bluuebunny/crossref_metadata_2025 huggingface dataset:
Zastupljenost sindroma izgaranja kod medicinskih sestara i tehničara na
primarnoj i sekundarnoj razini zdravstvene zaštite
Authors: Matuzić Silvija , Kosić Radoslav
Published: January 2021

Uvod: Sestrinska profesija predstavlja fizički, psihički, emocionalno i duhovno iscrpljujući te zahtjevan posao. Potreba pružanja usluga u zdravstvenoj skrbi u stalnom je porastu, uključujući sve zahtjevnija očekivanja od medicinskih sestara. Prema rezultatima istraživanja Svjetske zdravstvene organizacije o najstresnijim
zanimanjima, sestrinski posao zauzima visoko četvrto mjesto.
Cilj istraživanja: Cilj je istraživanja utvrditi subjektivne i objektivne dimenzije koje utječu na sindrom izgaranja medicinskih sestara i tehničara na primarnoj i sekundarnoj razini zdravstvene zaštite na području grada Karlovca.
Ispitanici i metode: Istraživanje je provedeno u Domu zdravlja Karlovac i Općoj bolnici Karlovac. U istraživanje su uključene medicinske sestre i medicinski tehničari. Anonimni upitnik ispunilo je 65 ispitanika, od čega 30 ispitanika zaposlenih u Domu zdravlja Karlovac i 35 ispitanika zaposlenih u Općoj bolnici Karlovac. U istraživanju je korišten Upitnik za određivanje sindroma izgaranja na poslu.
Rezultati: Rezultati istraživanja pokazuju da ne postoji statistički značajna razlika u zastupljenosti sindroma izgaranja s obzirom na primarnu i sekundarnu razinu zdravstvene zaštite, prema dobi i spolu, razini obrazovanja te rukovodećem radnom mjestu. Nadalje, rezultati pokazuju da je kod ispitanika koji imaju više godina radnog staža niža zastupljenost sindroma izgaranja, dok su stariji ispitanici više mrzovoljni, brže postanu razdražljivi i očekuju više od ljudi koji ih okružuju. Ispitanici višeg stupnja obrazovanja u većoj mjeri osjećaju da rade sve više, a manje su učinkoviti. Rezultati ukazuju na to da je 84,6 % ispitanika ovog istraživanja zahvaćeno sindromom izgaranja.
Zaključak: Kod zaposlenika koji imaju više godina radnog staža verificiran je manji stupanj sindroma izgaranja. Moguće je da je to povezano s većim stupnjem zadovoljstva (veći stupanj spremnosti za napredovanjem i trajnom edukacijom) što predstavlja osnovu za određivanje stupnja kvalitete radnog okruženja i prevenciju sindroma izgaranja.
Recording Intrinsic Nerve Activity at the Sinoatrial Node in Normal Dogs With High-Density Mapping
Authors: Yang Yufan , Yuan Yuan , Wong Johnson , Fishbein Michael C. , Chen Peng-Sheng , Everett Thomas H.
Published: January 2021

Background:

It is known that autonomic nerve activity controls the sinus rate. However, the coupling between local nerve activity and electrical activation at the sinoatrial node (SAN) remains unclear. We hypothesized that we would be able to record nerve activity at the SAN to investigate if right stellate ganglion (RSG) activation can increase the local intrinsic nerve activity, accelerate sinus rate, and change the earliest activation sites.

Methods:

High-density mapping of the epicardial surface of the right atrium including the SAN was performed in 6 dogs during stimulation of the RSG and after RSG stellectomy. A radio transmitter was implanted into 3 additional dogs to record RSG and local nerve activity at the SAN.

Results:

Heart rate accelerated from 108±4 bpm at baseline to 125±7 bpm after RSG stimulation (
P
=0.001), and to 132±7 bpm after apamin injection (
P
<0.001). Both electrical RSG stimulation and apamin injection induced local nerve activity at the SAN with the average amplitudes of 3.60±0.72 and 3.86±0.56 μV, respectively. RSG stellectomy eliminated the local nerve activity and decreased the heart rate. In ambulatory dogs, local nerve activity at the SAN had a significantly higher average Pearson correlation to heart rate (0.72±0.02,
P
=0.001) than RSG nerve activity to HR (0.45±0.04,
P
=0.001).

