bluuebunny/crossref_metadata_2025 huggingface dataset:
Perceptions of minimum age at marriage laws and their enforcement: qualitative evidence from Malawi
Authors: Melnikas Andrea J. , Mulauzi Nancy , Mkandawire James , Amin Sajeda
Published: July 2021

Background

Child marriage in Malawi is a significant problem with 42.1% of women 20–24 married by age 18. In 2017 the Malawi government formalized legislation to make marriage under age 18 illegal; violators are subject to fines. While leveraging laws to reduce child marriage is common, the enactment of laws and their enforcement has led to some novel practices. One such practice observed in Malawi is marriage withdrawal, where the community intervenes when a child marriage has taken place to force the girl to return to her natal home.

Methods

This paper is a qualitative analysis of perceptions regarding marriage withdrawal. We conducted focus group discussions and in-depth interviews with married and unmarried adolescents, parents of adolescents, and key community members in Mangochi and Nkhata Bay. Data were collected as part of an evaluation of the More Than Brides Alliance program aimed at delaying marriage and improving access to sexual and reproductive health services in Malawi.

Results

The knowledge that violation of marriage laws entails substantial fines is widespread and marriage withdrawals are seen by some respondents as a way of enforcing the spirit of child marriage laws while avoiding fines. Some respondents suggest that enforcement of marriage laws has an unintended effect of driving marriages underground. One important disconnect between the laws and the realities of child marriage practices in these communities is that the law holds parents responsible for the marriage and for preventing it, while parents do not necessarily exercise control, particularly when the marriage is precipitated by pregnancy. While parents and other adults view withdrawals as an acceptable resolution of a problematic child marriage, girls noted many drawbacks for withdrawn girls such as stigma and limited education and livelihood opportunities once withdrawn.

Conclusions

Our exploration of perceptions about marriage laws suggest that the imposition of fines may have some unintended consequences, both driving the practice underground and encouraging practices to evade fines, and may be associated with unintended consequences for adolescent girls. Programs to address child marriage should include other approaches that address more distal drivers including poverty and lack of alternatives to child marriage.

Trial registration

This work is part of an RCT registered August 4, 2016 in the AEA RCT registry identified as:AEARCTR-0001463. See:https://www.socialscienceregistry.org/trials/1463
The relationship between changes in serum myostatin and adiponectin levels in patients with obesity undergoing a weight loss program
Authors: Takao Nana , Kurose Satoshi , Miyauchi Takumi , Onishi Katsuko , Tamanoi Atsuko , Tsuyuguchi Ryota , Fujii Aya , Yoshiuchi Sawako , Takahashi Kazuhisa , Tsutsumi Hiromi , Kimura Yutaka
Published: July 2021

Background

An effective strategy for weight loss in patients who are overweight or obese is to reduce body fat mass while maintaining skeletal muscle mass. Adiponectin and myostatin are affected through changes in body composition due to weight loss, and examining their dynamics may contribute to strategies for maintaining skeletal muscle mass through weight loss. We aimed to examine the relationships among myostatin, adiponectin, and body composition, depending on the extent of weight loss, in patients with obesity undergoing a weight loss program.

Methods

We examined 66 patients with obesity (age: 46.8 ± 14.0 years, body mass index: 34.3 [31.0–38.4] kg/m2) attending a hospital weight loss program. We categorized the patients into two groups, namely an L group (those with a weight reduction of < 5% from baseline) and an M group (those with a weight reduction of > 5% from baseline). All patients underwent blood tests and were assessed for body composition, insulin resistance, adipocytokine and myokine levels, exercise tolerance, and muscle strength at baseline and post-intervention.

Results

Serum myostatin and adiponectin levels increased post-intervention in both groups. Body weight and %fat decreased, and the rate of lean body mass (%LBM) increased in both groups. Exercise capacity and muscle strength improved in the M group only. Change in (⊿) myostatin correlated with ⊿%fat, ⊿%LBM, and ⊿adiponectin. ⊿adiponectin (β = − 0.262, p = 0.035) was an independent predictor of ⊿myostatin.

Conclusions

Myostatin and adiponectin might cross-talk and regulate changes in skeletal muscle and fat mass with or without successful weight loss. These findings indicate that evaluating serum myostatin and adiponectin levels in clinical practice could be used to predict the effects of weight loss and help prevent skeletal muscle mass loss.
Phytochemical, antimicrobial, antioxidant and enzyme inhibitory potential of medicinal plant Dryopteris ramosa (Hope) C. Chr.
Authors: Alam Fiaz , Khan Syed Hurmat Ali , Asad Mohammad Hassham Hassan Bin
Published: July 2021

Background

Dryopteris ramosa has numerous potentials uses in the treatment of different maladies as old traditional medication. The fronds of D. ramose are edible and orally administered for producing antibiotic effect. They are also used as astringent and febrifuge, and as a pesticide.

Methods

Extraction of fronds of D. ramosa using solvents of increasing polarity, namely, ethyl acetate, methanol and water were tested for phytochemical (qualitative tests, GC-MS), antimicrobial (well method), antioxidant (DPPH), antifungal (tube dilution), cytotoxic activity (brine shrimps lethality assay) and LOX and COX inhibitory activities were performed using standard methods.

