bluuebunny/crossref_metadata_2025 huggingface dataset:
Carcinomatosis under control by osimertinib in EGFR and TP53 mutated lung adenocarcinoma
Authors: Provenzano Leonardo , Cuccarini Valeria , Platania Marco , Canziani Luca , Spagnoletti Andrea , Doniselli Fabio M. , Eoli Marica , Prelaj Arsela , Anghileri Elena
Published: November 2021

Introduction:

Approximately 25%–30% of patients with non-small cell lung cancer (NSCLC) develop central nervous system (CNS) metastases during the course of the disease; this percentage is higher in patients with epidermal growth factor receptor (EGFR) mutations. Leptomeningeal metastases, infrequent in the advanced setting, have a particularly dismal prognosis. Osimertinib, a third-generation EGFR inhibitor, can provide effective and durable response in this setting.

Case Description:

We present a 62-year-old man with progressive vomiting, headache, short-term memory impairment, and left lower limb hyposthenia. Computed tomography (CT) showed bilateral lung nodules, multiple lymphadenopathies, liver and bone metastases, and CNS and leptomeningeal dissemination, including multiple parenchymal nodules located at supra- and infratentorial brain. Bone needle biopsy documented TTF1+ lung adenocarcinoma. Whole brain radiotherapy (WBRT) and symptomatic treatments were started. Next-generation sequencing reported deletion of exon 19 of EGFR and mutation 8 of TP53. Osimertinib 80 mg was promptly started and WBRT interrupted. Some days after the patient experienced repetitive seizures and neurologic worsening, antiepileptic drugs and dexamethasone were implemented, with gradual improvement. Radiologic evaluation, including brain MRI and thorax–abdominal CT, showed partial response on CNS as well as extracranial sites, which was sustained.

Conclusions:

First-line treatment with osimertinib can be safe and effective in EGFR-mutated NSCLC even in presence of multiple negative predictive factors (poor Performance Status, diffuse leptomeningeal involvement, TP53 comutation), suggesting that deferring local treatments can be feasible in this setting, allowing the patient to maintain a good quality of life.
Measurement and Definition of Gentrification in Urban Studies and Planning
Authors: Finio Nicholas
Published: November 2021

The amount of empirical research on the extent, causes, and consequences of gentrification continues to expand. This article reviews the methods utilized to delimit and quantify gentrification in the literature. Such measurement is undertaken in order to assess the consequences of gentrification, such as displacement, over various time scales and geographies. Recent research has demonstrated that the use of different quantitative definitions of gentrification may yield conflicting research results, and further, can muddy the waters for policymaking and political discourse. This article critically assesses the breadth of quantitative definitions and offers recommendations for future studies.
Investigation of magnetorheological fluid-based finishing process for improving the functional performance of hydraulic cylinder
Authors: Paswan Sunil Kumar , Aggarwal Ankit , Singh Anant Kumar
Published: November 2021

A cylindrical barrel is a crucial part of the hydraulic cylinder that enables the mechanical system to apply high power to get the desired work, such as moving, pressing, and lifting the high-weight materials, done. The smoothness in the functioning of the machinery performing the tasks of these kinds is directly linked with the quality of the interior surface finish of the hydraulic cylinder’s cylindrical barrel. In this study, the inside surface of a real-time hydraulic cylinder's barrel is completed to achieve a fine finish. The cylindrical barrel of the hydraulic cylinder with a fine-finished internal surface causes the related machinery to consume less power to get the desired work done. The smooth functioning of different kinds of machinery is affected by the level of internal surface finish of the cylindrical barrel of the hydraulic cylinder. For investigating the best parameters of the magnetorheological finishing process over the interior surface of the hydraulic cylinder’s cylindrical barrel, the response surface methodology has been used. Through 60 min of magnetorheological-finishing using optimal finishing conditions, the final surface roughness is achieved up to 40 nm from 380 nm of initially honed roughness. Also, the improvement in dimensional and geometric accuracies has been analysed through surface waviness and circularity measurement before and after the magnetorheological-finished surface. Through the scanning electron microscopy tests, the enhancement in surface consistency of the cylindrical barrel of the hydraulic cylinder’s finished surface is analysed. The overall results demonstrate the significant importance of the rotating-magnetorheological honing process to fine finish the inside surface of the cylindrical barrel of the hydraulic cylinder.
Predicting cardiovascular risk using a novel risk score in young and middle-age adults with HIV: associations with biomarkers and carotid atherosclerotic plaque
Authors: Rodriguez Violeta J , Abbamonte John M , Parrish Manasi S , Jones Deborah L , Weiss Stephen , Pallikkuth Suresh , Toborek Michal , Alcaide Maria L , Jayaweera Dushyantha , Pahwa Savita , Rundek Tatjana , Hurwitz Barry E , Kumar Mahendra
Published: November 2021

Background

Traditional risk factors associated with cardiovascular disease (CVD) include older age, smoking, poor diet, lack of exercise, obesity, high blood pressure, high cholesterol, and family history. Young-to-middle age adults (YMAA) are less often identified as being at risk of CVD, but traditional risk scores primarily target older adults and do not accurately estimate risk among YMAA.

