bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic Variants Assessing Crohn’s Disease Pattern in Pediatric Inflammatory Bowel Disease Patients by a Clinical Exome Survey
Authors: Noel Dago Dougba , Marinella Pinelli , Mauro Giacomelli , Tripodi Serena Ilaria , Pin Alessia , Serena Arrigo , Matteo Bramuzzo , Giuseppe Fuoti Maurizio , Patrizia Alvisi , Stefano Calza , Tommasini Alberto , Raffaele Badolato
Published: December 2021

Background:

Inflammatory bowel diseases (IBDs) are complex, multifactorial disorders that comprise Crohn’s disease (CD) and ulcerative colitis (UC). Recent discoveries have brought much attention to the genetic predisposition of patients with IBD. Here we evaluate the interaction between IBD genetic risk factors susceptibility and CD occurrence in an IBD pediatric patient population, performing a clinical exome survey.

Methods:

From February 2018 to April 2019, we collected blood samples from 7 pediatric patients with IBD concerns from several collaborating health centers and/or hospitals. Blood samples were processed by extracting and sequencing DNA for a clinical exome survey. Shophia-DDM-v3-4 platform allowed sequenced reads alignment on hg19 genome as well as genetic variant calling. Both IBD risk and pathogenic genetic variants covered by at least 20 reads were selected for subjacent analysis.

Results:

Normality and Bartlett tests of both risk and pathogenic genetic variants suggested random and heterogeneous distribution of these variants in this group of IBD pediatric patients. P value clustering analysis by processing 157 IBD risk factors revealed genetic heterogeneity in IBD population and suggested two pathways influencing IBD development. In particular, (1) genetic variants associated with autoimmune and (2) metabolic diseases and CD risk factors (rs2066844 and rs2241880 single nucleotide polymorphism variants, respectively, of genes NOD2 and ATG16L) were identified in distinct clusters of IBD patients ( P < .05). Moreover, the heterogeneous distribution of the following variants rs10065172 (IRGM), rs1805010 (IL4R), rs5030737 (MBL2), and rs33995883 (LRRK2) in this group of IBD patients was consistent with their random distribution in that population.

Conclusion:

Our study revealed specific genetic variants linked to CD susceptibility, autoimmune and/or innate immunodeficiency as well as to metabolic defects, as favoring factors of IBD, suggesting the valuable role of next generation sequencing (NGS) approaches in IBD molecular diagnostic procedures.
Reddit’s cops and cop-watchers: Resisting and insisting on change in online interpretive communities
Authors: Buozis Michael
Published: December 2021

This study explores how two subreddits—r/Bad_Cop_No_Donut (Donut) and r/ProtectAndServe (PnS)—function as online interpretive communities discussing the same topic: police conduct. Members of Donut construct a genre from videos depicting a history of police violence in order to advocate for policing reform, arguing that cop-watching practices that produce this genre are essential to driving changes in policing. Members of PnS construct a genre from similar videos in order to advocate for resisting systemic reform, reading these videos as professional development opportunities for police to reestablish legitimacy with the public. Donut insists on change, while PnS resists change. Donut produces a discourse which engages with historical instances of police misconduct; PnS produces a discourse which rarely engages with this history. Studying these processes of interpretation reveals how dissonant meanings can arise from the same material, how meaning is made in communities consuming and repurposing texts, and how historical narratives are essential to challenging structural inequity.
Pay Now or Pay Later: The Impact of Time on Payment Preference in Hotel Booking
Authors: Jang Yisak , Miao Li , Chen Chih-Chien
Published: December 2021

The “book now, pay later” phenomenon is one form of payment which has flow-on effects such as increasing last-minute cancelations. To encourage prepayment, some hotels have been offering a price discount or free upgrade for choosing the “pay now” option, but little is known about which incentives can generate better outcomes. This study aims to examine what types of payment options are preferable based on the time between booking and check-in (i.e. temporal distance), and to investigate how the payment options and temporal distance jointly influence perceived risks. The findings demonstrate that while people prefer the pay now with monetary incentive option when traveling time is in the near future, they mostly prefer the pay later option when traveling time is distant. In addition, people planning a trip in the distant future perceive significantly higher risks from the pay now with non-monetary and monetary incentive options than from the pay later option.
Numerical and experimental study on knocking combustion in turbocharged direct-injection engines for a wide range of operating conditions
Authors: Kircher Magnus , Meindl Emmeram , Hasse Christian
Published: December 2021

A combined experimental and numerical study is conducted on knocking combustion in turbocharged direct-injection spark-ignition engines. The experimental study is based on parameter variations in the intake-manifold temperature and pressure, as well as the air-fuel equivalence ratio. The transition between knocking and non-knocking operating conditions is studied by conducting a spark timing sweep for each operating parameter. By correlating combustion and global knock quantities, the global knock trends of the mean cycles are identified. Further insight is gained by a detailed analysis based on single cycles. The extensive experimental data is then used as an input to support numerical investigations. Based on 0D knock modeling, the global knock trends are investigated for all operation points. Taking into consideration the influence of nitric oxide on auto-ignition significantly improves the knock model prediction. Additionally, the origin of the observed cyclic variability of knock is investigated. The crank angle at knock onset in 1000 consecutive single cycles is determined using a multi-cycle 0D knock simulation based on detailed single-cycle experimental data. The overall trend is captured well by the simulation, while fluctuations are underpredicted. As one potential reason for the remaining differences of the 0D model predictions local phenomena are investigated. Therefore, 3D CFD simulations of selected operating points are performed to explore local inhomogeneities in the mixture fraction and temperature. The previously developed generalized Knock Integral Method (gKIM), which considers the detailed kinetics and turbulence-chemistry interaction of an ignition progress variable, is improved and applied. The determined influence of spark timing on the mean crank angle at knock onset agrees well with experimental data. In addition, spatially resolved information on the expected position of auto-ignition is analyzed to investigate causes of knocking combustion.
Too old to vote? A democratic analysis of age-weighted voting
Authors: Poama Andrei , Volacu Alexandru
Published: December 2021