Results

The phytochemical analysis of the crude methanolic extract revealed that the fronds are rich in flavonoids, alkaloids, saponins, tannins, glycosides and triterpenoids. The total flavonoid content of the ethyl acetate fraction was 46.28 μg QE/mg extract. The GC-MS analysis revealed nine major compounds that constituted the crude drug and potentially had a role in reported activities. The crude extract was the most active amongst all the fractions against the bacterial and fungal strains used such that it inhibited the growth of P. aeruginosa with a zone of 13 mm and a MIC value of 16 μg/ml as compared to the standard cefixime, which inhibited the zone by only 10 mm and a MIC value of 32 μg/ml. The highest antioxidant potential in DPPH assay was shown by the crude extract with 91.948% free radical scavenging activity. The bring shrimps lethality potential of the crude extract was the highest, with a LD50 value of 47.635 μg/ml. The ethyl acetate fraction inhibits 91.36% of alpha glucosidase enzyme at a concentration of 0.5 mg/ml. In case of acetylcholine esterase inhibition assay, the methanol fraction inhibits 58.26% of the enzyme activity. Similarly, for butyrylcholine esterase inhibition, the maximum inhibitory effect was seen in the methanol fraction, with a percentage inhibition of 47.32%.

Conclusion

These test results support traditional medicinal uses of the plant. Dryopteris ramosa could be imperative for being used as a therapeutic agent and the medicinal importance of this plant should be further investigated.
Designing a reference architecture for health information systems
Authors: Tummers Joep , Tobi Hilde , Catal Cagatay , Tekinerdogan Bedir
Published: July 2021

Background

Healthcare relies on health information systems (HISs) to support the care and receive reimbursement for the care provided. Healthcare providers experience many problems with their HISs due to improper architecture design. To support the design of a proper HIS architecture, a reference architecture (RA) can be used that meets the various stakeholder concerns of HISs. Therefore, the objective of this study is to develop and analyze an RA following well-established architecture design methods.

Methods

Domain analysis was performed to scope and model the domain of HISs. For the architecture design, we applied the views and beyond approach and designed the RA’s views based on the stakeholders and features from the domain analysis. We evaluated the RA with a case study.

Results

We derived the following four architecture views for HISs: The context diagram, decomposition view, layered view, and deployment view. Each view shows the architecture of the HIS from a different angle, suitable for various stakeholders. Based on a Japanese hospital information system study, we applied the RA and derived the application architecture.

Conclusion

We demonstrated that the methods of the software architecture design community could be used in the healthcare domain effectively and showed the applicability of the RA.
Disparities in mothers’ healthcare seeking behavior for common childhood morbidities in Ethiopia: based on nationally representative data
Authors: Geda Nigatu Regassa , Feng Cindy Xin , Whiting Susan J. , Lepnurm Rein , Henry Carol J. , Janzen Bonnie
Published: July 2021

Background

Childhood morbidities such as diarrhea and pneumonia are the leading causes of death in Ethiopia. Appropriate healthcare-seeking behavior of mothers for common childhood illnesses could prevent a significant number of these early deaths; however, little nation-wide research has been conducted in Ethiopia to assess mothers’ healthcare-seeking behavior for their under five children.

Methods

The study used the Ethiopian Demographic and Health Surveys (EDHS) data. The EDHS is a cross sectional survey conducted in 2016 on a nationally representative sample of 10,641 respondents. The main determinants of care-seeking during diarrhea and acute respiratory infection (ARI) episodes were assessed using multiple logistic regression analyses while adjusting for complex survey design.

Results

Only 43% and 35% of households sought medical attention for their children in episodes of diarrhea and ARI, respectively, during a reference period of 2 weeks before the survey. The odds of seeking care for diarrhea are lower for non-working mothers versus working mothers. The likelihood of seeking care for diarrhea or ARI is higher for literate fathers compared to those with no education. The place of delivery for the child, receiving postnatal checkup and getting at least one immunization in the past determined the likelihood of seeking care for ARI, but not for diarrhea. The odds of seeking care are higher for both diarrhea and ARI among households that are headed by females and where mothers experienced Intimate Partner Violence (IPV) violence. Religion and types of family structure are also significant factors of seeking care for diarrhea episodes, but not for ARI.

Conclusions

The findings call for more coordinated efforts to ensure equitable access to health care services focusing on mothers living in deprived household environment. Strengthening partnerships with public facilities, private health care practitioners, and community-based organizations in rural areas would help further improve access to the services.
Uniform trichromacy in Alouatta caraya and Alouatta seniculus: behavioural and genetic colour vision evaluation
Authors: Henriques Leonardo Dutra , Hauzman Einat , Bonci Daniela Maria Oliveira , Chang Belinda S. W. , Muniz José Augusto Pereira Carneiro , da Silva Souza Givago , de Lima Silveira Luiz Carlos , de Faria Galvão Olavo , Goulart Paulo Roney Kilpp , Ventura Dora Fix
Published: July 2021

