses showed that intensive care unit (ICU) readmission rates were 7.19 times more likely to occur in malnourished patients ( p = 0.022).

Conclusions:

Preoperative malnutrition is associated with increased length of stay, ICU readmissions and poorer QoL following pelvic exenteration. Nutrition screening, assessment and optimisation of management are essential in this patient cohort to improve patient outcomes. Future studies are needed to measure the effect of interventions and identify the most beneficial model of care for this complex patient group.
Non-invasive assessment of heterogeneity of gliomas using diffusion and perfusion MRI: correlation with spatially co-registered PET
Authors: Zhang Ying , Lin Yu , Xing Zhen , Yao Shaobo , Cao Dairong , Miao Wei-bing
Published: April 2021

Background

Heterogeneity of gliomas challenges the neuronavigated biopsy and oncological therapy. Diffusion and perfusion magnetic resonance imaging (MRI) can reveal the cellular and hemodynamic heterogeneity of tumors. Integrated positron emission tomography (PET)/MRI is expected to be a non-invasive imaging approach to characterizing glioma.

Purpose

To evaluate the value of apparent diffusion coefficient (ADC), cerebral blood volume (CBV), and spatially co-registered maximal standard uptake value (SUVmax) for tissue characterization and glioma grading.

Material and Methods

Thirty-seven consecutive patients with pathologically confirmed gliomas were retrospectively investigated. The relative minimum ADC (rADCmin), relative maximal ADC (rADCmax), relative maximal rCBV (rCBVmax), the relative minimum rCBV (rCBVmin), and the corresponding relative SUVmax (rSUVmax) were measured. The paired t-test was used to compare the quantitative parameters between different regions to clarify tumor heterogeneity. Imaging parameters between WHO grade IV and grade II/III gliomas were compared by t-test. The diagnostic efficiency of multiparametric PET/MRI was analyzed by receiver operating characteristic (ROC) curve.

Results

The values of rSUVmax were significantly different between maximal diffusion/perfusion area and minimum diffusion/perfusion area ( P < 0.001/ P < 0.001) within tumor. The values of rADCmin ( P < 0.001), rCBVmax ( P = 0.002), and corresponding rSUVmax ( P = 0.001/ P < 0.001) could be used for grading gliomas. The areas under the ROC curves of rSUVmax defined by rADCmin and rCBVmax were 0.89 and 0.91, respectively.

Conclusion

Diffusion and perfusion MRI can detect glioma heterogeneity with excellent molecular imaging correlations. Regions with rCBVmax suggest tissues with the highest metabolism and malignancy for guiding glioma grading and tissue sampling.
Towards real-time fire data synthesis using numerical simulations
Authors: Jahn Wolfram , Sazunic Frane , Sing-Long Carlos
Published: April 2021

Synthesising data from fire scenarios using fire simulations requires iterative running of these simulations. For real-time synthesising, faster-than-real-time simulations are thus necessary. In this article, different model types are assessed according to their complexity to determine the trade-off between the accuracy of the output and the required computing time. A threshold grid size for real-time computational fluid dynamic simulations is identified, and the implications of simplifying existing field fire models by turning off sub-models are assessed. In addition, a temperature correction for two zone models based on the conservation of energy of the hot layer is introduced, to account for spatial variations of temperature in the near field of the fire. The main conclusions are that real-time fire simulations with spatial resolution are possible and that it is not necessary to solve all fine-scale physics to reproduce temperature measurements accurately. There remains, however, a gap in performance between computational fluid dynamic models and zone models that must be explored to achieve faster-than-real-time fire simulations.
Intimate Partner Violence and Posttraumatic Stress Symptoms: Indirect Effects Through Negative and Positive Emotion Dysregulation
Authors: Simpson Lauren E. , Raudales Alexa M. , Reyes Miranda E. , Sullivan Tami P. , Weiss Nicole H.
Published: April 2021

Women who experience intimate partner violence (IPV) are at heightened risk for developing posttraumatic stress (PTS). Emotion dysregulation has been linked to both IPV and PTS, separately, however, unknown is the role of emotion dysregulation in the relation of IPV to PTS among women who experience IPV. Moreover, existing investigations in this area have been limited in their focus on negative emotion dysregulation. Extending prior research, this study investigated whether physical, sexual, and psychological IPV were indirectly associated with PTS symptom severity through negative and positive emotion dysregulation. Participants were 354 women who reported a history of IPV recruited from Amazon’s MTurk platform ( Mage = 36.52, 79.9% white). Participants completed self-report measures assessing physical (Conflict Tactics Scale), sexual (Sexual Experiences Scale), and psychological (Psychological Maltreatment of Women) IPV; negative (Difficulties in Emotion Regulation Scale) and positive (Difficulties in Emotion Regulation Scale-Positive) emotion dysregulation; and PTS symptom severity (PTSD Checklist for DSM-5) via an online survey. Pearson’s correlation coefficients examined intercorrelations among the primary study variables. Indirect effect analyses were conducted to determine if negative and positive emotion dysregulation explained the relations between physical, sexual, and psychological IPV and PTS symptom severity. Physical, sexual, and psychological IPV were significantly positively associated with both negative and positive emotion dysregulation as well as PTS symptom severity, with the exception that psychological IPV was not significantly associated with positive emotion dysregulation. Moreover, negative and positive emotion dysregulation accounted for the relationships between all three IPV types and PTS symptom severity, with the exception of positive emotion dysregulation and psychological IPV. Our findings provide support for the potential underlying role of both negative and positive emotion dysregulation in the associations of IPV types to PTS symptom severity. Negative and positive emotion dysregulation may be important factors to integrate into interventions for PTS among women who experience IPV.
Moral Injury and Suicide Ideation Among Combat Veterans: The Role of Trauma-Related Shame and Collective Hatred
Authors: Schwartz Gal , Halperin Eran , Levi-Belz Yossi
Published: April 2021

