bluuebunny/crossref_metadata_2025 huggingface dataset:
Infinity Ankle Arthroplasty Early Latin-America Experience and Patient Outcomes
Authors: Baumfeld Daniel , Baumfeld Tiago , Fernandes Rezende Ricardo , Nery Caio , Guerreiro Santiago
Published: June 2022

Introduction

The promising data from Ankle Arthroplasty are consequence of the evolution of instruments and implants. Recent studies have shown good results in the short and intermediate follow-up, in addition to high patient satisfaction. The aim of this study is to present the results obtained with 49 cases treated with the Infinity total ankle prosthesis in 2 South America countries.

Methods

This is a case series of 48 patients (27 women and 22 men), treated with 49 Infinity prostheses in Brazil and Colombia. They underwent surgical treatment between April 1, 2016, and January 18, 2020. We used the visual-analogue pain scale (VAS), the AOFAS score for ankle and hindfoot and the measurement of range of motion (ROM) in the pre- and post-surgical period. The radiological evaluation was performed on ankle radiographs in anteroposterior and lateral views, obtained in orthostasis, measuring the parameters suggested by Hintermann. Average follow-up was 4 years.

Results

VAS reduced from an average of 7.94 to 1.98; AOFAS increased from 28.02 to 83.16 and ROM increased from 11.45 to 28.08. Distal Tibial Slope is higher for higher improvements in VAS and lower for higher improvements in AOFAS and ROM. We observed 4 wound infections, 1 intra-op medial malleolus fracture. No bone cysts, tibial or talar components subsidence, polyethylene component wear or failure were observed. No salvation procedures were required in this series.

Discussion

This study results corroborates literature data showing great improvements in pain, functional pattern, and movement.

Conclusion

Infinity Ankle Arthroplasty is a safe and reproducible procedure with good outcomes at a short-term follow-up.

Level of evidences:

4 - Case series
Zero-hours contracts and english employment law: Developments and possibilities
Authors: Atkinson Joe
Published: June 2022

The UK has seen a dramatic growth in precarious work over recent decades, including the amorphous category of ‘zero-hours contracts’ which are often regarded as a paradigm example of an exploitative and insecure form of work. Although somewhat overshadowed by litigation and debates surrounding the gig-economy, the regulation of zero hours work continues to be a pressing issue in the UK, and important questions as to the rights that are, and should be, available to individuals with these contracts remain unanswered. This article sets out the detrimental effects that zero hours working arrangements have in the absence of adequate regulatory safeguards and argues that the orthodox treatment of zero hours contracts under English law, and the standard tools of employment law, fail to protect against these economic and social harms. The article then assesses the extent to which recent legislative and common law developments improve the position of zero hours workers, and whether existing legislation might be creatively applied to better protect these individuals. While current statutory frameworks, including reforms and legislation aimed at regulating atypical work, fall short of adequately protecting zero hours workers, the ‘purposive approach’ to employment status developed by the Supreme Court in Uber makes it considerably easier for zero hours contracts to be brought within the protective scope of employment law. It is argued that under this approach many individuals with supposedly ‘zero hours’ working arrangements should in fact now be regarded as employees with overarching contracts of employment. Despite the significance of this, however, it is ultimately concluded that further statutory intervention is necessary to effectively regulate zero hours work in the UK.
Technology-supported models of nutrition care: Perspectives of health service providers
Authors: Barnett Amandine , Kelly Jaimon T , Wright Charlene , Campbell Katrina L
Published: June 2022

Objective

To determine the perspectives to the adoption, scale-up, sustainability, and spread of technology-supported models of nutrition care, in hospital and ambulatory care settings.

Methods

Thirty-one health service providers participated in individual semi-structured interviews from a tertiary health service in Queensland, Australia. The Non-adoption, Abandonment, and challenges to the Scale up, Spread and Sustainability (NASSS) framework, designed to evaluate technology-supported models’ success, informed the qualitative design.

Results

Key findings were that technology-supported models of care could benefit many chronic condition patient groups; dietitians are well suited to adopting this technology: and the value proposition in creating efficiency gains in the health service. However, challenges of transitioning and sustainability were identified. Perceived enablers for technology supported models of care included: previous intentions for technology supported models of care prior to the 2019 novel coronavirus pandemic; opportunity for clinicians to complete higher valued tasks; and integration of technology systems and assisted staff roles. Perceived barriers included: suitability for patients is dependent on experience and ability to use technology, varied confidence by clinicians when conducting clinical assessments; high investment required for set up and ongoing maintenance; and patients desire for adopting face-to-face care over technology. Health service providers perceived that embedding and adapting such models requires maintenance of high-quality service and continued research.

