bluuebunny/crossref_metadata_2025 huggingface dataset:
Design of combined brake system for light weight scooters
Authors: Lin Yuan-Ting , Tseng Chyuan-Yow , Kuang Jao-Hwa , Hwang Yeong-Maw
Published: June 2021

The combined brake system (CBS) is a mechanism that links the front and rear brakes for scooters. For two-wheeled scooters, a CBS with appropriate braking force distribution can reduce the risk of crashing accidents due to insufficient driving proficiency. The design of the braking force distribution for a CBS is challenging to the designer because it has to fulfill many requirements such as braking performance, ride comfort, reliability, and low costs. This paper proposes a systematic method to optimize the parameters of CBS. The evaluation indexes for the design are first discussed. The steps to determine the critical parameter to meet the indexes and a method to predict braking performance are developed. Finally, driving tests are carried out to verify the effectiveness of the proposed method. Experimental results showed that the deceleration of the tested scooter equipped with the designed CBS achieves an average mean fully developed deceleration (MFDD) of 5.246 m/s2, higher than the homologation requirement. Furthermore, the proposed method’s prediction of braking performance is in good agreement with the test results, with errors <1%.
Wheel wear performance assessment and model validation using Harold full scale test rig
Authors: Boyacioglu Pelin , Bevan Adam , Allen Paul , Bryce Barnaby , Foulkes Sam
Published: June 2021

The railway industry has focused on the improvement of maintenance through the use of novel technologies. Recently, the utilisation of repair welding to restore the worn area on wheels has been investigated, as it can bring significant savings in wheelset maintenance. Under an Innovate UK AURORA project, a worn wheel that previously operated on London Underground (LUL) was restored using this process. To test its performance and compare with a new standard steel grade wheel, the HAROLD full scale test rig was used in which an LUL vehicle bogie equipped with both the restored and R9 grade wheels was operated under the representative lateral and yaw displacements computed from vehicle dynamics simulations. The wear measurements carried out at the end of test cycles showed that although the restored wheel suffered from initial higher wear, the levels reduced and became similar to the R9 grade wheel. Furthermore, the full-scale testing provided an opportunity to validate the wear model predictions which were conducted using the vehicle dynamics simulations utilised in testing inputs. It was found that while the flange wear predictions were higher, the tread wear estimations were smaller than the measurements on the R9 grade wheel.
Mycoplasma genitalium: test positivity in syndromic presentations and clinicians’ adherence with treatment guidelines at Sydney Sexual Health Centre
Authors: Cheung Calvin , Bourne Christopher , Varma Rick
Published: June 2021

Mycoplasma genitalium ( M.genitalium) is associated with urethritis, cervicitis, pelvic inflammatory disease, proctitis and epididymitis. Its treatment is complicated by antimicrobial resistance. To assess clinicians’ adherence to M.genitalium diagnostic testing recommendations for syndromic presentations, as well as resistance-guided management of M.genitalium at Sydney Sexual Health Centre, we reviewed patients presenting between August and December 2018. 349/372 (94%) syndromic presentations were tested for M.genitalium with 16% M.genitalium test positivity and 81% macrolide resistance. 16/27 (59%) macrolide-sensitive infections and 65/77 (84%) macrolide-resistant infections received resistance-guided treatment. Tests of cure (TOCs) were unnecessarily ordered for 82% macrolide-sensitive cases, while 88% macrolide-resistant cases were correctly ordered TOCs. Co-existing STIs at the time of macrolide-sensitive ( p = 0.30) or macrolide-resistant M.genitalium ( p = 0.94) diagnosis did not significantly affect adherence to treatment guidelines. This study confirms the expected prevalence of M.genitalium and macrolide resistance in syndromic presentations while our real-world data highlight the decision-making challenges involved with managing M.genitalium, offering insights for further research.
Sexual healthcare professionals’ views on the rapid provision of remote services at the beginning of COVID-19 pandemic: A mixed-methods study
Authors: Lunt Alexandria , Llewellyn Carrie , Bayley Jake , Nadarzynski Tom
Published: June 2021

Introduction: The COVID-19 pandemic and social distancing measures forced sexual health services to engage with patients remotely. We aimed to understand perceived barriers and facilitators to the provision of digital sexual health services during the first months of the pandemic. Methods: An online survey and qualitative interviews with UK sexual healthcare professionals recruited online and via snowball sampling were conducted in May–July 2020. Results: Amongst 177 respondents (72% female, 86% White, mean age = 46, SD = 9), most utilised telephone and email as their main communication channels; however, their perceived effectiveness varied (94% and 66%, respectively). Most agreed that staff needed additional training (89%), the available technology was not adequate (66%) and health professionals were hesitant to provide online consultations (46%). They had positive attitudes towards digitalisation, improving service quality and cost-effectiveness but were concerned about exacerbating health inequalities. Discussion: The study identifies a need for clear guidelines and training around the use of digital tools as well as a demand for investment in hardware and software required for the provision of remote services. Future research needs to explore the acceptability, safety and effectiveness of various digital tools to narrow health inequalities in sexual health service users.
Coping as a Mediator of the Relationship between Stress and Anxiety in Caregivers of Patients with Acute Stroke
Authors: Lee Yoonmi , Song Yeoungsuk
Published: June 2021

