bluuebunny/crossref_metadata_2025 huggingface dataset:
Unpacking Populism: Using Correlational Class Analysis to Understand How People Interrelate Populist, Pluralist, and Elitist Attitudes
Authors: Dekeyser Dieter , Roose Henk
Published: May 2021

Populist attitudes are generally considered to consist of three types of beliefs, viz. people‐centrist, anti‐elitist, and Manichean beliefs. There is less agreement, however, on how populist attitudes are related to liberal democratic attitudes. Some argue that populist attitudes are incompatible with liberal democratic attitudes (e.g., pluralism and elitism). Others assert that these attitudes are compatible. Starting off from the concept of belief systems, we analyze the different ways in which people interrelate populist, pluralist, and elitist attitudes. Using correlational class analysis, we uncover four belief systems that differ in (a) how consistently people support populist beliefs and (b) the direction of the relationship between populist and pluralist beliefs. We also find that the differences between belief systems are related to people’s support for populism. People holding populist beliefs tend to associate populist attitudes with pluralist attitudes, while people who do not hold populist beliefs associate populist attitudes with anti‐pluralist attitudes.
Hepatocyte‐derived canine familiaris‐microRNAs as serum biomarkers of hepatic steatosis or fibrosis as implicated in the pathogenesis of canine cholecystolithiasis
Authors: El‐Sebaey Ahmed M. , Abramov Pavel N.
Published: May 2021

Background

Hepatic cholesterol accumulation in small breed dogs is a leading risk factor for hepatic fatty changes, gallbladder hypomotility, and cholelith development, which, if not discovered early, could lead to life‐threatening choledocholithiasis and acute pancreatitis.

Objective

This study proposed to assess the use of hepatocyte‐derived canine familiaris (cfa)‐microRNAs (miRNA‐122, ‐34a, and ‐21) as new diagnostic serum biomarkers of liver steatosis or fibrosis, for which both processes have been implicated in canine cholecystolithiasis.

Methods

Forty client‐owned dogs diagnosed with cholecystolithiasis and hepatic steatosis (C+HS) or fibrosis (C+HF) based on ultrasonographic, biochemical, and histopathologic findings, and 20 healthy dogs used as controls were included in the study. Serum cfa‐miRNA expression was determined using a real‐time polymerase chain reaction assay.

Results

Serum cfa‐miRNA‐122 and −34a expression was significantly upregulated in the C+HS (P < .001) and C+HF (P < .01) groups compared with the control group and showed a positive correlation with alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), alkaline phosphatase (ALP), γ‐glutamyl transferase (GGT), total cholesterol (TC), and triglycerides (TG) levels in the C+HS group. Cfa‐miRNA‐122 and −34a expression discriminated the diseased groups from the control group better than traditional serum‐derived liver biomarkers, as evidenced by areas under the receiver operating characteristic (AUC‐ROC) curve of 0.99 and 0.97 for cfa‐miRNA‐122 expression in the C+HS and C+HF groups, and 1.0 and 0.96 for cfa‐miRNA‐34a in the C+HS and C+HF groups, respectively. Cfa‐miRNA‐21 expression was upregulated only in the C+HF group compared with the C+HS (P < .01) and control (P < .001) groups and showed a positive correlation with serum ALT, AST, TBIL, ALP, and GGT and negative correlation with serum TC and TG levels. Cfa‐miRNA‐21 expression could also differentiate the C+HF group from the control and C+HS groups with a diagnostic performance superior to that of the conventional serum biochemical variables as evidenced by AUCs of 1.0 and 0.98, respectively.

Conclusions

Serum cfa‐miRNA‐122, ‐34a, and ‐21 expression was significantly upregulated in dogs with cholecystolithiasis with hepatic steatosis or fibrosis compared with control dogs. These miRNAs could serve as novel biomarkers for hepatic steatosis or fibrosis, which have been implicated in the pathogenesis of cholecystolithiasis.
Usability Evaluation of Encyclopedia Websites
Authors: Ismail Nor Azman , Jamaluddin Fadzrul Izwan , Hamidan Akmal Harraz , Ali Ahmad Fariz , Mohamed Su Elya , Said Che Soh
Published: May 2021

Usability is an important aspect that every website should focus more. It tells us how well and success website will function with real users. Many people often think usability tests are expensive and time-consuming. It can be a cost-effective and time saver with usability testing instead of spending more time fixing an unusable website. This study evaluates the usability of encyclopedia websites by using automated usability testing tools and questionnaire methods. The questionnaire was developed based on a standard form called Website Analysis and Measurement Inventory (WAMMI) that identified 20 common usability questions divided into five categories. Each category deals with one aspect of usability. Simultaneously, the automated usability testing tools used in this study were Pingdom and GT Metrix to calculate and analyse the website performance of selected encyclopedia websites based on website components including page load time, media size and overall web performance grades. This study could help web designer, developer, and practitioners design better and more user-friendly encyclopedia websites.
Identification of Potential Biomarkers using Improved Ranked Guided Iterative Feature Elimination
Authors: Ng Wen Xin , Chan Weng Howe
Published: May 2021