Are there any prima facie reasons that democracies might have for disenfranchising older citizens? This question reflects increasingly salient, but often incompletely theorized complaints that members of democratic publics advance about older citizens’ electoral influence. Rather than rejecting these complaints out of hand, we explore whether, suitably reconstructed, they withstand democratic scrutiny. More specifically, we examine whether the account of political equality that seems to most fittingly capture the logic of these complaints – namely, equal opportunity of political influence over electoral outcomes – can justify disenfranchising older citizens. We conclude that equal opportunity of influence cannot ground a blanket disenfranchisement of older people and that, taken in conjunction with other general considerations that apply to all sound electoral policies, partial disenfranchisement proposals (i.e. proposals for reducing the electoral influence of older citizens via age-weighted voting) are both quasi-inapplicable and practically unrobust across a relevant range of political contexts.
Improving Youth COVID-19 Knowledge, Attitudes, and Practices Through a Novel Medical Student Driven Curriculum
Authors: Kuehl Sarah , Olsen Eudora , Harris Carlyn , Mandal Sampurna (Megha) , Watt Matt , Spicer Jennifer O. , Sonu Stan
Published: December 2021

Despite widespread media coverage and public health messaging, many high school students lacked formal education about COVID-19 during the pandemic. Providing this education, particularly to underserved communities, may reduce health disparities and encourage youth to engage in the sciences. Twenty-five medical students at Emory University School of Medicine created a virtual, synchronous, COVID-19 curriculum. Learners included 25 students enrolled in a pipeline program from five high schools in metro-Atlanta. The five lesson topics included virus epidemiology, COVID-19 testing and mask-wearing, vaccine fundamentals, COVID-19 risk in communities, and mental health and wellness. Lessons were standardized through medical student-teacher practice presentations to faculty. The curriculum was evaluated with a 23-item pre- and postsurvey assessing learners’ COVID-19 knowledge, attitudes, and practices. Pre- and postsurvey scores were compared using descriptive statistics and paired-samples t test. After the curriculum, learners' (N = 9) COVID-19 knowledge scores increased from 67% correct to 90% correct. Participants were better able to identify risk factors for severe COVID-19 infection, define “herd immunity,” and describe how socioeconomic status can influence infection risk. In addition, after the curriculum implementation, more learners thought vaccines were safe, with 67% responding that vaccines are “very safe,” compared with 0% at pretest. This initiative increased learners’ COVID-19 knowledge and established bridges between medical students and underserved communities. These connections are essential to combat misinformation surrounding COVID-19, encourage participation in the sciences from underrepresented areas, and empower students to be health advocates within their communities.
Creating Community During COVID-19: A Virtual Art Gallery to Address Social Isolation During a Pandemic
Authors: Baumann Sara E. , Burke Jessica G.
Published: December 2021

The COVID-19 pandemic, a public health crisis, significantly impacted millions of people around the world. “Creating Community During COVID-19” is a community-engaged virtual art gallery that explores resilience, social cohesion, and creativity during the onset of the pandemic in the United States. It aimed to address social isolation and encourage inclusion at a large public university in the early days of the pandemic. The community was invited to submit artworks that reflected how they are staying connected during the pandemic. The artworks were then qualitatively analyzed and highlighted three key themes: (1) reflecting (turning inward), (2) advocating (turning outward), and (3) engaging (coming together). This arts-based project demonstrates promise as a creative approach for promoting social cohesion and positive health and well-being, especially in times of uncertainty.
Proton Pump Inhibitors and Risk of Dementia: A Hypothesis Generated but Not Adequately Tested
Authors: Azhar Mishah , Fiedler Lawrence , Espinosa Patricio S. , Hennekens Charles H.
Published: December 2021

We reviewed the evidence on proton pump inhibitors (PPIs) and dementia. PPIs are among the most widely utilized drugs in the world. Dementia affects roughly 5% of the population of the United States (US) and world aged 60 years and older. With respect to PPIs and dementia, basic research has suggested plausible mechanisms but descriptive and analytic epidemiological studies are not inconsistent. In addition, a single large-scale randomized trial showed no association. When the evidence is incomplete, it is appropriate for clinicians and researchers to remain uncertain. Regulatory or public health authorities sometimes need to make real-world decisions based on real-world data. When the evidence is complete, then the most rational judgments for individual patients the health of the general public are possible At present, the evidence on PPIs and dementia suggests more reassurance than alarm. Further large-scale randomized evidence is necessary to do so.
From Community Coalitions to City Hall: Shaping Policy in Chicago With Mayor Harold Washington
Authors: Giloth Robert
Published: December 2021