According to Lazarus and Folkman’s theory, stress and coping affect an individual’s anxiety, which is an adaptive outcome. This study examined the mediation effects of stress-coping strategies on the relationship between stress and anxiety in caregivers of patients with acute stroke. A cross-sectional descriptive design was used to analyze a total of 131 caregivers caring for patients with acute stroke at a university hospital. The Caregivers Stress Scale, Ways of Coping Questionnaire, and Korean Beck Anxiety Inventory were used to quantify the participants’ responses. Our results revealed that emotion-focused coping (β = .56, p  < .001) partially mediated the relationship between stress and anxiety ( Z = 3.30, p < .001), suggesting its ability to exacerbate anxiety in the short term by acting as a mediator between stress and anxiety. Developing appropriate coping strategies for caregivers of patients with acute stroke is therefore critical for reducing their anxiety.
Challenging Diagnosis in NUT Carcinoma
Authors: Claudia Grosse , Alexandra Grosse
Published: June 2021

Nuclear protein in testis (NUT) carcinoma represents a highly aggressive, poorly differentiated carcinoma that is genetically defined by rearrangement of NUT gene. The histomorphological appearance ranges from entirely undifferentiated carcinoma to carcinoma with prominent squamous differentiation. NUT carcinoma can display neuroendocrine features. Although it is typically distributed along the midline axis, it may manifest in nonmidline locations. The majority of patients develop rapidly disseminated disease. We illustrate 2 cases of NUT carcinoma, one located in the lung, which closely resembled a neuroendocrine carcinoma, and the other one with assumed lung origin demonstrating metastatic dissemination with diffuse bone involvement, which was clinically first suspected to be a hematological malignancy. Due to its undifferentiated nature, NUT carcinoma may be confused with many entities. NUT immunohistochemistry is considered to be sufficient for the diagnosis. Fluorescence in-situ hybridization analysis and next-generation sequencing are currently used to confirm the diagnosis.
HiTOP Assessment of the Somatoform Spectrum and Eating Disorders
Authors: Sellbom Martin , Forbush Kelsie T. , Gould Sara R. , Markon Kristian E. , Watson David , Witthöft Michael
Published: June 2021

We report on Phase 1 efforts of the Hierarchical Taxonomy of Psychopathology (HiTOP) measurement subgroup tasked with developing provisional scales for the somatoform spectrum and eating disorders. In Study 1, items were written to assess five somatoform spectrum constructs (bodily distress symptoms, conversion symptoms, health anxiety, disease conviction, and somatic preoccupation). Scale development analyses were conducted on 550 university students. The conversion symptom items were too infrequently endorsed and were set aside for Phase 2. Analyses of the other items yielded four scales corresponding closely to their hypothesized structure. In Study 2, we delineated 15 specific feeding and eating disorder constructs. A sample of 400 university students were administered candidate items and several eating disorder questionnaires for criterion validity. Analyses yielded six scales capturing previously described constructs, tapping content related to body image and weight concerns, restricting and purging, cognitive restraint, binging, excessive exercise, and muscle building. Two scales representing additional constructs deemed to be of high clinical import—negative attitude towards obesity and avoidant/restrictive food intake disorder—were retained for Phase 2, for a total of eight scales. Overall, we concluded that Phase 1 had been successful at generating a comprehensive set of provisional scales for inclusion in Phase 2.
Examination of the Social Emotional Assets and Resilience Scales (SEARS) Youth Report: Factor Structure, Measurement Invariance, and Validity
Authors: Klages Kimberly L. , Ittenbach Richard F. , Long Alanna , Willard Victoria W. , Phipps Sean
Published: June 2021

The Social and Emotional Assets and Resilience Scale (SEARS) is a promising instrument for prediction of resilience in youth; however, there is limited data to support its use. The purpose of the current study was to examine the factor structure, measurement invariance, internal consistency, and validity of the SEARS-Adolescent Report in youth 8 to 20 years of age. Two hundred and twenty-five childhood cancer survivors ( Mage = 15.9, SD = 4.2; 51.4% male; 74.5% White) and 122 student controls without history of significant health problems ( Mage = 14.2, SD = 3.5; 54.1% female; 79.5% White) 8 to 20 years of age completed the SEARS-A. The SEARS-A was found to have an adequate factor structure and model fit (χ2 = 1215.5, p < .001; root mean square error of approximation = .057; comparative fit index = .95; standardized root mean square residual = .06) and demonstrated invariance across domains of age, health status, gender, race, and socioeconomic status (Δ comparative fit index < −0.01). It also demonstrated excellent internal reliability, criterion validity, and current validity when compared with another well-established measure of psychological adjustment. As such, the SEARS-A has potential to be a useful, valid, and psychometrically sound tool for predicting social–emotional adjustment outcomes among at-risk youth 8 to 20 years of age.
Detail-Based Analysis in the Study of Land Reform: A Methodology for Studying Modern Chinese History
Authors: Cao Shuji
Published: June 2021