In healthcare, biomarkers serve an important role in disease classification. Many existing works are focusing in identifying potential biomarkers from gene expression. Moreover, the large number of redundant features in a high dimensional dataset such as gene expression would introduce bias in the classifier and reduce the classifierâ€™s performance. Embedded feature selection methods such as ranked guided iterative feature elimination have been widely adopted owing to the good performance in identification of informative features. However, method like ranked guided iterative feature elimination does not consider the redundancy of the features. Thus, this paper proposes an improved ranked guided iterative feature elimination method by introducing an additional filter selection based on minimum redundancy maximum relevance to filter out redundant features and maintain the relevant feature subset to be ranked and used for classification. Experiments are done using two gene expression datasets for prostate cancer and central nervous system. The performance of the classification is measured in terms of accuracy and compared with existing methods. Meanwhile, biological context verification of the identified features is done through available knowledge databases. Our method shows improved classification accuracy, and the selected genes were found to have relationship with the diseases.
An Improved SQL Injection Attack Detection Model Using Machine Learning Techniques
Authors: Abdulmalik Yazeed
Published: May 2021

SQL Injection Attack (SQLIA) is a common cyberattack that target web application database. With the ever increasing and varying techniques to exploit web application SQLIA vulnerabilities, there is no a comprehensive method that can solve this kind of attacks. Therefore, these various of attack techniques required to establish many methods against in order to mitigate its threats. However, most of these methods have not yet been evaluated, where it is still just theories and require to implement and measure its performance and set its limitation. Moreover, most of the existing SQL injection countermeasures either used syntax-based detection methods or a list of predefined rules to detect the SQL injection, which is vulnerable in advance and sophisticated type of attacks because attackers create new ways to evade the detection utilizing their pre-knowledge. Although semantic-based features can improve the detection, up to our knowledge, no studies focused on extracting the semantic features from SQL stamens. This paper, investigates a designed model that can improve the efficacy of the SQL injection attack detection using machine learning techniques by extracting the semantic features that can effectively indicate the SQL injection attack. Also, a tenfold approach will be used to evaluate and validate the proposed detection model.
Experimental Study of Hydraulic Sealability and Shear Bond Strength of Cementitious Barrier Materials
Authors: Kamali Mohammadreza , Khalifeh Mahmoud , Eid Elsayed , Saasen Arild
Published: May 2021

In this experimental study, two different cementitious materials, including (i) a class of expansive cement currently used for plug and abandonment (P&A) operations and (ii) a non-cement-based naturally occurring rock, known as geopolymer, are selected to examine the hydraulic bond strength and shear bond strength. Clean machined steel and rusty corroded steel were selected to represent the casing. The test samples were cured at 90 °C considered as bottom-hole static temperature (BHST) and under elevated pressure of 17.2 MPa for 1 week. The hydraulic sealability of the barrier materials tested up to 3.4 MPa of differential pressure. The results indicated that additives used in slurry preparation impact the hydraulic sealability of the material. Additionally, the rusty corroded steel provided a better hydraulic sealability comparing to the clean machined steel for the same cementitious material. The shear bond strength test was performed by running the push-out test. According to the present test observations, no correlation was found between the shear bond and hydraulic bond strength of different barrier materials. The geopolymer showed the lowest shear bond strength, while it provided the highest hydraulic sealability.
Relating Lifetime Activity Behavior to the Current Level of Physical Activity of Older Adults
Authors: Vogel Oliver , Niederer Daniel , Wilke Jan , Steinmann Maike , Vogt Lutz
Published: May 2021

This study investigates methods of data gathering and management, along with the relationship of lifespan and older adults’ activity. Community-dwelling older adults (n = 47, 81.7 ± 3.6 years) completed the Lifetime Leisure Physical Activity Questionnaire. Current activity was assessed by use of accelerometers. The data were converted to the metabolic equivalent of task hours. Correlations between the main outcomes (metabolic equivalent of task/hour, Lifetime Leisure Physical Activity Questionnaire), as well as individual estimation errors for data adjustments, were computed. The accelerometer and Lifetime Leisure Physical Activity Questionnaire data for the last 12 months’ activity were associated (r = .31, p = .033). The average overestimation in the self-reported data was 176%. The adapted data on lifetime physical activity reveals correlations between older adults’ activity and the activity levels of three 15-year episodes (r = .354; r = .336; r = .323; each p < .05), as well as compliance with guidelines throughout life (Hotelling’s T2 = 45–164; p ≤ .002). Our findings indicate a relationship between lifetime and older adults’ activity and provide further support for lifelong engagement in physical activity.
Instrument-Assisted Soft Tissue Mobilization Forces Applied by Trained Clinicians During a Simulated Treatment
Authors: Martonick Nickolai J.P. , Reeves Ashley J. , Whitlock James A. , Stevenson Taylor C. , Cheatham Scott W. , McGowan Craig P. , Baker Russell T.
Published: May 2021