Primate colour vision depends on a matrix of photoreceptors, a neuronal post receptoral structure and a combination of genes that culminate in different sensitivity through the visual spectrum. Along with a common cone opsin gene for short wavelengths (sws1), Neotropical primates (Platyrrhini) have only one cone opsin gene for medium-long wavelengths (mws/lws) per X chromosome while Paleotropical primates (Catarrhini), including humans, have two active genes. Therefore, while female platyrrhines may be trichromats, males are always dichromats. The genus Alouatta is inferred to be an exception to this rule, as electrophysiological, behavioural and molecular analyses indicated a potential for male trichromacy in this genus. However, it is very important to ascertain by a combination of genetic and behavioural analyses whether this potential translates in terms of colour discrimination capability. We evaluated two howler monkeys (Alouatta spp.), one male A. caraya and one female A. seniculus, using a combination of genetic analysis of the opsin gene sequences and a behavioral colour discrimination test not previously used in this genus. Both individuals completed the behavioural test with performances typical of trichromatic colour vision and the genetic analysis of the sws1, mws, and lws opsin genes revealed three different opsin sequences in both subjects. These results are consistent with uniform trichromacy in both male and female, with presumed spectral sensitivity peaks similar to Catarrhini, at ~ 430 nm, 532 nm, and 563 nm for S-, M- and L-cones, respectively.
Effectiveness of non-pharmacological interventions on sleep characteristics among adults with musculoskeletal pain and a comorbid sleep problem: a systematic review
Authors: Papaconstantinou Efrosini , Cancelliere Carol , Verville Leslie , Wong Jessica J. , Connell Gaelan , Yu Hainan , Shearer Heather , Timperley Charlotte , Chung Chadwick , Porter Bryan J. , Myrtos Danny , Barrigar Matthew , Taylor-Vaisey Anne
Published: July 2021

Sleep problems are common and may be associated with persistent pain. It is unclear whether non-pharmacological interventions improve sleep and pain in adults with comorbid sleep problems and musculoskeletal (MSK) pain. We conducted a systematic review on the effectiveness of non-pharmacological interventions on sleep characteristics among adults with MSK pain and comorbid sleep problems. We searched MEDLINE, EMBASE, CINAHL, Cochrane Central and PsycINFO from inception to April 2, 2021 for randomized controlled trials (RCTs), cohort, and case-control studies. Pairs of independent reviewers critically appraised and extracted data from eligible studies. We synthesized the findings qualitatively. We screened 8459 records and identified two RCTs (six articles, 467 participants). At 9 months, in adults with insomnia and osteoarthritis pain, cognitive behavioral therapy for pain and insomnia (CBT-PI) was effective at improving sleep (Insomnia Severity Index, ISI) when compared to education (OR 2.20, 95% CI 1.25, 3.90) or CBT for pain (CBT-P) (OR 3.21, 95% CI 1.22, 8.43). CBP-P vs. education was effective at increasing sleep efficiency (wrist actigraphy) in a subgroup of participants with severe pain at baseline (mean difference 5.45, 95% CI 1.56, 9.33). At 18 months, CBT-PI, CBT-P and education had similar effectiveness on sleep and pain or health outcomes. In adults with insomnia and knee osteoarthritis, CBT-I improved some sleep outcomes including sleep efficiency (diary) at 3 months (Cohen’s d 0.39, 95% CI 0.24, 1.18), and self-reported sleep quality (ISI) at 6 months (Cohen’s d − 0.62, 95% CI -1.01, − 0.07). The intervention was no better than placebo (behavioural desensitization) for improving other sleep outcomes related to sleep onset or pain outcomes. Short-term improvement in sleep was associated with pain reduction at 6 months (WOMAC pain subscale) (sensitivity 54.8%, specificity 81.4%). Overall, in two acceptable quality RCTs of adults with OA and comorbid insomnia, CBT-PI/I may improve some sleep outcomes in the short term, but not pain outcomes in the short or long-term. Clinically significant improvements in sleep in the short term may improve longer term pain outcomes. Further high-quality research is needed to evaluate other non-pharmacological interventions for people with comorbid sleep problems and a range of MSK conditions.
Full-length transcriptome analysis reveals the mechanism of acupuncture at PC6 improves cardiac function in myocardial ischemia model
Authors: Yuan Jing , Wang Jun-Meng , Li Zhi-Wei , Zhang Cheng-Shun , Cheng Bin , Yang Su-Hao , Liu Bai-Tong , Zhu Li-Juan , Cai Ding-Jun , Yu Shu-Guang
Published: July 2021

Background

The pathological process of myocardial ischemia (MI) is very complicated. Acupuncture at PC6 has been proved to be effective against MI injury, but the mechanism remains unclear. This study investigated the mechanism that underlies the effect of acupuncture on MI through full-length transcriptome.

Methods

Adult male C57/BL6 mice were randomly divided into control, MI, and PC6 groups. Mice in MI and PC6 group generated MI model by ligating the left anterior descending (LAD) coronary artery. The samples were collected 5 days after acupuncture treatment.

Results

The results showed that treatment by acupuncture improved cardiac function, decreased myocardial infraction area, and reduced the levels of cTnT and cTnI. Based on full-length transcriptome sequencing, 5083 differential expression genes (DEGs) and 324 DEGs were identified in the MI group and PC6 group, respectively. These genes regulated by acupuncture were mainly enriched in the inflammatory response pathway. Alternative splicing (AS) is a post-transcriptional action that contributes to the diversity of protein. In all samples, 8237 AS events associated with 1994 genes were found. Some differential AS-involved genes were enriched in the pathway related to heart disease. We also identified 602 new genes, 4 of which may the novel targets of acupuncture in MI.