I use “procedure,” rather than “resulting,” files in local archives to re-interpret the politics of China’s Land Reform. I demonstrate that, at the time, China’s rural population was not divided into landlords, rich peasants, middle peasants, poor peasants, and tenant peasants. Instead, the “rich tenant peasant” was an essential group to understand the land ownership and relations among the different groups. Furthermore, the existence of “one field with two owners” indicates that the land ownership in rural China was much more complicated than the dichotomous framework advocated by the Chinese Communist state. I discuss the methodological implications of my findings.
A Replication of “The Robust Relationship between Taxes and US State Income Growth” (National Tax Journal 2008)
Authors: Brewer Ben , Conway Karen Smith , Rork Jonathan C.
Published: June 2021

Using state-level data from 1970 to 1999 and a five-year interval approach, Reed provides robust evidence that taxes have a negative effect on state economic growth. Subsequent work by Gale, Krupkin, and Rueben uses more recent data, ending with the five-year period around the Great Recession, and provides evidence that the relationship is not stable. We take a systematic approach to replicating and then updating Reed to include the most recent data possible to see whether the relationship is sensitive to the time period considered. Our analyses corroborate Reed’s findings of a consistently negative and often statistically significant effect of taxes on state economic growth but also suggest that the long-run effects no longer exist in more current years.
Mechanical, microstructure, and hot corrosion investigations on P22/P91 dissimilar tungsten inert gas weld
Authors: Khan Furkan , Mahajan Sumit , Khan Waris Nawaz , Chhibber Rahul
Published: June 2021

The P22/P91 dissimilar weld increasingly used in supercritical power plan boilers calls for experimental investigations on its properties for enhanced performance in high-temperature service conditions. This study investigates the weld joint between P22/P91 steel using tungsten inert gas process employing a P22 matching filler metal. The fabricated weld has been characterized for mechanical properties of tensile strength and microhardness. The microstructural examination has been carried out in the weld region, transition zones, and base metals. The weld was exposed to a temperature of 700 °C in the environment of molten salt (50% Na2SO4 + 50% NaCl) to quantify the effect of high-temperature corrosion at its sight of application. Furthermore, the welds were also shot-peened and its effect on corrosion properties has been examined. The corroded specimens were examined using X-ray diffraction and scanning electron microscope to analyze the oxide scale produced upon exposure to high temperature in a controlled environment. The P22 base metal was found to oxidize more severely as compared to the weld fusion zone. Shot peening improves the corrosion resistance of weld by 7.56%. The results of this study comprehensively cover multiple aspects of weld integrity as per the service conditions, with its results having significant application in the power plant industry.
Reflecting on “Our Place”
Authors: Keehan Bridget , Rogers Amanda
Published: June 2021

In this conversation, we reflect on the development of a soundwalk produced by a theatre maker during her artistic residency in the Department of Geography at Swansea University. We discuss the approach taken to ‘place’ and the people in it, and the dynamics of an artist-geographer collaboration.
Recurrent Pulmonary Embolism Caused by Superficial Femoral Vein Aneurysm
Authors: Nomura Yoshikatsu , Shun Meng , Kawashima Motoharu , Fujisue Jun , Fujimoto Masato , Miyahara Shunsuke , Fukase Keigo , Honda Tasuku , Mukohara Nobuhiko , Murakami Hirohisa
Published: June 2021

Venous aneurysms (VA), particularly superficial femoral VAs (SFVAs), are rare vascular lesions. A 65-year-old woman with a history of pulmonary embolism (PE), treated with tissue plasminogen activator and oral anticoagulation, was admitted to hospital for dyspnea. Enhanced computed tomography showed recurrent PE and right SFVA with a mural thrombus. The SFVA was not identified during the first PE. The PE was not massive and was treated with direct oral anticoagulants. The thrombus in the SFVA caused the PE, and surgical repair was performed to prevent further embolic events. Under general anesthesia, the SFVA was excised, and direct anastomosis was performed. PE recurrence, venous aneurysmal changes, and thrombosis were not noted at the 1-year follow-up.
When Is It Safe to Operate After Therapeutic Carpal Tunnel Injections?
Authors: Fakunle Omolola , Farley Kevin X. , DeMaio Emily L. , Gottschalk Michael B. , Wagner Eric R. , Daly Charles A.
Published: June 2021

Background

Recent studies suggest increased complications when surgery closely follows corticosteroid injection. The purpose of this study was to understand the occurrence of surgical site infection (SSI), wound complications, and reoperation rates after carpal tunnel release (CTR) when corticosteroid injections were given within 180 days preoperatively.

Methods

Data were collected from the Truven MarketScan database from 2009 to 2018. Cohorts were created based on preoperative timing of injection (<30, 30-60, 61-90, 91-180 days) and number of injections (0, 1, 2, 3+). Logistic regression was performed to assess the contribution of preoperative injections on 90-day surgical site complications and 1-year reoperation while controlling for demographics and comorbidities.

Results

Overall, 223 899 patients underwent CTR. Of these, 17 391 (7.76%) had a preoperative injection in the 180 days preceding surgery. Univariate analysis demonstrated a relationship between timing of injections and noninfectious wound complications ( P = .006) and rate of 1-year reoperation ( P = .045). Univariate analysis demonstrated a relationship between number of injections and 1-year reoperation ( P < .001). On multivariate analysis, those receiving injections within 30 days preoperatively had increased rates of SSI ( P = .034) and noninfectious wound complications ( P = .006) compared with those with no injection or at other time points. Patients with 2 ( P = .002) or 3 or more injections ( P < .001) in the 180-day preoperative period had increased odds of 1-year reoperation.