Context: Instrument-assisted Soft Tissue Mobilization (IASTM) is a therapeutic intervention used by clinicians to identify and treat myofascial dysfunction or pathology. However, little is known about the amount of force used by clinicians during an IASTM treatment and how it compares to reports of force in the current literature. Objective: To quantify the range of force applied by trained clinicians during a simulated IASTM treatment scenario. Design: Experimental. Setting: University research laboratory. Participants: Eleven licensed clinicians (physical therapist = 2, chiropractor = 2, and athletic trainer = 7) with professional IASTM training participated in the study. The participants reported a range of credentialed experience from 1 to 15 years (mean = 7 [4.7] y; median = 6 y). Intervention: Participants performed 15 one-handed unidirectional sweeping strokes with each of the 5 instruments for a total of 75 data points each. Force data were collected from a force plate with an attached skin simulant during a hypothetical treatment scenario. Main Outcome Measures: Peak force and average forces for individual strokes across all instruments were identified. Averages for these forces were calculated for all participants combined, as well as for individual participants. Results: The average of peak forces produced by our sample of trained clinicians was 6.7 N and the average mean forces was 4.5 N. Across individual clinicians, average peak forces ranged from 2.6 to 14.0 N, and average mean forces ranged from 1.6 to 10.0 N. Conclusions: The clinicians in our study produced a broad range of IASTM forces. The observed forces in our study were similar to those reported in prior research examining an IASTM treatment to the gastrocnemius of healthy individuals and greater than what has been reported as effective in treating delayed onset muscle soreness. Our data can be used by researchers examining clinically relevant IASTM treatment force on patient outcomes.
Polyclonal expansion of TCR Vβ 21.3+CD4+and CD8+T cells is a hallmark of multisystem inflammatory syndrome in children
Authors: Moreews Marion , Le Gouge Kenz , Khaldi-Plassart Samira , Pescarmona Rémi , Mathieu Anne-Laure , Malcus Christophe , Djebali Sophia , Bellomo Alicia , Dauwalder Olivier , Perret Magali , Villard Marine , Chopin Emilie , Rouvet Isabelle , Vandenesch Francois , Dupieux Céline , Pouyau Robin , Teyssedre Sonia , Guerder Margaux , Louazon Tiphaine , Moulin-Zinsch Anne , Duperril Marie , Patural Hugues , Giovannini-Chami Lisa , Portefaix Aurélie , Kassai Behrouz , Venet Fabienne , Monneret Guillaume , Lombard Christine , Flodrops Hugues , De Guillebon Jean-Marie , Bajolle Fanny , Launay Valérie , Bastard Paul , Zhang Shen-Ying , Dubois Valérie , Thaunat Olivier , Richard Jean-Christophe , Mezidi Mehdi , Allatif Omran , Saker Kahina , Dreux Marlène , Abel Laurent , Casanova Jean-Laurent , Marvel Jacqueline , Trouillet-Assant Sophie , Klatzmann David , Walzer Thierry , Mariotti-Ferrandiz Encarnita , Javouhey Etienne , Belot Alexandre
Published: May 2021

MIS-C is characterized by a polyclonal activation of Vβ21.3+CD4+and CD8+T cells that poorly respond to SARS-CoV-2 antigens.
Emergence of
Morganellaceae
Harboring
bla
IMP-27
Metalloenzyme in Canada
Authors: Boyd David A. , Mataseje Laura F. , Dingle Tanis , Hoang Linda , Lefebvre Brigitte , McGeer Allison , Melano Roberto G. , Stuart Ian , Walkty Andrew , Wilmer Amanda , Mulvey Michael R.
Published: May 2021

Over the last decade or so, the frequency of isolation of clinical carbapenemase-producing organisms (CPOs) has increased among health care-associated infections. This may seriously compromise antimicrobial therapy, as carbapenems are considered the last line of defense against these organisms.
Supplemental Material: Detrital zircon provenance and depositional links of Mesozoic Sierra Nevada intra-arc strata
Authors: Attia S. , al. et
Published: May 2021

File S1: Detrital zircon U-Pb geochronology analytical methods and details of exploratory data analysis. File S3: Detrital zircon age compilation from pre-Cenozoic strata across the Sierra Nevada (with two tables)
POS1070 ANXIETY IN PSORIATIC ARTHRITIS PATIENTS: RESULTS FROM THE HUR-BIO BIOLOGIC REGISTRY
Authors: Ayan G. , Farisoğullari B. , Bilgin E. , Bolek E. C. , Yardimci G. K. , Duran E. , Özsoy Z. , Sandal Uzun G. , Kiliç L. , Akdoğan A. , Karadag O. , Bilgen Ş. A. , Kiraz S. , Ertenli A. İ. , Kalyoncu U.
Published: May 2021

Background:

Anxiety is commonly observed, underestimated problem in patients with psoriatic arthritis (PsA). Overall rate has been reported around 20% [1]. However the data on anxiety in PsA patients requiring advanced treatment and change in response to therapy is scarce.

Objectives:

Our aim was to understand the frequency of anxiety before starting biologic agents and change in the anxiety scores with the treatment.

Methods:

PsA patients from the Hacettepe University biological database (HUR-BIO) were assessed for anxiety (score ≥ 4) using the patient self-reported measure of anxiety on a 0-10 numerical scale, included in the Psoriatic Arthritis Impact of Disease questionnaire (PSAID-12) [2]. The anxiety rate and scores were determined before starting biologic agents and at first visit in 6 months. Change in the scores were compared between patients according to the favourable treatment responses (Table 1). The correlation between the score-changes in anxiety and treatment response parameters was assessed by spearman correlation analysis.

Results:

From 520 patients registered, 147 [mean (SD) age 43.3 (12.4) years, 70.7% female] had anxiety score registered both at baseline and first visit in 6 months. Both the frequency and mean (SD) score of anxiety decreased at first visit [63.9% vs 41.4 %, 4.8(3.4) vs 3.2 (3.1) respectively, p<0.001 for both] after a mean (SD) follow-up of 105.7 (22.2) days. There was a statistically significant difference between changes in the anxiety scores in patients with/without treatment responses in pain, PGA, BASDAI, HAQ-DI and DAS-28. A positive correlation between the change in anxiety and all treatment response parameters was observed (Table 1, Figure 1).

Table 1.

Patient characteristics at baseline and changes in the anxiety score according to treatment response

Conclusion:

Anxiety is a more frequent problem at the time of biologic initiation compared to rates observed in general PsA population which could be related to the high disease activity. The rates are still high in 6 months under treatment, however both the frequency and score of anxiety showed a decreasing trend parallel to the treatment response.