Methods

This study examined biomarkers associated with CVD risk in YMAA in the context of HIV and cocaine use; risk was assessed by two methods: (1) a relative cardiovascular (CV) risk score that includes several factors and (2) carotid atherosclerotic plaque. Associations between CVD risk (CV risk score and carotid atherosclerotic plaque) and proinflammatory cytokines, markers of immune activation, HIV status, and cocaine use were examined. Participants ( N = 506) included people with and without HIV and people who use or do not use cocaine.

Results

Participants’ mean age was 36 (SD = 9.53); half (51%) were men. Cocaine use and C-reactive protein were associated with greater relative CV risk scores, but no associations between biomarkers and CV risk emerged. Age and CV risk scores were associated with carotid atherosclerotic plaque, but biomarkers were not. HIV was not associated with CV risk scores or carotid atherosclerotic plaque.

Conclusions

Among YMAA, CV risk scores may help providers identify lifestyle changes needed among those at risk for CVD before more advanced risk (e.g., atherosclerotic plaque) is identified. Implications are discussed.
Translating Thoughts Into Action: Optimizing Motor Performance and Learning Through Brief Motivational and Attentional Influences
Authors: Wulf Gabriele , Lewthwaite Rebecca
Published: November 2021

Skilled motor performance is essential in sports, the performing arts, various occupations, and many daily activities. Scientists and practitioners alike are therefore interested in understanding the conditions that influence the performance and learning of movement skills, and how they can be utilized to optimize training. In OPTIMAL theory, three motivational and attentional factors are key: enhanced expectancies for future performance, the performer’s autonomy, and an external focus of attention. We review recent evidence suggesting that each factor contributes independently to strengthen the coupling of goals to actions. This work has implications ranging from fostering more effective skill development in novice learners, to increasing the efficiency of athletes’ and musicians’ performance, and to facilitating the success of patients in regaining functional capabilities.
Lessons Learnt in Health Management: Paediatric Spinal Tumours: A 6-year Retrospective Review from Central India
Authors: Sharma Pranati , Rege Shrikant V. , Jain Nilesh
Published: November 2021

Background:

From the management perspective, rare medical conditions do not attract enough attention, though their management can often be resource intensive. Increased awareness among health professionals can lead to early diagnosis of cases and prevention of complications leading to improved outcomes. Paediatric spinal tumours are rare disease entities with an annual incidence of approximately 1 per 1 million children. The profile of spinal tumours in the paediatric population is significantly different than that in adults. In this study we retrospectively analyse a heterogenous variety of paediatric spinal tumours which were treated at our institution over the last 6 years, with the goal of contributing to existing knowledge of this relatively rare disease entity.

Methods:

This retrospective study includes paediatric patients (under 18 years of age) who underwent surgery for primary spinal tumours from 2014 to 2019. The medical records were reviewed retrospectively and the information regarding clinical presentation, tumour location, operative findings, and postoperative status and functional outcome were analysed. The modified McCormick grade was used to assess the neurological status. Patients with spinal metastasis or incomplete medical records were excluded from the study.

Results:

Of 74 patients with primary spinal tumours operated at our centre between 2014 to 2019, a total of 8 patients (5 males and 3 females) who met the inclusion criteria were identified for the present study. The mean age of the patients included was 12.1±5.3 and the median follow-up period was 24 months. An improvement in the neurological status, as assessed by the modified McCormick grade, was seen in 37.5% of the patients. Three of the patients received adjuvant radiotherapy, post-surgical resection. A unique feature of this series was the wide variety of cases encountered, as each case had a different histopathological diagnosis, despite being limited by its sample size.

Conclusion:

Primary paediatric spinal cord tumours are rare, and surgical resection remains the treatment of choice. Adjuvant therapy is warranted in cases of high-grade lesions or recurrences. Through this study, we realised that due to its relative rarity and low incidence, a lack of public awareness can often lead to disproportionately increased morbidity and mortality. Prospective multi-centric studies can provide tools to help develop future management strategies for improved survival rates and reduced complications.
Co-movement of Banking Stress Across Emerging and Developed Economies: A Dynamic Factor Model and Wavelet Coherence Approach
Authors: Rajesh S. P.
Published: November 2021

This study develops a robust banking stability indicator for emerging and advanced economies and examines the linkage of banking stress across economies. We contribute by including interbank borrowings and banking sector volatility to measure contagious risk besides the traditional variables. Second, we use aggregate banking sector data for five countries (China, India, Japan, the UK and the USA) from 1998 to 2015 and employ dynamic factor model to develop the index. Results show higher stress levels in the UK and China, and all economies witness increased stress during the 2007–2009 crises, but the recovery phase varies. Finally, we use wavelet coherence analysis and find evidence of stress transmission from emerging economies to other emerging and advanced economies.
Fatigue, Depression, Cardiovascular Risk, and Self-Rated Health: Comparing a Community Sample of Adults to Those With a History of Myocardial Infarction
Authors: Hirsch Sophie , Stephens Alexandria R. , Crane Patricia B.
Published: November 2021