Conclusion

Our study suggests increased risk of SSI, wound complications, and 1-year reoperation when corticosteroid injections are administered in the 30-day preoperative period. In addition, multiple steroid injections may increase the risk of 1-year reoperation.
“The desert’s no home for a rose”: Filipinx childhood and music as aesthetic experience
Authors: Mecija Casey
Published: June 2021

This article examines Diane Paragas’ film Yellow Rose (2019) for its capacity to offer important insights into the reparative utility of music for a child separated from a parent due to deportation. While the film depicts the brutality of contemporary U.S. migration policies, Yellow Rose is also a story about the role of aesthetic expression in childhood’s diasporic imaginaries. The film teaches us about the agentic potential of music as a mode of dealing with the trauma of forced separation. In particular, the genre of American country music is affectively instrumentalized by the film’s young, Filipinx protagonist. In deepening my argument, I work with the film to explain that the kinship between Rose and a genre of music that is hegemonically associated with whiteness produces a “queer sonic” that serves as conduit for the emergence of contingent networks of care and methods of survival. I propose that queer sonic expression, or the unassimilable qualities of sound and genre, is a site where we can broaden racialized imaginings of Filipinx childhood, as it offers an opportunity for reparation.
The Other Side of the Coin: Perceptions of Twice-Exceptional Students by Their Close Friends
Authors: Conejeros-Solar María Leonor , Gómez-Arizaga María Paz , Schader Robin M. , Baum Susan M. , Sandoval-Rodríguez Katia , Henríquez Sandra Catalán
Published: June 2021

Friendship can be critical at any age but considering the gifts and challenges of twice-exceptional students, friends can be an essential element in navigating school years. The purpose of this study was to explore the perceptions that close friends of twice-exceptional students have about their friendship, characteristics, and how they relate to classmates and teachers. The sample was comprised of 17 students. Under a qualitative design, in-depth interviews were conducted with friends of students who were gifted with attention deficit hyperactivity disorder or with autism spectrum disorder. Results showed a deep relationship, in which friends of twice-exceptional students were able to make a realistic depiction of them, which was based on empathy, common interests, and a connection that stems from facing adversity. The results are not only a contribution to current research but also take a positive and strengths-based angle not always found in the literature. Implications for practice and research were discussed.
Performance as Critical Resistance: Playwriting and Public Sociology
Authors: Grills Sylvia
Published: June 2021

In this article, I argue that playwriting and performance can act as powerful forms of activism that bridge academic work and public engagement. I analyze my experiences writing and producing a stage production that mobilizes knowledge from my research about queer antiracism in Toronto. This methodological discussion is contextualized within the current political moment that positions work in the humanities as irrelevant and elitist. Performance as a method of knowledge mobilization emerged from interviews with queer peoples and community organizers. I found through conversations with participants that academic forms of knowledge mobilization, such as publishing in peer-reviewed journals, would not necessarily be accessible to community members or appropriate for encouraging discussion and social action at the local level. Participants suggested a range of antiracism organizing strategies, most of their suggestions centered on increasing the understanding and the value of the arts. I decided to meet the challenge of engaging in effective knowledge mobilization that would be in service to the community by developing a stage production called We without You that focuses on the opinions and experiences of participants. I found that producing a stage production based on academic research had powerful social effects that are not possible through traditional knowledge dissemination methods. This article encourages academics to broaden their ideas about effective knowledge mobilization; to position their work as useful and relevant to social issues and as a means of critical resistance against polarization within and outside academia.
Tocilizumab for the Treatment of COVID-19-Induced Cytokine Storm and Acute Respiratory Distress Syndrome: A Case Series From a Rural Level 1 Trauma Center in Western Pennsylvania
Authors: Suresh Krithika , Figart Michael , Formeck Samantha , Mehmood Talha , Abdel Salam Mahmoud , Bassilly David
Published: June 2021

An outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2, initially in December 2019 at Wuhan, China, subsequently spread around the world. We describe a case series of COVID-19 patients treated at our academic medical center with focus on cytokine storm and potential therapeutic role of tocilizumab. A 59-year-old female admitted for shortness of breath (SOB), productive cough, fever, and nausea in the setting of COVID-19 pneumonia. Oxygen saturation was 81% necessitating supplemental oxygen. She was transferred to intensive care unit (ICU) for worsening hypoxia; intubated and received tocilizumab following which her oxygen requirements improved. A 52-year-old female admitted from an outside hospital with SOB, intubated for worsening hypoxia, in the setting of COVID-19 pneumonia. She received tocilizumab 400 mg intravenous for 2 doses on ICU admission, with clinical improvement. A 56-year-old female hospitalized with worsening SOB, fever, and cough for 8 days saturating 88% on room air in the setting of COVID-19 pneumonia. Worsening hypoxia necessitated high flow nasal cannula. She was transferred to the ICU where she received 2 doses of tocilizumab 400 mg intravenous. She did not require intubation and was transitioned to nasal cannula. A hyperinflammatory syndrome may cause a life-threatening acute respiratory distress syndrome in patients with COVID-19 pneumonia. Tocilizumab is the first marketed interleukin-6 blocking antibody, and through targeting interleukin-6 receptors likely has a role in treating cytokine storm. We noted clinical improvement of patients treated with tocilizumab.
Pyometra: An Atypical Cause of Abdominal Pain
Authors: Walthall Leonidas , Heincelman Marc
Published: June 2021