References:

[1]Zusman EZ, Howren AM, Park JYE,et. al (2020) Epidemiology of depression and anxiety in patients with psoriatic arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 50 (6):1481-1488.

[2]Gossec L, de Wit M, Kiltz U, Braun J, et al (2014) A patient-derived and patient-reported outcome measure for assessing psoriatic arthritis: elaboration and preliminary validation of the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, a 13-country EULAR initiative. Ann Rheum Dis 73 (6):1012-1019.

Figure 1.

Correlation between the score changes

Disclosure of Interests:

None declared.
POS1275 PERITENON THICKENING IS ASSOCIATED WITH THE INTENSITY OF MANUAL SPORTS ACTIVITY
Authors: Guillén-Astete C. , Zurita-Prada P. , Urrego-Laurín C. , García-Montes N. , García-López H.
Published: May 2021

Background:

Peritenon enlargement has been considered as a specific ultrasound finding associated with psoriatic arthritis based on studies in patients. Recent observations in athletes have demonstrated the existence of this finding although its relationship with the type of physical activity performed has not been determined.

Objectives:

To determine to what extent manual physical activity is associated with the prevalence of peritenon thickening in the fingers of healthy athletic subjects.

Methods:

Thirty-five healthy young male volunteers were recruited from a local sports centre in the community of Madrid. All of them performed sports activities with their hands for more than 12 hours a week.A digital dynamometer was used to determine the flexion strength of the fingers of the dominant hand. A single observer performed an ultrasound scan of this hand to determine the presence or absence of a hypoechoic image surrounding the extensor digitorum tendon of the 2nd, 3rd, 4th and 5th fingers, according to previous definitions. Mean flexion strengths were compared with the number of positive ultrasound findings.

Results:

Fifteen volunteers (mean age 24.3 years, BMI 24.4) did not present peritenon enlargement (42.8%). The mean ± standard deviation of the fingers flexor strength according to the number of peritenon enlargement detected were 43.5 ± 6.2, 49.2 ± 3.8, 53.2 ± 1.64 and 63.0 ± 4.83 Kg for volunteers with none, 1, 2, 3 and 4 peritenon enlargements, respectively. (ANOVA P<0.001; Pearson’s coefficient 0.827, P<0.001). Correlation between BMI, body fat percentage or training hours per week and the number of peritenon enlargement detected was not demonstrated.

Conclusion:

Peritenon enlargement, also knew as peritenon tendon inflammation, is detectable by ultrasound scan in healthy subjects and it seems to be associated to the physical activity intensity, indirectly measured by the flexor strength of the fingers.

References:

[1]Gutierrez et al. Ann Rheum Dis. 2011;70:1111-4

[2]Zabotti et al. Clin Exp Rheumatol. 2016;34:459-65

[3]Husic et al. Ann Rheum Dis. 2014;73:1529-36

Disclosure of Interests:

None declared
POS1281 HOW DOES OBESITY INFLUENCE THE FEATURES OF KNEE OSTEOARTHRITIS?
Authors: Hachfi H. , Khalifa D. , Brahem M. , Ben Chekaya N. , Younes M.
Published: May 2021

Background:

Knee osteoarthritis and obesity are both major health problems. It is now admitted that the prevalence of knee osteoarthritis gets higher with obesity and that weight loss helps knee function and allows patients to avoid surgery.

Objectives:

The aim of this study was to study the influence of obesity on knee osteoarthritis features.

Methods:

A cross-sectional study was conducted in the university hospital Taher Sfar of Tunisia over a period of 6 months. Patients who had knee osteoarthritis confirmed by radiographs were included. Sociodemographic, clinical, radiological and therapeutic data were collected from medical records and visits. Obesity was defined by a body mass index (BMI) ≥30. Functional impairment was assessed by the Womac index and Lequesne index.

Results:

The study included 186 patients. There were 31 males and 155 femmes. The mean age was 60±10 years. The percentage of obese patients was 53,8%. The mean age was similar in both groups obese and non obese. There were more women in the obese group compared to the non obese group (p=0.0001), more patients who had diabetes mellitus and dyslipidemia (p=0.002). Non-obese patients had a shorter duration of symptoms with no statistical significance (p=0.151). Obese patients had more involvement of both knees (p<0.0001). Obesity did not have an impact on pain severity. Severity of radiological images (p=0,0001) were more frequent in obese patients. Functional impairment was similar in both groups. However, the percentage of patients having a very important functional impairment with Lequesne index was higher in obese patients (p<0.029). Obese patients also needed more physical therapy sessions (p=0.035).

Conclusion:

Knee osteoarthritis in obese patients is characterized with the femlae gender predominance, bilateral knee involvement, and a more severe images on radiographs. Thus the need for better control of weight and the importance of physical activity.

References:

[1]Coggon D, Reading I, Croft P, et al. Knee osteoarthritis and obesity. Int J Obes Relat Metab Disord J Int Assoc Study Obes 2001; 25: 622–627.

Disclosure of Interests:

None declared
POS0950 ARE THERE GENDER DIFFERENCES IN AXIAL SPONDYLOARTHRITIS: DATA FROM A PORTUGUESE SPONDYLOARTHRITIS COHORT
Authors: Cunha A. R. , Aguiar R. , Santos M. J. , Afreixo V. , Barcelos A.
Published: May 2021

Background:

Historically, axial spondyloarthritis (particularly ankylosing spondylitis) was considered a men’s disease and has been under-recognized in women.