Exposure to potentially morally injurious events (PMIEs) among combat veterans has been acknowledged as a significant stressful combat event that may lead to mental health problems, including suicide ideation (SI). Several studies have examined the risk and protective factors that can explain the conditions in which PMIEs may contribute to the development and maintenance of SI. However, the contribution of social-emotional factors has yet to be examined. In the current study, we examined the association between PMIE-Self and SI among combat veterans and explored the mediating role of trauma-related shame and the moderation role of collective hatred in this association. A volunteer sample of 336 Israeli combat veterans was recruited, completing self-report questionnaires in a cross-sectional study. Results indicated that PMIE-Self was positively associated with SI, and trauma-related shame mediated this association. Moreover, collective hatred moderated both their direct (PMIE–SI) and indirect (PMIE–Shame–SI) association. Notably, collective hatred had an inverse role for each of the associations. Thus, collective hatred was found to comprise both a risk and a protective factor for SI following PMIE-Self. The current findings highlight the crucial contribution of trauma-related shame and collective hatred to the association between moral injury and suicidality. Moreover, the findings demonstrate that even years after their military service release, combat veterans exposed to PMIEs may still feel consumed by painful memories and maintain premonitions of a foreshortened future. Furthermore, the findings help to better understand the dynamics of collective hatred and the challenge of modifying it.
Systemic lupus erythematosus in children and adults: A retrospective study in Brazilian patients
Authors: Bortolini Maria Fernanda Ferraz , Pereira Vitória Peres , Gomes Dos Santos Thiago AF , Nisihara Renato , Skare Thelma L
Published: April 2021

Background

Systemic lupus erythematosus (SLE) may have a different serological and clinical profile according to age of disease onset.

Aim

To compare clinical presentation and serological data from patients with SLE onset in childhood (cSLE) with disease onset in adulthood (aSLE) in a sample of Brazilian patients.

Methods

Retrospective study of 614 SLE patients from a single Rheumatology Unit from Brazil: 77 (12.5%) cSLE and 537 (87.4%) aSLE. Clinical and serological data were obtained from the charts. Comparisons of cSLE with aSLE in general and according to patient’s gender were made.

Results

The comparison of whole sample showed that children had more malar rash (p = 0.04), seizures (p < 0.0001), psychosis (p = 0.02), glomerulonephritis (p = 0.001), anti-dsDNA (p = 0.008), anticardiolipin IgM (p = 0.04) but less discoid lesions (p = 0.01), anti-Ro (p < 0.0001) and anti-La antibodies (p = 0.007). When only the male sample was compared, no differences in glomerulonephritis and anti-dsDNA frequencies were found.

Conclusion

Children had a higher frequency of severe manifestations (glomerulonephritis and central nervous system) than adults. The difference in glomerulonephritis occurrence disappeared when only males were compared.
Why women judges really matter: The impact of women judges on property law outcomes in Kenya
Authors: Gayoye Martha
Published: April 2021

In this paper, I discuss the impact that women judges have made in property law outcomes in Kenya. The study shows that women judges were able to influence a feminist jurisprudence in matrimonial property and inheritance disputes peripherally even though they were not sitting in some of those cases – through trainings of other [male] judges and informal interactions with colleagues. I argue that there is need to focus lens on the collaborative and networking programmes of women judges to bring about institutional change as opposed to a focus on individual women judges. The findings suggest that studies that focus on individual [women] judges have far less potential to uncover the impact of collective efforts of women judges. Existing studies are based largely on Anglo-American positivist methodologies that are based on methodological individualism over collectivism. It is no wonder that the collective efforts of women judges under the auspices of the International Women Judges Association has received little to no scholarly attention.
Particle swarm optimization–based characterization technique of nonproportional viscous damping parameter of a cantilever beam
Authors: Das Subhajit , Mondal Subhajit , Guchhait Shyamal
Published: April 2021