Conclusions

Health service providers recognize adopting, scaling, and sustaining technology-supported models of nutrition care benefits patients, clinicians, and health services in general. Robust clinical trials and health service evaluations of technology-supported models of care, across practice settings are now needed.
Talent Management and Its Impact on Organizational Commitment: An Empirical Investigation of Indian Hospitality Industry
Authors: Bahuguna P.C. , Bangwal Deepak , Kumar Rajeev
Published: June 2022

The hospitality industry grapples with many workforces related issues like many other industries. Talent retention, turnover, commitment are significant issues in the hospitality industry in India. As a result of macro-level concerns such as the recent pandemic, the hospitality industry has started viewing talent management (TM) as a strategic lever to enhance organizational performance through committed and engaged employees. However, though organizational commitment has been an important research topic, only a few studies have been conducted on TM and organizational commitment in the Indian hospitality sector. Therefore, after the review of literature on the related field, the study tested three hypotheses to examine the causal relationship between TM practices and organizational commitment. Structural equation modelling using AMOS 26 was used to find empirical evidence in favour of the proposed hypotheses. The result of the study, showed that TM practices of the hospitality industry significantly influences the organizational commitment among the employees.
Is There an Association in Young Patients Between Quadriceps or Hamstring Strength After ACL Reconstruction and Graft Rupture?
Authors: Blucher Nicola C. , Feller Julian A. , Devitt Brian M. , Klemm Haydn J. , Whitehead Timothy S. , McClelland Jodie A. , Webster Kate E.
Published: June 2022

Background:

Younger patients who sustain anterior cruciate ligament (ACL) ruptures are at high risk for reinjury after ACL reconstruction. Restoring muscle strength before return to sports (RTS) is regarded as an important factor in reducing the reinjury risk, and quadriceps and hamstring strength assessment is commonly included in RTS testing. However, it is not clear whether reduced strength is a risk factor for subsequent graft rupture in this patient population.

Purpose:

To investigate the association between quadriceps and hamstring strength at 12 months after primary ACL reconstruction and ACL graft rupture in young patients.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

The cohort consisted of 210 patients (100 men and 110 women) who were younger than 20 years at the time of primary ACL reconstruction with a hamstring tendon autograft and who had no previous contralateral ACL injury. Isokinetic strength testing (60 and 180 deg/s) of knee flexors and extensors was performed at 12 months postoperatively, and the limb symmetry index (LSI) for each strength outcome was calculated. RTS rates and the incidence of further ACL graft ruptures were recorded.

Results:

Measures of central tendency (mean and median) of LSI values ranged from 88 to 98. The percentage of patients with LSI ≥90 was 57% to 69% for quadriceps strength and 45% to 47% for hamstring strength. Overall, 19 patients (9%) sustained an ACL graft rupture. No significant differences were found between the patients who sustained an ACL graft rupture and those who did not in terms of quadriceps and hamstring strength at 12 months. No significant associations were found between achieving LSI ≥90 for quadriceps peak torque and subsequent ACL graft rupture.

Conclusion:

In young patients who underwent an ACL reconstruction, no association was noted between quadriceps and hamstring strength at 12 months postoperatively and subsequent graft ruptures. The role of strength testing as part of the RTS criteria after ACL reconstruction, and specifically the use of limb symmetry thresholds, warrants further investigation and clarification.
Epidemiology and Outcomes of Ankle Injuries in the National Football League
Authors: Desai Sohil S. , Dent Craig S. , Hodgens Blake H. , Rizzo Michael G. , Barnhill Spencer W. , Allegra Paul R. , Popkin Charles A. , Aiyer Amiethab A.
Published: June 2022

Background:

Traumatic ankle injuries are commonly complicated by persistent symptoms and the development of chronic ankle instability.

Purpose:

To describe the epidemiology of ankle injuries in the National Football League (NFL) and investigate the effects that ankle injuries have on performance metrics in the years after injury.

Study Design:

Descriptive epidemiologic study.

Methods:

Ankle injuries sustained by NFL players during the 2015-2016, 2016-2017, and 2017-2018 seasons were identified using the Pro Football Reference database. Cumulative incidence was calculated, and demographic identifiers were collected for each injury. The return-to-play (RTP) rate was also recorded. For each player who met inclusion for the performance analysis, power rating (PR) was calculated for the preinjury season (Y–1) and 2 postinjury seasons (Y+1 and Y+2) as follows: PR = ( offensive yards/10) + ( total touchdowns × 6) + ( combined tackles) + ( sacks × 2) + ( interceptions × 2). Mean PRs were calculated for each season as well as the percentage change and mean difference in PR between Y–1 and Y+1 (ΔPR1%, ΔPR1) and between Y–1 and Y+2 (ΔPR2%, ΔPR2). Subgroup analyses of PR were performed by player position, injury type, and years of experience.

Results:

Overall, 668 ankle injuries were identified, with an average cumulative incidence across the 3 seasons of 11.2% and RTP rate of 91%. Of those injuries, 159 met inclusion criteria for the PR analysis. The mean overall PR (96.95 in Y–1) declined 22% in Y+1 to 76.10 (–20.85 [95% CI, –13.82 to –27.89]; P < .001) and 27% in Y+2 to 70.93 (–26.02 [95% CI, –18.04 to –34.00]; P < .001). The mean PR per game played (6.70 in Y–1) decreased 14% in Y+1 to 5.75 (–0.95 [95% CI, –0.56 to –1.34]; P < .001) and 17% in Y+2 to 5.54 (–1.16 [95% CI, –0.63 to –1.62]; P < .001).