Conclusions:

Local intrinsic nerve activity can be recorded at the SAN. Short bursts of these local nerve activities are present before each atrial activation during heart rate acceleration induced by stimulation of the RSG.
Influence of Atrial Fibrillation on Functional Tricuspid Regurgitation in Patients With HeartMate 3
Authors: Hayashi Hideyuki , Naka Yoshifumi , Sanchez Joseph , Takayama Hiroo , Kurlansky Paul , Ning Yuming , Topkara Veli K. , Yuzefpolskaya Melana , Colombo Paolo C. , Sayer Gabriel T. , Uriel Nir , Takeda Koji
Published: January 2021

Background

Functional tricuspid regurgitation (TR) can occur secondary to atrial fibrillation (AF). The impact of AF on functional TR and cardiovascular events is uncertain in patients with left ventricular assist devices. This study aimed to investigate the effect of AF on functional TR and cardiovascular events in patients with a HeartMate 3 left ventricular assist device.

Methods and Results

We retrospectively reviewed 133 patients who underwent HeartMate 3 implantation at our center between November 2014 and November 2018. We excluded patients who had undergone previous or concomitant tricuspid valve procedures and those whose echocardiographic images were of insufficient quality. The primary end point was death and the presence of a cardiovascular event at 1 year. We defined cardiovascular event as a composite of death, stroke, and hospital readmission due to recurrent heart failure and significant residual TR as vena contracta width ≥3 mm. In total, 110 patients were included in this analysis. Patients were divided into 3 groups: no AF (n=51), paroxysmal AF (n=40), and persistent AF (PeAF) (n=19). Kaplan‐Meier analysis showed that patients with PeAF had the worst survival (no AF 98%, paroxysmal AF 98%, PeAF 84%, log‐rank
P
=0.038) and event‐free rate (no AF 93%, paroxysmal AF 89%, PeAF 72%, log‐rank
P
=0.048) at 1 year. Thirty‐one (28%) patients had residual TR 1 month after left ventricular assist device implantation. Patients with residual TR had a significantly poor prognosis compared with those without residual TR (log‐rank
P
=0.014).

Conclusions

PeAF was associated with increased mortality, cardiovascular events, and residual TR compared with no AF and paroxysmal AF.
Systematic Theology and Biblical Theology—Part Two
Authors: Allen Michael
Published: January 2021

In many times and various ways, some significant Reformed theologians have claimed that biblical theology must be coordinated with or contribute to the task of systematic theology. In these last days, they have even suggested that biblical theology should fill the place of systematic theology. Part One described the way in which Geerhardus Vos, John Murray, and Richard Gaffin have addressed the role of biblical theology in relation to systematic theology and analyzed their arguments. This essay will offer counterproposals regarding the origin, mainstreaming, and end of biblical theology (and theological interpretation of scripture) as exegetical therapies meant to serve the functioning of dogmatics and exegesis.
Eschatology and the Munus Triplex
Authors: Liston Gregory John
Published: January 2021

The traditional Reformed understanding of Jesus Christ as prophet, priest, and king, and of Christian participation in this munus triplex, can be refined, complemented, and extended through viewing this theologumenon eschatologically. Applying the methodology of Third Article Theology to the doctrine of eschatology enables the full breadth of Christ’s pneumatological interaction with humanity to be explored. Recent attempts to partially employ the munus triplex in the service of eschatology reveal considerable advances with regards to Christ’s prophetic and priestly offices. These efforts are categorized and then extended with a constructive discussion of Christ’s kingly eschatological office, which reveals how through the Spirit the kingdom realities that define our future are drawn back to become (in part) characteristics of our present ecclesial existence.
The Role of International Tribunals in the Development of Historical Narratives
Authors: Hirsch Moshe
Published: January 2021

Collective memories are significant for both individuals and societies, as they play an important role in the construction of collective identities. This article focuses on the role of non-criminal international tribunals in the development of collective memories, asking whether it is desirable for such international tribunals to be involved in the construction of historical narratives. International tribunals have not adopted a consistent approach concerning the presentation of a case’s historical background in their judgments. The question of whether it is desirable for non-criminal tribunals to assume an active role in this sphere is analysed using three major sociological perspectives: the structural-functional approach, the symbolic-interactionist perspective, and the social conflict approach. The discussion regarding each theoretical approach is accompanied by illustrative examples from the case law of international tribunals. The conclusions drawn from this analysis integrate certain elements from each theoretical approach; but primarily draw on recommendations associated with the symbolic-interactionist perspective, and to a lesser extent on some recommendations associated with the social-conflict approach.
Refugees and Algorithmic Humanitarianism: Applying Artificial Intelligence to RSD Procedures and Immigration Decisions and Making Global Human Rights Obligations Relevant to AI Governance
Authors: Ahmad Nafees
Published: January 2021