A complex eigenvector is a result of nonproportional damping present in a structural system. However, it is difficult to identify the accurate damping matrix considering the modal sparsity and coordinate sparsity. A nonproportional viscous damping parameter identification is formulated as an unconstrained optimization problem in the present study. The damping coefficient of each element is considered as the design variable for the optimization problem. The objective function is defined using the incomplete complex eigenvectors, which are generated because of the presence of external damping devices in the structure. This objective function is then minimized using standard particle swarm optimization to identify the damping coefficient of the damping matrix. The accuracy and efficiency of the particle swarm optimization are investigated by solving a few numerical problems with simulated measured data. The proposed method works well with the incomplete measured modal data. The current methodology performs satisfactorily with and without noisy data. A comparison study is performed with the existing gradient-based method, and the results show that the proposed method performs better than the existing gradient-based method for the present problem with and without noisy measurement data.
Effects of bearing lubrication conditions on rotor dynamic behavior
Authors: Cunha Barbara Z , Daniel Gregory B
Published: April 2021

Usually, rotor dynamic analyses do not consider the effects of the lubricant supply condition, although this is an important aspect of journal bearing performance. Therefore, this work has implemented a mass-conserving model to realistically describe the oil feeding condition and evaluate its influence on rotor dynamics. This analysis was carried out by varying feeding pressure and groove position and the results indicate that the oil supply conditions significantly influence the bearing performance and affect the dynamic behavior of the entire rotor. In general, lower flow rates lead to a bearing with a greater stability region, as observed mainly in the bearing with a groove at 270° and, on the other hand, the increase in feeding pressure reduces the instability threshold.
Comorbid chronic tic disorder and tourette syndrome in children requiring inpatient mental health treatment
Authors: Zinna Shaheen , Luxton Rebecca , Papachristou Efstathios , Dima Danai , Kyriakopoulos Marinos
Published: April 2021

Objective:

Children needing admission to an inpatient mental health unit often present with severe neuropsychiatric disorders characterised by complex psychopathology. We aimed to examine all admitted children with comorbid chronic tic disorder (CTD) and Tourette syndrome (TS) over a 10-year period and determine the clinical significance of these diagnoses.

Method:

A retrospective, naturalistic study was conducted, comparing children with and without CTD/TS in terms of co-morbid diagnoses, medication use, access to education, aggression contributing to the admission, duration of admission, functional outcomes and satisfaction with treatment. Data were analysed using Chi-square/Fisher’s exact test and t-test for categorical and continuous variables, respectively, and subsequently with unadjusted and adjusted linear and logistic regression analyses.

Results:

A relatively high proportion of children had co-morbid CTD/TS (19.7%). There was a significant association with co-morbid obsessive-compulsive disorder, intellectual disability and autism spectrum disorder but not attention deficit hyperactivity disorder. CTD/TS were associated with longer admissions even after adjustments for confounding but did not seem to be independently associated with other examined clinical characteristics.

Conclusions:

The prevalence of CTD/TS in children needing inpatient treatment is significant. In our sample, comorbid CTD/TS seem to represent a marker of overall symptom severity as evidenced by longer admissions.
Teachers’ perceptions of linguistic mediation in the curriculum for advanced English in Madrid secondary schools
Authors: Fernández Álvarez Miguel , García Hernández Silvia
Published: April 2021

After the publication of the CEFR Companion Volume in 2018, a revision of the curriculum in force for the English subject in the Bilingual Sections in the Community of Madrid has been implemented. One of the main changes is the inclusion of the concept of linguistic mediation in the subject ‘Advanced English’ in the last stage of secondary education. In an attempt to understand how linguistic mediation strategies and activities are being developed in real classroom contexts, this study has focused on teachers’ perceptions of linguistic mediation. A questionnaire and a focus group were used to examine teachers’ understanding and awareness of linguistic mediation, as well as the type of mediation activities that are relevant for their students and the extent to which they include linguistic mediation activities and strategies in their lessons. Additionally, the study has shown some of the deficiencies that exist in the way linguistic mediation is currently being addressed in the classroom, as well as teachers’ needs in order to better implement it.
Neonatal coagulopathies: A review of established and emerging treatments
Authors: Moiseiwitsch Nina , Brown Ashley C
Published: April 2021

Despite the relative frequency of both bleeding and clotting disorders among patients treated in the neonatal intensive care unit, few clear guidelines exist for treatment of neonatal coagulopathies. The study and treatment of neonatal coagulopathies are complicated by the distinct hemostatic balance and clotting components present during this developmental stage as well as the relative scarcity of studies specific to this age group. This mini-review examines the current understanding of neonatal hemostatic balance and treatment of neonatal coagulopathies, with particular emphasis on emerging treatment methods and areas in need of further investigative efforts.
Bony Edema and Clinical Examination Findings Predict the Need for Distal Clavicle Excision at the Time of Shoulder Arthroscopy
Authors: Garry Conor B. , Adsit Matthew H. , Land Vaughn , Sanderson Galen , Sheppard Sean G. , Balazs George C.
Published: April 2021