Conclusion:

It was found that ankle injuries hampered the performance of NFL players, even multiple years after the injury occurred, despite a relatively high RTP rate. There was a decrease in total games played after ankle injuries as well as a decreased performance output per game played.
A systematic review of the academic achievement of primary and secondary school-aged students with developmental language disorder
Authors: Ziegenfusz Shaun , Paynter Jessica , Flückiger Beverley , Westerveld Marleen F
Published: June 2022

Background and aims

The ability to communicate is a fundamental skill required to participate in school. Students with Developmental Language Disorder (DLD) have persistent and significant language difficulties that impact daily functioning. However, the impact of DLD on the academic achievement of primary and secondary school-aged students has received limited attention.

Methods

A systematic review of the empirical research published between 2008 and 2020 was undertaken to identify studies that have examined the academic achievement of school-aged students with DLD within curriculum areas. A total of 44 studies were identified that met inclusion criteria for review.

Results

Students with DLD demonstrated difficulties with academic achievement across all measured curriculum areas compared to their typically developing peers. Most studies focused on literacy skills, including reading, spelling, writing and narratives.

Conclusions and implications

The performance of students with DLD was heterogeneous with individual students demonstrating relative strengths in some areas of academic achievement. The implications of these results for educational practices and future research are discussed.
Cross-border division of labor and China’s border control upon Myanmar migrants
Authors: Li Cansong , Su Xiaobo
Published: June 2022

Border cities in Yunnan, China, have become attractive destinations among Myanmar migrants. Using Ruili as a case study, this paper analyzes China’s border control upon Myanmar migrants to create a cross-border division of labor. It finds that China experiments with a flexible model of border control by allowing Myanmar migrants to cross the border with relative ease and integrate into the local labor market, while denying their rights to civil protection and limiting their mobility to other Chinese cities. This model promotes and regulates the movement of Myanmar migrant workers, constituting a pragmatic order to facilitate the logic of capital accumulation. The cross-border division of labor in production between Ruili and northern Myanmar articulates a spatially uneven structure of capitalist production that creates incentive and hinderance to low-end workers’ transnational migration and, moreover, reflects the Chinese state’s efforts to encourage industrial relocation from the affluent coast to the poor hinterland to address regional disparity.
Erdafitinib-Induced Secondary Maculopathy
Authors: Becker Brian , El Hamichi Sophia , Gold Aaron S. , Murray Timothy G.
Published: June 2022

Purpose:

This work presents a case of secondary maculopathy associated with the use of erdafitinib (Balversa) for the management of bladder urothelial carcinoma with bony metastasis.

Methods:

A case report is presented.

Results:

A 58-year-old Hispanic man presented with blurry vision 3 weeks after starting erdafitinib for the management of bony metastases associated with urothelial carcinoma. A comprehensive evaluation identified multiple areas of subretinal fluid induced by erdafitinib. Throughout treatment, the ocular condition progressed, causing worsening of vision; this led to discontinuation of the drug. Discontinuation was associated with visual and anatomic function improvement.

Conclusions:

Fibroblast growth factor receptor (FGFR) plays a major role in maintaining mature and premature retinal pigment epithelium cells. Drugs that inhibit the FGFR pathway block the activation of the mitogen-activated protein kinase pathway, leading to synthesis of antiapoptotic proteins. Erdafitinib is associated with ocular toxicity and leads to multifocal pigment epithelial detachments associated with secondary subretinal fluid.
Specialist and Patient Perspectives on Strategies to Improve Cardiovascular Disease Prevention Among Persons Living With Psoriatic Disease
Authors: Gustafson Alix C. , Gelfand Joel M. , Davies Julia , Lieberman Adina E. , Mason Jennifer B. , Armstrong April W. , Ogdie Alexis , Mehta Nehal N. , Barbieri John S. , Beidas Rinad S.
Published: June 2022

Background

Psoriasis is an immune-mediated disease associated with excess risk for cardiovascular disease (CVD). Guidelines recognize psoriasis as a CVD risk enhancer; however, psoriasis patients often do not have CVD risk factors identified nor managed.

Objective

This study examines strategies to improve CVD prevention care from the perspective of physicians and patients with psoriasis.

Methods

Qualitative interviews were conducted using the Consolidated Framework for Implementation Research to examine the perspectives of physicians (N = 16) and patients with psoriatic disease (N = 16) on barriers and facilitators to CVD prevention. Interviews were transcribed and coded using an integrated approach designed to enhance reliability and validity using NVivo software.

Results

We found 3 major themes suggesting areas to target for the future: (1) Appropriateness: perceptions of whether CVD care should be deployed in this setting by both physicians and patients, (2) Feasibility: whether CVD prevention care could be integrated into the current structure of specialist practice, and (3) Care Coordination: an interest by all parties to better integrate a team approach in CVD preventative care to reduce duplicative efforts, work practically in an already existing system rather than reinventing the wheel, and progress with the patients’ best interests in mind.