Emerging evidence reveals gender differences in patophysiology, disease presentation and therapeutic efficacy.

Objectives:

To determine if there are differences between genders in a Portuguese cohort of patients with axSpA as regards clinical manifestations, disease activity, functional capacity, patient related outcomes and radiographic findings.

Methods:

Patients with ≥18 years fulfilling the ASAS- Assessment of Spondyloarthritis International Society classification criteria for axSpA and registered in the electronic national database- Reuma.pt were included in a multicentric cross-sectional study. Sociodemographic data, clinical features and radiographic findings were collected from the first record in Reuma.pt. These variables were compared between genders using Mann-Whitney test and Chi-Square test. Variables with a significant association with group variable (gender) were considered in the multiple variable analysis to adjust the gender effect on the outcome variables.

Results:

A total of 1995 patients were included, 1114 (55.9%) men and 881 (44.1%) women. Men had a lower median age at onset of disease (25.1 vs 28.4, p=0.000) and median age at diagnosis (26.9 vs 30.4, p=0.000) and were more frequently smokers (32.1% vs 15.7%, p=0.000). Comparing to women, men had worse BASMI scores (4.0 vs 3.4, p=0.000), higher levels of CPR (10.5 vs 6.9, p=0.000) and were more often HLA-B27 positive (67.8% vs 54%, p=0.000). In univariable analysis, sacroiliitis on radiograph or/and MRI (95.5% vs 91.7%, p=0.04) was more common in men, however that wasn’t confirmed in multivariable analysis.

In contrast, women more frequently had more inflammatory bowel disease (8.8% vs 4.9%, p=0,004), higher levels of ESR (25.0 vs 21.0, p=0.003) and worse PROs- BASDAI (5.7 vs 4.5, p=0.000), PGA (60.0 vs 55.0, p=0.000) and fatigue (6.2 vs 5.4, p=0,000).

Conclusion:

Physicians must be aware of differences between genders in axial spondyloarthritis because this can result in less underdiagnosis and misdiagnosis, allow optimization of treatment strategies, and decrease overall disease burden in women with axSpA patients.

References:

[1]Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE. Gender Differences in Axial Spondyloarthritis: Women Are Not So Lucky. Curr Rheumatol Rep. 2018;20(6):35.

[2]Tournadre A, Pereira B, Lhoste A, Dubost JJ, Ristori JM, Claudepierre P, et al. Differences between women and men with recent-onset axial spondyloarthritis: results from a prospective multicenter French cohort. Arthritis Care Res (Hoboken). 2013;65(9):1482-9.

Disclosure of Interests:

None declared
POS1090 ASSOCIATION BETWEEN ANTIBIOTIC USE AND KNEE PAIN AND FUNCTION IN OA: DATA FROM THE OSTEOARTHRITIS INITIATIVE
Authors: Shirinsky I. , Zagainova V. , Shirinsky V.
Published: May 2021

Background:

Recently, gut dysbiosis has been linked with joint pain in osteoarthritis (OA) (1). Thus, it can be hypothesized that antibiotic use impacts symptoms of OA. To date, there have been no studies assessing association between the intake of antibiotics and clinical manifestations of knee OA.

Objectives:

To evaluate association between the use of antibiotics and OA-related knee pain and function.

Methods:

For the current study we used 4-year longitudinal data obtained from the Osteoarthritis Initiative (OAI) progression (n= 1390) and incidence (n = 3284) subcohorts, which are publically available at https://oai.nih.gov. The outcome variables studied were Western Ontario McMaster Osteoarthritis Index (WOMAC) pain and function subscales. To acquire information about the use of antibiotics, a medication inventory method was used. We excluded participants who used antibiotics at or 30 days prior to baseline (a “new-user” design). Antibiotic users were defined as those with at least one recorded use during first four years of the study. The participants were matched into antibiotic users/non-users pairs using genetic matching based on various demographic and clinical characteristics. The outcomes were assessed at baseline and annually until year 4. Generalized estimating equations (GEE) were used to model the relationship between outcomes and antibiotic use by time interaction.

Results:

A total of 515 new antibiotic users were matched with 515 non-users. After matching, all standardized differences of means were less than 0.05 indicating that covariates were well balanced between groups. No association between the use of antibiotic and changes in WOMAC pain and function scores was found (Table 1). No associations were also observed in multiple stratified analyses based on different duration of antibiotic use, particular classes of antibiotics, or different baseline WOMAC pain or disability levels.

Table 1.

Longitudinal analysis (with treatment*time interaction) of WOMAC subcategories and antibiotics use

β coefficient95% CIP valueWOMAC Pain-0.008(-0.08 to 0.07)0.8WOMAC Function-0.014(-0.24 to 0.21)0.9

Conclusion:

These findings do not support the effects of antibiotics on knee OA pain or disability. More research is needed on the role of microbiota and its modulation in OA.