Today’s cities are seeking more social equity—a response in part to police violence, pandemic disparities, and the racial wealth gap. Activists, planners, and local government reformers are looking for bold examples of equity planning—single initiatives and multi-faceted equity plans. The mayoral administration of Harold Washington in Chicago (1983–1987) shows how a grassroots electoral campaign combined with participatory policy development produced the Chicago Works Together (CWT) Development Plan—that promoted jobs, neighborhoods, and citizen participation. This article recounts the development of CWT and examines the impacts of CWT for Chicago and equity planning.
Unruptured Intradural Posterior Circulation Dissecting/Fusiform Aneurysms Natural History and Treatment Outcome
Authors: Dmytriw Adam Andrew , Alrashed Abdullah , Enriquez-Marulanda Alejandro , Medhi Gorky , Mendes Pereira Vitor
Published: December 2021

Background

The natural history and outcome of unruptured posterior circulation dissecting fusiform aneurysms is not fully understood. These have a high risk of morbidity and mortality, not only due to natural history but also due to the challenging and controversial treatment approaches currently available compared to other types of intracranial aneurysms.

Methods

We performed a retrospective study of a prospectively collected aneurysm database at a quaternary neurovascular hospital. We included consecutive patients with unruptured intradural vertebrobasilar dissecting aneurysms between January 2000 and July 2016 who were followed to 2020. Description of baseline, procedural, and outcomes data was performed. Comparisons of patient who had aneurysm rupture on follow-up, increase in 2 or more points of mRS in follow-up and progression of the aneurysm was performed.

Results

Seventy patients with 78 fusiform posterior circulation aneurysms were identified. Thirty-nine (55.7%) patients were male with a mean age of 51.7 years (SD ± 17.6). When multiple, aneurysms were more likely to be fusiform (60%) than saccular (40.0%). Baseline diameter (measured on CTA/MRA/DSA), length as well as symptomatic presentation were significantly higher in aneurysms which grew over time. Coronary disease, diabetes and growth were associated an >2 increase in mRS. Diabetes as well as initial symptomatic presentation were associated with rupture.

Conclusions

Unruptured dissecting/fusiform aneurysm are associated with a considerable rate of rupture during follow-up. Growth is associated with morbidity even in the absence of rupture. Initial large size, coronary disease, diabetes, and to a lesser extent female gender may merit closer follow-up and/or prophylactic treatment.
Patient, carer and healthcare professional perspectives on increasing calorie intake in Amyotrophic Lateral Sclerosis
Authors: Coates Elizabeth , Zarotti Nicolò , Williams Isobel , White Sean , Halliday Vanessa , Beever Daniel , Hackney Gemma , Stavroulakis Theocharis , White David , Norman Paul , McDermott Christopher ,   on behalf of the HighCALS group
Published: December 2021

Objectives

Research suggests that higher Body Mass Index is associated with improved survival in people with Amyotrophic Lateral Sclerosis (pwALS). Yet, understanding of the barriers and enablers to increasing calorie intake is limited. This study sought to explore these issues from the perspective of pwALS, informal carers, and healthcare professionals.

Methods

Interviews with 18 pwALS and 16 informal carers, and focus groups with 51 healthcare professionals. Data were analysed using template analysis and mapped to the COM-B model and Theoretical Domains Framework (TDF).

Results

All three COM-B components (Capability, Opportunity and Motivation) are important to achieving high calorie diets in pwALS. Eleven TDF domains were identified: Physical skills (ALS symptoms); Knowledge (about high calorie diets and healthy eating); Memory, attention, and decision processes (reflecting cognitive difficulties); Environmental context/resources (availability of informal and formal carers); Social influences (social aspects of eating); Beliefs about consequences (healthy eating vs. high calorie diets); Identity (interest in health lifestyles); Goals (sense of control); Reinforcement (eating habits); and Optimism and Emotion (low mood, poor appetite).

Discussion

To promote high calorie diets for pwALS, greater clarity around the rationale and content of recommended diets is needed. Interventions should be tailored to patient symptoms, preferences, motivations, and opportunities.
Kleptocracy and Foreign Loan Decision-Making Process: Insights From Malaysia's Deals and Renegotiations With China
Authors: Abadi Abdul Muein
Published: December 2021

One the largest cases of kleptocracy is attributed to the 1Malaysia Development Berhad (1MDB) scandal involving the former Malaysian Prime Minister, Najib Razak. As a result of the pressure to pay the debt, Najib signed multiple inflated infrastructure loans from China in 2016. This study analyses the manipulation of Public Service Bargains as a critical variable influencing the foreign loan decision-making of the kleptocrat leader. It concludes that Najib's manipulation strategies transformed the established Trustee-type to kleptocratic-type bargains in Malaysia's foreign loan decision-making process. The post-Najib's restoration of Trustee-type bargains under the new Malaysian government, followed by a series of successful renegotiations with China, attest to the significance of the Public Service Bargains system on the foreign loan decision-making process. This analysis also contributes to the wider discussion on the critical side of China's Belt and Road Initiative amidst a global call for good governance.
Flavonoids of the Heartwood of Cotinus coggygria Scop. Showing Protective Effect on Human Lymphocyte DNA
Authors: Milosavljevic Slobodan , Djordjevic Iris , Mandic Boris , Tesevic Vele , Stankovic Miroslava , Todorovic Nina , Novakovic Miroslav
Published: December 2021