Conclusions

These findings will inform the design of a clinical trial comparing the effectiveness of specialist clinician implementation of CVD guideline-based prevention care in patients with psoriasis. Ultimately, this study aims to increase the lifespan and health of patients living with psoriatic disease by decreasing barriers to their receiving appropriate CVD prevention care.
Fossil neoliberalism and its limits: Governing coal in South India
Authors: Kumar Mukul
Published: June 2022

Over the last three decades of neoliberalization, India's fossil fuel infrastructures have been transformed into an archipelago of coal-fired power plants and industrial ports in coastal zones. Drawing upon the case of coal infrastructures sited on the coast of south India, this article tracks processes of what I call “fossil neoliberalism”: the ways in which neoliberal modes of governance have transformed the state into an agent of market-based fossil fuel extraction. The article calls for attention to how particular technologies of governance—from disinvestment and initial public offerings to corporatized landlord ports—have reconfigured and respatialized, rather than reduced, the role of the state in processes of fossil fuel extraction. The article also analyzes how fossil neoliberalism, as an ensemble of market-based technologies of governance, is enabled by coastal zone illegalities and limited by political mobilizations.
From fish to fishworker traceability in Thai fisheries reform
Authors: Kadfak Alin , Widengård Marie
Published: June 2022

This paper explores the question of what traceability systems mean for the labour situation of fishworkers; for whom and in what respects is traceability effective, and what impact do these systems have? The limited social criteria in fishery governance is a core reason for recurrent problems of extreme abuse of fishworkers around the world, including trafficking, forced labour and so called modern slavery. New traceability systems, thus, now include social criteria to advance sustainable fisheries globally. Drawing from a Thai fisheries reform case study, we analyse how the new labour traceability system emerges and is perceived by migrant fishworkers. We base our analysis on interviews, documents and two periods of fieldwork in Thailand. We argue that labour traceability is a double-edged sword. While fishworkers have seen major improvement in limiting extreme abuse, labour traceability has a downsides of state surveillance and costs passed onto workers. Moreover, traceability does not solve underlying problems regarding the complex formalization of migrant workers, working conditions on fishing boats, freedom to change employer or the everyday vulnerability of being a migrant worker. Thus, while labour traceability has promising policy relevance for the integration of labour rights into fisheries governance, it requires contextual underpinning in migrant circumstances.
Affective Teaching: A Method to Reduce Negative Classroom Behavior and Improve Relationships
Authors: Abu-Yaman Mary Mulla , Shechtman Zipora
Published: June 2022

The established connection between disruptive and aggressive behavior, classroom climate, and classroom relationships led to an increase in suggested prevention programs. In the current study, we suggest a teaching modality (rather a program) named affective teaching and assess its effect on students’ behavior, motivation, achievement, and classroom climate, as well as on teacher self-efficacy. Participants were 92 teachers of 2893 fifth and sixth graders from 19 Arab schools in Israel. A hierarchical model of analysis (Mixed Models) was used to assess children’s gains in two randomized teaching conditions: affective teaching and conventional teaching. Results indicated more favorable outcomes on all measures in the affective teaching condition compared to control. Relationships, behavior, and teacher efficacy were significantly associated with children’s gains in motivation and content knowledge. The discussion focuses on the potential effect of this unique teaching modality on children’s psychological growth and adjusting behavior.
α7 nicotinic acetylcholine receptor agonist GTS-21 attenuates DSS-induced intestinal colitis by improving intestinal mucosal barrier function
Authors: Ye Ziping , Zhu Yunjuan , Tang Nana , Zhao Xiaojing , Jiang Jingyue , Ma Jingjing , Zhang Hongjie
Published: June 2022

Background and aims

Cholinergic output, which could modulate innate immune responses through stimulation of α7 nicotinic acetylcholine receptor (α7nAChR), might be a target to minimize tissue damage in autoimmune disease. GTS-21, a selective α7nAChR agonist, has previously demonstrated to inhibit synovium inflammation in rheumatoid arthritis. In this study, we investigated the effect of GTS-21 on dextran sulfate sodium (DSS)-induced colitis model and its potential mechanism.

Methods

Male BABL/c mice (n = 32) were randomly divided into four groups: normal control group, DSS-induced colitis group, GTS-21 treatment with or without α7nAChR antagonist α-BGT treatment group. Disease activity index (DAI), histological activity index (HAI) and colonic macroscopic damage were evaluated. Fluorescein isothiocyanate (FITC)–dextran assay was applied to measure intestinal permeability. The expressions of tight junction (TJ) proteins and NF-κB associated proteins were detected by Western blot.

Results

GTS-21 could decrease DAI scores, HAI scores, intestinal permeability and reduce the intestinal bacterial translocation in DSS-induced colitis group, whereas α7nAChR antagonist α-BGT could impair this protective influence. The expressions of TJ proteins were increased with administration of GTS-21 both in vivo and in vitro. Furthermore, GTS-21 also inhibited the NF-қB activation in intestinal epithelial cells and colitis model, while α-BGT reversed the inhibitory effect.