References:

[1]Boer, C.G., Radjabzadeh, D., Medina-Gomez, C. et al. Intestinal microbiome composition and its relation to joint pain and inflammation. Nat Commun 10, 4881 (2019). https://doi.org/10.1038/s41467-019-12873-4

Disclosure of Interests:

None declared.
School-aged neurodevelopmental outcomes for children born extremely preterm
Authors: Doyle Lex W , Spittle Alicia , Anderson Peter J , Cheong Jeanie Ling Yoong
Published: May 2021

As survival rates for children born extremely preterm (EP, <28 weeks’ gestation) have increased with advances in perinatal and neonatal care, their long-term functioning and quality of life assume more importance. Outcomes in early childhood provide some information, but outcomes at school-age are more informative of life-long functioning. Children born EP at school-age have substantially higher rates of intellectual impairment, poorer executive, academic and motor function, more neurodevelopmental disability, and poorer health-related quality of life than do contemporaneous term-born controls. Because the rates of adverse outcomes remain unacceptably high, and particularly since some outcomes may be deteriorating rather than improving over time, new strategies to ameliorate these problems, targeting periods before, during and after birth, and throughout the lifespan, are a priority.
Extraovarian primary seromucinous cystadenoma masquerading as mesenteric cyst
Authors: R J Kishor , Harikrishnan Bhuvaneshwari , Alexander Naveen , Bheeman Veena
Published: May 2021

We report an interesting case of extraovarian, primary seromucinous cystadenoma, which presented as a mesenteric cyst. A 31-year-old woman came with complaints of lower abdominal pain for 2 years, which is intermittent and aggravated during the menstrual cycle. On examination, her vitals were within normal limits; per abdominal examination revealed 7×7 cm mass in the right lumbar and right hypochondrium with well-defined margins. A Contrast-enhanced whole abdomen done showed a thin-walled of cyst of size 7×8×9 cm in the right lumbar region abutting and replacing the mesenteric border of ascending colon suggesting of mesenteric cyst. Patient underwent laparoscopic excision of mesenteric cyst. Histopathology revealed seromucinous cystadenoma without ovarian stroma.
Primary cutaneous nocardiosis of the head and neck in an immunocompetent patient
Authors: Acevedo Claudio Tirso , Imkamp Frank , Marques Maggio Ewerton , Brugger Silvio Daniel
Published: May 2021

Nocardiosis is known to be an opportunistic infection most commonly affecting immunocompromised patients that can lead to life-threatening conditions. Primary cutaneous disease remains a rare manifestation and unlike pulmonary or disseminated nocardiosis, it usually affects immunocompetent individuals. We present a case of a primary cutaneous nocardiosis of the head and neck after an insect bite in a healthy 50-year-old woman who had recently travelled from Greece. She presented with a painful right-sided swelling of her face and neck and an ulcerated plaque over the right temple. Biopsy of the plaque revealed inflammation with abscess formation indicating underlying infection. Culture from the biopsy showed growth ofNocardiaspp and 16S rRNA gene sequence analysis identifiedNocardia brasiliensis. The patient was treated with trimethoprim/sulfamethoxazole and subsequently switched to amoxicillin/clavulanic acid due to a drug eruption. Antibiotic therapy was continued for a total of 3 months with complete resolution of the skin lesions.
Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient
Authors: Lee Jaekyoung , Lee Dong Cheol
Published: May 2021

Dacryocystorhinostomy (DCR) is the ‘gold standard’ treatment for nasolacrimal duct obstruction (NLDO). However, despite its recent technical advancements, complications are possible. Herein, to the best of our knowledge, we present the first reported case of delayed unilateral pneumocephalus after bilateral endoscopic DCR. An 85-year-old man with bilateral NLDO underwent endoscopic DCR with silicone intubation. After 1 month, he became lethargic and was admitted to emergency room. Brain CT demonstrated left pneumocephalus and a suspected microfistula in left orbital wall. Intravenous antibiotic therapy was started, and cerebrospinal fluid studies showed no evidence of meningitis. After 13 days of antibiotic treatment, his mental state recovered with no signs of pneumocephalus. Although DCR has high success rate and is relatively safe, surgeons should be aware of the risk, although low, of pneumocephalus, especially in elderly patients who are vulnerable to fractures and who exhibit headache or mental status changes after endoscopic DCR.
Elizabethkingia anophelisinfection in an infant: an unusual presentation
Authors: Mantoo Mohsin Raj , Ghimire Jagat Jeevan , Mohapatra Sarita , Sankar Jhuma
Published: May 2021

A 7-month-old male infant presented with history of fever for 2 weeks, multiple ecchymotic patches over face, trunk and lower limbs, and one episode of seizure. The infant had shock, respiratory failure, severe anaemia, thrombocytopenia and temporoparietal haematoma on CT scan of the head. He was managed with supportive care and broad-spectrum empiric antibiotics. Two consecutive blood cultures grewElizabethkingia anophelis, sensitive only to piperacillin–tazobactam. The infant responded to therapy and was discharged after 2 weeks of hospital stay. Repeated coagulation studies done to rule out an underlying bleeding disorder were negative. There was no clue in favour of non-accidental trauma. We report this case to highlight the unusual clinical presentation of this emerging pathogen. Mostly reported in outbreaks from surgical and post-operative intensive care units, it was worrisome to find this infant presenting with community-acquiredE. anophelisinfection.
Terbinafine used safely in autoimmune hepatitis for treatment of tinea corporis
Authors: Ferguson Jessica Elizabeth , Prouty Megan
Published: May 2021

Terbinafine is often considered contraindicated in those with liver disease, as one of the known side effects is hepatotoxicity. We report the first case documenting the safe use of oral terbinafine in a 77-year-old woman with stable autoimmune hepatitis presenting with extensive tinea corporis. Precautions were carried out to minimise the risk of worsening hepatotoxicity, including consultation with the patient’s hepatologist, limiting terbinafine exposure to less than 6 weeks, monitoring of liver function tests, and patient education. The patient’s fungal infection cleared without any signs or symptoms of worsening liver disease. The rash had not recurred 6 months after treatment. When terbinafine must be used in a patient with pre-existing liver disease, we recommend considering a short course of oral terbinafine after consultation with their hepatologist, obtaining baseline liver function tests with consideration of further monitoring during treatment course, and patient education on the signs and symptoms of liver injury.
Development and validation of a clinical prediction rule for development of diabetic foot ulceration: an analysis of data from five cohort studies
Authors: Chappell Francesca M , Crawford Fay , Horne Margaret , Leese Graham P , Martin Angela , Weller David , Boulton Andrew J M , Abbott Caroline , Monteiro-Soares Matilde , Veves Aristidis , Riley Richard D
Published: May 2021

Introduction

The aim of the study was to develop and validate a clinical prediction rule (CPR) for foot ulceration in people with diabetes.