Pyometra, a purulent infection of the uterus, is a rare cause of a very common complaint—abdominal pain. Risk factors include gynecologic malignancy and postmenopausal status. The classically described presentation includes abdominal pain, fever, and vaginal discharge. In this article, we present an atypical presentation of nonperforated pyometra in an 80-year-old female who was admitted to the internal medicine inpatient service. She initially presented with nonspecific subacute right lower quadrant abdominal pain. Physical examination did not demonstrate vaginal discharge. Laboratory evaluation failed to identify an underlying etiology. Computed tomography scan of the abdomen and pelvis with oral and intravenous contrast demonstrated a 6.5 × 6.1 cm cystic containing structure within the uterine fundus, concerning for a gynecologic malignancy. Pelvis ultrasound confirmed the mass. Endometrial biopsy did not reveal underlying malignancy, but instead showed frank pus, leading to the diagnosis of pyometra. This report illustrates that pyometra should be considered in the differential diagnosis of lower abdominal pain in elderly women.
Bullying as a Risk Factor of Depression on Undergraduate Health Students
Authors: Setiadi Rizky , Arsyawina  , Kalsum Umi , Syukur Nursari Abdul , Ramdan Iwan Muhamad
Published: June 2021

Depression is a serious health problem that needs to be treated early so that it does not get worse in the future. Bullying can cause a mental health problem on students. This study aims to analyze the relationship between bullying and depression among undergraduate health students. This was an observational study with a cross-sectional design. Respondents filled out questionnaires online using the Google Form application. A total of 246 undergraduate health students participated in this study. Multivariate logistic regression was used to analyse the data. There was a relationship between bullying and the incidence of depression in undergraduate health students (AOR: 2.158 (95% CI: 1.050-4.435)) after being controlled by physical attacked, close friends, loneliness, and smartphone addiction. This study proves that bullying is a risk factor for depression. Prevention of bullying is important to prevent depression. Handling and prevention are done by involving peer support from students through peer-counselor or peer-educator programs. Students with severe depression need to be treated further through an appropriate referral system.
Devbans, Caste, Gender and the State:Political Ecology of a Sacred Grove of Himachal Pradesh
Authors: Rani Supriya , Agnimitra Neera
Published: June 2021

Devbans are the parts of forest territory that have been traditionally conserved in reverence to the local deities in various parts of Himachal Pradesh. Today, they stand at the intersection of tradition and modernity. This paper endeavours to study the political ecology of a Devban in the contemporary times by looking at the power dynamics between various stakeholders with respect to their relative decision making power in the realm of managing the Devban of Parashar Rishi Devta. It further looks at howcertain political and administrative factors can contribute towards the growth or even decline of any Devban. The study argues that in the contemporary times when the capitalist doctrines have infiltrated every sphere of the social institutions including the religion, Devbans have a greater probability of survival when both the state and the community have shared conservatory idealsand powers to preserve them.
Healthcare Resource Utilization and Baseline Characteristics of Patients With Generalized Pustular Psoriasis: Real-World Results From a Large US Database of Multiple Commercial Medical Insurers
Authors: Sobell Jeffrey M. , Gao Ran , Golembesky Amanda K. , Kotowsky Nirali , Garry Elizabeth M. , Comerford Erin O. , Bohn Rhonda L. , Valdecantos Wendell C. , Feldman Steven R. , Leonardi Craig
Published: June 2021

Background:

Generalized pustular psoriasis (GPP) is a rare, severe neutrophilic skin disease with high unmet clinical need. The introduction of a GPP-specific International Classification of Diseases, 10th Revision (ICD-10), code has made it possible to generate a more accurate GPP patient profile.

Objectives:

To describe the characteristics and compare the patient profile and burden of disease of patients with GPP with patients with plaque psoriasis.

Methods:

A retrospective study was conducted using a US administrative claims database, the IBM® MarketScan® Research Database. The study took place between October 1, 2015, and September 30, 2018. Patients with at least 1 inpatient or 2 outpatient L40.1 (GPP) or L40.0 (psoriasis vulgaris) diagnostic codes were included for analysis. Outcome measures included descriptions of comorbidities, medication use, and healthcare resource utilization (HCRU) among GPP, plaque psoriasis, and general population (matched to those with GPP) cohorts.

Results:

Patients with GPP had more baseline comorbidities than those with plaque psoriasis and the matched cohort, including psoriatic arthritis (20.6% vs 6.4% and <0.1%) and hyperlipidemia (20.4% vs 16.3% and 11.8%). Patients with GPP also had greater medication use and higher HCRU than those with plaque psoriasis and the matched cohort.