This cross-sectional descriptive study was designed to compare fatigue, depression, cardiovascular risk, and self-rated health in community dwelling adults (CDA) without a history of myocardial infarction (MI) compared to adults who had experienced an MI 3 to 7 years ago. A convenience sample ( n = 40) of CDA completed: demographic health form, Revised Piper Fatigue Scale, and CES-D. Age-matched controls ( n = 40) were randomly selected from the Recurrence of Myocardial Infarction (ROMI) study. Most ( N = 80) were White (66%) with a mean age of 58.3 ( SD = 11.5; range 21–83). The ROMI group reported more diabetes, hypercholesterolemia, obesity, and hypertension, and had higher fatigue ( t(61) = 4.51, p < .001). No differences were noted in depression scores ( p = .952). Higher fatigue and depression scores were correlated with poorer self-rated health: r = .544 ( p < .001) and r = .295 ( p = .008).
Primary Cleft Lip Repair in Adults Under Local Anesthesia
Authors: Das Bijoy Krishna , Dhar Satyajit
Published: November 2021

Objective

There are many adults with cleft lip deformities in developing countries. This is due to the lack of public awareness, social stigma, distance from the health center, and parents' financial condition. Lip repair under local anesthesia is safe, cost-effective and would be beneficial for the underprivileged population.

Design

A retrospective cohort study with follow-up of 1 to 8 years

Setting

Academic Hospital.

Patients/Participants

Cleft lip repair was performed in 252 patients of age more than 12 years from 2012 to 2019. Patients with cleft palate, cardiopulmonary disease, who did not consent for the procedure while awake were excluded.

Interventions

Cleft lip surgery done under local anesthesia

Main Outcome Measures

Outcome measures were patients’ self-satisfaction and comments of peer.

Results

Two hundred fifty-two primary cleft lip operations were done in 168 male and 84 female patients. The mean age was 23.62 years, and the mean weight was 49.66 kg. Unilateral was 227, Bilateral cleft lip 25. The postoperative period was uneventful. No case of wound dehiscence or wound infection was observed. Patients were discharged on the same day, except the ones who traveled a long distance.

Conclusion

Cleft lip repair in adults under local anesthesia is safe and cost-effective.
Longitudinal Skeletal Growth Analysis of Mandibular Asymmetry in Unoperated Patients With Unilateral Craniofacial Microsomia (UCFM)
Authors: Shetye Pradip R. , Grayson Barry H. , McCarthy Joseph G.
Published: November 2021

Purpose

To examine the growth rate discrepancy of the affected and unaffected ramus heights in Pruzansky Type I and Type II mandibles.

Methods

This is a serial retrospective longitudinal growth study of 30 untreated patients (21 males and 9 females) with UCMF (age range from 5 years to 14 years). The mean age of patients was 8.5 years, and the mean follow-up records were 3.7 years. There were 13 patients in group I with a Pruzansky Type I mandible and 17 patients in group II with a Pruzansky Type II. The unaffected side of the mandible served as a control. Eighteen cephalometric parameters were examined at each of the two-time intervals.

Results

In patients with Pruzansky Type I mandible, the affected ramus grew on average 1.41 mm per year; the unaffected ramus grew 1.66 mm per year during the same period. In patients with Pruzansky Type II mandible, the affected ramus grew on average 0.84 mm per year; during the same period, unaffected ramus grew 1.79 per year. When the growth rate of the ramus height on the affected side was compared to the unaffected side, there was no statistically significant difference in Pruzansky Type I mandibles (p > .05); however, there was a statistically significant difference in the Pruzansky Type II mandibles (p < .05).

Conclusion

The growth rate discrepancy of the affected and unaffected ramus heights was more severe in Pruzansky Type II mandibles than Pruzansky Type I mandibles explaining the progressive nature of facial asymmetry in Pruzansky II mandibles.
Multidisciplinary Presurgical Education: Clinical Impact on Children With Orofacial Clefts Undergoing Maxillary Distraction via Rigid External Distraction
Authors: Kim Erinn N. , Moss Whitney D. , Rosales Megan N. , Lyon Natalee , Lotz Analise , Yamashiro Duane K. , Gociman Barbu R. , Siddiqi Faizi A. , Johns Dana N.
Published: November 2021

Objective

Treatment of severe maxillary hypoplasia is commonly addressed via distraction osteogenesis with a rigid external device (RED). While effective, this method can be socially stigmatizing in an already vulnerable patient population. To prepare children and their caregivers for life with a RED and decrease peri-operative anxiety, we instituted a multidisciplinary pre-surgical education session (MPES). This educational team involves our cleft care coordinator, child life specialist, orthodontist and plastic surgeon 2 weeks prior to surgery. We reviewed the impact of this intervention by examining clinical outcomes before and after its implementation.

Design

From February 2017 to February 2020, a retrospective chart review was performed to include patients with orofacial clefts and maxillary hypoplasia who underwent maxillary distraction osteogenesis with RED at our center before (28 patients) and after (29 patients) the implementation of MPES.

Results

MPES was associated with a significantly shorter length of stay compared to controls who did not receive MPES (3.6 vs 3.1 days, p < 0.03) and significantly decreased usage of inpatient narcotic pain medication compared to controls (16.8 morphine equivalents vs 31.8 morphine equivalents, p < 0.02). Our intervention also demonstrated a trend towards decrease in minor complications but did not achieve statistical significance p = 0.32).