Artificial intelligence (ai) has created algorithmic-driven humanitarianism without ethics, justice, and morality. Current ai dynamics do not protect humanity and mitigate its sufferings in refugee status determination procedures and immigration decisions, raising a host of data privacy and confidentiality issues. Data from refugees, asylum–seekers and migrants and the stateless might be deployed and manipulated for geostrategic, geopolitical, geo-engineering, medico-research, socio-economic, and demographical purposes by international organisations and governments. ai lacks anthropogenic sensitivity, critical thinking, and human traits of subjectivity and objectivity. The author ruminates on these issues by examining the application of ai and assessing its impact on the global human rights norms. The author adopts a human rights-based approach while espousing the reprogramming of algorithmic humanitarianism within new ai technologies for sustainable artificial intelligence.
The Political Economy of Guanxi Networking in Thai-Chinese Enterprises: An Empirical Research
Authors: Tai Wan-Ping
Published: January 2021

The value attached to the concept of guanxi (關係) by Chinese enterprises in Southeast Asia can be observed in their business culture. Previous scholars have attributed the success of Chinese enterprises in Southeast Asia to “guanxi networks.” The author’s observations on Thai enterprises made over a 5-year period are here used to validate their research findings. In conclusion, the author classifies Thailand as a market economy where business activities are conducted based on the value of guanxi and economic strategies.
Trechispora daweishanensis and T. xantha spp. nov. (Hydnodontaceae, Trechisporales) found in Yunnan Province of China

Authors: ZONG TONG-KAI , LIU CHAO-MAO , WU JIAN-RONG , ZHAO CHANG-LIN
Published: January 2021

Two wood-inhabiting fungal species, Trechispora daweishanensis and T. xantha spp. nov. are proposed based on morphological features and molecular evidence. Trechispora daweishanensis is characterized by basidiomata with an annual growth habit, a tuberculate hymenophore, a monomitic hyphal system with clamped generative hyphae and ellipsoid, hyaline, thin-walled, smooth basidiospores measuring 3.8–5 × 2.7–3.5 µm. Trechispora xantha is characterized by resupinate, cracked basidiomata with a buff-coloured hymenial surface, a monomitic hyphal system and ellipsoid, hyaline, thin-walled, smooth basidiospores measuring 4.3–5.7 × 3.2–4 µm. Sequences of ITS and nLSU gene regions of the studied samples were generated. The phylogenetic analysis based on molecular data of ITS+nLSU sequences supported the novelty of these two species. Furthermore, we provide a key to the known species of Trechispora in China.
Structural variation among species of Leeuwenia (Thysanoptera, Phlaeothripinae) with three new species from Australia
Authors: MOUND LAURENCE A. , TREE DESLEY J.
Published: January 2021

The remarkable range of structural variation among the leaf-feeding thrips of the genus Leeuwenia is discussed and contrasted with the lack of intra-generic diversity exhibited by the leaf-feeding species of the related genus Liothrips. An identification key is provided to the eight species of Leeuwenia known from Australia, including three newly described species.
On the Role of the Antarctic Slope Front on the Occurrence of the Weddell Sea Polynya under Climate Change
Authors: Lockwood Joseph W. , Dufour Carolina O. , Griffies Stephen M. , Winton Michael
Published: January 2021

This study investigates the occurrence of the Weddell Sea polynya under an idealized climate change scenario by evaluating simulations from climate models of different ocean resolutions. The GFDL-CM2.6 climate model, with roughly 3.8-km horizontal ocean grid spacing in the high latitudes, forms a Weddell Sea polynya at similar time and duration under idealized climate change forcing as under preindustrial forcing. In contrast, all convective models forming phase 5 of the Coupled Model Intercomparison Project (CMIP5) show either a cessation or a slowdown of Weddell Sea polynya events under climate warming. The representation of the Antarctic Slope Current and related Antarctic Slope Front is found to be key in explaining the differences between the two categories of models, with these features being more realistic in CM2.6 than in CMIP5. In CM2.6, the freshwater input driven by sea ice melt and enhanced runoff found under climate warming largely remains on the shelf region since the slope front restricts the lateral spread of the freshwater. In contrast, for most CMIP5 models, open-ocean stratification is enhanced by freshening since the absence of a slope front allows coastal freshwater anomalies to spread into the open ocean. This enhanced freshening contributes to the slowdown the occurrence of Weddell Sea polynyas. Hence, an improved representation of Weddell Sea shelf processes in current climate models is desirable to increase our ability to predict the fate of the Weddell Sea polynyas under climate change.
Improving Australian Rainfall Prediction Using Sea Surface Salinity
Authors: Rathore Saurabh , Bindoff Nathaniel L. , Ummenhofer Caroline C. , Phillips Helen E. , Feng Ming , Mishra Mayank
Published: January 2021