Conclusions

Our findings suggest that the effect of acupuncture on MI may be based on the multi-level regulation of the transcriptome.
Is ghrelin a biomarker of early-onset scoliosis in children with Prader–Willi syndrome?
Authors: Pacoricona Alfaro Dibia Liz , Diene Gwenaelle , Pinto Graziella , Salles Jean-Pierre , Gennero Isabelle , Faye Sandy , Molinas Catherine , Valette Marion , Arnaud Catherine , Tauber Maithé
Published: July 2021

Background

Adolescents with idiopathic scoliosis display high ghrelin levels. As hyperghrelinemia is found in patients with PWS and early-onset scoliosis (EOS) is highly prevalent in these patients, our aims were to explore (1) whether ghrelin levels differ between those with and without EOS and correlate with scoliosis severity, and (2) whether ghrelin levels in the first year of life are associated with the later development of EOS.

Methods

We used a case control study design for the first question and a longitudinal design for the second. Patients with PWS having plasma ghrelin measurements recorded between 2013 and 2018 in our database were selected and 30 children < 10 years old with EOS and 30 age- and BMI-matched controls without EOS were included. The Cobb angle at diagnosis was recorded. In addition, 37 infants with a ghrelin measurement in the first year of life were followed until 4 years of age and assessed for EOS. Total ghrelin (TG), acylated (AG) and unacylated ghrelin (UAG), and the AG/UAG ratio were analyzed.

Results

EOS children had an AG/UAG ratio statistically significantly lower than controls. The Cobb angle was positively correlated with TG and UAG. TG and AG in the first year of life were higher in infants who later develop EOS without reaching a statistically significant difference.

Conclusions

Our results suggest that ghrelin may play a role in the pathophysiology of EOS in PWS. Higher ghrelinemia in the first year of life required careful follow-up for EOS.
Maternal steroid levels and the autistic traits of the mother and infant
Authors: Tsompanidis A. , Aydin E. , Padaigaitė E. , Richards G. , Allison C. , Hackett G. , Austin T. , Holt R. , Baron-Cohen S.
Published: July 2021

Background

Prenatal sex steroids have been associated with autism in several clinical and epidemiological studies. It is unclear how this relates to the autistic traits of the mother and how early this can be detected during pregnancy and postnatal development.

Methods

Maternal serum was collected from pregnant women (n = 122) before or during their first ultrasound appointment [mean = 12.7 (SD = 0.7) weeks]. Concentrations of the following were measured via immunoassays: testosterone, estradiol, dehydroepiandrosterone sulphate, progesterone; and sex hormone-binding globulin which was used to compute the free fractions of estradiol (FEI) and testosterone (FTI). Standardised human choriogonadotropin (hCG) and pregnancy-associated plasma protein A (PAPP-A) values were obtained from clinical records corresponding to the same serum samples. Mothers completed the Autism Spectrum Quotient (AQ) and for their infants, the Quantitative Checklist for Autism in Toddlers (Q-CHAT) when the infants were between 18 and 20 months old.

Results

FEI was positively associated with maternal autistic traits in univariate (n = 108, Pearson’s r = 0.22, p = 0.019) and multiple regression models (semipartial r = 0.19, p = 0.048) controlling for maternal age and a diagnosis of PCOS. Maternal estradiol levels significantly interacted with fetal sex in predicting infant Q-CHAT scores, with a positive relationship in males but not females (n = 100, interaction term: semipartial r = 0.23, p = 0.036) after controlling for maternal AQ and other covariates. The opposite was found for standardised hCG values and Q-CHAT scores, with a positive association in females but not in males (n = 151, interaction term: r = −0.25, p = 0.005).

Limitations

Sample size of this cohort was small, with potential ascertainment bias given elective recruitment. Clinical covariates were controlled in multiple regression models, but additional research is needed to confirm the statistically significant findings in larger cohorts.

Conclusion

Maternal steroid factors during pregnancy are associated with autistic traits in mothers and their infants.
Fibroid expulsion: a unique presentation of mechanical small bowel obstruction 11 years after uterine artery embolization: a case report
Authors: Roberson Jeffrey L. , Krumeich Lauren N. , Darwich Nabil F. , Babatunde Victor , Laczko Dorottya , Albee Andrew , Yang Zhaohai , Jack Amr El , Shlansky-Goldberg Richard , DeAgostino-Kelly Mary , Braslow Benjamin M.
Published: July 2021

Background

Uterine artery embolization in the treatment of uterine leiomyoma has been rarely associated with dislodgement and expulsion of infarcted uterine fibroids through the vagina, peritoneum, or bowel wall, predominantly occurring within 6 months of uterine artery embolization.

Case presentation

We present the case of a 54-year-old African American woman who underwent uterine artery embolization 11 years prior and developed mechanical small bowel obstruction from the migration of fibroid through a uteroenteric fistula with ultimate impaction within the distal small bowel lumen. Small bowel resection and hysterectomy were curative.