Conclusions

Multidisciplinary presurgical education is a beneficial adjunct in the care of patients with orofacial clefts and maxillary hypoplasia undergoing maxillary advancement with a RED.
Childhood Maltreatment and Adolescents’ Aggression: A Moderated Mediation Model of Callous-Unemotional Traits and Friendship Quality
Authors: Li Wenqing , Yang Jiping , Gao Ling , Wang Xingchao
Published: November 2021

A growing body of research has documented that childhood maltreatment is associated with increased risk of child aggression. However, little is known about the mediating and moderating mechanisms underlying the relationships between childhood maltreatment and reactive and proactive functions of aggression. Therefore, the present study examined whether callous-unemotional traits mediated the relationships between childhood maltreatment and two subtypes of aggression and whether these mediating processes were moderated by friendship quality. A cross-sectional study was conducted among 2407 adolescents between 11 and 16 years ( Mage= 12.75, SD = .58) in Shanxi province, China. Participants filled out questionnaires regarding childhood maltreatment, callous-unemotional traits, aggression, and friendship quality. The results indicated that childhood maltreatment was significantly and positively associated with proactive and reactive aggression, and these relationships were partially mediated by callous-unemotional traits after controlling for demographic variables. Friendship quality moderated the relationship between childhood maltreatment and proactive aggression as well as callous-unemotional traits and proactive aggression. These relationships became weaker for adolescents with high levels of friendship quality. Friendship quality did not moderate the effects of childhood maltreatment and callous-unemotional traits on reactive aggression.
Urban Policy in Times of Crisis: The Policy Capacity of European Cities and the Role of Multi-Level Governance
Authors: Cucca Roberta , Ranci Costanzo
Published: November 2021

This article investigates how the policy capacity of urban governments in Europe to deal with the social challenges caused by the 2008-2009 financial crisis, has been strongly shaped by the institutional multi-level governance (MLG) settings in which cities were embedded. We consider the financial crisis as an important ‘stress test’ for urban policy. Urban governments faced a highly complex, trilemmatic situation: they faced not only growing social and economic problems at the local level, but also a process of devolution of institutional responsibility from central to local governments, and important cuts in central funding. Our analysis is based on an empirical investigation carried out between 2009 and 2016 in six major European cities: Barcelona, Copenhagen, Lyon, Manchester, Milan, and Munich. What clearly emerges from the research is that European cities may still show a certain capacity to innovate and govern economic changes and social challenges only if supported by an enabling MLG system.
Crisis-Resilient and Antiracist Approaches to Community-Based Participatory Research During COVID-19 and Beyond
Authors: Boland Sarah E. , Ivanich Jerreed D. , Wesner Chelsea A. , Tuitt Nicole R. , Zacher Tracy , Asdigian Nancy L. , Rumbaugh Whitesell Nancy
Published: November 2021

Social and health inequities among communities of color are deeply embedded in the United States and were exacerbated by the COVID-19 pandemic. Community-based participatory research (CBPR) is a powerful approach to advance health equity. However, emergencies both as global as a pandemic or as local as a forest fire have the power to interrupt research programs and weaken community relationships. Drawing from Public Health Critical Race Praxis (PHCRP), as well as our research experience during the pandemic, this article proposes an expansion of prior CBPR principles with an emphasis on advocacy and storytelling, community investment, and flexibility. The article summarizes key principles of CBPR and PHCRP, contextualizes their relevance in COVID-19, and outlines a practical vision for crisis-resilient research through deeper engagement with antiracism scholarship. Structural barriers remain an issue, so policy changes to funding and research institutions are recommended, as well, to truly advance health equity.
Turning disability into a business: Disabled entrepreneurs’ anomalous bodily capital
Authors: Jammaers Eline , Williams Jannine
Published: November 2021

In a time and place where being impaired is equated to being of lesser economic value, some disabled people take matters into their own hands by creating their own job and converting their bodily difference into bodily capital. This paper uses a Bourdieuan lens to discover what sets apart disabled entrepreneurs who build their business around disability and those who do not. Building on the experiences of 40 entrepreneurs, we outline the existence of certain bodily and mental schemata that lead to a body habituated to run a business centred around one’s impairment and experience of living as a disabled person in an ableist world. We specify such ‘anomalous’ bodily capital and discuss the constraints to its conversion related to the social environment and impairment effects. This study speaks back to the literature on disability in organizational contexts by extending the ‘value in disability’ debate whilst remaining cognizant of the danger of ‘supercrip’ stereotyping and disability ghettoization. In addition, the complex structure/agency interplay inherent to the practice of leveraging anomalous bodily capital offers a contribution to entrepreneurship research that tends to adhere to a simplistic view of the body.
Governing Corporeal Movement in India during the COVID-19 Pandemic
Authors: Holwitt Pablo
Published: November 2021

This article explores the impact of the COVID-19 pandemic on the relationship between bodies, risk and mobility. Drawing upon ethnographic data from India, it is argued that measures taken by the Indian government to contain the spread of the pandemic link mobile bodies to the notion of risk which has profound consequences for the way in which people access and engage with public spaces in Indian cities. In this process, a new type of body – the risky mobile body – is produced. At the same time, these measures run into problems due to the volatile nature of knowledge about bodies and diseases that they rely on. While the mobility of the COVID-19 virus is a subject of public debate, the fluidity and open-endedness of mobile bodies makes them difficult to regulate. This mismatch between governmental logics and unknowable bodies constitutes a significant challenge for the fight against the pandemic.
Topical cidofovir for benign human papillomavirus–associated skin lesions
Authors: Napolitano Larry , Schroedl Liesl , Kerman Alexander , Shea Christopher R
Published: November 2021