Conclusion

The α7nAChR agonist GTS-21 attenuated DSS-induced colitis through increasing expressions of TJ proteins in colon tissues and improved intestinal barrier function, which might be due to  modulating NF-қB activation in intestinal epithelial cells.
Impact of the surgical approach, considering Goh classification, on long-term results in patients with vesicovaginal fistula repair
Authors: Mazuran Berislav , Hrkac Adelina , Habek Dubravko
Published: June 2022

Background

This study aims to present long-term results, preoperative classification, and surgical approach in the therapy of vesicovaginal fistulas (VVF) and neovesicovaginal fistulas (NVVF). Unlike developing countries, where fistulas are mainly the result of delivery trauma, in the modern world, the main causes are urogynecological surgery and irradiation therapy.

Methods

Data of 36 woman who underwent surgical treatment of VVF and NVVF were collected retrospectively. After clinical assessment, fistulas were categorized by the Goh classification system, which led to the choice of surgical approach: transvaginal or transabdominal. Follow-up period was 60 to 108 months.

Results

Out of 36 patients evaluated, 23 were operated transabdominal, and 13 were operated transvaginal. Patients selected for the transabdominal approach were mainly categorized as Goh 1 and 2, including patients after radiotherapy and patients with large fistulas. Patients selected for the transvaginal approach were mainly Goh 3 and 4. There were no statistical differences between groups regarding the success of the operation (83.3%) and complication rate. Complications included fistula recurrence (16.6%), stress urinary incontinence (22.2%), urinary tract infections (11.1%), overactive bladder (13.9%), and urosepsis (2.8%). There was a statistical difference in the duration of the hospital stay in favor of the transvaginal approach (12.00 ± 5.8 vs 16.27 ± 4.65).

Conclusions

Success in the surgical treatment of VVF and NVVF can be achieved by careful preoperative classification, selection of surgical approach, assessment of local tissue status, taking into consideration the characteristics of the fistulas, and adhering to the basic surgical principles. Regardless of the surgical approach, conducting such a preoperative stratification can achieve similar long-term outcomes. Most fistula recurrence (83.3%) appeared within 6 months after the surgery.
Ternary metal-organic framework/multi-walled carbon nanotube/iron oxide nanocomposite for removal of butachlor pesticide
Authors: Azizzadeh Ali , Amooey Ali Akbar , Ghasemi Shahram
Published: June 2022

Background

Butachlor (BUT) as an organochlorine pesticide (OCP) that prevents weeds from growing has been used in the agriculture field. It remains in the environment for a long time and causes mutagenicity and cancer.

Results

In the current study, magnetic multi-walled carbon nanotube with zeolitic imidazolate frameworks-67 (Fe3O4–MWCNT–ZIF67) was used as adsorbent to remove BUT from the aqueous solution. The characteristics and the chemical composition of the adsorbent were evaluated using FE-SEM, TEM, MAP, EDX, FTIR, BET, TGA and VSM. The response surface methodology (RSM) as a method for the design of experiment was applied to optimize variables such as the initial concentration of BUT, adsorbent dosage, contact time and temperature in the batch experiment by central composite design (CCD). The optimum adsorption condition predicted by RSM was pH = 4.5, initial concentration = 5.75 ppm, dosage = 0.07 g and contact time = 95 min. The results showed that maximum removal efficiency for the butachlor is 86%.

Conclusions

Different adsorption isotherms were evaluated using adsorption equilibrium data and results showed that Temkin model has the best compatibility with the experimental data. In addition, the adsorption kinetics data were closer with pseudo-second-order model. Thermodynamic study showed that the adsorption process was spontaneous, endothermic and physical. This composite can be effectively used for the remediation/clean-up of groundwater and agricultural run-off water which are contaminated with harmful pesticides.

Graphical Abstract
Rare and population-specific functional variation across pig lines
Authors: Ros-Freixedes Roger , Valente Bruno D. , Chen Ching-Yi , Herring William O. , Gorjanc Gregor , Hickey John M. , Johnsson Martin
Published: June 2022

Background

It is expected that functional, mainly missense and loss-of-function (LOF), and regulatory variants are responsible for most phenotypic differences between breeds and genetic lines of livestock species that have undergone diverse selection histories. However, there is still limited knowledge about the existing missense and LOF variation in commercial livestock populations, in particular regarding population-specific variation and how it can affect applications such as across-breed genomic prediction.

Methods

We re-sequenced the whole genome of 7848 individuals from nine commercial pig lines (average sequencing coverage: 4.1×) and imputed whole-genome genotypes for 440,610 pedigree-related individuals. The called variants were categorized according to predicted functional annotation (from LOF to intergenic) and prevalence level (number of lines in which the variant segregated; from private to widespread). Variants in each category were examined in terms of their distribution along the genome, alternative allele frequency, per-site Wright’s fixation index (FST), individual load, and association to production traits.

Results

Of the 46 million called variants, 28% were private (called in only one line) and 21% were widespread (called in all nine lines). Genomic regions with a low recombination rate were enriched with private variants. Low-prevalence variants (called in one or a few lines only) were enriched for lower allele frequencies, lower FST, and putatively functional and regulatory roles (including LOF and deleterious missense variants). On average, individuals carried fewer private deleterious missense alleles than expected compared to alleles with other predicted consequences. Only a small subset of the low-prevalence variants had intermediate allele frequencies and explained small fractions of phenotypic variance (up to 3.2%) of production traits. The significant low-prevalence variants had higher per-site FST than the non-significant ones. These associated low-prevalence variants were tagged by other more widespread variants in high linkage disequilibrium, including intergenic variants.