Background: Deciding to perform a distal clavicle excision for acromioclavicular joint arthritis, especially in conjunction with other arthroscopic shoulder procedures, is challenging for surgeons. Studies have reported mixed results on the value of magnetic resonance imaging (MRI) in decision making. Purpose: We sought to correlate MRI findings with clinical symptoms and the surgeon’s decision to perform a distal clavicle excision. Methods: We compared MRI, clinical examination, and MRI findings of 200 patients who underwent distal clavicle excision for symptomatic acromioclavicular joint arthritis with 200 patients who underwent arthroscopic shoulder procedures for other reasons. Univariate statistics were used to determine correlations between physical examination findings, MRI findings, and the decision to perform distal clavicle excision. A binary logistic regression model was used to determine independent predictors of need for distal clavicle excision. Results: There was no difference in mean age, sex, and race between groups. Advanced acromioclavicular joint osteoarthritis was strongly correlated with positive physical examination findings. Bony edema correlated strongly with tenderness at the acromioclavicular joint but not pain with cross-body adduction testing. There was no association between higher MRI grade of osteoarthritis and the need for distal clavicle excision. Regression analysis identified both physical examination findings and bony edema on MRI as independent predictors of the need for distal clavicle excision. Conclusion: In the setting of positive clinical examination findings and bony edema of the distal clavicle, surgeons should feel reassured that distal clavicle excision is likely indicated.
Cost-effectiveness of ribociclib plus letrozole versus palbociclib plus letrozole or letrozole as monotherapy in first-line treatment of postmenopausal women with HR+/HER2− locally advanced or metastatic breast cancer: a Brazilian private payer perspective
Authors: Buehler Anna Maria , Castilho Gabriela , Dionne Pierre-Alexandre , Stefani Stephen
Published: April 2021

Background:

The global burden of breast cancer (BC) is high, especially in advanced stages. CDK 4/6 inhibitors represent a paradigm shift in the treatment of advanced BC HR+/HER2−, given the clinically and statistically significant gain in overall survival associated with this new class of medications. Nevertheless, as an innovation, the incorporation of these drugs impacts healthcare budgets, requiring cost-effectiveness analyses for decision-making. The aim of this study was to evaluate the cost-effectiveness of ribociclib plus letrozole compared with palbociclib plus letrozole or letrozole as monotherapy for first-line treatment of postmenopausal women with HR+/HER2− locally advanced or metastatic BC (aBC) from a Brazilian private healthcare system perspective.

Methods:

A model including progression-free survival (PFS), progressed disease, and death health states was used to simulate lifetime costs and outcomes. PFS and overall survival were derived from the MONALEESA-2 trial (lifetime horizon). Healthcare costs included drug acquisition and monitoring, subsequent therapies, adverse events, and end-of-life costs. Effectiveness was measured in quality-adjusted life-years (QALYs). Deterministic and probabilistic sensitivity analyses were performed.

Results:

The total cost of treatment with ribociclib plus letrozole was USD 72,091.82 versus USD 92,749.64 for palbociclib plus letrozole. Total QALYs were 3.30 and 3.16, respectively. Base-case analysis showed ribociclib as dominant over palbociclib in first-line treatment of women with HR+/HER2− aBC, associated with cost savings and QALY gains. The total cost of treatment with ribociclib plus letrozole was USD 83,058.73 versus USD 29,215.10 for letrozole. Total QALYs were 3.84 and 2.61, respectively. Compared with letrozole, ribociclib plus letrozole was associated with an incremental cost of USD 53,843.64 and an incremental QALY gain of 1.23, with incremental cost-effectiveness ratio of USD 43,826.91 per QALY gained.

Conclusions:

As demonstrated by the cost-effectiveness dominance over palbociclib, ribociclib results in savings when used as first-line treatment in postmenopausal women with HR+/HER2− aBC, warranting incorporation in the private healthcare system.
Proactive and reactive flexibility: How does flexibility mediate the link between supply chain information integration and performance?
Authors: Tsai Yao-Te , Lasminar Rivo Giovanni
Published: April 2021

To maintain competitiveness, businesses need to upgrade their operational performance and financial performance more efficiently and effectively in order to control uncertainty and costs. The purposes of the study are to (1) investigate the relationship between three dimensions, namely integration, flexibility, and performance; and (2) examine the mediating effects of supply chain flexibility. This research collected annual reports from the Indonesian basic and chemical industry from 2014 to 2017. Content analysis was used to extract information from companies’ annual reports, and hierarchical analysis examined the hypotheses. The results show that external information integration positively influences both reactive and proactive flexibility. Furthermore, proactive flexibility significantly affects financial performance and operational performance. Moreover, both reactive and proactive flexibility have positive mediating effects on the connection between external information integration and operational performance. Lastly, reactive flexibility positively mediates external information integration’s effect on financial performance. As the market has been becoming more competitive, this study provides important insights for decision-makers. This study contributes to the knowledge of the Indonesian basic and chemical supply chain by considering both financial and operational performance, especially as these performance indexes measure different dimensions.
Provider Implicit Bias Impacts Pediatric Type 1 Diabetes Technology Recommendations in the United States: Findings from The Gatekeeper Study
Authors: Addala Ananta , Hanes Sarah , Naranjo Diana , Maahs David M. , Hood Korey K.
Published: April 2021

Background:

Diabetes technology use is associated with favorable type 1 diabetes (T1D) outcomes. American youth with public insurance, a proxy for low socioeconomic status, use less diabetes technology than those with private insurance. We aimed to evaluate the role of insurance-mediated provider implicit bias, defined as the systematic discrimination of youth with public insurance, on diabetes technology recommendations for youth with T1D in the United States.