Cidofovir is a broad-spectrum antiviral agent that has shown efficacy against skin lesions caused by human papillomavirus (HPV). We present a case of extensive verruca vulgaris lesions refractory to imiquimod that was responsive to topical cidofovir therapy, and analyze other case series in the literature of successful treatment of benign HPV-associated skin lesions with topical cidofovir. Topical cidofovir’s favorable response rate and tolerability make it a useful treatment option for patients of differing ages and immune status who have nonmalignant HPV-associated skin lesions and desire topical therapy.
The relative importance of clinical factors in initiating interfacility transfer of major trauma patients: A discrete choice experiment
Authors: Lin Steve , Nolan Brodie , Dashi Gerhard , Nathens Avery B
Published: November 2021

Introduction and Objectives

Approximately 30% of patients meeting severe injury criteria are never transferred to lead trauma centers (LTCs). The reasons for this gap are not fully understood but involve both system-level factors and individual decision-making. We used a method called discrete choice modeling (DCM) to evaluate which clinical and demographic patient factors might make emergency physicians more likely to initiate transfers to LTCs.

Methods

An email survey was distributed to physicians working in emergency departments (EDs) in Ontario. The relative importance of clinical and demographic patient attributes as drivers for transfer was evaluated using DCM. Simulated patient cases were created using a random generator to combine attributes. Each respondent was presented with 36 different patients in sets of three and asked if they would transfer each patient to an LTC. The relative importance of each driver was then compared across physician characteristics.

Results

One hundred and fifty three emergency physicians completed the survey. The drivers for transfer, expressed as utility scores, were derangements in hemodynamics (22), CNS/head injuries (19), pelvic fractures (11), chest injuries (10), comorbidities (9), abdominal injuries (8), extremity injuries (7), mechanism of injury (7), age (5), and gender (2). Drivers for patient transfer did not differ based on physician experience or type of training.

Conclusion

In this DCM study, the clinical and demographic factors most likely to make emergency physicians consider patient transfers to LTCs were patient hemodynamic derangements and CNS/head injuries. Overall, these drivers did not differ by physician experience or training. An understanding of such patient-level drivers for transfers to LTCs may improve the implementation of evidence-based interfacility transfer criteria.
Clinical profile of ocular trauma at a tertiary care hospital in South India: A retrospective study
Authors: Wadwekar Bhagwati , Hansdak Amod , Sahu Pratima , Karnam Ali Hasan F , Sanjana Elfride F
Published: November 2021

Introduction

Ocular injury is the commonest ocular emergency and can vary across geographical and socioeconomic regions. This study was conducted to determine the pattern of ocular injuries presenting to our tertiary care hospital located in Puducherry, Southern India.

Methods

A retrospective hospital-based study was performed and analyzed the records of the patients who presented with ocular injuries to the emergency department between January 2016 and December 2017. Data were collected using a structured format and noted the demographic profile and clinical profile of ocular injury.

Results

Of the 392 ocular emergencies, 318 (81.1%) were caused by ocular trauma. Mechanical trauma was most common (306; 96.2%). Males were more frequently affected (ratio; 3.7:1). Most cases of trauma belonged to the 21–30 years age group (86, 28.1%) and were caused by road traffic accidents (RTAs) (197; 64.4%). Adnexal injuries were commonest (285; 93.1%). The ocular injury was close globe type in 93 (30.4%) and the open globe in three (1.0%). Serious lid injury was present in 71 cases (23.2%). Serious injuries such as globe rupture and traumatic optic neuropathy were present in three (1.0%) and eleven (3.6%) cases, respectively.

Conclusion

Ocular trauma is the most common cause of ocular emergencies and RTA is the commonest cause of ocular trauma. We need to explore strategies to minimize ocular trauma as a priority.
Characteristics associated with delays in decision to transfer injured patients
Authors: Myers Victoria , Nolan Brodie
Published: November 2021

Introduction

The regionalized nature of trauma care necessitates interfacility transfer which is vulnerable to delays given its complexity. Little is known about the interval of time a patient spends at the sending hospital prior to when the transfer is initiated—the “decision to transfer” time. This primary objective of the study was to explore the impact of patient, environmental, and institutional characteristics on decision to transfer time.

Methods

This was a retrospective cohort study of injured adult patients who underwent emergent interfacility transfer by a provincial critical care transport organization over a 31-month period. Quantile regression was used to evaluate the impact of patient, environmental, and institutional characteristics on the time to decision to transfer.

Results

A total of 1128 patients were included. The median decision to transfer time was 2.42 h and the median total transport time was 3.12 h. The following variables were associated with an increase in time to decision to transfer at the 90th percentile of time: age >75 (+2.47 h), age 66–75 (+3.70 h), age 56–65 (+1.20 h), transfer between 00:00 and 07:59 (+2.08 h), and transfer in the summer (+2.25 h). The following variables were associated with a decrease in time to decision to transfer at the 90th percentile of time: Glasgow Coma Scale 3–8 (−2.21 h), respiratory rate >30 (−2.01 h), sending site being a community hospital with <100 beds (−4.11 h), or the sending site being a nursing station (−5.66 h).

