bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlates of adaptive skills in children with autism spectrum disorder
Authors: Aishworiya Ramkumar , Goh Tze Jui , Sung Min , Tay Stacey Kiat Hong
Published: March 2021

This study aimed to identify potential modifiable factors prior to early intervention that are associated with better adaptive skills in children with autism spectrum disorder. This cross-sectional study recruited patients with autism spectrum disorder, aged 5–12 years from two tertiary developmental programmes in Singapore. Demographics, family socio-economic status and early intervention details were collected. The primary outcome was the Vineland Adaptive Behaviour Scales Adaptive Behaviour Composite score. Multivariate linear regression analysis was done. The sample ( N = 193) comprised 84% males with a mean age of 6 years and 7 months. Mean age at diagnosis was 35.5 months and mean Vineland Adaptive Behaviour Scales Adaptive Behaviour Composite standard score was 76.5. Mean waiting time for early intervention was 6.2 months with a mean intensity of 8.0 h/week. Waiting time for early intervention was a negative correlate of the Vineland Adaptive Behaviour Scales Adaptive Behaviour Composite score after controlling for other variables ( β = −0.74, p = 0.04). Significant correlates also included paternal education ( β = 5.44, p = 0.03) and the presence of financial difficulties in the family ( β = −5.98, p = 0.04). Waiting time for early intervention is a modifiable risk factor that may be addressed during service planning to potentially improve adaptive skills in autism spectrum disorder. Children from low socio-economic status families may be at risk for poor functional skills and will benefit from targeted intervention plans.

Lay abstract

Despite improving services and care for individuals with autism spectrum disorder, functional outcomes such as daily living skills tend to be suboptimal for many. This study wanted to identify modifiable early intervention factors that are associated with better outcomes and possible high-risk groups of children who are at risk of poorer outcomes. Participants included 193 children aged between 5 and 12 years of age whose parents provided information on their family background and early intervention characteristics. These children also had their adaptive behaviour skills examined by formal testing. Results indicated that shorter wait time for early intervention was associated with better adaptive behaviour scores. Children from families with financial difficulties and lower paternal education were also at risk of poorer adaptive skills. Designing services for children with autism such that wait times to enter early intervention services are minimised following initial diagnosis can improve their eventual functional outcomes. Changes in healthcare policy to allow expedited entry or targeted intervention to children from low socio-economic status families can also enhance their eventual adaptive skill gains.
Supporting vocabulary development in a culturally/linguistically diverse family
Authors: Anderson Ann , Anderson Jim
Published: March 2021

Educators and researchers consider vocabulary development foundational in young children’s language and literacy learning and for academic achievement; adult-child shared book reading is potentially a rich site for word learning and concept development. In this article, we report on how an immigrant father and his four year old daughter, English Language Learners living in a community identified as “vulnerable”, attended to words and their meanings in two shared reading sessions. Results indicate the father enacted a number of strategies including: verbal explanations; providing verbal explanations and pointing to the relevant illustration; referencing the child’s previous experiences; and using demonstration and gesture. The findings challenge some of the assumptions about immigrant families and families living in “vulnerable” communities, as well as the role of fathers in young children’s language and literacy development.
The injustices of global justice scholarship
Authors: Havercroft Jonathan
Published: March 2021

Duncan Bell’s Empire, Race and Global Justice is an edited volume that makes an important intervention in philosophical debates about global justice. Its contributors argue that global justice scholarship has paid insufficient attention to the role of imperialism and racism in generating global hierarchies. This review considers the contributions of this volume from three perspectives: as a critique of the global justice literature, as a guide for what methods global justice scholars should use and as a reconsideration of what texts should be incorporated into the global justice canon. Empire is an important book for anyone who researches and teaches in the area of global justice because it demonstrates both why a different approach to this topic is necessary and how a different approach is possible.
The activist university: Identities, profiles, conditions
Authors: Barnett Ronald
Published: March 2021

At first sight, the very term ‘the activist university’ may seem strange. Universities have to be active in all manner of ways – insofar as we can attribute actions to large complex institutions – but ‘activist’? An activist is someone who takes up the cudgels in a cause, who contends against an enemy and demonstrates for and even fights for a cause. Students may be activists in movements of radical politics and can be seen resisting and even attacking the forces of the state. But what might it mean for their university, indeed any university, to be an activist university? I argue that the term ‘the activist university’ opens to different meanings. The concept of the activist university is a space in which alternative interpretations jostle with each other. These different readings are expressive of competing senses of the responsibilities of the university and its place in society. Academic activism lends itself to a panoply of stances. Nevertheless, I argue that academic activism is a universal category that gains its fullest realization when it is exhibited in a situation of epistemic injustice and is an expression of epistemic agency.
Stadium Attendance Demand Research: A Scoping Review
Authors: Schreyer Dominik , Ansari Payam
Published: March 2021