Conclusion:

Patients with GPP generally experience more comorbidities, with higher HCRU, than patients with plaque psoriasis. Although the large dataset permitted identification of GPP patients with longitudinal follow-up, the lack of a validation algorithm for GPP is a limitation and a potential area for future research.
Palliative care services for cancer patients in Nepal, a lower-middle-income country
Authors: Gautam Deepa , Adhikari Sudhir
Published: June 2021

With the rise in cancer burden, need for palliative care services has increased simultaneously and majority of people requiring services are from low- and middle-income countries where palliative care is in primitive stage. Nepal is also facing similar challenges of dealing with cancer care and end-of-life care. From its initiation in the early 1990s, there has been gradual progress in the development of palliative care with joint effort of government as well as non-governmental organizations. Morphine, a major milestone for pain management, is being manufactured in the country for nearly a decade, yet morphine equivalence mg per capita is far below the global average. Currently, Nepal has been placed under ‘Category 3a’ with isolated care provision and there are a lot of challenges to overcome to improve the existing services. Majority of hospice and palliative care centres are located in the capital city and only a few in the periphery. Scarcity of treatment centres and expertise, limited finances, lack of awareness among patients and health care workers, and difficult terrain are major barriers for optimal care. Proper implementation of national guidelines, human resource development and integration of palliative care to primary healthcare level would be crucial steps for further improvement.
Correction to: The Design of the AZO Conductive Layer on Microchannel Plate
Authors: Wang Yuman , Liu Shulin , Yan Baojun , Qi Ming , Wen Kaile , Zhang Binting , Gu Jianyu , Yao Wenjing
Published: June 2021

An amendment to this paper has been published and can be accessed via the original article.
The opportunity of shared autonomous vehicles to improve spatial equity in accessibility and socio-economic developments in European urban areas
Authors: Eppenberger Norman , Richter Maximilian Alexander
Published: June 2021

Background

This paper provides insight into the opportunity offered by shared autonomous vehicles (SAVs) to improve urban populations’ spatial equity in accessibility. It provides a concrete implementation model for SAVs set to improve equity in accessibility and highlights the need of regulation in order for SAVs to help overcome identified spatial mismatches.

Methodology

Through the formulation of linear regression models, the relationship between land-use and transportation accessibility (by car and public transport) and socio-economic well-being indicators is tested on district-level in four European cities: Paris, Berlin, London and Vienna. Accessibility data is used to analyse access to points of interest within given timespans by both car and public transport. To measure equity in socio-economic well-being, three district-level proxies are introduced: yearly income, unemployment rate and educational attainment.

Results

In the cities of Paris, London and Vienna, as well as partially in Berlin, positive effects of educational attainment on accessibility are evidenced. Further, positive effects on accessibility by yearly income are found in Paris and London. Additionally, negative effects of an increased unemployment rate on accessibility are observed in Paris and Vienna. Through the comparison between accessibility by car and public transportation in the districts of the four cities, the potential for SAVs is evidenced. Lastly, on the basis of the findings a ‘SAV identification matrix’ is created, visualizing the underserved districts in each of the four cities and the need of equity enhancing policy for the introduction of SAVs is emphasized.
Characterization of nucleic acids from extracellular vesicle-enriched human sweat
Authors: Bart Geneviève , Fischer Daniel , Samoylenko Anatoliy , Zhyvolozhnyi Artem , Stehantsev Pavlo , Miinalainen Ilkka , Kaakinen Mika , Nurmi Tuomas , Singh Prateek , Kosamo Susanna , Rannaste Lauri , Viitala Sirja , Hiltunen Jussi , Vainio Seppo J
Published: June 2021

Background

The human sweat is a mixture of secretions from three types of glands: eccrine, apocrine, and sebaceous. Eccrine glands open directly on the skin surface and produce high amounts of water-based fluid in response to heat, emotion, and physical activity, whereas the other glands produce oily fluids and waxy sebum. While most body fluids have been shown to contain nucleic acids, both as ribonucleoprotein complexes and associated with extracellular vesicles (EVs), these have not been investigated in sweat. In this study we aimed to explore and characterize the nucleic acids associated with sweat particles.

Results

We used next generation sequencing (NGS) to characterize DNA and RNA in pooled and individual samples of EV-enriched sweat collected from volunteers performing rigorous exercise. In all sequenced samples, we identified DNA originating from all human chromosomes, but only the mitochondrial chromosome was highly represented with 100% coverage. Most of the DNA mapped to unannotated regions of the human genome with some regions highly represented in all samples. Approximately 5 % of the reads were found to map to other genomes: including bacteria (83%), archaea (3%), and virus (13%), identified bacteria species were consistent with those commonly colonizing the human upper body and arm skin. Small RNA-seq from EV-enriched pooled sweat RNA resulted in 74% of the trimmed reads mapped to the human genome, with 29% corresponding to unannotated regions. Over 70% of the RNA reads mapping to an annotated region were tRNA, while misc. RNA (18,5%), protein coding RNA (5%) and miRNA (1,85%) were much less represented. RNA-seq from individually processed EV-enriched sweat collection generally resulted in fewer percentage of reads mapping to the human genome (7–45%), with 50–60% of those reads mapping to unannotated region of the genome and 30–55% being tRNAs, and lower percentage of reads being rRNA, LincRNA, misc. RNA, and protein coding RNA.