In continuation of our study on Cotinus coggygria from Serbia, 10 known flavonoids (1-10) were isolated from the methylene chloride/methanol extract of the heartwood. They were tested for in vitro protective effect against chromosome aberrations in peripheral human lymphocytes, using the cytokinesis-block micronucleus assay. All tested compounds (in minimal doses of 1 μg/mL) exerted a beneficial effect by decreasing DNA damage of human lymphocytes in the range of 24.2% to 54.5%, better than the radio protectant control, amifostine. Functional groups, such as 3′,4′-dihydroxyphenyl (catechol), 5-OH, 3-OH, and 4-keto in flavonoids (3-keto in aurones), which play a key role in antioxidant activity, are proposed to be responsible for the DNA protective activity of the tested compounds.
Antibiotic use and ileocolonic immune cells in patients receiving fecal microbiota transplantation for refractory intestinal GvHD: a prospective cohort study
Authors: Spindelboeck Walter , Halwachs Bettina , Bayer Nadine , Huber-Krassnitzer Bianca , Schulz Eduard , Uhl Barbara , Gaksch Lukas , Hatzl Stefan , Bachmayr Victoria , Kleissl Lisa , Kump Patrizia , Deutsch Alexander , Stary Georg , Greinix Hildegard , Gorkiewicz Gregor , Högenauer Christoph , Neumeister Peter
Published: December 2021

Introduction:

Treatment-refractory, acute graft- versus-host disease (GvHD) of the lower gastrointestinal tract (GI) after allogeneic hematopoietic stem cell transplantation is life threatening and lacks effective treatment options. While fecal microbiota transplantation (FMT) was shown to ameliorate GI-GvHD, its mechanisms of action and the factors influencing the treatment response in humans remain unclear. The objective of this study is to assess response to FMT treatment, factors influencing response, and to study the mucosal immune cell composition in treatment-refractory GI-GvHD.

Methods:

Consecutive patients with treatment-refractory GI-GvHD were treated with up to six endoscopically applied FMTs.

Results:

We observed the response to FMT in four out of nine patients with severe, treatment refractory GI-GvHD, associated with a significant survival benefit ( p = 0.017). The concomitant use of broad-spectrum antibiotics was the main factor associated with FMT failure ( p = 0.048). In addition, antibiotic administration hindered the establishment of donor microbiota after FMT. Unlike in non-responders, the microbiota characteristics (e.g. α- and β-diversity, abundance of anaerobe butyrate-producers) in responders were more significantly similar to those of FMT donors. During active refractory GI-GvHD, an increased infiltrate of T cells, mainly Th17 and CD8+ T cells, was observed in the ileocolonic mucosa of patients, while the number of immunomodulatory cells such as regulatory T-cells and type 3 innate lymphoid cells decreased. After FMT, a change in immune cell patterns was induced, depending on the clinical response.

Conclusion:

This study increases the knowledge about the crucial effects of antibiotics in patients given FMT for treatment refractory GI-GvHD and defines the characteristic alterations of ileocolonic mucosal immune cells in this setting.
Does alexithymia, independent of depressive and anxiety disorders, correlate with the severity of somatic manifestations among patients with medically unexplained physical symptoms?
Authors: Rady Ahmed , Alamrawy Roa , Ramadan Ismail , Abd El Raouf Mervat
Published: December 2021

Background: Medically unexplained physical symptoms (MUPS) are highly prevalent, frequently co-occurring with psychiatric symptoms such as depression, alexithymia, and anxiety. Objective: To evaluate the relation between depression, anxiety, and alexithymia and severity of somatic symptoms in patients with MUPS. Method: This is a cross-sectional study conducted on 196 patients suffering from MUPS. The patients were recruited from tertiary care internal medicine and neuropsychiatry clinics during the first quarter of 2019. The Patient Health Questionnaire (PHQ-15), (PHQ-9), Generalized Anxiety Disorder (GAD-7), Structured Clinical Interview for DSM-IV Axis I Disorders Clinician Version (SCID-I-CV), and Toronto Alexithymia Scale (TAS-20) were employed to assess somatic severity, depression, anxiety, major mental disorders, and alexithymia in the sample of patients. Results: The results of the study indicate that GAD-7 and PHQ-9 scores had a positive correlation with PHQ-15 ( p < 0.05) in multivariate regression. In contrast, TAS-20 was not independently correlated with PHQ-15. Adding TAS-20 to GAD-7 and PHQ-9 in the equation of the regression model enhances the predictive capacity of the model ( p < 001). Conclusion: The results of the study indicate that only anxiety and depressive symptoms, but not alexithymia, were associated independently with MUPS severity.
Season of birth is associated with multiple sclerosis and disease severity
Authors: Stridh P , Huang J , Hedström AK , Alfredsson L , Olsson T , Hillert J , Manouchehrinia A , Kockum I
Published: December 2021

Background

The latitude gradient in multiple sclerosis incidence indicates that low sun exposure and therefore vitamin D deficiency is associated with multiple sclerosis risk.