Because maximizing stadium attendance demand is of utmost importance, for both sports economists and sport management researchers, understanding the potential determinants of such demand better has become a priority in the last decades. Here, conducting a systematic scoping review, we map this previous research in terms of its characteristics, its nature, and its volume, thus offering a concise perspective on what has been previously explored, and, more importantly, what remains to be analyzed in the future. Intriguingly, we observe a lack of studies exploring data generated in both niche and women’s sports, as well as in most emerging markets. Further, the field has not yet established the use of disaggregated stadium attendance data, despite notable potential methodological pitfalls.
The Chronic Effects of Narghile Use on Males’ Cardiovascular Response During Exercise: A Systematic Review
Authors: Chaieb Faten , Ben Saad Helmi
Published: March 2021

Narghile use has regained popularity throughout the world. Public opinion misjudges its chronic harmful effects on health, especially on the cardiovascular system. This systematic review aimed to evaluate the chronic effects of narghile use on cardiovascular response during exercise. It followed the preferred reporting items for systematic reviews guidelines. Original articles from PubMed and Scopus published until January 31, 2020, written in English, and tackling the chronic effects of narghile use on human cardiovascular response during exercise were considered. Five studies met the inclusion criteria. Only males were included in these studies. They were published between 2014 and 2017 by teams from Tunisia ( n = 4) and Jordan ( n = 1). One study applied the 6-min walk test, and four studies opted for the cardiopulmonary exercise test. Narghile use was associated with reduced submaximal (e.g., lower 6-min walk distance) and maximal aerobic capacities (e.g., lower maximal oxygen uptake) with abnormal cardiovascular status at rest (e.g., increase in heart rate and blood pressures), at the end of the exercise (e.g., lower heart rate, tendency to chronotropic insufficiency) and during the recovery period (e.g., lower recovery index). To conclude, chronic narghile use has negative effects on cardiovascular response to exercise with reduced submaximal and maximal exercise capacities.
Pregnancy-related inappropriate sinus tachycardia: A cohort analysis of maternal and fetal outcomes
Authors: Sharp Alexander , Patient Charlotte , Pickett Janet , Belham Mark
Published: March 2021

Background

Little literature exists regarding the syndrome of inappropriate sinus tachycardia during pregnancy. We aimed to further understand the natural history of inappropriate sinus tachycardia in pregnancy, and to explore maternal and fetal outcomes.

Methods

A retrospective, observational cohort analysis of 19 pregnant women who presented with inappropriate sinus tachycardia.

Results

42% attended the emergency department on more than one occasion with symptoms of inappropriate sinus tachycardia; 32% required hospital admission and 26% required pharmacological therapy. There were no maternal deaths, instances of heart failure or acute coronary syndrome, and no thromboembolic or haemorrhagic complications during pregnancy. Rates of caesarean section were similar to the background rate of our unit (32% and 27%, respectively). Rates of induction were notably elevated (58% vs 25%).

Conclusion

Inappropriate sinus tachycardia in pregnancy is associated with high rates of hospitalization and induction of labour, which may not be mandatory given the clinical findings in this group of women.
Pterostilbene Inhibits Dyslipidemia-Induced Activation of Progenitor Adipose Gene Under High-Fat Diet and Radiation Stressor
Authors: Moustafa Enas M. , Rashed Engy R. , Rashed Rasha R.
Published: March 2021

Repeated exposure to ionizing radiation has been reported to increase the risk of chronic metabolic disorders such as systemic hyperlipidemia and intracellular lipid accumulation that might lead to diabetes-induced heart disease. The purpose of this study was to investigate the effect of pterostilbene on high-fat diet rats suffering from ionizing radiation-induced hyperlipidemia. High-fat diet rats showed an increase in body weight and body fat compared with rats fed with normal chow. Pterostilbene and Orlistat treatments resulted in lower body weight and body fat gain, insulin resistance, reduced lipid peroxidation with attenuated liver enzyme levels, and regulated lipogenesis-related genes in the HFD + IR rat group. Regulation of Peroxisome proliferator-activated receptor-γ (PPAR-γ) mRNA enhanced paraoxonase-1 (PON-1) and arylesterase (AE) activities and inhibited that of 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA). It also increased the activities of plasma lecithin-cholesterol acyltransferase (LCAT) and lipoprotein lipase (LPL). Pterostilbene and Orlistat also corrected the alterations of serum leptin and adiponectin levels in lipidemic rats. Such findings provide evidence that Pterostilbene and Orlistat can act as normolipidemic agents that possess lipid-lowering effects and potential as a radioprotector.
Beyond the Family Resemblance: Mapping the Normative Roles of Journalists Across Europe in the Early 2010s
Authors: Standaert Olivier
Published: March 2021

This article describes and discusses how normative journalistic roles are formulated across Europe. The material was obtained from the 2012–2016 wave of the Worlds of Journalism Study, a comparative study designed to assess the state of journalism throughout the world. The advantage of this study over similar undertakings in the past is that we did not confront journalists with ready-made statements but invited them to tell us, in their own words, what they thought the major roles of journalists in their countries ought to be. Open responses of more than 10,200 journalists from twenty-seven European countries yielded 12,860 references. Results show that the most important roles refer to the domain of political life, especially the informational-instructive and the critical-monitorial functions—a finding that is consistent across the twenty-seven countries investigated. Beyond this shared global vision, it is, however, possible to point out some national specificities, keeping in mind that even if the core of the normative roles remains somewhat universal, a detailed comparison of those roles in their cultural context allows us to grasp some differences in their hierarchy and their meaning.
“Strategic Lying”: The Case of Brexit and the 2019 U.K. Election
Authors: Gaber Ivor , Fisher Caroline
Published: March 2021