Methods:

Multi-disciplinary pediatric diabetes providers completed a bias assessment comprised of a clinical vignette and ranking exercises ( n = 39). Provider bias was defined as providers: (1) recommending more technology for those on private insurance versus public insurance or (2) ranking insurance in the top 2 of 7 reasons to offer technology. Bias and provider characteristics were analyzed with descriptive statistics, group comparisons, and multivariate logistic regression.

Results:

The majority of providers [44.1 ± 10.0 years old, 83% female, 79% non-Hispanic white, 49% physician, 12.2 ± 10.0 practice-years] demonstrated bias ( n = 33/39, 84.6%). Compared to the group without bias, the group with bias had practiced longer (13.4±10.4 years vs 5.7 ± 3.6 years, P = .003) but otherwise had similar characteristics including age (44.4 ± 10.2 vs 42.6 ± 10.1, p = 0.701). In the logistic regression, practice-years remained significant (OR = 1.47, 95% CI [1.02,2.13]; P = .007) when age, sex, race/ethnicity, provider role, percent public insurance served, and workplace location were included.

Conclusions:

Provider bias to recommend technology based on insurance was common in our cohort and increased with years in practice. There are likely many reasons for this finding, including healthcare system drivers, yet as gatekeepers to diabetes technology, providers may be contributing to inequities in pediatric T1D in the United States.
Magnitude, risk factors and antimicrobial susceptibility pattern of Shigella and Salmonella, among children with diarrhea in Southern Ethiopia: A Cross-sectional Study
Authors: Hayamo Manamo , Alemayehu Tsegaye , Tadesse Bereket , Mitiku Enkosilassie , Bedawi Zufan
Published: April 2021

Objective:

This study was aimed at identifying Shigella and Salmonella infection, their antibiotic susceptibility pattern and associated risk factors among children with diarrhea who attended Alamura Health Center.

Method:

A facility-based cross-sectional study was conducted on 263 children aged below 14 years with diarrhea. A structured questionnaire was used to collect socio-demographic and clinical data after obtaining the necessary consent from their parents or caretakers. The culture and sensitivity tests were performed using the standard operating procedure of the microbiology laboratory.

Results:

Accordingly, 20/263 (7.6%), 95% confidence interval: 4.4%–11.4% Shigella and 1/263 (0.38%), 95% confidence interval: 0.0%–1.1% Salmonella were isolated. Shigella dysenteriae was dominant 11 (4.2%), followed by Shigella spp. 9 (3.42%) and Salmonella typ 1 (0.38%). The isolates showed 71.4% overall resistance to ampicillin and 61.9% for augmentin and tetracycline, whereas 95.2% of the isolates were sensitive to ciprofloxacin, 85.9% to ceftriaxone and ceftazidime, 81% to gentamycin, 76.2% to chloramphenicol, 66.7% to cefuroxime and 52.4% to cotrimoxazole. The habit of washing hands after toilet use for a while (adjusted odds ratio: 235.1, 95% confidence interval: 20.9–2643.3, p < 0.000) and storing cooked food in an open container for later use (adjusted odds ratio: 36.44, 95% confidence interval: 5.82–228.06, p < 0.000) showed a statistically significant association.

Conclusion:

High level of Shigella and single Salmonella was isolated. Ampicillin, augmentin and tetracycline were resistant and ciprofloxacin, ceftriaxone, ceftazidime, gentamycin, chloramphenicol, cefuroxime and cotrimoxazole were relatively sensitive. Hand-washing after defecation for some time and storing of foods for later use in an open container were statistically associated. Therefore, to alleviate this infection, the concerned body should focus on imparting health education for hand-wash after defecation and storing food in a closed container for later use is mandatory.
Reduction inTLCOand survival in a clinical population
Authors: Miller Martin Raymond , Cooper Brendan G.
Published: April 2021

Background

How best to express the level of transfer factor of the lung for carbon monoxide (TLCO) has not been properly explored.

Methods

We used the most recent clinical data from 13 829 patients (54% male; 10% non-European ancestry; median age 60.5 years, range 20–97 years; median survival 3.5 years, range 0–20 years) to determine how best to expressTLCOfunction in terms of its relationship to survival.