Objective

Investigation of the effect of month of birth, which influences postnatal vitamin D levels, on multiple sclerosis risk and severity in Sweden.

Methods

Patients and population-based controls were included from three nationwide cohorts. Differences in month of birth between cases and controls were analyzed using logistic regression and examined for effect modification by calendar year and geographic region at birth.

Results

Males had a reduced risk of multiple sclerosis if born in the winter and increased risk if born in the early fall. Individuals born before 1960 had an increased risk if born in summer or fall. Being born in late summer and early fall was associated with more severe disease.

Conclusions

We identified a birth cohort effect on the association between the month of birth and multiple sclerosis, with a more significant effects for births before 1960. This coincides with a period of lower breastfeeding rates, recommended intake of vitamin D, and sun exposure, resulting in a lower vitamin D exposure during the fall/winter season for infants born in the summer.
Myths of nationhood: Cultural nationalism, political Islam, and the movement against sculptures in Bangladesh
Authors: Hajjaj Bobby
Published: December 2021

In November 2020, the government of Bangladesh announced plans to erect a 25-foot-tall sculpture of Bangabandhu Sheikh Mujibur Rahman in the national memorial located in the country's capital, Dhaka. This announcement caused a massive uproar among the religious ulema and quickly turned into a quasi-mass scale movement, sparking a torrent of political and religious rhetoric from both sides. This article argues that behind the religious rhetoric, the true cause underlying this fracas was purely political in nature, and tied to the clash of two contrasting nationalist dogmas. The country's Islamic political parties and the Qawmi madrasas leaders face a clear and perceived threat from the nationalist narratives expounded by the ruling political party, the Bangladesh Awami League, and this movement was a retaliatory attempt and will not be the last.
Vlogging as a Tool in the Self-Reflective Journey: Professional Identity Development as a Space Between
Authors: Brott Pamelia E. , Willis David A.
Published: December 2021

The authors present an interpretative phenomenological analysis (IPA) case study used to uncover the meaning-making system of professional identity development experienced by a graduate student completing a two-semester school counseling internship. The intern engaged in critical self-reflections as weekly vloggings, which are single-turn video monologs. The rigor of IPA allowed the researchers to explore the intern’s personal reflexivity as a space between what the intern was doing and his process of becoming a professional. The super-ordinate theme that emerged from the analysis in this case study was connecting the dots. . . it’s all about the kids. Findings from this research have implications in higher education and professional studies for creating a transformative learning environment and engaging individuals in the professional identity development process.
Awareness of Linguistic Ambiguity and Translator Training
Authors: Liu Chin-Ting , Chen Yuan-shan
Published: December 2021

As a first step toward understanding the relationship between conscious awareness of linguistic knowledge and translation performance, this study investigated whether enhancement of trainee translators’ awareness of linguistic ambiguity helped them increase their awareness of ambiguity in translation and whether the effects were correlated with the participants’ language proficiency. Forty-six first-year undergraduate students from a translation program received a multiple-choice pretest, a 20-minute awareness-raising lecture focusing on linguistic ambiguity immediately after the pretest, and the same multiple-choice posttest a week later. The results indicated that the participants detected more items with linguistic ambiguity in translation after their awareness of linguistic ambiguity had been increased. However, the participants also judged a higher number of unambiguous sentences as ambiguous in the posttest. Additionally, the increases or decreases in participants’ scores in the posttest were not correlated with their English proficiency. The findings could be accounted for by Schmidt’s Noticing Hypothesis. The implications for the curriculum design of translation programs as well as directions for future studies are discussed.
Physical Fitness Testing and Screening Reveal a Gateway to Identify Locomotive Disorders: Retrospective Study of a Japanese Elementary School Population
Authors: Ito Syuro , Fukumoto Takahiko , Imagita Hidetaka
Published: December 2021

This retrospective epidemiological study investigated the relationship between physical fitness testing and locomotive disorder screening results among elementary school children in Japan. The test and screening results of 1033 children from a single elementary school between 2016 and 2018 were examined. Multiple regression analysis was performed for each gender of children of grades third and fourth to generate receiver-operating characteristic curves. Of the 69 children with parent-identified locomotor problems, 29 (42%) had physical fitness test score of mean ± 2 SD. For the standing long jump test in fourth grade girls, the results differed significantly ( P < .001; cut-off, 127 cm) for children whose parents did (n = 7) and did not (n = 84) suspect a possible locomotive disorder. Physical fitness testing in combination with school-based screening for locomotive disorders may be useful for identifying and accurately diagnosing these disorders in children.
Examination of the Effectiveness of Direct Oral Anticoagulants in Comparison to Warfarin in an Obese Population
Authors: Watson Rachel M. , Smith Carmen B. , Crannage Erica F. , Challen Laura M.
Published: December 2021