The final days of the Trump presidency and its aftermath brought into sharp focus the issue of political lying. Politicians have historically employed rhetoric and rhetorical spin to embellish the truth and hide damaging information. However, outright lying has traditionally been deemed politically too risky, resulting in resignation and the undermining of public trust. In contrast, recent electoral successes —the 2016 Brexit Referendum and the 2019 general election in the United Kingdom, and Trump's victory in 2016 and his increased electoral support in 2020—point to an apparent growing tendency for politicians caught lying not to be punished at the ballot box. Using the U.K. Brexit referendum and the 2019 general election as its case study, this conceptual paper argues that strategic political lying has been designed as a priming device to set the news agenda. As an effective campaigning tactic “strategic lying” represents a development of political spin—first evident in the mass media era—that has been intensified by the increasing professionalization of political communications and the rise of social media. In doing so, the concept of “strategic lying” theorized here contributes to deepening our understanding of the ongoing evolution of “spin” in the digital era.
A case report of disseminated verrucosis secondary to ustekinumab in a patient with Crohn’s disease
Authors: Svoboda Steven A , Rush Patrick S , Sharghi Kevin G , Rady Peter L , Tyring Stephen K , Eikenberg Joshua D
Published: March 2021

Ustekinumab is a biologic agent with Food and Drug Administration approval for the treatment of moderate-to-severe plaque psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn’s disease. It functions to inhibit the p40 subunit common to both interleukin-12 and interleukin-23. These pro-inflammatory cytokines are implicated in autoinflammatory and autoimmune disorders, but they also play an important role in cell-mediated immunity against viral, bacterial, and fungal pathogens. Therefore, antagonism of interleukin-12 and interleukin-23 by ustekinumab may increase the risk of human papillomavirus infection or reactivation which can lead to the development of verrucae. To the best of our knowledge, there is only one published report of disseminated verrucosis secondary to ustekinumab treatment for psoriasis. Here, we present the first case report of ustekinumab-induced disseminated verrucosis occurring in the setting of treatment for Crohn’s disease.
Initial Challenges and Possible Useful Countering Strategies: Perspectives From Malaysian Novice Principals
Authors: Tahir Lokman Mohd , Samah Narina A. , Hamzah Mohd Hilmi , Abdullah Abdul Halim , Ali Mohd Fadzli , Mohd Yusof Sanitah
Published: March 2021

As school leaders, novice principals faced some challenges within the first years of their leadership journey. This mixed-methods study explores the initial challenges faced by novice principals while leading their schools. At the same time, their countering strategies in handling the initial challenges are also being explored. A total of 168 novice principals responded to all items within a questionnaire on their initial challenges and their useful strategies to overcome the challenges. In addition, 11 novice principals were interviewed for in-depth information on their challenges and possible strategies in overcoming them. Findings revealed that dealing with a previous principal’s legacy and heavy workloads were major challenges faced by novice principals. In terms of their countering strategies, novice principals employed various approaches such as organizing an initial meeting with teachers, getting parents involved in school activities, and sharing leadership practice.
Language Use in Group Discourse and Its Relationship to Group Processes
Authors: Van Swol Lyn M. , Ahn Paul Hangsan , Prahl Andrew , Gong Zhenxing
Published: March 2021

The study examined the relationship between language use and perception of group processes. In an experiment, participants discussed their views about climate change in a group chat. Afterward, participants ( n = 239) filled out their perception of themselves and group processes. Participants who perceived more similarity among group members used less complex language (cognitive processes language) and more assenting language. As participants felt more knowledgeable and credible about the topic, their use of “we” pronouns and word count increased and use of “I” pronouns decreased. Replicating past research, participants with more extreme opinions used more “you” pronouns, and participants who reported engaging in more perspective-taking used more complex language and “we” pronouns. Results are integrated within an input–process–output model of group processes and suggest that language is reflective of individual inputs and perception of group processes.
Exploring Teacher Leadership and the Factors Contributing to It: An Empirical Study on Chinese Private Higher Education Institutions
Authors: Zhang Mohan , Tian Jing , Ni Hao , Fang Guangbao
Published: March 2021

China has witnessed a considerable expansion of private higher education institutions (HEIs) over the last two decades, and research has shown that teacher leadership (TL) is an essential aspect of providing quality higher education. This study proposed a model to explain TL and the factors that contribute to it in private HEIs. A sample of 4,152 participants responded to an 11-item questionnaire using a 5-point scale designed to measure three variables: TL, teacher self-efficacy (TSE), and teacher competence (TC). The results showed that the three variables were valid in explaining TL and the factors that contribute to it. Hypothesis tests revealed that both hypotheses were supported. Finally, the results revealed that TSE and TC are both significantly associated with TL. The practical and theoretical implications of these findings and the scope for future research are discussed.
Sports Journalism Content When No Sports Occur: Framing Athletics Amidst the COVID-19 International Pandemic
Authors: Sadri Sean R. , Buzzelli Nicholas R. , Gentile Patrick , Billings Andrew C.
Published: March 2021