Conclusions

Uteroenteric fistula with small bowel obstruction due to fibroid expulsion may present as a delayed finding after uterine artery embolization and requires heightened awareness.
Paraganglioma presenting as hypertension during pregnancy, proteinuria, thrombocytosis, and diabetes mellitus: a case report
Authors: Mohamed Ramjan Sanas , Antonypillai Charles Naveenan , Mahendran Harishanthi
Published: July 2021

Background

Paraganglioma is a very rare cause of pregnancy-induced hypertension. The objective of this case report is to present a case of paraganglioma presented during pregnancy and missed. Later, the diagnosis was made during the postpartum period because of persistence of hypertension.

Case presentation

Here, we describe the case of a patient with paraganglioma who initially presented with pregnancy-induced hypertension and gestational diabetes mellitus. She had persistence of hypertension and diabetes mellitus following delivery with proteinuria, thrombocytosis, and spells. Once her pelvic paraganglioma was removed, her blood pressure and blood sugar were normal without antihypertensives or hypoglycemic agents, respectively. Her proteinuria settled with near-normal platelet counts.

Conclusion

Although neuroendocrine tumors are a rare cause of pregnancy-induced hypertension, it should be suspected in the appropriate clinical setting. Diabetes mellitus, proteinuria, and thrombocytosis can be a clinical feature in paraganglioma.
Characteristics of patients with osteonecrosis of the jaw with oral versus intravenous bisphosphonate treatment
Authors: Lee Seung-Hun , Choi So-Young , Bae Min-Su , Kwon Tae-Geon
Published: July 2021

Purpose

This retrospective study was aimed to evaluate the clinical characteristics and treatment outcomes in patients with osteonecrosis of the jaw who were receiving oral versus intravenous (IV) bisphosphonate (BP).

Materials and methods

This retrospective study enrolled subjects who had been diagnosed with medication-related osteonecrosis of the jaw (MRONJ) during the period from July 2010 to June 2014. Information regarding the following demographic and clinical characteristics was collected: demographic data, administration route and type of BP, duration of BP medication, primary disease, number of involved sites, location of the lesion, number of surgeries, outcome of treatments, and laboratory test. All the patients were divided into oral and IV BP groups; and the between-group differences were compared.

Results

Total 278 patients were divided into two groups as per the route of BP administration. The proportion of oral BP-related MRONJ group were more dominant over IV BP group (oral BP, n = 251; IV BP, n = 27). In the IV BP group, the average dosing duration (31.4 months) was significantly shorter than that in the oral BP group (53.1 months) (P < 0.001). The average number of involved sites in the oral BP group (1.21 ± 0.48) was smaller than that in the IV BP group (1.63 ± 0.84) (P < 0.001). The average number of surgeries was higher in the IV BP group (1.65 ± 0.95) as compared to that in the oral BP group (0.98 ± 0.73) (P < 0.001). Outcome after the surgery for MRONJ after IV BP was poor than oral BP group.

Conclusion

IV administration of BP causes greater inhibition of bone remodeling and could lead more severe inflammation. Therefore, even if the duration of IV administration of BP is shorter than that of oral BP, the extent of the lesion could be more extensive. Therefore, the result suggests that the MRONJ after IV BP for cancer patients needs to be considered as different characteristics to oral BP group for osteoporosis patents.
Pathogenic implications, incidence, and outcomes of COVID-19 in autoimmune inflammatory joint diseases and autoinflammatory disorders
Authors: Ruscitti Piero , Conforti Alessandro , Cipriani Paola , Giacomelli Roberto , Tasso Marco , Costa Luisa , Caso Francesco
Published: July 2021

As the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread rapidly, there are still many unresolved questions of how this virus would impact on autoimmune inflammatory joint diseases and autoinflammatory disorders. The main aim of this paper is to describe the main studies focusing their attention on COVID-19 incidence and outcomes of rheumatoid arthritis (RA), spondylarthritis (SpA), and autoinflammatory disease cohorts. We also revised possible pathogenic mechanisms associated with. Available data suggest that, in patients with RA and SpA, the immunosuppressive therapy, older age, male sex, and the presence of comorbidities (hypertension, lung disease, diabetes, CVD, and chronic renal insufficiency/end-stage renal disease) could be associated with an increased risk of infections and high rate of hospitalization. Other studies have shown that lower odds of hospitalization were associated with bDMARD or tsDMARDs monotherapy, driven largely by anti-TNF therapies. For autoinflammatory diseases, considering the possibility that COVID-19 could be associated with a cytokine storm syndrome, the question of the susceptibility and severity of SARS-CoV-2 infection in patients displaying innate immunity disorders has been raised. In this context, data are very scarce and studies available did not clarify if having an autoinflammatory disorder could be or not a risk factor to develop a more severe COVID-19. Taking together these observations, further studies are likely to be needed to fully characterize these specific patient groups and associated SARS-CoV-2 infection.
COVID-19 in Egypt after a year: the first and second pandemic waves from the radiological point of view; multi-center comparative study on 2000 patients
Authors: Samir Ahmed , Elabd Amr Magdy , Mohamed Walid , Baess Ayman Ibrahim , Sweed Rania Ahmed , Abdelgawad Mohamed Saied
Published: July 2021

Background

One year has passed since the announcement of COVID-19 as a pandemic and two waves had already stricken Egypt. The authors witnessed several atypical radiological features through the second pandemic wave, either early at the active infective stage or delayed at the post-infectious convalescent period. They believed every radiologist should be familiar with these features. Therefore, they performed this comparative study on 2000 Egyptian patients using multi-slice computed tomography (MSCT) to highlight the radiological differences between the first and second pandemic waves and correlate them to the clinical status.