Background: While commonly prescribed today, direct oral anticoagulants (DOACs) have historically been avoided in patients with class III obesity or a weight >120 kg due to limited literature regarding the efficacy and safety in this population. Objective: The overall objective was to examine the effectiveness of DOACs compared to warfarin in a population with obesity. Methods: Patients with a diagnosis of venous thromboembolism (VTE) or atrial fibrillation and a body mass index (BMI) ≥35 kg/m2 from August 1, 2015, to August 1, 2020, were included in this retrospective cohort study. Patients receiving a DOAC were matched in a 1:2 ratio to warfarin. The primary outcome was a composite of stroke or recurrent VTE. Secondary outcomes included the individual components of the primary outcome, hospitalization for bleed, and the primary outcome in patients with a BMI ≥40 kg/m2. Results: A total of 162 patients were included, with 54 and 108 in the DOAC and warfarin groups, respectively. Baseline BMI was similar between groups (45.7 kg/m2 for DOACs vs 43.8 kg/m2 for warfarin), with approximately 70% of patients having a BMI ≥40 kg/m2. The primary outcome occurred in 1 patient (1.9%) in the DOAC group and 2 patients (1.9%) in the warfarin group. The DOAC group had a higher, nonsignificant incidence of bleeding (5.6% vs 0.9%, P = 0.11). There was no difference between groups in incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), or stroke in patients with a BMI ≥40 kg/m2. Conclusion: DOACs may be as efficacious as warfarin in the prevention of stroke or recurrent VTE in patients with a BMI of ≥35 kg/m2. Prospective, randomized trials are warranted to further assess the efficacy and safety of DOACs in this population.
2021 US National Seismic Hazard Model for the State of Hawaii
Authors: Petersen Mark D , Shumway Allison M , Powers Peter M , Moschetti Morgan P , Llenos Andrea L , Michael Andrew J , Mueller Charles S , Frankel Arthur D , Rezaeian Sanaz , Rukstales Kenneth S , McNamara Daniel E , Okubo Paul G , Zeng Yuehua , Jaiswal Kishor S , Ahdi Sean K , Altekruse Jason M , Shiro Brian R
Published: December 2021

The 2021 US National Seismic Hazard Model (NSHM) for the State of Hawaii updates the previous two-decade-old assessment by incorporating new data and modeling techniques to improve the underlying ground shaking forecasts of tectonic-fault, tectonic-flexure, volcanic, and caldera collapse earthquakes. Two earthquake ground shaking hazard forecasts (public policy and research) are produced that differ in how they account for declustered catalogs. The earthquake source model is based on (1) declustered earthquake catalogs smoothed with adaptive methods, (2) earthquake rate forecasts based on three temporally varying 60-year time periods, (3) maximum magnitude criteria that extend to larger earthquakes than previously considered, (4) a separate Kīlauea-specific seismogenic caldera collapse model that accounts for clustered event behavior observed during the 2018 eruption, and (5) fault ruptures that consider historical seismicity, GPS-based strain rates, and a new Quaternary fault database. Two new Hawaii-specific ground motion models (GMMs) and five additional global models consistent with Hawaii shaking data are used to forecast ground shaking at 23 spectral periods and peak parameters. Site effects are calculated using western US and Hawaii specific empirical equations and provide shaking forecasts for 8 site classes. For most sites the new analysis results in similar spectral accelerations as those in the 2001 NSHM, with a few exceptions caused mostly by GMM changes. Ground motions are the highest in the southern portion of the Island of Hawai’i due to high rates of forecasted earthquakes on décollement faults. Shaking decays to the northwest where lower earthquake rates result from flexure of the tectonic plate. Large epistemic uncertainties in source characterizations and GMMs lead to an overall high uncertainty (more than a factor of 3) in ground shaking at Honolulu and Hilo. The new shaking model indicates significant chances of slight or greater damaging ground motions across most of the island chain.
NGA-Subduction research program
Authors: Bozorgnia Yousef , Abrahamson Norman A , Ahdi Sean K , Ancheta Timothy D , Atik Linda Al , Archuleta Ralph J , Atkinson Gail M , Boore David M , Campbell Kenneth W , S-J Chiou Brian , Contreras Victor , Darragh Robert B , Derakhshan Sahar , Donahue Jennifer L , Gregor Nick , Gulerce Zeynep , Idriss IM , Ji Chen , Kishida Tadahiro , Kottke Albert R , Kuehn Nicolas , Kwak DongYoup , O-L Kwok Annie , Lin P , Macedo Jorge , Mazzoni Silvia , Midorikawa Saburoh , Muin Sifat , Parker Grace A , Rezaeian Sanaz , Si Hongjun , Silva Walter J , Stewart Jonathan P , Walling Melanie , Wooddell Katie , Youngs Robert R
Published: December 2021

This article summarizes the Next Generation Attenuation (NGA) Subduction (NGA-Sub) project, a major research program to develop a database and ground motion models (GMMs) for subduction regions. A comprehensive database of subduction earthquakes recorded worldwide was developed. The database includes a total of 214,020 individual records from 1,880 subduction events, which is by far the largest database of all the NGA programs. As part of the NGA-Sub program, four GMMs were developed. Three of them are global subduction GMMs with adjustment factors for up to seven worldwide regions: Alaska, Cascadia, Central America and Mexico, Japan, New Zealand, South America, and Taiwan. The fourth GMM is a new Japan-specific model. The GMMs provide median predictions, and the associated aleatory variability, of RotD50 horizontal components of peak ground acceleration, peak ground velocity, and 5%-damped pseudo-spectral acceleration (PSA) at oscillator periods ranging from 0.01 to 10 s. Three GMMs also quantified “within-model” epistemic uncertainty of the median prediction, which is important in regions with sparse ground motion data, such as Cascadia. In addition, a damping scaling model was developed to scale the predicted 5%-damped PSA of horizontal components to other damping ratios ranging from 0.5% to 30%. The NGA-Sub flatfile, which was used for the development of the NGA-Sub GMMs, and the NGA-Sub GMMs coded on various software platforms, have been posted for public use.
Patients’ and clinicians’ perceptions of oral anticoagulants in atrial fibrillation: a systematic narrative review and meta-analysis
Authors: Osasu Yeyenta Mina , Cooper Richard , Mitchell Caroline
Published: December 2021