Conclusion

Time to decision to transfer was a sizable proportion of the patients interfacility transfer. Older patients were associated with a delay in decision to transfer as were patients transferred overnight and in the summer. These findings may be used to support the implementation of geriatric trauma triage guidelines and promote ongoing education and quality improvement initiatives to decrease delay.
A cross-sectional study of exposure across social media platforms for the British Orthodontic Society retention awareness campaign: #HoldthatSmile
Authors: Lam Yung , Seehra Jadbinder , Abela Stefan , Cobourne Martyn T
Published: November 2021

Objective:

The use of media campaigns in health promotion has become more common in recent years. #HoldthatSmile is a British Orthodontic Society life-long retention awareness campaign aimed at the general public and dental profession launched in 2017. This study investigated #HoldthatSmile exposure on social media platforms over a 12-month period following campaign launch.

Design:

A cross-sectional content analysis.

Setting:

Public-facing, English-language posts tagged #HoldthatSmile on the Facebook, Instagram and Twitter social media platforms.

Methods:

Data were collected relating to a 12-month period, from September 2017 immediately following campaign launch, to the end of September 2018. The primary outcome was exposure to the #HoldthatSmile campaign on the different platforms through analysis of posts, measurement of audience reached and engagement. Secondary outcomes included demographics of user-types and content analysis of reactive comments on posts.

Results:

A total of 205 relevant posts with #HoldthatSmile were identified on Twitter (n=90, 43.9%), Facebook (n=64, 31.2%) and Instagram (n=51, 24.9%) with an overall calculated audience reach of 108,807 individuals. There were 1849 reactions across the three platforms. The percentage of reactions that generated comments was low at 3%, 6.1% and 5.7% for Twitter, Facebook and Instagram, respectively. Just over three-quarters of users were either Dental Surgeries (53%) or Professional Dental Bodies (28%) and the vast majority were from the United Kingdom. Overall, most comments were positive (46%, n=36) or neutral (44%, n=35) with only 10% (n=8) negative. The overriding theme was a person’s name, with the user commonly typing a friend’s name in order to bring their attention to the post.

Conclusion:

There were a relatively low number of posts relevant to #HoldthatSmile on Twitter, Facebook and Instagram over the campaign’s first 12 months. However, the majority of these did convey positive or neutral messages.
A 24-hour lighting scheme to promote alertness and circadian entrainment in railroad dispatchers on rotating shifts: A field study
Authors: Sahin L , Figueiro MG
Published: November 2021

Shift-working railway personnel are highly susceptible to fatigue stemming from poor-quality sleep that can impair the performance of safety-critical functions. Disruption of the 24-h light–dark pattern incident on the retinae appears to play a central role in exacerbating these problems, especially with respect to exposure to light at night and circadian rhythms disruption. This field study tested and demonstrated the effectiveness and acceptability of an intervention (red and blue light combined with white light) to (1) promote circadian alignment, (2) advance the timing of dim light melatonin onset, (3) improve objective and subjective sleep quality, and (4) reduce subjective sleepiness in an operational context compared to a baseline (conventional lighting) condition. The lighting intervention promoted significantly greater synchrony between day-shift participants’ light–dark exposures and rest–activity patterns, but did not significantly advance the timing of dim light melatonin onset. The intervention was also associated with reduced objective sleep disturbances and improved (albeit less robustly) subjective sleep quality, but it only reduced participants’ subjective sleepiness while they were off duty during the day shift. This research demonstrates that lighting interventions can promote circadian alignment and improve sleep quality among railway shift workers and may be translatable to other 24-h industries.
Test a Witness’s Memory of a Suspect Only Once
Authors: Wixted John T. , Wells Gary L. , Loftus Elizabeth F. , Garrett Brandon L.
Published: November 2021

Eyewitness misidentifications are almost always made with high confidence in the courtroom. The courtroom is where eyewitnesses make their last identification of defendants suspected of (and charged with) committing a crime. But what did those same eyewitnesses do on the first identification test, conducted early in a police investigation? Despite testifying with high confidence in court, many eyewitnesses also testified that they had initially identified the suspect with low confidence or failed to identify the suspect at all. Presenting a lineup leaves the eyewitness with a memory trace of the faces in the lineup, including that of the suspect. As a result, the memory signal generated by the face of that suspect will be stronger on a later test involving the same witness, even if the suspect is innocent. In that sense, testing memory contaminates memory. These considerations underscore the importance of a newly proposed recommendation for conducting eyewitness identifications: Avoid repeated identification procedures with the same witness and suspect. This recommendation applies not only to additional tests conducted by police investigators but also to the final test conducted in the courtroom, in front of the judge and jury.
Enhancing the labor division in the balancing of apparel assembly lines with parallel workstation through an improved ant colony algorithm
Authors: Xie Ziang , Du Jinsong , Chen Qingting , Wang Xiaotong
Published: November 2021