Results

The proportion of subjects of non-European ancestry with Global Lung Function Initiative (GLI)TLCOz-scores above predicted was reduced, but was significantly increased between −1.5 and −3.5, suggesting the need for ethnicity-appropriate equations. Applying GLI forced vital capacity (FVC) ethnicity methodology to GLITLCOz-scores removed this ethnic bias and was used for all subsequent analysis.TLCOz-scores using the GLI equations were compared with Miller's USA equations with medianTLCOz-scores being −1.43 and −1.50 for GLI and Miller equations, respectively (interquartile range −2.8 to −0.3 and −2.4 to −0.7, respectively). GLITLCOz-scores gave the best Cox regression model for predicting survival. A previously proposed six-tier grading system for level of lung function did not show much separation in survival risk in the less-severe grades. A new four-tier grading based on z-scores of −1.645, −3 and −5 showed better separation of risk with hazard ratio for all-cause mortality of 2.0, 3.4 and 6.6 with increasing severity.

Conclusion

Applying GLI FVC ethnicity methodology to GLITLCOpredictions to remove ethnic bias together with a new four-tier z-score grading best relatesTLCOfunction to survival.
Skeletal muscle mass is associated with erythropoietin response in hemodialysis patients
Authors: Takata Tomoaki , Mae Yukari , Yamada Kentaro , Taniguchi Sosuke , Hamada Shintaro , Yamamoto Marie , Iyama Takuji , Isomoto Hajime
Published: April 2021

Background

Hyporesponsiveness to erythropoietin stimulating agent (ESA) is associated with poor outcomes in patients with chronic kidney disease. Although ESA hyporesponsiveness and sarcopenia have a common pathophysiological background, clinical evidence linking them is scarce. The purpose of the study was to investigate the relationship between ESA responsiveness and skeletal muscle mass in hemodialysis patients.

Methods

This cross-sectional study analyzed 70 patients on maintenance hemodialysis who were treated with ESA. ESA responsiveness was evaluated by erythropoietin resistance index (ERI), calculated as a weekly dose of ESA divided by body weight and hemoglobin (IU/kg/week/dL), and a weekly dose of ESA/hemoglobin (IU/week/dL). A dose of ESA is equivalated to epoetin β. Correlations between ESA responsiveness and clinical parameters including skeletal muscle mass were analyzed.

Results

Among the 70 patients, ERI was positively correlated to age (p < 0.002) and negatively correlated to height (p < 0.001), body weight (p < 0.001), BMI (p < 0.001), skeletal muscle mass (p < 0.001), transferrin saturation (TSAT) (p = 0.049), and zinc (p = 0.006). In the multiple linear regression analysis, TSAT, zinc, and skeletal muscle mass were associated with ERI and weekly ESA dose/hemoglobin.

Conclusions

Skeletal muscle mass was the independent predictor for ESA responsiveness as well as TSAT and zinc. Sarcopenia is another target for the management of anemia in patients with hemodialysis.
The mediating role of prenatal depression in adult attachment and maternal-fetal attachment in primigravida in the third trimester
Authors: Zhang Ling , Wang Lei , Yuan Qiuyu , Huang Cui , Cui Shu , Zhang Kai , Zhou Xiaoqin
Published: April 2021

Background

Prenatal depression and adult attachment are factors that affect the establishment of an intimate relationship between a mother and fetus. The study explored differences in prenatal depression and maternal-fetal attachment (MFA) scores between different types of adult attachment and the effects of maternal depression scores and attachment dimensions on maternal intimacy with the fetus.

Methods

The Edinburgh Postnatal Depression Scale (EPDS), Experience of Close Relationship (ECR) scale, Maternal Antenatal Attachment Scale (MAAS) and a general data scale were used to investigate 260 primigravida. An exploratory analysis was performed to analyze the effects of the depression score and adult attachment on MFA.

Results

The results showed that pregnant women with insecure attachment exhibited an increased prevalence of prenatal depression, lower total MFA scores, and lower MFA quality compared with those women with secure adult attachment. The explorative analysis showed that the depression scores mediated the relationship between adult attachment avoidance and MFA quality.

Conclusions

Primigravida who had insecure adult attachment exhibited an increased prevalence of prenatal depression and lower MFA. Maternal depression and adult attachment may affect the emotional bond between a mother and fetus. This finding should be seriously considered, and timely intervention needs to take personality traits into consideration.
Survival and predictors of mortality among severe acute malnourished under-five children admitted at Felege-Hiwot comprehensive specialized hospital, northwest, Ethiopia: a retrospective cohort study
Authors: Kassaw Amare , Amare Desalegne , Birhanu Minyichil , Tesfaw Aragaw , Zeleke Shegaw , Arage Getachew , Kefale Demewoz
Published: April 2021

Background

Malnutrition is still a global public health problem contributing for under-five morbidity and mortality. The case is similar in Ethiopia in which severe acute malnutrition is the major contributor to mortality being an underlying cause for nearly 45% of under-five deaths. However, there is no recent evidence that shows the time to death and public health importance of oxygen saturation and chest in drawing in the study area. Therefore, estimated time to death and its predictors can provide an input for program planners and decision-makers.