Conclusions

Most low-prevalence variants have low minor allele frequencies and only a small subset of low-prevalence variants contributed detectable fractions of phenotypic variance of production traits. Accounting for low-prevalence variants is therefore unlikely to noticeably benefit across-breed analyses, such as the prediction of genomic breeding values in a population using reference populations of a different genetic background.
Investigation of stress, anxiety, and depression levels of Pre-Hospital Emergency Medicine personnel in eastern Iran during the Covid-19 pandemic
Authors: Sabbaghi Mohammadreza , Miri Kheizaran , Kahi Reza , Nia Mohammad Namazi
Published: June 2022

Background

Pre-hospital emergency medicine (PHEM) personnel are at risk of developing psychological disorders during the Covid-19 pandemic. This study aimed to investigate depression, anxiety, and stress levels of the Iranian PHEM personnel during the Covid-19 pandemic.

Methods

This descriptive cross-sectional study was performed on 544 PHEM personnel chosen by purposive sampling in North Khorasan, Khorasan-Razavi, South Khorasan, Sistan-Baluchestan, and Kerman provinces in eastern Iran from August to September 2021. Data collection tools included a demographic information questionnaire and the standardized 21-item Depression, Anxiety, and Stress Scale (DASS-21). Data were analyzed in SPSS 16 using one-way analysis of variance and linear regression.

Results

The mean scores of depression, anxiety, and stress were 8.7 ± 9.2, 7.0 ± 7.8, and 11.6 ± 9.2, respectively. Depression, stress, and anxiety were more prevalent in the age group of 41-55 years, people with master’s and higher degrees, people with a history of underlying diseases, and people with over 10 years of work experience(p < 0.05). Depression and stress also showed a significant relationship with the type of employment. Stress alone was also significantly associated with working less than 35 hours a week and living separately from family(p < 0.05).

Conclusions

PHEM personnel suffer from significant levels of depression, anxiety, and stress during the Covid-19 pandemic. Therefore, in order to improve the mental condition, it is recommended that the work schedule and services provided to these people be designed in such a way that they have more time for rest and communication with their family members. The personnel should also have easier access to the expert team in the fields of counseling and psychiatry.
Prehospital assessment of patients with abdominal pain triaged to self-care at home: an observation study
Authors: Larsson Glenn , Hansson Peter , Olsson Emelie , Herlitz Johan , Hagiwara Magnus Andersson
Published: June 2022

Background

Patients who call for emergency medical services (EMS) due to abdominal pain suffer from a broad spectrum of diseases, some of which are time sensitive. As a result of the introduction of the concept of ‘optimal level of care‘, some patients with abdominal pain are triaged to other levels of care than in an emergency department (ED). We hypothesised that it could be challenging in a patient safety perspective.

Aim

This study aims to describe consecutive patients who call for EMS due to abdominal pain and are triaged to self-care by EMS clinicians.

Methods

This was an observational study performed in an EMS organisation in Western Sweden during 2020. The triage tool Rapid Emergency Triage and Treatment System (RETTS), which included Emergency Signs and Symptom (ESS) codes, was used to find medical records where patients with abdominal pain have been triaged to self-care and 194 patients was included in the study.

Results

Of total 48,311 ambulance missions, A total of 1747 patients were labelled with ESS code six (abdominal pain), including 223 (12.8%) who were given the code for self-care and 194 who were further assessed by the research group. Of these patients, 32 (16.3%) had a return visit within 96 hours due to the same symptoms and 11 (5.6%) were hospitalised. In six of these patients, the EMS triage was evaluated retrospectively and assessed as inappropriate. These patients had a final diagnosis of ruptured abdominal aneurysm (n = 1), acute appendicitis with peritonitis (n = 2) and acute pancreatitis (n = 3). All these patients required extensive evaluation and different treatments, including acute surgery, antibiotics and fluid therapy.

Conclusion

Amongst the 1747 patients assessed by EMS due to abdominal pain, 223 (12.8%) were triaged to self-care. Of the 194 patients who were further assessed, 16.3% required a return visit to the ED within 96 hours and 5.6% were hospitalised. Six patients had obvious time-sensitive conditions. Our study highlights the difficulties in the early assessment of abdominal pain and the requirement for an accurate decision support tool.
Identifying factors associated with intravenous fluid administration in patients with sepsis presenting to the emergency department: a retrospective cohort study
Authors: Kabil Gladis , Frost Steven A. , McNally Stephen , Hatcher Deborah , Saavedra Aldo , Suster Carl J. E. , Moscova Michelle , Shetty Amith
Published: June 2022

Background

Appropriate and timely administration of intravenous fluids to patients with sepsis-induced hypotension is one of the mainstays of sepsis management in the emergency department (ED), however, fluid resuscitation remains an ongoing challenge in ED. Our study has been undertaken with two specific aims: firstly, for patients with sepsis, to identify factors associated with receiving intravenous fluids while in the ED; and, secondly to identify determinants associated with the actual time to fluid administration.