Results

This random multi-center comparative study was retrospectively conducted on 2000 COVID-19 Egyptian patients; 1000 patients were registered at the first pandemic wave from April 2020 till September 2020, while the other 1000 patients were registered at the second pandemic wave from October 2020 till March 2020. Follow up CT examinations were performed for 49 and 122 patients through the first and second pandemic waves respectively. MSCT examinations were carefully evaluated by four expert consulting radiologists who came to a consensus. Meanwhile, the correlation with the clinical outcome was performed by two consulting pulmonologists. During the second pandemic wave, the prevalence rate of the “crazy-paving” pattern had significantly increased by 1.3 times (P value = 0.002). Additionally, the prevalence rate of the “air-bubble” sign had significantly increased by 1.9 times (P value = 0.02). Similarly, the presence of enlarged mediastinal lymph nodes (> 1 cm in short-axis diameter) had significantly increased by 1.7 times (P value = 0.036). Furthermore, the prevalence rate of pericardial effusion had significantly increased by 2.5 times (P value = 0.003). The above-mentioned signs were correlated to increased clinical severity and higher rates of hospitalization. Unexpectedly, other atypical radiological signs were only encountered through the second pandemic wave, including bronchiectatic changes (2.5%), “head-cheese” pattern (0.8%), cavitation (0.5%), and “bulls-eye” sign (0.2%). The prevalence rate of post-COVID fibrosis had doubled through the second wave but not in a significant way (P value = 0.234). Secondary fungal infection was only encountered throughout the second pandemic wave in four patients. COVID-19 reinfection was encountered in a single patient only during the second pandemic wave.

Conclusion

After 1 year from the announcement of COVID-19 as a pandemic, the radiological presentation of COVID-19 patients showed some significant differences between its first and second waves.
Roles of mortar volume in porosity, permeability and strength of pervious concrete
Authors: Li Leo Gu , Feng Jia-Jian , Xiao Bo-Feng , Chu Shao-Hua , Kwan Albert Kwok Hung
Published: July 2021

Pervious concrete is designed to be porous to allow permeation of water and air for combating the environmental and drainage problems arising from urbanization. However, despite extensive research, it is still not clear how best to design pervious concrete mixes to achieve good concurrent permeability-strength performance. In a previous study, the authors found that there is a necessity to distinguish between interconnected porosity and open porosity, and between unsubmerged permeability and submerged permeability. In this study, based on the thinking that fine aggregate may be added to reduce the paste volume provided the fine aggregate is fine enough to form a coherent mass with the paste, further research was conducted to develop the mortar type pervious concrete with reduced paste volume and investigate the roles of the mortar volume in porosity, permeability and strength. A new series of concrete mixes with varying mortar volume were tested and the results revealed that the interconnected porosity is the major factor determining the permeability while the open porosity and water/cement ratio are the major factors determining the strength. More importantly, the mortar volume plays a key role in each performance attribute.
Application of SeDeM Expert System in the development of novel directly compressible co-processed excipients via co-processing
Authors: Salim Ilyasu , Olowosulu Adeniji Kehinde , Abdulsamad Abdulrahman , Gwarzo Mahmud Sani , Khalid Garba Mohammed , Ahmad Naimatu Tijjani , Eichie Florence Egbomonjiade , Kurfi Fatima Shuaibu
Published: July 2021

Background

Computer-aided formulation design is gaining fantastic attention in chemical engineering of high functionality pharmaceutical materials for dosage form manufacture. To accelerate development of novel formulations in a quality-by-design perspective, SeDeM Expert System preformulation algorithm was developed as a tool for the design of solid drug delivery systems and for prediction of direct compression manufacturability of solid formulations. This research aims to integrate SeDeM Expert System into particle engineering design space of co-processing of solid excipients to develop novel composites with optimum direct compression propensity, using corn starch and microcrystalline cellulose powders as model primary excipients.

Result

The data and information generated from the expert system have elucidated the bulk-level characteristics of the primary excipients, enabled computation of the optimum co-processing ratio of the ingredients, and validated the impact of co-processing on material functionality. The experimental flowability (7.78±0.17), compressibility functions (5.16±0.14), parameter profile (0.92), and parametric profile index (6.72±0.27) of the engineered composites, were within the acceptable thresholds. With a reliability constant of 0.961, the net direct compression propensity of the composites expressed as Good Compression Index (6.46±0.26) was superior to that of the primary excipients, but comparable to reference co-processed materials, StarLac® (6.44±0.14) and MicroceLac®100 (6.58±0.03).