Methods

A facility -based retrospective cohort study was conducted among 488 severe acute malnourished under-five children admitted from the 1st of January 2016 to the 30th of December 2019. The study participants were selected by using simple random sampling technique. Data were entered in to Epi-Data version 3.1 and exported to STATA version15 statistical software for further analysis. The Kaplan Meier was used to estimate cumulative survival probability and a log-rank test was used to compare the survival time between different categories of explanatory variables. The Cox-proportional hazard regression model was fitted to identify predictors of mortality. P-value< 0.05 was used to declare statistical significance.

Results

Out of the total 488 randomly selected charts of children with severe acute malnutrition, 476 records were included in the final analysis. A total of 54(11.34%) children died with an incidence rate of 9.1death /1000 person- days. Failed appetite test (AHR: 2.4; 95%CI: 1.26, 4.67), altered consciousness level at admission (AHR: 2.4; 95%CI: 1.08, 4.67), oxygen saturation below 90% (AHR: 3.3; 95%CI: 1.40, 7.87), edema (AHR 2.9; 95%CI: 1.45, 5.66) and HIV infection (AHR: 2.8; 95%CI: 1.24, 6.36) were predictors of mortality for children diagnosed with severe acute malnutrition.

Conclusion

The overall survival status of severe acute malnourished children was low as compared to national sphere standards and previous reports in the literature. The major predictors of mortality were oxygen saturation below 90%, altered consciousness, HIV infection, edema and failed appetite test. Therefore, early screening of complications, close follow up and regular monitoring of sever acute malnourished children might improve child survival rate.
Sagittal alignment changes and postoperative complications following surgery for adult spinal deformity in patients with Parkinson’s disease: a multi-institutional retrospective cohort study
Authors: Kawabata Atsuyuki , Yoshii Toshitaka , Sakai Kenichiro , Hirai Takashi , Yuasa Masato , Inose Hiroyuki , Matsukura Yu , Morishita Shingo , Tomori Masaki , Torigoe Ichiro , Kusano Kazuo , Otani Kazuyuki , Arai Yoshiyasu , Shindo Shigeo , Okawa Atsushi
Published: April 2021

Background

Parkinson’s disease (PD) has been found to increase the risk of postoperative complications in patients with adult spinal deformity (ASD). However, few studies have investigated this by directly comparing patients with PD and those without PD.

Methods

In this multicenter retrospective cohort study, we reviewed all surgically treated ASD patients with at least 2 years of follow-up. Among them, 27 had PD (PD+ group). Clinical data were collected on early and late postoperative complications as well as any revision surgery. Radiographic parameters were evaluated before and immediately after surgery and at final follow-up, including sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, sacral slope, and pelvic tilt. We compared the surgical outcomes and radiographic parameters of PD patients with those of non-PD patients.

Results

For early complications, the PD+ group demonstrated a higher rate of delirium than the PD− group. In terms of late complications, the rate of non-union was significantly higher in the PD+ group. Rates of rod failure and revision surgery due to mechanical complications also tended to be higher, but not significantly, in the PD+ group (p = 0.17, p = 0.13, respectively). SVA at final follow-up and loss of correction in SVA were significantly higher in the PD+ group.

Conclusion

Extra attention should be paid to perioperative complications, especially delirium, in PD patients undergoing surgery for ASD. Furthermore, loss of correction and rate of non-union were greater in these patients.
Correction to: Bioavailability of subcutaneous and intramuscular administrated buprenorphine in New Zealand White rabbits
Authors: Askar Raad , Fredriksson Elin , Manell Elin , Hedeland Mikael , Bondesson Ulf , Bate Simon , Olsén Lena , Hedenqvist Patricia
Published: April 2021

An amendment to this paper has been published and can be accessed via the original article.
Prevalence of overuse of short-acting beta-2 agonists (SABA) and associated factors among patients with asthma in Germany
Authors: Worth Heinrich , Criée Carl-Peter , Vogelmeier Claus F. , Kardos Peter , Becker Eva-Maria , Kostev Karel , Mokros Ingo , Schneider Andrea
Published: April 2021

Background

Overuse of short-acting beta-2 agonists (SABA), which do not treat the underlying inflammation of asthma, is linked to poor clinical outcomes such as increased exacerbation risk. This study, as part of the SABINA program, estimated the prevalence of SABA overuse and associated variables in outpatients in Germany.

Methods

This retrospective study used anonymized electronic healthcare data from the Disease Analyzer database (IQVIA). A total of 15,640 patients aged ≥ 12 years with asthma who received ≥ 1 SABA prescription(s) between July 2017 and June 2018 in 924 general physician and 22 pneumologist (PN) practices were included. SABA overuse was defined as ≥ 3 prescribed inhalers (~ 200 puffs each) during the study period. The associations between SABA overuse and physician specialty, Global Initiative for Asthma (GINA) steps (based on asthma medications), age, sex, and inhaled corticosteroid (ICS)/long-acting beta agonist (LABA) use were estimated using multivariable regression for patients with probable moderate (GINA step 2) and probable severe (GINA steps 3–5) asthma.