On March 11, 2020, the National Basketball Association suspended its season after a player tested positive for COVID-19. Within days, the rest of the sports world similarly suspended play in the wake of the pandemic. This study focuses on sports media storytelling when covering athletic competition was no longer an option. Utilizing four distinct time periods and framing theory as the foundation of our theoretical framework, the content analysis examined shifts from the normal reporting routine and how those shifts morphed as pandemic information dictated. As the pandemic grew more widespread, health and safety became the predominant focus of national sports media. In spring 2020, sports news experienced a significant shift in coverage as economic and fairness frames were replaced with health, safety, and quality of life as the principal frames in the coded articles. By pinpointing the major differences in coverage across time, the study revealed that sports content and frames quickly shifted to reflect the perceived severity to the global health community, while the sources used in those articles stayed largely the same. The theoretical and applied implications of the study are discussed.
Helicopter Parenting Versus Autonomy Supportive Parenting? A Latent Class Analysis of Parenting Among Emerging Adults and Their Psychological and Relational Well-Being
Authors: Hwang Woosang , Jung Eunjoo
Published: March 2021

We aim to identify typologies of parenting among emerging adults and describe how parenting typologies are related to their life satisfaction, self-efficacy, and parent-child relationship. Using a three-step latent class approach, we analyzed 472 mother-child and 426 father-child relations. We recruited the students from a private university in Upstate New York. We confirmed four parenting classes among emerging adult mothers and fathers: helicopter parenting, autonomy supportive parenting, uninvolved parenting, and parenting that combined characteristics of helicopter parenting and autonomy supportive parenting. We found that emerging adults whose parents were in the autonomy supportive parenting class reported higher scores on life satisfaction, self-efficacy, and their relationship with their parents than those in the helicopter parenting and uninvolved parenting classes. In addition, we found that emerging adults in the combined parenting class reported higher scores for life satisfaction and their relationship with their parents than those in the autonomy supportive parenting class.
Injury Rates in Major League Baseball During the 2020 COVID-19 Season
Authors: Platt Brooks N. , Uhl Timothy L. , Sciascia Aaron D. , Zacharias Anthony J. , Lemaster Nicole G. , Stone Austin V.
Published: March 2021

Background:

The 2020 Major League Baseball (MLB) season was drastically altered because of the COVID-19 pandemic. The changes included an extended layoff between March and July as well as a shortened preseason.

Purpose/Hypothesis:

To determine the incidence and epidemiology of MLB injuries in the abbreviated 2020 season compared with prior seasons. We hypothesized that there was an increase in the overall injury rate in the 2020 season compared with the 2018-2019 seasons and that it equally affected all body regions.

Study Design:

Descriptive epidemiology study.

Methods:

The MLB transactions database was queried to find players who had been placed on the injury list between 2018 and 2020. Injuries were categorized into upper extremity, lower extremity, spine/core, and other injuries. Incidence per 1000 athlete-exposures was calculated for the prior 2 seasons (2018-2019) and for the 2020 season separately. Incidence for each category was also calculated separately for pitchers and fielders. Incidence rate ratios (IRRs) and confidence intervals were used to compare injury rates in 2018-2019 versus 2020. The z test for proportions was used to determine significant differences between injury incidences.

Results:

In 2020, the overall incidence rate per 1000 athlete-exposures was almost twice the rate compared with the 2 seasons before COVID-19 (8.66 vs 5.13; IRR, 1.69 [95% CI, 1.53-1.87]; P < .001). Injury incidence increased similarly in 2020 for both pitchers (IRR, 1.68 [95% CI, 1.47-1.91]; P < .001) and fielders (IRR, 1.68 [95% CI, 1.45-1.96]; P < .001). Increases in injury incidence were seen in the upper extremity, spine/core, and other injury categories; however, the incidence of the lower extremity did not change significantly.

Conclusion:

There was a significant increase in injury incidence for both pitchers and fielders in 2020. Injury rates increased in anatomic zones of the upper extremity and spine/core but were not significantly changed in the lower extremity. The overall increase in injury rate suggests that irregular or insufficient sport-specific preparation prior to the start of the season placed athletes at a greater risk of injury when play resumed.
Utilization of Long-Acting Reversible Contraceptives and Associated Factors Among Reproductive Age Women Attending Governmental Health Institutions for Family Planning Services in Wondo Genet District, Sidama, National Regional State, Southern Ethiopia
Authors: Gujo Amelo Bolka , Kare Assefa Philipos
Published: March 2021

Background:

Utilization of family planning services improves women’s reproductive health outcomes. Long-acting reversible contraceptive (LARCs) methods, in particular, prevent unwanted pregnancy and significantly reduce maternal mortality and morbidity. In Ethiopia utilization of LARCs was very low. Therefore, this study was aimed at assessing the utilization of LARCs and associated factors among reproductive-age women in Wondo Genet District, Southern Ethiopia.