Research design and methods

Development of a CPR using individual participant data from four international cohort studies identified by systematic review, with validation in a fifth study. Development cohorts were from primary and secondary care foot clinics in Europe and the USA (n=8255, adults over 18 years old, with diabetes, ulcer free at recruitment). Using data from monofilament testing, presence/absence of pulses, and participant history of previous ulcer and/or amputation, we developed a simple CPR to predict who will develop a foot ulcer within 2 years of initial assessment and validated it in a fifth study (n=3324). The CPR’s performance was assessed with C-statistics, calibration slopes, calibration-in-the-large, and a net benefit analysis.

Results

CPR scores of 0, 1, 2, 3, and 4 had a risk of ulcer within 2 years of 2.4% (95% CI 1.5% to 3.9%), 6.0% (95% CI 3.5% to 9.5%), 14.0% (95% CI 8.5% to 21.3%), 29.2% (95% CI 19.2% to 41.0%), and 51.1% (95% CI 37.9% to 64.1%), respectively. In the validation dataset, calibration-in-the-large was −0.374 (95% CI −0.561 to −0.187) and calibration slope 1.139 (95% CI 0.994 to 1.283). The C-statistic was 0.829 (95% CI 0.790 to 0.868). The net benefit analysis suggested that people with a CPR score of 1 or more (risk of ulceration 6.0% or more) should be referred for treatment.

Conclusion

The clinical prediction rule is simple, using routinely obtained data, and could help prevent foot ulcers by redirecting care to patients with scores of 1 or above. It has been validated in a community setting, and requires further validation in secondary care settings.
Smartphone-based remote monitoring of vision in macular disease enables early detection of worsening pathology and need for intravitreal therapy
Authors: Islam Meriam , Sansome Stafford , Das Radha , Lukic Marko , Chong Teo Kelvin Yi , Tan Gavin , Balaskas Konstantinos , Thomas Peter B M , Bachmann Lucas M , Schimel Andrew M , Sim Dawn A
Published: May 2021

Background/aims

To assess the outcomes of home monitoring of distortion caused by macular diseases using a smartphone-based application (app), and to examine them with hospital-based assessments of visual acuity (VA), optical coherence tomography-derived central macular thickness (CMT) and the requirement of intravitreal injection therapy.

Design

Observational study with retrospective analysis of data.

Methods

Participants were trained in the correct use of the app (Alleye, Oculocare, Zurich, Switzerland) in person or by using video and telephone consultations. Automated threshold-based alerts were communicated based on a traffic light system. A ‘threshold alarm’ was defined as three consecutive ‘red’ scores, and turned into a ‘persistent alarm’ if present for greater than a 7-day period. Changes of VA and CMT, and the requirement for intravitreal therapy after an alarm were examined.

Results

245 patients performing a total of 11 592 tests (mean 46.9 tests per user) were included and 85 eyes (164 alarms) examined. Mean drop in VA from baseline was −4.23 letters (95% CI: −6.24 to −2.22; p<0.001) and mean increase in CMT was 29.5 µm (95% CI: −0.08 to 59.13; p=0.051). Sixty-six eyes (78.5%) producing alarms either had a drop in VA, increase in CMT or both and 60.0% received an injection. Eyes with persistent alarms had a greater loss of VA, −4.79 letters (95% CI: −6.73 to −2.85; p<0.001) or greater increase in CMT, +87.8 µm (95% CI: 5.2 to 170.4; p=0.038).

Conclusion

Smartphone-based self-tests for macular disease may serve as reliable indicators for the worsening of pathology and the need for treatment.
Establishing communicable disease surveillance systems
Authors: Falconer Hall Thomas , Ross D A
Published: May 2021

Humanitarian emergencies can result in an increase of communicable diseases, leading to a rise in mortality and/or morbidity in vulnerable populations. This requires a public health approach to re-establish control of communicable disease. Communicable disease surveillance systems play a key role, providing the information required for disease control measures, through systematic data collection, analysis, interpretation and dissemination. In humanitarian emergencies, they use the principles, practices and processes of wider surveillance systems, while being more focused on urgent priorities. However, communicable disease surveillance systems in humanitarian emergencies are constrained by multiple environmental, epidemiological and sociopolitical factors. Basic data collection, the bedrock of surveillance systems, can be extremely challenging and may require additional methods to estimate population size and prioritise diseases. Surveillance systems may be operating in conditions of weak state capacity with little physical or institutional infrastructure to support their operation. However, there are examples of successful self-sustaining disease surveillance systems in these circumstances, such as the deployment of WHO’s Early Warning Alert and Response System in a Box. Individuals and organisations charged with establishing communicable disease surveillance systems in emergencies would be well advised to learn from recent examples of success, use the sources of planning guidance outlined in this article and seek advice from organisations with recent experience. This is a paper commissioned as a part of the Humanitarian and Disaster Relief Operations special issue ofBMJ Military Health.
Longitudinal study of medical downgrades in the Royal Air Force
Authors: Capella Stefano , Demoulin E , Wilkinson C , Hindle P
Published: May 2021

Introduction

As the focus of the Royal Air Force (RAF) shifts from sustained to contingency operations and the number of personnel is reduced, the burden of retained, medically downgraded personnel may affect operational readiness. The main aims were: to define the prevalence of morbidity leading to permanent medical downgrading; to determine at risk populations and identify areas for improvement.