Background

Atrial fibrillation (AF) increases the risk of developing a stroke by 20%. AF related strokes are associated with greater morbidity. Historically, warfarin was the anticoagulant of choice for stroke prevention in patients with AF but lately patients are being switched or started on direct oral anticoagulants (DOACs). DOACs are promoted as safer alternatives to warfarin and it is expected that they will be associated with fewer challenges both for patients and healthcare professionals. This systematic narrative review aimed to explore perspectives of patients and professionals on medicines optimisation of oral anticoagulation with vitamin K antagonists and DOACs in atrial fibrillation.

Methods

Prospero registration CRD42018091591. Systematic searches undertaken of research studies (qualitative and quantitative), published February 2018 to November 2020 from several databases (Web of Science, Scopus, Medline Via Ovid, CINHAL via Ebsco, and PubMED via NCBI) following PRISMA methodology. Data were organised using Covidence software. Two reviewers independently assessed the quality of the included studies and synthesized the findings (thematic analysis approach).

Results

Thirty-four studies were included. Studies were critically appraised using established critical appraisal tools (Qualsyst) and a risk of bias was assigned. Clinicians considered old age and the associated complexities such as co-morbidities and the increased potential for bleeding as potential barriers to optimising anticoagulation. Whereas patients’ health and medication beliefs influenced adherence. Notably, structured patient support was important in enhancing safety and effective anticoagulation. For both patients and clinicians, confidence and experience of safe anticoagulation was influenced by the presence of co-morbidities,  poor knowledge and understanding of AF and the purpose of anticoagulation.

Conclusion

Age, complex multimorbidity and polypharmacy influence prescribing, with DOACs being perceived to be safer than warfarin. This systematic narrative review suggests that interventions are needed to support patient self-management. There are residual anxieties associated with long term anticoagulation in the context of complexities.

Trial registration

Not applicable.
Doctor-patient relationship improved during COVID-19 pandemic, but weakness remains
Authors: Zhou Yanan , Ma Yuejiao , Yang Winson Fu Zun , Wu Qiuxia , Wang Qianjin , Wang Dongfang , Ren Honghong , Luo Yinli , Yang Dong , Liu Tieqiao , Wu Xiaoming
Published: December 2021

Objective

To assess the quality of the doctor-patient relationship (DPR) in China and possible influencing factors during the COVID-19 period from the patient’s perspective.

Methods

An online survey was carried out nationwide from March 12, 2020 to March 30, 2020 in China via a convenience sampling strategy. Patients who met the inclusion criteria were invited to complete a questionnaire regarding the quality of DPR, including sociodemographic information, the Patient-Doctor Relationship Questionnaire (PDRQ-9), and influencing factors for DPR during the pandemic.

Results

A total of 1903 patients were included. Our result showed that participants had a higher PDRQ-9 score during the COVID-19 pandemic (4.18 ± 0.51) than that before the COVID-19 pandemic (3.86 ± 0.67). Importance-performance analysis (IPA) revealed that doctor-patient communication, patient satisfaction, consultation time, doctor’s attitude, and medical knowledge were specific aspects that needed to be prioritized to improve the DPR. Multiple linear regression analysis suggested that positive media reports, telemedicine, and national policies had a significantly positive effect on the DPR during the pandemic (P < 0.05).

Conclusion

In general, the DPR had been improved during the COVID-19 pandemic. Our research found the key points that needed to be prioritized to improve the DPR during the pandemic, which may provide effective suggestions for building a harmonious DPR in the future.
Prerequisites for providing effective support to family caregivers within the primary care setting – results of a study series in Germany
Authors: Wangler Julian , Jansky Michael
Published: December 2021

Background

General Practitioners are considered to be well placed to monitor home-care settings and to respond specifically to family caregivers. To do this, they must be sensitive to the needs and expectations of caregivers. In order to determine the current status of GP care in terms of the support given to family caregivers, a series of studies were conducted to gather the perspectives of both caregivers and GPs. The results are used to derive starting points as to which measures would be sensible and useful to strengthen support offered to family caregivers in the primary care setting.

Methods

Between 2020 and 2021, three sub-studies were conducted: a) an online survey of 612 family caregivers; b) qualitative interviews with 37 family caregivers; c) an online survey of 3556 GPs.

Results

Family caregivers see GPs as a highly skilled and trustworthy central point of contact; there are many different reasons for consulting them on the subject of care. In the perception of caregivers, particular weaknesses in GP support are the absence of signposting to advisory and assistance services and, in many cases, the failure to involve family caregivers in good time. At the same time, GPs do not always have sufficient attention to the physical and psychological needs of family caregivers. The doctors interviewed consider the GP practice to be well suited to being a primary point of contact for caregivers, but recognise that various challenges exist. These relate, among other things, to the timely organisation of appropriate respite services, targeted referral to support services or the early identification of informal caregivers.