Method:

Institution based cross-sectional study was conducted from 15 May to 15 August 2020 among reproductive-age women. A systematic sampling method was applied to recruit 376 women and the sample size was allocated to health centers proportionally. Data collection was conducted by trained collectors using pretested and structured questionnaires. Data coded and entered into EPI Info 7 and the analysis was done using SPSS version 25. Binary and multiple logistic regression analyses were done. Statistical significance was declared with P < 0.05.

Result:

The utilization of LARCs was 37.8% (95% CI: 32.9-42.7). The multivariable analysis showed that odds of the utilization of LARCs were increased among reproductive-aged ≥25 years (Adjusted odds ratio (AOR) = 2.21, 95% CI: 1.04, 4.41), gave birth to ≥3 live births (AOR = 2.2, 95% CI: 1.2, 4.04), employed (AOR = 1.92, 95% CI: 1.17, 3.14), earned high monthly income (AOR = 2.02, 95% CI: 1.25, 3.26) and discussed contraceptive methods with their husbands (AOR = 2.87, CI: 1.68, 4.89].

Conclusions:

Utilization of LARCs was low. The odds of the utilization of LARCs were increased in women aged ≥25 years, gave birth to 3 or more children, earned high monthly income, and discussed with their husbands about contraception methods.
The Level of Knowledge and Awareness About Sex and Reproductive Health Among Adolescents in Kashmir
Authors: Iqbal Mohmad
Published: March 2021

Background:

A human body keeps changing physiologically, biologically, and psychologically from birth to death. There is always a change in all human faculties. But adolescence is a phase earmarked where a human body experiences drastic changes among all these faculties. And any such bodily change carrying baggage of shame, insecurity, stigma, and concealment demands on-time awareness and intervention.

Aim:

The aim of the study is to understand the knowledge and level of awareness regarding sexual and reproductive health among the school-going adolescents of Kashmir Valley where majority of the population belongs to Muslim conservative culture.

Methodology:

Due to COVID-19 lockdown, the inability of access to schools and children gave the researcher the opportunity to utilize the alternate places and a total of 550 students from classes 8, 9, and 10 were selected for the purpose. The permission was sought from the respective teachers and then the parents. The sample was a combination of boys and girls, students from both private and government-run schools. The researcher collected the data and it was tabulated systematically and analyzed using Microsoft Excel. P value was evaluated by using an application “P Value: A Statistical Tool” from Play Store.

Results and Conclusion:

The results depicted that higher the level of class, more the knowledge they had about the matter. Girls had a little knowledge about sexual and reproductive health than boys. This study felt a dire need of educating both parents and adolescent boys and girls regarding sexual health. The shame does not lie in educating the children but in the mishaps that may result due to unawareness about the same.
Engagement of older adults with multimorbidity as patient research partners: Lessons from a patient-oriented research program
Authors: Markle-Reid Maureen , Ganann Rebecca , Ploeg Jenny , Heald-Taylor Gail , Kennedy Laurie , McAiney C , Valaitis Ruta
Published: March 2021

Background:

Patient “engagement” in health research broadly refers to including people with lived experience in the research process. Although previous reviews have systematically summarized approaches to engaging older adults and their caregivers in health research, there is currently little guidance on how to meaningfully engage older adults with multimorbidity as research partners.

Objectives:

This paper describes the lessons learned from a patient-oriented research program, the Aging, Community and Health Research Unit (ACHRU), on how to engage older adults with multimorbidity as research partners. Over the past 7-years, over 40 older adults from across Canada have been involved in 17 ACHRU projects as patient research partners.

Methods:

We developed this list of lessons learned through iterative consensus building with ACHRU researchers and patient partners. We then met to collectively identify and summarize the reported successes, challenges and lessons learned from the experience of engaging older adults with multimorbidity as research partners.

Results:

ACHRU researchers reported engaging older adult partners across many phases of the research process. Five challenges and lessons learned were identified: 1) actively finding patient partners who reflect the diversity of older adults with multimorbidity, 2) developing strong working relationships with patient partners, 3) providing education and support for both patient partners and researchers, 4) using flexible approaches for engaging patients, and 5) securing adequate resources to enable meaningful engagement.

Conclusion:

The lessons learned through this work may provide guidance to researchers on how to facilitate meaningful engagement of this vulnerable and understudied subgroup in the patient engagement literature.
Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone Autograft: Challenges and Solutions of Medial Independent Femoral Tunnel Drilling
Authors: Raji Yazdan , Vakharia Ajit M. , Strony John T. , Sivasundaram Lakshmanan , Trivedi Nikunj N. , Karns Michael R. , Salata Michael J. , Voos James E.
Published: March 2021

Background:

As the main translational and rotatory stabilizer of the knee, the anterior cruciate ligament (ACL) plays a critical role in knee biomechanics. Anterior cruciate ligament ruptures generally require surgical attention for not only restoration of knee stability but also prevention of meniscal and chondral injuries. There are countless options for both the surgeon and the patient when contemplating graft choice and surgical technique for ACL reconstruction. However, the literature assessing the outcomes following various autografts has varied with some studies citing no significant difference in clinical and patient-reported outcomes, while others showing notable advantage when using bone–patellar tendon–bone (BPTB) autograft. In addition, there have been challenges associated with femoral tunnel placement using an anteromedial portal technique.