Method

Database of personnel referred to the RAF Medical Board was analysed from January 2012 to October 2013 and January 2017 to December 2019. Patients were excluded if they did not require a formal medical board; incomplete and duplicate entries were also excluded. The primary reason for medical downgrade was categorised with an ICD-10 code. Further subanalysis compared musculoskeletal disease with age, individual trade groups and anatomic region.

Results

2% of RAF service personnel were permanently downgraded annually. Musculoskeletal disease was the leading cause for permanent downgrade across both periods: 58% and 49%. Female personnel were at a greater risk of musculoskeletal downgrade compared with males. Spinal and knee pathology were the leading cause for downgrading among ‘high risk’ personnel. Personnel downgraded due to musculoskeletal pathology were often retained in a limited role with 10% and 5% retained as medically fully deployable. 14% and 12% of personnel downgraded due to musculoskeletal pathology were medically discharged.

Conclusion

Musculoskeletal disease was the leading cause for permanent medical downgrades in the RAF. A greater proportion of downgraded personnel with musculoskeletal conditions were retained in service with medical limitations rather than medically discharged.
Mental health and suicidal ideation in US military veterans with histories of COVID-19 infection
Authors: Na Peter , Tsai J , Harpaz-Rotem I , Pietrzak R
Published: May 2021

Introduction

There have been reports of increased prevalence in psychiatric conditions in non-veteran survivors of COVID-19. To date, however, no known study has examined the prevalence, risk and protective factors of psychiatric conditions among US military veterans who survived COVID-19.

Methods

Data were analysed from the 2019 to 2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative, prospective cohort of 3078 US veterans. Prepandemic and 1-year peripandemic risk and protective factors associated with positive screens for peripandemic internalising (major depressive, generalised anxiety and/or posttraumatic stress disorders) and externalising psychiatric disorders (alcohol and/or drug use disorders) and suicidal ideation were examined using bivariate and multivariate logistic regression analyses.

Results

A total of 233 veterans (8.6%) reported having been infected with COVID-19. Relative to veterans who were not infected, veterans who were infected were more likely to screen positive for internalising disorders (20.5% vs 13.9%, p=0.005), externalising disorders (23.2% vs 14.8%, p=0.001) and current suicidal ideation (12.0% vs 7.6%, p=0.015) at peripandemic. Multivariable analyses revealed that greater prepandemic psychiatric symptom severity and COVID-related stressors were the strongest independent predictors of peripandemic internalising disorders, while prepandemic trauma burden was protective. Prepandemic suicidal ideation, greater loneliness and lower household income were the strongest independent predictors of peripandemic suicidal ideation, whereas prepandemic community integration was protective.

Conclusion

Psychiatric symptoms and suicidal ideation are prevalent in veterans who have survived COVID-19. Veterans with greater prepandemic psychiatric and substance use problems, COVID-related stressors and fewer psychosocial resources may be at increased risk of these outcomes.
Protocol for the WARM Hearts study: examining cardiovascular disease risk in middle-aged and older women - a prospective, observational cohort study
Authors: Rose Alexandra V , Boreskie Kevin F , Hay Jacqueline L , Thompson Liam , Arora Rakesh C , Duhamel Todd A
Published: May 2021

Introduction

Cardiovascular disease (CVD) is a leading cause of death in women. Novel approaches to detect early signs of elevated CVD risk in women are needed. Enhancement of traditional CVD risk assessment approaches through the addition of procedures to assess physical function or frailty as well as novel biomarkers of cardiovascular, gut and muscle health could improve early identification. The Women’s Advanced Risk-assessment in Manitoba (WARM) Hearts study will examine the use of novel non-invasive assessments and biomarkers to identify women who are at elevated risk for adverse cardiovascular events.

Methods and analysis

One thousand women 55 years of age or older will be recruited and screened by the WARM Hearts observational, cohort study. The two screening appointments will include assessments of medical history, gender variables, body composition, cognition, frailty status, functional fitness, physical activity levels, nutritional status, quality of life questionnaires, sleep behaviour, resting blood pressure (BP), BP response to moderate-intensity exercise, a non-invasive measure of arterial stiffness and heart rate variability. Blood sample analysis will be used to assess lipid and novel biomarker profiles and stool samples will support the characterisation of gut microbiota. The incidence of the adverse cardiovascular outcomes will be assessed 5 years after screening to compare WARM Hearts approaches to the Framingham Risk Score, the current clinical standard of assessing CVD risk in Canada.

Ethics and dissemination

The University of Manitoba Health Research Ethics Board (7 October 2019) and the St Boniface Hospital Research Review Committee (7 October 2019) approved the trial (Ethics Number HS22576 (H2019:063)). Recruitment started 10 October 2020. Data gathered from the WARM Hearts study will be published in peer-reviewed journals and presented at national and international conferences. Knowledge translation strategies will be created to share our findings with stakeholders who are positioned to implement evidence-informed CVD risk assessment programming.

Trial registration number

NCT03938155.