Conclusions

GP practices can play a central role in supporting family caregivers. Caregivers should be approached by the practice team at an early stage and consistently signposted to help and support services. In order to support care settings successfully, it is important to consider the triadic constellation of needs, wishes and stresses of both the caregiver and the care recipient. More training and greater involvement of practice staff in the support and identification of caregivers seems advisable.
Ruxolitinib versus dexamethasone in hospitalized adults with COVID-19: multicenter matched cohort study
Authors: Stanevich O. V. , Fomina D. S. , Bakulin I. G. , Galeev S. I. , Bakin E. A. , Belash V. A. , Kulikov A. N. , Lebedeva A. A. , Lioznov D. A. , Polushin Yu. S. , Shlyk I. V. , Vorobyev E. A. , Vorobyeva S. V. , Surovceva T. V. , Bakulina N. V. , Lysenko M. A. , Moiseev I. S.
Published: December 2021

Background

Several anti-cytokine therapies were tested in the randomized trials in hospitalized patients with severe acute respiratory syndrome coronavirus 2 infection (COVID-19). Previously, dexamethasone demonstrated a reduction of case-fatality rate in hospitalized patients with respiratory failure. In this matched control study we compared dexamethasone to a Janus kinase inhibitor, ruxolitinib.

Methods

The matched cohort study included 146 hospitalized patients with COVID-19 and oxygen support requirement. The control group was selected 1:1 from 1355 dexamethasone-treated patients and was matched by main clinical and laboratory parameters predicting survival. Recruitment period was April 7, 2020 through September 9, 2020.

Results

Ruxolitinib treatment in the general cohort of patients was associated with case-fatality rate similar to dexamethasone treatment: 9.6% (95% CI [4.6–14.6%]) vs 13.0% (95% CI [7.5–18.5%]) respectively (p = 0.35, OR = 0.71, 95% CI [0.31–1.57]). Median time to discharge without oxygen support requirement was also not different between these groups: 13 vs. 11 days (p = 0.13). Subgroup analysis without adjustment for multiple comparisons demonstrated a reduced case-fatality rate in ruxolitnib-treated patients with a high fever (≥ 38.5 °C) (OR 0.33, 95% CI [0.11–1.00]). Except higher incidence of grade 1 thrombocytopenia (37% vs 23%, p = 0.042), ruxolitinib therapy was associated with a better safety profile due to a reduced rate of severe cardiovascular adverse events (6.8% vs 15%, p = 0.025). For 32 patients from ruxolitinib group (21.9%) with ongoing progression of respiratory failure after 72 h of treatment, additional anti-cytokine therapy was prescribed (8–16 mg dexamethasone).

Conclusions

Ruxolitinib may be an alternative initial anti-cytokine therapy with comparable effectiveness in patients with potential risks of steroid administration. Patients with a high fever (≥ 38.5 °C) at admission may potentially benefit from ruxolitinib administration.

Trial registration The Ruxolitinib Managed Access Program (MAP) for Patients Diagnosed With Severe/Very Severe COVID-19 Illness NCT04337359, CINC424A2001M, registered April, 7, 2020. First participant was recruited after registration date
Toscana virus encephalitis in Southwest Germany: a retrospective study
Authors: Dersch R. , Sophocleous A. , Cadar D. , Emmerich P. , Schmidt-Chanasit J. , Rauer S.
Published: December 2021

Background

Toscana virus (TOSV) is an arthropod-borne virus transmitted by phlebotomine sandflies (Phlebotomus sp.) widespread throughout the Mediterranean having the potential to cause meningoencephalitis in humans. In Germany, the vectors of TOSV are introduced recently and become endemic especially in Southwestern Germany. As TOSV is not investigated regularly in patients with meningoencephalitis, cases of TOSV-neuroinvasive disease may remain mostly undetected.

Methods

We conducted a retrospective cohort study on patients with meningoencephalitis without identification of a causal pathogen from 2006 to 2016. Serologic assessment for anti-TOSV-IgG and IgM was performed on serum and CSF. Demographic, clinical and CSF data from TOSV-positive patients were compared to a cohort of patients with meningoencephalitis due to enterovirus. Informed consent was obtained from all included patients.

Results

We found 138 patients with meningoencephalitis without identified causal pathogen. From 98 of these patients CSF and serum was available for further testing. Additionally, we included 27 patients with meningoencephalitis due to enterovirus. We identified two patients with serological confirmed TOSV-neuroinvasive disease (TOSV-IgM and IgG positive, 2%) and two patients with possible TOSV-neuroinvasive disease (isolated TOSV-IgM positive, 2%). Overall, TOSV-neuroinvasive was detected in 4% of our cases with suspected viral meningoencephalitis. None of them had a history of recent travel to an endemic area.

Conclusions

We found cases of TOSV-neuroinvasive disease in our German cohort of patients with meningoencephalitis. As no recent history of travel to an endemic area was reported, it remains probable that these cases resemble autochthonous infections, albeit we cannot draw conclusions regarding the origin of the respective vectors. TOSV could be considered in patients with meningoencephalitis in Germany.