Indications:

In this study, we present a young female patient with a history of remote mid-substance ACL tear now presenting with worsening knee instability and a bucket-handle medial meniscus tear as a sequela of the incompetent ACL. After extensive discussion regarding the treatment options, patient had decided to proceed with surgical intervention with a BPTB autograft using the anteromedial portal technique for femoral tunnel placement and compression technique with bio-absorbable interference screw fixation.

Results:

Bone–patellar tendon–bone autograft has been noted to have lower risk of revision when compared with other graft options.

Discussion:

In this surgical technique study, we underline the importance of peritenon handling. We highlight the use of a 70-degree arthroscope to improve posterolateral wall visualization during femoral tunnel placement as well as for inspection of the reamed tibial tunnel. We also provide technique commentary and solutions for management of the medial femoral condyle (MFC) articular surface and femoral tunnel placement using an anteromedial portal technique. Last, we review graft-related outcomes, postoperative management, and rehabilitation protocol.
Dualmarker: a flexible toolset for exploratory analysis of combinatorial dual biomarkers for clinical efficacy
Authors: Ma Xiaopeng , Huang Ruiqi , Wu Xikun , Zhang Pei
Published: March 2021

Background

An increasing number of clinical trials require biomarker-driven patient stratification, especially for revolutionary immune checkpoint blockade therapy. Due to the complicated interaction between a tumor and its microenvironment, single biomarkers, such as PDL1 protein level, tumor mutational burden (TMB), single gene mutation and expression, are far from satisfactory for response prediction or patient stratification. Recently, combinatorial biomarkers were reported to be more precise and powerful for predicting therapy response and identifying potential target populations with superior survival. However, there is a lack of dedicated tools for such combinatorial biomarker analysis.

Results

Here, we present dualmarker, an R package designed to facilitate the data exploration for dual biomarker combinations. Given two biomarkers, dualmarker comprehensively visualizes their association with drug response and patient survival through 14 types of plots, such as boxplots, scatterplots, ROCs, and Kaplan–Meier plots. Using logistic regression and Cox regression models, dualmarker evaluated the superiority of dual markers over single markers by comparing the data fitness of dual-marker versus single-marker models, which was utilized for de novo searching for new biomarker pairs. We demonstrated this straightforward workflow and comprehensive capability by using public biomarker data from one bladder cancer patient cohort (IMvigor210 study); we confirmed the previously reported biomarker pair TMB/TGF-beta signature and CXCL13 expression/ARID1A mutation for response and survival analyses, respectively. In addition, dualmarker de novo identified new biomarker partners, for example, in overall survival modelling, the model with combination of HMGB1 expression and ARID1A mutation had statistically better goodness-of-fit than the model with either HMGB1 or ARID1A as single marker.

Conclusions

The dualmarker package is an open-source tool for the visualization and identification of combinatorial dual biomarkers. It streamlines the dual marker analysis flow into user-friendly functions and can be used for data exploration and hypothesis generation. Its code is freely available at GitHub at https://github.com/maxiaopeng/dualmarker under MIT license.
Effects of sevoflurane anesthesia and abdominal surgery on the systemic metabolome: a prospective observational study
Authors: Wei Yiyong , Zhang Donghang , Liu Jin , Ou Mengchan , Liang Peng , Zuo Yunxia , Zhou Cheng
Published: March 2021

Background

Metabolic status can be impacted by general anesthesia and surgery. However, the exact effects of general anesthesia and surgery on systemic metabolome remain unclear, which might contribute to postoperative outcomes.

Methods

Five hundred patients who underwent abdominal surgery were included. General anesthesia was mainly maintained with sevoflurane. The end-tidal sevoflurane concentration (ETsevo) was adjusted to maintain BIS (Bispectral index) value between 40 and 60. The mean ETsevo from 20 min after endotracheal intubation to 2 h after the beginning of surgery was calculated for each patient. The patients were further divided into low ETsevo group (mean − SD) and high ETsevo group (mean + SD) to investigate the possible metabolic changes relevant to the amount of sevoflurane exposure.

Results

The mean ETsevo of the 500 patients was 1.60% ± 0.34%. Patients with low ETsevo (n = 55) and high ETsevo (n = 59) were selected for metabolomic analysis (1.06% ± 0.13% vs. 2.17% ± 0.16%, P < 0.001). Sevoflurane and abdominal surgery disturbed the tricarboxylic acid cycle as identified by increased citrate and cis-aconitate levels and impacted glycometabolism as identified by increased sucrose and D-glucose levels in these 114 patients. Glutamate metabolism was also impacted by sevoflurane and abdominal surgery in all the patients. In the patients with high ETsevo, levels of L-glutamine, pyroglutamic acid, sphinganine and L-selenocysteine after sevoflurane anesthesia and abdominal surgery were significantly higher than those of the patients with low ETsevo, suggesting that these metabolic changes might be relevant to the amount of sevoflurane exposure.

Conclusions

Sevoflurane anesthesia and abdominal surgery can impact principal metabolic pathways in clinical patients including tricarboxylic acid cycle, glycometabolism and glutamate metabolism. This study may provide a resource data for future studies about metabolism relevant to general anaesthesia and surgeries.