Methods

We conducted a retrospective multicentre cohort study of adult ED presentations between October 2018 and May 2019 in four metropolitan hospitals in Western Sydney, Australia. Patients meeting pre-specified criteria for sepsis and septic shock and treated with antibiotics within the first 24 h of presentation were included. Multivariable models were used to identify factors associated with fluid administration in sepsis.

Results

Four thousand one hundred forty-six patients met the inclusion criteria, among these 2,300 (55.5%) patients with sepsis received intravenous fluids in ED. The median time to fluid administration from the time of diagnosis of sepsis was 1.6 h (Interquartile Range (IQR) 0.5 to 3.8), and the median volume of fluids administered was 1,100 mL (IQR 750 to 2058). Factors associated with patients receiving fluids were younger age (Odds Ratio (OR) 1.05, 95% Confidence Interval (CI (1.03 to 1.07), p < 0.001); lower systolic blood pressure (OR 1.11, 95% CI (1.08 to 1.13), p < 0.001); presenting to smaller hospital (OR 1.48, 95% CI (1.25 to 1.75, p < 0.001) and a Clinical Rapid Response alert activated (OR 1.64, 95% CI (1.28 to 2.11), p < 0.001). Patients with Triage Category 1 received fluids 101.22 min earlier (95% CI (59.3 to131.2), p < 0.001) and those with Category 2 received fluids 43.58 min earlier (95% CI (9.6 to 63.1), p < 0.001) compared to patients with Triage Category 3–5. Other factors associated with receiving fluids earlier included septic shock (-49.37 min (95% CI (-86.4 to -12.4), p < 0.001)); each mmol/L increase in serum lactate levels (-9.0 min, 95% CI (-15.7 to -2.3), p < 0.001) and presenting to smaller hospitals (-74.61 min, 95% CI (-94.0 to -55.3), p < 0.001).

Conclusions

Younger age, greater severity of sepsis, and presenting to a smaller hospital increased the probability of receiving fluids and receiving it earlier. Recognition of these factors may assist in effective implementation of sepsis management guidelines which should translate into better patient outcomes. Future studies are needed to identify other associated factors that we have not explored.
Barriers to following imaging guidelines for the treatment and management of patients with low-back pain in primary care: a qualitative assessment guided by the Theoretical Domains Framework
Authors: Pike Andrea , Patey Andrea , Lawrence Rebecca , Aubrey-Bassler Kris , Grimshaw Jeremy , Mortazhejri Sameh , Dowling Shawn , Jasaui Yamile ,   De-implementing Wisely Research Group, Bhatia Sacha , Duquettes D’Arcy , Gionet Erin , Kirkham Kyle , Levinson Wendy , Johnston Brian , Mrklas Kelly , Parfrey Patrick , Presseau Justin , Sikorski Todd , Taljaard Monica , Thavorn Kednapa , Mahoney Krista , Ruzycki Shannon , Hall Amanda
Published: June 2022

Background

Low back pain (LBP) is a leading cause of disability and is among the top five reasons that patients visit their family doctors. Over-imaging for non-specific low back pain remains a problem in primary care. To inform a larger study to develop and evaluate a theory-based intervention to reduce inappropriate imaging, we completed an assessment of the barriers and facilitators to reducing unnecessary imaging for NSLBP among family doctors in Newfoundland and Labrador (NL).

Methods

This was an exploratory, qualitative study describing family doctors’ experiences and practices related to diagnostic imaging for non-specific LBP in NL, guided by the Theoretical Domains Framework (TDF). Data were collected using in-depth, semi-structured interviews. Transcripts were analyzed deductively (assigning text to one or more domains) and inductively (generating themes at each of the domains) before the results were examined to determine which domains should be targeted to reduce imaging.

Results

Nine family doctors (four males; five females) working in community (n = 4) and academic (n = 5) clinics in both rural (n = 6) and urban (n = 3) settings participated in this study. We found five barriers to reducing imaging for patients with NSLBP: 1) negative consequences, 2) patient demand 3) health system organization, 4) time, and 5) access to resources. These were related to the following domains: 1) beliefs about consequences, 2) beliefs about capabilities, 3) emotion, 4) reinforcement, 5) environmental context and resources, 6) social influences, and 7) behavioural regulation.

Conclusions

Family physicians a) fear that if they do not image they may miss something serious, b) face significant patient demand for imaging, c) are working in a system that encourages unnecessary imaging, d) don’t have enough time to counsel patients about why they don’t need imaging, and e) lack access to appropriate practitioners, community programs, and treatment modalities to prescribe to their patients. These barriers were related to seven TDF domains. Successfully reducing inappropriate imaging requires a comprehensive intervention that addresses these barriers using established behaviour change techniques. These techniques should be matched directly to relevant TDF domains. The results of our study represent the important first step of this process – identifying the contextual barriers and the domains to which they are related.
Laparoscopic right hemihepatectomy following a novel optimized portal vein embolization: a video case report
Authors: Liu Lei , Ding Wenbin , Liu Xue , Zhou Weiping , Yuan Shengxian
Published: June 2022

Background

This article is the first report of laparoscopic major hepatectomy of Hepatocellular carcinoma (HCC) following optimized portal vein embolization (oPVE).