Conclusions

Our data demonstrates that sweat, as all other body fluids, contains a wealth of nucleic acids, including DNA and RNA of human and microbial origin, opening a possibility to investigate sweat as a source for biomarkers for specific health parameters.
A rapid and efficient method for the extraction and identification of menaquinones from Actinomycetes in wet biomass
Authors: Xie Fuquan , Pei Shengxiang , Lin Xihuang , Tian Yun , Zhang Gaiyun
Published: June 2021

Background

Menaquinones are constituents of prokaryote cell membranes where they play important functions during electron transport. Menaquinone profiles are strongly recommended for species classification when proposing a new Actinomycetes taxon. Presently, the most widely used methods to determine menaquinones are based on freeze-dried cells. Taxonomic research in our lab has revealed that menaquinone concentrations are low for some species of the genus Microbacterium, leading to difficulties in identifying menaquinones.

Results

Menaquinones extracted using the novel lysozyme-chloroform-methanol (LCM) method were comparable in quality to those obtained using the Collins method, the most widely used method. All tested strains extracted via the LCM method showed higher concentrations of menaquinones than those extracted via the Collins method. For some Microbacterium strains, the LCM method exhibited higher sensitivity than the Collins method, and more trace menaquinones were detected with the LCM method than the Collins method. In addition, LCM method is faster than the Collins method because it uses wet cells.

Conclusion

The LCM method is a simple, rapid and efficient technique for the extraction and identification of menaquinones from Actinomycetes.
Two-dose varicella vaccine effectiveness in China: a meta-analysis and evidence quality assessment
Authors: Zhang Zhujiazi , Suo Luodan , Pan Jingbin , Zhao Dan , Lu Li
Published: June 2021

Background

The objectives of this review were to evaluate the vaccine effectiveness (VE) of the two-dose varicella vaccine for healthy children in China and explore the application of the approach of Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) in observational studies on VE.

Methods

We searched for observational studies on two-dose varicella VE for children in China aged 1–12 years that were published from 1997 to 2019, and assessed the quality of each study using the Newcastle Ottawa Scale (NOS). We used meta-analysis models to obtain the pooled two-dose VE, and the studies were divided into subgroups and analysed according to whether or not it was an outbreak investigation and its NOS score. The quality of evidence of VEs were rated by approach of the GRADE system.

Results

A total of 12 studies and 87,196 individuals were included. The pooled two-dose VE was 90% (95% confidence interval [CI]: 69–97%). The VE of outbreak studies (87% [95% CI: 76–93%]) was lower than non-outbreak studies (99% [95% CI: 98–99%]). There was no significant difference in VEs by different NOS quality. The quality of the evidence assessment of pooled two-dose VE was “low”, which was rated down by one category in limitations and publication bias respectively and rated up by two category in large effect. The quality of evidence assessment in subgroup of NOS score ≥ 7 was “moderate”.

Conclusions

The VE of two-dose varicella vaccine is relatively high in preventing varicella, and is recommended for countries which need further control for varicella. However, higher quality evidence is needed as a supplement for stronger recommendations. The approach of GRADE could be applied for rating the quality of evidence in observational study.
Increased risk factors associated with lower BMD in antiretroviral-therapy–naïve HIV-infected adult male
Authors: Atencio Patricia , Cabello Alfonso , Conesa-Buendía Francisco M. , Pérez-Tanoira Ramón , Prieto-Pérez Laura , Carrillo Irene , Álvarez Beatriz , Arboiro-Pinel Rosa , Díaz-Curiel Manuel , Herrero-Beaumont Gabriel , Mediero Aránzazu , Górgolas Miguel
Published: June 2021

Background

Low BMD (bone mineral density) has been described as a non–AIDS (Acquired Immune Deficiency Syndrome)-related event in HIV (human immunodeficiency virus)-patients but it is poorly studied in young HIV-infected men who have received no previous antiretroviral therapy.

Methods

A cross-sectional study of 245 naïve-HIV-infected men over 21 and under 50 years old who voluntary attended the Infectious Disease Division appointment in Hospital Fundación Jimenez Díaz in Madrid, from January 1st, 2014 to September 30th, 2017. All subjects underwent a baseline DXA scan (dual energy x-ray absorptiometry) performed prior to start antiretroviral treatment. Further, all patients who started treatment between May 1st and September 30th, 2017 were invited to participate in a substudy on bone mineral metabolism. All the information was collected through clinical history and complementary questionnaire.

Results

The mean age was 36.4 years, been 68% Caucasian, 29.3% Latin American and 2.7% African race. At the time of diagnosis, 91% of patients had stage-A (median CD4+ T-cell 481cells/μL, IQR, 320–659). 10% had a count below 200 CD4 cells/μL, and 40% had a CD4/CD8 cell-count-ratio below 0.4. Regarding lifestyle and risk factors, 14.1% presented underweight, 36.1% were not engage in any regular exercise, 51.9% were active smokers and 35.3% reported drug use. Low levels of vitamin D were seen in 87.6% of the study participants. Low BMD (Z-score <- 2.0) was found in 22.8% of the patients. It was only observed a significant association of Z-score in lumbar spine (LS) with CD8 and the CD4/CD8 ratio, and with alcohol for femoral neck (FN) measurement.