In order to overcome the inefficiency of labor division and management confusion in garment manufacturing assembly lines when introducing parallel workstations, an improved ant colony optimization (IACO) algorithm with multi-pheromones is proposed in this paper, which provides a new strategy to improve the match degree of operators and tasks in garment assembly line with parallel workstations. In proposed IACO, the first pheromone is set for ant to improve the efficiency of lines efficiency by balancing the workload allocation among workstations, and the second pheromone determines whether to create parallel workstations by valuing the complexity distribution of tasks. Existing real data of a garment manufacturing factory is used to verify the effective of IACO and the result shows that IACO contributes to a smooth work flow, and simultaneously reduce the efficiency loss of labor divisions (ELLD). Moreover, experiments are conduct to explore the trade-off relation between labor division and line arrangement efficiency when introducing parallel workstations. And based on the relation, strategies to create parallel workstations in the assembly line is provided for garment factories with different staff qualities for different apparel products.
Cost-effectiveness of mechanical thrombectomy for acute ischemic stroke in Brazil: Results from the RESILIENT trial
Authors: de Souza Ana Claudia , Martins Sheila O , Polanczyk Carisi Anne , Araújo Denizar Vianna , Etges Ana Paula BS , Zanotto Bruna Stella , Neyeloff Jeruza Lavanholi , Carbonera Leonardo Augusto , Chaves Márcia Lorena Fagundes , de Carvalho João José Freitas , Rebello Letícia Costa , Abud Daniel Giansante , Cabral Lucas Scotta , Lima Fabrício O , Mont’Alverne Francisco , SC Magalhães Pedro , Diegoli Henrique , Safanelli Juliana , André Silveira Salvetti Thales , de Sousa Mendes Parente Bruno , Eli Frudit Michel , Silva Gisele Sampaio , Pontes-Neto Octávio M , Nogueira Raul G
Published: November 2021

Background

The RESILIENT trial demonstrated the clinical benefit of mechanical thrombectomy in patients presenting acute ischemic stroke secondary to anterior circulation large vessel occlusion in Brazil.

Aims

This economic evaluation aims to assess the cost-utility of mechanical thrombectomy in the RESILIENT trial from a public healthcare perspective.

Methods

A cost-utility analysis was applied to compare mechanical thrombectomy plus standard medical care (n = 78) vs. standard medical care alone (n = 73), from a subset sample of the RESILIENT trial (151 of 221 patients). Real-world direct costs were considered, and utilities were imputed according to the Utility-Weighted modified Rankin Score. A Markov model was structured, and probabilistic and deterministic sensitivity analyses were performed to evaluate the robustness of results.

Results

The incremental costs and quality-adjusted life years gained with mechanical thrombectomy plus standard medical care were estimated at Int$ 7440 and 1.04, respectively, compared to standard medical care alone, yielding an incremental cost-effectiveness ratio of Int$ 7153 per quality-adjusted life year. The deterministic sensitivity analysis demonstrated that mRS-6 costs of the first year most affected the incremental cost-effectiveness ratio. After 1000 simulations, most of results were below the cost-effective threshold.

Conclusions

The intervention's clear long-term benefits offset the initially higher costs of mechanical thrombectomy in the Brazilian public healthcare system. Such therapy is likely to be cost-effective and these results were crucial to incorporate mechanical thrombectomy in the Brazilian public stroke centers.
Longitudinal treatment responsiveness on plasma neurofilament light chain and glial fibrillary acidic protein levels in neuromyelitis optica spectrum disorder
Authors: Zhang Tian-Xiang , Chen Jing-Shan , Du Chen , Zeng Pei , Zhang Huiming , Wang Xuejiao , Liu Ye , Huang Zhenning , Yuan Meng , Li Yu-Lin , Jia Dongmei , Shi Fu-Dong , Zhang Chao
Published: November 2021

Background:

Neurofilament light chain (NfL) and glial fibrilliary acidic protein (GFAP) have been suggested to be biomarkers of the pathophysiological process of neuromyelitis optica spectrum disorders (NMOSD), but the relationship between the plasma levels of these molecules with disease activity and treatment is incompletely understood.

Objective:

To investigate the treatment effects of disease-modifying drugs on plasma neurofilament light chain (pNfL) and plasma glial fibrillary acidic protein (pGFAP) and explore the predictive value of pNfL and pGFAP in the activity of NMOSD.

Methods:

pNfL and pGFAP levels were measured using single-molecule arrays in 72 patients with NMOSD and 38 healthy controls (HCs). Patients with NMOSD received tocilizumab ( n = 29), rituximab ( n = 23), oral prednisone ( n = 16), and oral azathioprine or mycophenolate mofetil ( n = 4).

Results:

NMOSD patients had significantly higher pNfL and pGFAP levels than HCs (pNfL, 18.3 (11.2–39.3) versus 11.5 (7.0–23.3) pg/mL; p = 0.001; pGFAP, 149.7 (88.6–406.5) versus 68.7 (59.4–80.8) pg/mL; p < 0.001). Multivariable regression analyses indicated that baseline pNfL concentration was associated with age ( p = 0.017), Expanded Disability Status Scale (EDSS) score ( p = 0.002), and recent relapses ( p < 0.001). Baseline pGFAP concentration was also associated with EDSS ( p < 0.001) and recent relapses ( p < 0.001). Compared with prednisone, tocilizumab and rituximab significantly reduced pNfL [tocilizumab, exp(β), 0.65; 95% confidence interval (CI), 0.56–0.75; p < 0.001; rituximab, exp(β), 0.79; 95% CI = 0.68–0.93; p = 0.005] and pGFAP levels [tocilizumab, exp(β), 0.64; 95% CI, 0.51–0.80; p < 0.001; rituximab, exp(β), 0.77; 95% CI, 0.61–0.98; p = 0.041] at the end of the study. The pNfL levels in the tocilizumab and rituximab groups were reduced to those of HCs [tocilizumab, 8.5 (7.06–17.90) pg/mL; p = 0.426; rituximab, 14.0 (9.94–21.80) pg/mL; p = 0.216]. However, the pGFAP levels did not decrease to those of HCs in NMOSD patients at the end of study [tocilizumab, 88.9 (63.4–131.8) pg/mL; p = 0.012; rituximab, 141.7 (90.8–192.7) pg/mL; p < 0.001].