Case presentation

The patient was diagnosed with a single 3 × 3.5 cm HCC located in segment 5 and 8 detected by enhanced computed tomography and magnetic resonance imaging. The lesion was adjacent to the right anterior and posterior portal veins, making it difficult to confirm the adequate liver functional remnant volume, surgical margin and R0 resection. In addition, the liver cirrhosis induced by a long history of chronic hepatitis B virus increased the potential risk of postoperative liver failure and refractory ascites. Therefore, we conducted a laparoscopic surgery following oPVE, by which the safe tumor margin was ensured and the outcome of the surgery was improved. The patient was discharged on the seventh day after the surgery. The AFP gradually decreased to a normal level during the 90-day follow-up.

Conclusion

This case report demonstrates that, in experienced hands for selected patients, laparoscopic hepatectomy after portal vein embolization is feasible and may be an alternative to open liver resection.
Validation of the Kihon Checklist and the frailty screening index for frailty defined by the phenotype model in older Japanese adults
Authors: Watanabe Daiki , Yoshida Tsukasa , Watanabe Yuya , Yamada Yosuke , Miyachi Motohiko , Kimura Misaka
Published: June 2022

Background

The term “frailty” might appear simple, but the methods used to assess it differ among studies. Consequently, there is inconsistency in the classification of frailty and predictive capacity depending on the frailty assessment method utilised. We aimed to examine the diagnostic accuracy of several screening tools for frailty defined by the phenotype model in older Japanese adults.

Methods

This cross-sectional study included 1,306 older Japanese adults aged ≥ 65 years who underwent physical check-up by cluster random sampling as part of the Kyoto-Kameoka Study in Japan. We evaluated the diagnostic accuracy of several screening instruments for frailty using the revised Japanese version of the Cardiovascular Health Study criteria as the reference standard. These criteria are based on the Fried phenotype model and include five elements: unintentional weight loss, weakness (grip strength), exhaustion, slowness (normal gait speed), and low physical activity. The Kihon Checklist (KCL), frailty screening index (FSI), and self-reported health were evaluated using mailed surveys. We calculated the non-parametric area under the receiver operating characteristic curve (AUC ROC) for several screening tools against the reference standard.

Results

The participants’ mean (standard deviation) age was 72.8 (5.5) years. The prevalence of frailty based on the Fried phenotype model was 12.2% in women and 10.3% in men. The AUC ROC was 0.861 (95% confidence interval: 0.832–0.889) for KCL, 0.860 (0.831–0.889) for FSI, and 0.668 (0.629–0.707) for self-reported health. The cut-off for identifying frail individuals was ≥ 7 points in the KCL and ≥ 2 points in the FSI.

Conclusions

Our results indicated that the two instruments (KCL and FSI) had sufficient diagnostic accuracy for frailty based on the phenotype model for older Japanese adults. This may be useful for the early detection of frailty in high-risk older adults.
Assessment of low-dose paranasal sinus CT imaging using a new deep learning image reconstruction technique in children compared to adaptive statistical iterative reconstruction V (ASiR-V)
Authors: Li Yang , Liu Xia , Zhuang Xun-hui , Wang Ming-jun , Song Xiu-feng
Published: June 2022

Purpose

To compare the effects of deep learning image reconstruction (DLIR) and adaptive statistical iterative reconstruction V (ASiR-V) on image quality in low-dose computed tomography (CT) of paranasal sinuses in children.

Methods

Low-dose CT scans of the paranasal sinuses in 25 pediatric patients were retrospectively evaluated. The raw data were reconstructed with three levels of DLIR (high, H; medium, M; and low, L), filtered back projection (FBP), and ASiR-V (30% and 50%). Image noise was measured in both soft tissue and bone windows, and the signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) of the images were calculated. Subjective image quality at the ethmoid sinus and nasal cavity levels of the six groups of reconstructed images was assessed by two doctors using a five-point Likert scale in a double-blind manner.

Results

The patients’ mean dose-length product and effective dose were 36.65 ± 2.44 mGy·cm and 0.17 ± 0.03 mSv, respectively. (1) Objective evaluation: 1. Soft tissue window: The difference among groups in each parameter was significant (P < 0.05). Pairwise comparisons showed that the H group’ s parameters were significantly better (P < 0.05) than those of the 50% post-ASiR-V group. 2. Bone window: No significant between-group differences were found in the noise of the petrous portion of the temporal bone or its SNR or in the noise of the pterygoid processes of the sphenoids or their SNRs (P > 0.05). Significant differences were observed in the background noise and CNR (P < 0.05). As the DLIR intensity increased, image noise decreased and the CNR improved. The H group exhibited the best image quality. (2) Subjective evaluation: Scores for images of the ethmoid sinuses were not significantly different among groups (P > 0.05). Scores for images of the nasal cavity were significantly different among groups (P < 0.05) and were ranked in descending order as follows: H, M, L, 50% post-ASiR-V, 30% post-ASiR-V, and FBP.

Conclusion

DLIR was superior to FBP and post-ASiR-V in low-dose CT scans of pediatric paranasal sinuses. At high intensity (H), DLIR provided the best reconstruction effects.