Conclusions

We find prevalence of increased bone involvement among naïve HIV-infected men under 50 years old. Further studies are necessary to evaluate if changes in actual guidelines are needed to assess BMD measurements in HIV-infected adult male patients under 50.
Spontaneous perirenal hemorrhage in systemic lupus erythematosus: a rare case report and literature review
Authors: Zhao Youlu , Jia Xiaoyu , Tong Xiaoqiang , Niu Guochen , Wang Rui , Liu Lijun , Zhou Fude
Published: June 2021

Background

Spontaneous perirenal hemorrhage is relatively uncommon but may be life-threatening. There are some challenges in early diagnosis due to the lack of specific presentations.

Case presentation

We report a case of spontaneous perirenal hemorrhage in a newly diagnosed systemic lupus erythematosus patient who initially presented with non-specific flank pain. Weakness and unstable vital signs were noted on admission. Abdominal ultrasonography and computed tomography revealed a sizable perirenal hematoma over the left retroperitoneal cavity. Renal arteriography identified active extravasation of contrast media from a distant branch of the left renal artery, and selective embolization effectively obliterated the bleeding spot. After cessation of bleeding, the patient received intensive immunosuppressive therapy for acute kidney injury and encephalopathy due to lupus. Her mental status recovered successfully, and she was withdrawn from short-term hemodialysis.

Conclusions

Spontaneous perirenal hemorrhage in the condition of systemic lupus erythematosus was a rare clinical entity with life-threatening potential. Early accurate diagnosis of spontaneous renal hemorrhage requires both detailed clinical examination and radiologic studies. Interventional embolization is essential and effective for both diagnosis and treatment. A high index of suspicion is necessary to avoid missing this potentially fatal syndrome, especially in patients with an increased risk of bleeding.
Validity and reliability of the Georgian-language brief international cognitive assessment for multiple sclerosis (BICAMS)
Authors: Botchorishvili Nazibrola , Shiukashvili Nino , Mikeladze Nina , Dzagnidze Ann , Mikava Nino , Tighashvili Maia , Janelidze Marina
Published: June 2021

Background

Cognitive impairment is one of the common features of multiple sclerosis (MS). Despite high prevalence, cognitive decline is often overlooked by neurologists. The Brief International Cognitive Assessment for MS (BICAMS) was therefore introduced by the international expert committee as a brief and effective tool for the assessment and monitoring of cognitive functions in patients with MS. The validity and reliability of BICAMS have been demonstrated in many countries. Our aim was to validate the BICAMS in Georgian patients with MS.

Methods

A total of 68 patients with MS and 68 matched controls were assessed by the Georgian-language BICAMS. All healthy controls and seven patients were re-evaluated with identical tests to assess retest reliability.

Results

In comparison to healthy controls, patients with MS performed significantly worse on all tests in the assessment battery. Test–retest reliability measures were good for all tests. The prevalence of cognitive impairment in patients with MS was 43%.

Conclusion

The Georgian-language BICAMS is a reliable and valid battery for the assessment of cognitive function in patients with MS.
Low dose statins improve prognosis of ischemic stroke patients with intravenous thrombolysis
Authors: Cui Chaohua , Li Yanbo , Bao Jiajia , Dong Shuju , Gao Lijie , He Li
Published: June 2021

Background

For acute ischaemic stroke patients, it is uncertain whether intravenous thrombolysis combined with statins might increase the therapeutic effect. Additionally, using high-intensity statins after thrombolysis may increase the risk of bleeding in patients. Asian stroke patients often take low-dose statins. It is speculated that reducing the dose of statins may improve the risk of bleeding.

Methods

Data from consecutive acute ischaemic stroke patients with intravenous thrombolysis were prospectively collected. Efficacy outcomes included NIHSS (National Institutes of Health Stroke Scale) score improvement at 7 days after admission and mRS (Modified Rankin Scale) improvement at 90 days. Safety outcomes included haemorrhage events (intracerebral haemorrhage and gastrointestinal haemorrhage) in the hospital and death events within 2 years.

Results

The study finally included 215 patients. The statin group had a higher percentage of NIHSS improvement at 7 days (p < 0.001) and a higher percentage of a favourable functional outcome (FFO, mRS <  = 2) (p < 0.001) at 90 days. The statin group had a lower percentage of intracerebral haemorrhage (p < 0.001) and gastrointestinal haemorrhage (p = 0.003) in the hospital and a lower percentage of death events (p < 0.001) within 2 years. Logistic regression indicated that statin use was significantly related to NIHSS improvement (OR = 4.697, p < 0.001), a lower percentage of intracerebral haemorrhage (OR = 0.372, p = 0.049) and gastrointestinal haemorrhage (OR = 0.023, p = 0.016), and a lower percentage of death events (OR = 0.072, p < 0.001).

Conclusion

For acute ischaemic stroke patients after intravenous thrombolysis, the use of low-dose statins was related to NIHSS improvement at 7 days and inversely related to haemorrhage events in the hospital and death events within 2 years, especially for moderate stroke or noncardioembolic stroke patients.