Trial registration

www.chictr.org.cn. identifier: ChiCTR1800014327.
School-based surveillance on visit-to-visit blood pressure variability and high blood pressure in children and adolescents
Authors: Wang Jiaxiang , Shen Hui , Liu Jieyu , Xiao Chengqi , Chen Cailong , Teng Haoyue , Hu Jia , Yin Jieyun
Published: March 2021

Background

The predictive importance of visit-to-visit blood pressure variability (VVV) for high blood pressure (HBP) in a pediatric population has been largely unsettled. We aimed to evaluate it based on Health Promotion Program for Children and Adolescents (HPPCA), a school-based surveillance conducted from 2012 to 2018 in Suzhou, China.

Methods

A total of 330,618 participants had BP measurement in 2018 and ≥ 3 BP records during 2012–2017, were recruited from HPPCA. Absolute BP values (in mmHg) were converted into age-, sex- and height- normalized z-scores. VVV was expressed as standard deviation (SD), coefficient of variation (CV) or average real variability (ARV) of BP z-scores during 2012–2017. Logistic regression models were used to assess the associations between VVV and HBP in 2018.

Results

In 2018, 42,554 (12.87%) subjects were defined as HBP. VVV, except for SBP-CV and DBP-CV, was significantly higher in the HBP group than normotensives group. After adjusting for covariates including mean BP values from 2012 to 2017, SBP-SD, SBP-ARV, DBP-SD and DBP-ARV, increased the risk of HBP by 5.70 [95% confidence interval (95% CI) 5.54–5.87], 4.10 (95% CI 4.01–4.20), 4.70 (95% CI 4.50–4.90) and 3.39 (95% CI 3.28–3.50) times, respectively. Notably, SBP-SD significantly improved risk discrimination of HBP based on other risk variables (c-statistics, net reclassification index and integrated discrimination improvement significantly increased).

Conclusions

Higher SD or ARV of BP, was independently related with higher probability of HBP in Chinese pediatric population. SBP-SD could be potentially helpful for detecting HBP. Future researches investigating the predictive value of VVV are warrant.
Patient perceptions of oral health care following stroke: a qualitative study
Authors: Ajwani Shilpi , Ferguson Caleb , Kong Ariana C. , Villarosa Amy R. , George Ajesh
Published: March 2021

Background

Stroke is a serious cerebrovascular disease and is one of the world’s leading causes of disability. Maintaining good oral health is a challenge among those hospitalised after stroke. A multidisciplinary approach to oral care involving non-dental professionals can be beneficial in improving oral health outcomes for patients. The aim of this study was to understand the perceptions of stroke survivors regarding oral healthcare across acute and rehabilitation settings.

Methods

A descriptive qualitative approach was used. Face-to-face semi-structured interviews were conducted. A framework analysis was employed to analyse the data. Patients who had recently experienced a stroke were purposively recruited across both acute and rehabilitation settings, at two metropolitan hospitals in Sydney, Australia. In total, 11 patients were interviewed.

Results

Although participants recognised the importance of oral health, few understood the link between oral and general health. Regular oral hygiene practices varied since having stroke, with a few receiving oral care assistance from nurses. Time, cost and lack of information were some barriers to accessing dental services, while supportive measures such as coordination of oral care, financial subsidy and nurse assistance were strategies proposed to support oral care practices amongst stroke survivors.

Conclusions

There is scope to improve current models of oral care in stroke. While stroke survivors understand the importance of oral care, an integrated oral health model with a multidisciplinary approach could improve health outcomes.
A program evaluation reporting student perceptions of early clinical exposure to primary care at a new medical college in Qatar
Authors: Kane Tanya , Chivese Tawanda , Al-Moslih Ayad , Al-Mutawa Noora A. M. , Daher-Nashif Suhad , Hashemi Nehdia , Carr Alison
Published: March 2021

Background

Though common practice in Europe, few studies have described the efficacy of early clinical exposure (ECE) in the Middle East. The barriers to clinical learning experienced by these novice medical students have not been reported. This evaluation reports on introducing ECE in primary care, supported by Experiential Review (ER) debriefing sessions. The evaluation explores students’ experiences of their acquisition of clinical and non-technical skills, sociocultural issues commonly encountered but underreported and barriers to clinical learning experienced.

Methods

We conducted a cross-sectional study of three student cohorts in 2017–19: All second and third-year students at the new College of Medicine were invited to participate. The primary outcome was students’ perceptions of the aims of the Primary Health Centre Placement (PHCP) programme and how it facilitated learning. Secondary outcome measures were students’ perceptions of their learning in ER sessions and perceived barriers to learning during PHCPs. Student perceptions of the PHCPs were measured using a Likert scale-based questionnaire.