Conclusion

Application of SeDeM Expert System in particle engineering via co-processing has provided an accelerated upstream proactive mechanism for designing directly compressible co-processed excipients in a quality-by-design fashion. A four-stage systematic methodology of co-processing of solid excipients was postulated. Stage I entails the characterization of CMAs of both defective and corrective excipients, and elucidation of their physicomechanical limitations using SeDeM diagrams. Stage II involves computation of loading capacity of the corrective excipient using dilution potential equation. Stage III entails the selection of co-processing technique based on desired Critical Material Attributes as revealed by the information obtained from Stage I. Stage IV evaluates the impact of co-processing by monitoring the critical behavior of the engineered composites with a decision on either to accept or reject the product.
The Motherhood Penalty in Context: Assessing Discrimination in a Polarized Labor Market
Authors: Ishizuka Patrick
Published: July 2021

Prior research provides important insights into employer discrimination against mothers but has focused exclusively on college-educated mothers in professional and managerial occupations. As a result, we lack evidence about whether less-educated mothers navigating the low-wage labor market experience similar disadvantages and whether the mechanisms underlying discrimination vary across contexts. These gaps are important because more- and less-educated mothers increasingly possess distinct resources and face unique demands both at home and at work, which may impact employer perceptions of conflicts between motherhood and job performance. This study reports results from an original field experiment in which 2,210 fictitious applications were submitted to low-wage service and professional/managerial job openings across six U.S. cities, experimentally manipulating signals of motherhood status. Findings provide causal evidence that employers in both contexts discriminate against mothers relative to equally qualified childless women. However, within labor market segments, distinct job demands listed in job advertisements are associated with stronger discrimination: time pressure, collaboration, and travel in professional/managerial jobs and schedule instability in low-wage service jobs. These findings have important implications for our understanding of the mechanisms underlying mothers' disadvantages in an increasingly polarized labor market.
MRI accuracy and interobserver agreement in locally advanced cervix carcinoma
Authors: Jacquot Amalia , Chauleur Céline , Russel-Robillard Anne-Sophie , Tinquaut Fabien , Sotton Sandrine , Magne Nicolas , Etievent Guillaume
Published: July 2021

Objectives:

The main standard of care for locally advanced cervix carcinoma (LACC) is radiochemotherapy (RCT) followed by brachytherapy. A surgical approach may still be discussed based on pelvic MRI-derived residual tumour evaluation. As no interobserver agreement study has ever been conducted to our knowledge, the aim of the present study was to report on pelvic MRI accuracy and interobserver agreement in LACC.

Methods:

We carried out a retrospective study in a French university hospital. Medical records of all consecutive patients treated with curative intent for LACC by RCT followed by brachytherapy and completion pelvic surgery between January 2014 and January 2020 were reviewed. Local response was assessed through pelvis MRI and histological analysis after completion surgery. MRI data were independently evaluated by two radiologists with varying experience. The two main interobserving criteria we used were complete response and residual tumour.

Results:

23 patients fulfilled the inclusion criteria. Agreement between the junior and senior radiologist was moderate to strong. Indeed, regarding main criteria, κ was 0.65 for complete response and 0.57 for residual tumour. Interestingly, the present study shows a lower sensitivity whatever the radiologists than in the international literature.

Conclusion:

The present study highlights a low interobserver variability regarding pelvic MRI in the assessment of RCT followed by brachytherapy in LACC. Yet, sensitivity was lower than in literature.

Advances in knowledge:

Radiology is part of treatment decision-making, the issue of heterogeneity regarding radiologists’ training and experience to cancer (sensitivity and specificity) turns essential, so does MRI accuracy.
Diversity and inclusion in radiology: a necessity for improving the field
Authors: Manik Ritika , Sadigh Gelareh
Published: July 2021

Women and minorities are systematically under-represented in medicine, and this effect is pronounced in the field of radiology, across education, workforce and leadership. The proportion of women and minorities represented in radiology diminishes as their rank or job title elevates. Much of this are likely due to implicit biases, generational attitudes, and workplace cultures that can be discriminatory towards women and minorities. Steps that can be taken include closing the gender pay-gap, providing more opportunities for mentorship, addressing biases, and supporting the upward career mobility of women and minorities. Ultimately, increasing diversity will benefit all stakeholders in medicine, as collaboration among diverse individuals fosters innovation, greater financial efficiency, and better patient outcomes.
Prostate MRI quality: a critical review of the last 5 years and the role of the PI-QUAL score
Authors: Giganti Francesco , Kasivisvanathan Veeru , Kirkham Alex , Punwani Shonit , Emberton Mark , Moore Caroline M , Allen Clare
Published: July 2021

There is increasing interest in the use of multiparametric magnetic resonance imaging (mpMRI) in the prostate cancer pathway. The European Association of Urology (EAU) and the British Association of Urological Surgeons (BAUS) now advise mpMRI prior to biopsy, and the Prostate Imaging Reporting and Data System (PI-RADS) recommendations set out the minimal technical requirements for the acquisition of mpMRI of the prostate.

The widespread and swift adoption of this technique has led to variability in image quality. Suboptimal image acquisition reduces the sensitivity and specificity of mpMRI for the detection and staging of clinically significant prostate cancer.

This critical review outlines the studies aimed at improving prostate MR quality that have been published over the last 5 years. These span from the use of specific MR sequences, magnets and coils to patient preparation. The rates of adherence of prostate mpMRI to technical standards in different cohorts across the world are also discussed.

Finally, we discuss the first standardised scoring system (i.e., Prostate Imaging Quality, PI-QUAL) that has been created to evaluate image quality, although further iterations of this score are expected in the future.
A prediction model for degree of differentiation for resectable locally advanced esophageal squamous cell carcinoma based on CT images using radiomics and machine-learning
Authors: Kawahara Daisuke , Murakami Yuji , Tani Shigeyuki , Nagata Yasushi
Published: July 2021

Objective:

To propose the prediction model for degree of differentiation for locally advanced esophageal cancer patients from the planning CT image by radiomics analysis with machine learning.