Results

Annually, 36% of all patients (GINA steps 1–5) in general and 38% in PN practices received ≥ 3 SABA inhalers. The risk of SABA overuse was 14% higher in patients treated by a general practitioner vs. a PN; 34% and 85% higher in GINA steps 4 and 5, respectively, vs. GINA step 3; and 40% higher in male vs. female patients.

Conclusions

SABA overuse is prevalent among patients with asthma across all GINA steps in Germany, which may indicate suboptimal asthma control. Further studies are needed to investigate the reasons behind SABA overuse.
Lifestyle, Exercise and Activity Package for People living with Progressive Multiple Sclerosis (LEAP-MS): adaptions during the COVID-19 pandemic and remote delivery for improved efficiency
Authors: Lowe Rachel , Barlow Christy , Lloyd Barry , Latchem-Hastings Julie , Poile Vincent , Scoble Charlotte , Dean-Young Andrew , Button Kate , Playle Rebecca , Busse Monica
Published: April 2021

The LEAP-MS (Lifestyle, Exercise and Activity Package for People living with Progressive Multiple Sclerosis) study has developed an individualised supported self-management approach for physical activity for people with progressive multiple sclerosis (MS) and severe disability. The intervention has been evaluated in a single-arm feasibility study with embedded process evaluation. The feasibility study was due to open to recruitment during the COVID-19 2020–2021 pandemic, 1 month into the first UK-wide lockdown. We worked rapidly to implement adaptions to the trial procedures and intervention delivery that we believe are applicable to randomised controlled trials.

Recruitment became predominantly via self-referral. Electronic consent was employed, with consent discussions occurring over the telephone. Registration, consent, eligibility assessment and data collection as well as the intervention (online physical activity tool) were via a secure, encrypted multi-user web-based platform for participants, physiotherapists and researchers accessible via various hardware. Physiotherapy consultations, as well as the process evaluation, were conducted remotely using video conferencing software or the telephone. A remote training package for physiotherapists and site initiations was also developed and electronic site files employed.

Our adaptions are extremely topical given the COVID-19 situation, and whilst not what we had originally planned, have enabled successful delivery of the feasibility study and are relevant to conducting randomised controlled trials and meeting the needs of people with MS who are far more isolated than ever before.

Trial registration

ClinicalTrials.govNCT03951181. Registered on 15 May 2019.
IrGO: Iranian traditional medicine General Ontology and knowledge base
Authors: Naghizadeh Ayeh , Salamat Mahdi , Hamzeian Donya , Akbari Shaghayegh , Rezaeizadeh Hossein , Vaghasloo Mahdi Alizadeh , Karbalaei Reza , Mirzaie Mehdi , Karimi Mehrdad , Jafari Mohieddin
Published: April 2021

Background

Iranian traditional medicine, also known as Persian Medicine, is a holistic school of medicine with a long prolific history. It describes numerous concepts and the relationships between them. However, no unified language system has been proposed for the concepts of this medicine up to the present time. Considering the extensive terminology in the numerous textbooks written by the scholars over centuries, comprehending the totality of concepts is obviously a very challenging task. To resolve this issue, overcome the obstacles, and code the concepts in a reusable manner, constructing an ontology of the concepts of Iranian traditional medicine seems a necessity.

Construction and content

Makhzan al-Advieh, an encyclopedia of materia medica compiled by Mohammad Hossein Aghili Khorasani, was selected as the resource to create an ontology of the concepts used to describe medicinal substances. The steps followed to accomplish this task included (1) compiling the list of classes via examination of textbooks, and text mining the resource followed by manual review to ensure comprehensiveness of extracted terms; (2) arranging the classes in a taxonomy; (3) determining object and data properties; (4) specifying annotation properties including ID, labels (English and Persian), alternative terms, and definitions (English and Persian); (5) ontology evaluation. The ontology was created using Protégé with adherence to the principles of ontology development provided by the Open Biological and Biomedical Ontology (OBO) foundry.

Utility and discussion

The ontology was finalized with inclusion of 3521 classes, 15 properties, and 20,903 axioms in the Iranian traditional medicine General Ontology (IrGO) database, freely available at http://ir-go.net/. An indented list and an interactive graph view using WebVOWL were used to visualize the ontology. All classes were linked to their instances in UNaProd database to create a knowledge base of ITM materia medica.

Conclusion

We constructed an ontology-based knowledge base of ITM concepts in the domain of materia medica to help offer a shared and common understanding of this concept, enable reuse of the knowledge, and make the assumptions explicit. This ontology will aid Persian medicine practitioners in clinical decision-making to select drugs. Extending IrGO will bridge the gap between traditional and conventional schools of medicine, helping guide future research in the process of drug discovery.