Conclusion:

pNfL and pGFAP may serve as biomarkers for NMOSD disease activity and treatment effects.
Delivering urgent oral healthcare in Sub-Saharan Africa: supporting sustainable local development
Authors: England Rachael , Paterson Andrew , Jones Adam
Published: November 2021

Oral disease continues to be a public health burden, affecting almost half of the global population, and disproportionately affecting the most vulnerable communities.1 Development organisations use different approaches to tackle this through short-term volunteering programmes in low- and middle-income countries, to address oral health needs in a variety of ways. There is evidence that volunteering requires a high level of cultural competence to avoid negatively impacting on local healthcare systems.2-4

The oral health care needs of communities in Sub-Saharan Africa (SSA) differ markedly from those in the developed world, posing challenges for volunteering organisations to provide effective programmes in circumstances where there is a lack of resources, equipment and infrastructure.
Provision of dental care by public health dental clinics during the COVID-19 pandemic in Alberta, Canada
Authors: Rabie Heidi , Figueiredo Rafael
Published: November 2021

Objectives:

This study aims to describe dental services provided to a low income population in dental public health settings during the first wave of COVID-19 pandemic in Alberta, Canada.

Methods:

Routinely collected clinical data were recorded by dentists in electronic medical record files at Alberta’s two Public Health Dental Clinics (PHDCs). Patient contact was via teledentistry or in person, respecting phased provincial pandemic restrictions. A descriptive analysis of data relating to all patients contacting PHDC with dental problems between 17 March - 31 October 2020 was undertaken and compared to equivalent pre-COVID 2019 data.

Results:

In the period examined, 851 teledentistry consultations and 1031 in person visits were performed. Compared to the same period in 2019, 46% fewer patients were treated, representing a decrease in dental procedures: tooth extractions (17%), silver diamine fluoride applications (17%), endodontic treatments (82%) and fillings (84%). By contrast, prescriptions increased by 66% overall; representing 76%, 121% and 44% in antibiotics, non-opioid analgesics, and opioid analgesics respectively. In both years, antibiotics were the most prescribed drugs (66% in 2019 versus 62% in 2020) followed by non-opioid analgesics (28% in 2019 versus 33% in 2020); opioids accounted for the remainder (6.5% in 2019 and 5% in 2020). The largest drug prescription increases occurred during April-May 2020, when access to care was most restricted: antibiotics and non-opioid analgesics were 300% and 738% higher than the same time in 2019.

Conclusions:

Teledentistry and pharmacotherapy were used to triage and organise dental patients accessing care during the early stages of the pandemic. However, teledentistry did not replace definitive in person dental treatment, particularly for low income populations with high incidence of toothache and odontogenic infection. Reduced provision of dental procedures was accompanied by an increase in drug prescribing. Expedient access to care must be provided to address the dental needs of this population avoiding risks of further complications associated with infection and overprescribing antibiotics and opiates.
“Then COVID happened…”: Veterans’ Health, Wellbeing, and Engagement in Whole Health Care During the COVID-19 Pandemic
Authors: Purcell Natalie , Sells Joanna , McGrath Sarah , Mehlman Haley , Bertenthal Daniel , Seal Karen H
Published: November 2021

Background

Little is known about the COVID-19 pandemic’s impact on US military veterans’ health, wellbeing, and care engagement. Healthcare systems like VA need additional information about the pandemic’s biopsychosocial impacts and how a Whole Health approach may help to address them.

Objective

To examine how the pandemic has affected veterans’ health, wellbeing, and engagement in the VA Whole Health System of Care.

Method

We conducted qualitative interviews with 40 veterans at a large multicampus VA healthcare system during the pandemic. Informed by a Whole Health approach, interviews used open-ended questions to holistically explore pandemic impacts on mental and physical health, healthcare access and engagement, social support, coping strategies, and use of VA healthcare and wellness services. Interviews were conducted by telephone, audio-recorded, and analyzed using a matrix-based technique. Interviews were supplemented by an original survey assessing pandemic impacts; descriptive frequencies were calculated to describe and characterize the interviewed sample.

Interview Results

Nearly, all participating veterans described significant pandemic impacts on their wellbeing, especially loneliness and sorrow stemming from isolation and disruptions to ordinary routines. These emotional impacts—sometimes combined with new constraints on care access and personal mobility—disrupted veterans’ health plans and sometimes deterred engagement in both routine and wellness care. Veterans already struggling with chronic mental and physical health conditions and those who experienced transitions or losses during the pandemic described the most severe impacts on their wellbeing. Virtual VA wellness services, especially health coaching and mind-body wellness groups, were a key source of support and connection for those who engaged in them.

Conclusion

We discuss the implications of our findings for care systems attempting to implement a Whole Health System of Care, including how they can address postpandemic barriers to engagement in healthcare and wellness programs, and how wellness programs can be leveraged to support those most at risk after the COVID-19 pandemic and in future crises.