Methods:

Data of 104 patients with esophagus cancer, who underwent chemoradiotherapy followed by surgery at the Hiroshima University hospital from 2003 to 2016 were analyzed. The treatment outcomes of these tumors were known prior to the study. The data were split into 3 sets: 57/16 tumors for the training/validation and 31 tumors for model testing. The degree of differentiation of squamous cell carcinoma was classified into two groups. The first group (Group I) was a poorly differentiated (POR) patients. The second group (Group II) was well and moderately differentiated patients. The radiomics feature was extracted in the tumor and around the tumor regions. A total number of 3480 radiomics features per patient image were extracted from radiotherapy planning CT scan. Models were built with the least absolute shrinkage and selection operator (LASSO) logistic regression and applied to the set of candidate predictors. The radiomics features were used for the input data in the machine learning. To build predictive models with radiomics features, neural network classifiers was used. The precision, accuracy, sensitivity by generating confusion matrices, the area under the curve (AUC) of receiver operating characteristic curve were evaluated.

Results:

By the LASSO analysis of the training data, we found 13 radiomics features from CT images for the classification. The accuracy of the prediction model was highest for using only CT radiomics features. The accuracy, specificity, and sensitivity of the predictive model were 85.4%, 88.6%, 80.0%, and the AUC was 0.92.

Conclusion:

The proposed predictive model showed high accuracy for the classification of the degree of the differentiation of esophagus cancer. Because of the good prediction ability of the method, the method may contribute to reducing the pathological examination by biopsy and predicting the local control.

Advances in knowledge:

For esophageal cancer, the differentiation of degree is the import indexes reflecting the aggressiveness. The current study proposed the prediction model for the differentiation of degree with radiomics analysis.
Radiation in orthopaedics (RIO) study: a national survey of UK orthopaedic surgeons
Authors: Raza Mohsen , Geleit Ryan , Houston James , Williams Rachel , Trompeter Alex
Published: July 2021

Objectives:

Orthopaedic surgeons have a responsibility to minimise risks of ionising radiation to patients, themselves and staff. This study aims to establish the understanding of radiation practice, legislation and risk by orthopaedic surgeons.

Methods:

A nationwide online survey of UK-based orthopaedic surgeons was conducted. Participants answered 18 multiple-choice questions assessing level of radiation safety training, basic principles/knowledge of ionising radiation, relevant legislation and operating practice.

Results:

A total of 406 surgeons completed the survey. 92% reported using intraoperative ionising radiation at least once per week. 38% received no formal training on radiation safety. Knowledge of basic principles of radiation and legislation was limited. There was variable knowledge when labelling an image intensifier machine and choosing its safest orientation. Poor uptake of radiation protection equipment was noted. Only 19% agreed they had adequate training in ionising radiation safety and 27% reported receiving adequate training in equipment emitting ionising radiation in the operating theatre.

Conclusion:

Many orthopaedic surgeons in the UK do not believe they are adequately trained in radiation safety. There is a deficiency amongst practicing surgeons in basic knowledge, relevant legislation and practicalities of the use of ionising radiation in the operating room. This could potentially put patients and health-care professionals at additional risk. We recommend that a standardised national training programme on the basic principles and safety of ionising radiation is implemented for all practicing orthopaedic surgeons.

Advances in knowledge:

This paper is the first UK national survey amongst orthopaedic surgeons and is one of the largest reported internationally.
Laryngeal schwannoma with extralaryngeal extension mimicking a thyroid tumour
Authors: Mikoshi Ayako , Edo Hiromi , Hase Tatsu , Sakima Taishi , Uno Kosuke , Kumazawa Fumihisa , Sato Kimiya , Shinmoto Hiroshi
Published: July 2021

Objective:

A schwannoma is a common benign tumour that can arise anywhere in the body. When it occurs in an unusual location such as the larynx, its differentiation from other tumours can be challenging. Herein, we report a case of a laryngeal schwannoma with extralaryngeal extension that mimicked a thyroid tumour, focusing on its characteristic features on MRI.

Methods:

A 19-year-old male presented with a mass in the left side of the neck and hoarseness for 2 years. Endoscopy showed a submucosal mass in the laryngeal region. MRI found a well-defined solid mass in the thyroid gland, extending to the larynx through the lower edge of the thyroid cartilage. T2 weighted MRI showed slightly low signal intensity at the central part of the tumour and high signal intensity at the peripheral part of the tumour. Pre-operative imaging suggested that the tumour originated in the thyroid gland. Left thyroidectomy with tumour excision was performed; the tumour was diagnosed as a laryngeal schwannoma with extralaryngeal extension, compressing the thyroid gland. In retrospect, features such as the dumbbell-shape and known as ‘target sign’ on T2 weighted MRI were typical features of schwannoma. Additionally, the tumour’s extension pattern was similar to previous reports of laryngeal schwannomas with extralaryngeal extension.

Conclusion:

A large laryngeal schwannoma may extend outside the larynx with significant compression of the thyroid gland. Understanding the pattern of extension and familiarity with the features on MRI can improve the preoperative diagnosis accuracy.