Results

One hundred and fifty-one students participated: 107 in year 2 and 44 in year 3; 72.3% were female. Overall, most students (> 70%) strongly agreed or agreed with the purposes of the PCHPs. Most students (71%) strongly agreed or agreed that the PCHPs allowed them to learn about patient care; 58% to observe doctors as role models and 55% to discuss managing common clinical problems with family physicians. Most students (year 2 = 62.5% and year 3 = 67%) strongly agreed/agreed that they were now confident taking histories and examining patients. Student barriers to clinical learning included: Unclear learning outcomes (48.3%); faculty too busy to teach (41.7%); lacking understanding of clinical medicine (29.1%); shyness (26.5%); and finding talking to patients difficult and embarrassing (25.8%). Over 70% reported that ER enabled them to discuss ethical and professional issues.

Conclusions

Overall, our Middle Eastern students regard ECE as beneficial to their clinical learning. PHCPs and ER sessions together provide useful educational experiences for novice learners. We recommend further exploration of the barriers to learning to explore whether these novice students’ perceptions are manifesting underlying cultural sensitivities or acculturation to their new environment.
CircFAM73A promotes the cancer stem cell-like properties of gastric cancer through the miR-490-3p/HMGA2 positive feedback loop and HNRNPK-mediated β-catenin stabilization
Authors: Xia Yiwen , Lv Jialun , Jiang Tianlu , Li Bowen , Li Ying , He Zhongyuan , Xuan Zhe , Sun Guangli , Wang Sen , Li Zheng , Wang Weizhi , Wang Linjun , Xu Zekuan
Published: March 2021

Background

Circular RNAs (circRNAs) have emerged as a new subclass of regulatory RNAs that play critical roles in various cancers. Cancer stem cells (CSCs), a small subset of cancer cells, are believed to possess the capacities to initiate tumorigenesis and promote progression. Although accumulating evidence has suggested that cells with CSC-like properties are crucial for the malignancy of gastric cancer (GC), it remains unclear whether circRNAs are related to the acquisition of CSC-like properties in GC.

Methods

CircFAM73A expression was analyzed by GEO datasets and verified in GC samples. The roles of circFAM73A in GC cell proliferation, migration, cisplatin resistance, and CSC-like properties were determined by a series of functional experiments both in vitro and in vivo. RNA pulldown was used to explore the miRNAs and proteins binding to circFAM73A. Bioinformatic analysis and experimental verification confirmed the downstream targets of circFAM73A. The regulation of circFAM73A by HMGA2 was verified by ChIP and RIP assays.

Results

Elevated circFAM73A expression was confirmed in GC tissues, and higher circFAM73A predicted poor prognosis in GC patients. The upregulation of circFAM73A enhanced CSC-like properties in GC, thus facilitating cell proliferation, migration, and cisplatin resistance. Mechanistically, circFAM73A promoted GC malignancy by regulating miR-490-3p/HMGA2 in a positive feedback loop and recruiting HNRNPK to facilitate β-catenin stabilization. Moreover, HMGA2 further enhanced E2F1 and HNRNPL activity, which in turn promoted circFAM73A expression.

Conclusions

Our work demonstrates the crucial role of circFAM73A in the CSC-like properties of GC and uncovers a positive feedback loop in circFAM73A regulation that leads to the progression of gastric cancer, which may provide new insights into circRNA-based diagnostic and therapeutic strategies.
Enhanced hydrogen production of Rhodobacter sphaeroides promoted by extracellular H+ of Halobacterium salinarum
Authors: Ye Jiang-Yu , Pan Yue , Wang Yong , Wang Yi-Chao
Published: March 2021

Purpose

This study utilized the principle that the bacteriorhodopsin (BR) produced by Halobacterium salinarum could increase the hydrogen production of Rhodobacter sphaeroides. H. salinarum are co-cultured with R. sphaeroides to determine the impact of purple membrane fragments (PM) on R. sphaeroides and improve its hydrogen production capacity.

Methods

In this study, low-salinity in 14 % NaCl domesticates H salinarum. Then, 0–160 nmol of different concentration gradient groups of bacteriorhodopsin (BR) and R. sphaeroides was co-cultivated, and the hydrogen production and pH are measured; then, R. sphaeroides and immobilized BR of different concentrations are used to produce hydrogen to detect the amount of hydrogen. Two-chamber microbial hydrogen production system with proton exchange membrane-assisted proton flow was established, and the system was operated. As additional electricity added under 0.3 V, the hydrogen production rate increased with voltages in the coupled system.

Results

H salinarum can still grow well after low salt in 14% NaCl domestication. When the BR concentration is 80 nmol, the highest hydrogen production reached 217 mL per hour. Both immobilized PC (packed cells) and immobilized PM (purple membrane) of H. salinarum could promote hydrogen production of R. sphaeroides to some extent. The highest production of hydrogen was obtained by the coupled system with 40 nmol BR of immobilized PC, which increased from 127 to 232 mL, and the maximum H2 production rate was 18.2 mL−1 h−1 L culture. In the 192 h experiment time, when the potential is 0.3 V, the hydrogen production amount can reach 920 mL, which is 50.3% higher than the control group.

Conclusions

The stability of the system greatly improved after PC was immobilized, and the time for hydrogen production of R. sphaeroides significantly extended on same condition. As additional electricity added under 0.3 V, the hydrogen production rate increased with voltages in the coupled system. These results are helpful to build a hydrogen production-coupled system by nitrogenase of R. sphaeroides and proton pump of H. salinarum.

Graphical abstract