This study uses sea surface salinity (SSS) as an additional precursor for improving the prediction of summer [December–February (DJF)] rainfall over northeastern Australia. From a singular value decomposition between SSS of prior seasons and DJF rainfall, we note that SSS of the Indo-Pacific warm pool region [SSSP (150°E–165°W and 10°S–10°N) and SSSI (50°–95°E and 10°S–10°N)] covaries with Australian rainfall, particularly in the northeast region. Composite analysis that is based on high or low SSS events in the SSSP and SSSI regions is performed to understand the physical links between the SSS and the atmospheric moisture originating from the regions of anomalously high or low, respectively, SSS and precipitation over Australia. The composites show the signature of co-occurring La Niña and negative Indian Ocean dipole with anomalously wet conditions over Australia and conversely show the signature of co-occurring El Niño and positive Indian Ocean dipole with anomalously dry conditions there. During the high SSS events of the SSSP and SSSI regions, the convergence of incoming moisture flux results in anomalously wet conditions over Australia with a positive soil moisture anomaly. Conversely, during the low SSS events of the SSSP and SSSI regions, the divergence of incoming moisture flux results in anomalously dry conditions over Australia with a negative soil moisture anomaly. We show from the random-forest regression analysis that the local soil moisture, El Niño–Southern Oscillation (ENSO), and SSSP are the most important precursors for the northeast Australian rainfall whereas for the Brisbane region ENSO, SSSP, and the Indian Ocean dipole are the most important. The prediction of Australian rainfall using random-forest regression shows an improvement by including SSS from the prior season. This evidence suggests that sustained observations of SSS can improve the monitoring of the Australian regional hydrological cycle.
Home spirometry in patients with idiopathic pulmonary fibrosis: data from the INMARK trial
Authors: Noth Imre , Cottin Vincent , Chaudhuri Nazia , Corte Tamera J. , Johannson Kerri A. , Wijsenbeek Marlies , Jouneau Stephane , Michael Andreas , Quaresma Manuel , Rohr Klaus B. , Russell Anne-Marie , Stowasser Susanne , Maher Toby M.
Published: January 2021

Background

Data from the INMARK trial were used to investigate the feasibility and validity of home spirometry as a measure of lung function decline in patients with idiopathic pulmonary fibrosis (IPF).

Methods

Subjects with IPF and preserved forced vital capacity (FVC) were randomised to receive nintedanib or placebo for 12 weeks followed by open-label nintedanib for 40 weeks. Clinic spirometry was conducted at baseline and weeks 4, 8, 12, 16, 20, 24, 36 and 52. Subjects were asked to perform home spirometry at least once a week and ideally daily. Correlations between home- and clinic-measured FVC and rates of change in FVC were assessed using Pearson correlation coefficients.

Results

In total, 346 subjects were treated. Mean adherence to weekly home spirometry decreased over time but remained above 75% in every 4-week period. Over 52 weeks, mean adherence was 86%. Variability in change from baseline in FVC was greater when measured by home rather than clinic spirometry. Strong correlations were observed between home- and clinic-measured FVC at all time-points (r=0.72–0.84), but correlations between home- and clinic-measured rates of change in FVC were weak (r=0.26 for rate of decline in FVC over 52 weeks).

Conclusion

Home spirometry was a feasible and valid measure of lung function in patients with IPF and preserved FVC, but estimates of the rate of FVC decline obtained using home spirometry were poorly correlated with those based on clinic spirometry.
A real-life comparative effectiveness study into the addition of antibiotics to the management of asthma exacerbations in primary care
Authors: Murray Clare S. , Lucas Sarah J. , Blakey John , Kaplan Alan , Papi Alberto , Paton James , Phipatanakul Wanda , Price David , Teoh Oon Hoe , Thomas Mike , Turner Steve , Papadopoulos Nikolaos G.
Published: January 2021

Background

Asthma exacerbations are major contributors to asthma morbidity and mortality. They are usually managed with bronchodilators and oral corticosteroids (OCS), but clinical trial evidence suggests that antibiotics could be beneficial. We aimed to assess whether treatment of asthma exacerbations with antibiotics in addition to OCS improved outcomes in larger, more representative routine-care populations.

Method

A retrospective comparative effectiveness study into managing asthma exacerbations with OCS aloneversusOCS plus antibiotics was conducted using the Optimum Patient Care Research Database. The dataset included 28 637 patients; following propensity score matching 20 024 adults and 4184 children were analysed.

Results

Antibiotics in addition to OCS were prescribed for the treatment of asthma exacerbations in 45% of adults and 32% of children. Compared to OCS alone, OCS plus antibiotics was associated with reduced risk of having an asthma/wheeze consultation in the following 2 weeks (children hazard ratio (HR) 0.84 (95% CI 0.73–0.96), p=0.012; adults HR 0.86 (95% CI 0.81–0.91), p<0.001), but an increase in risk of a further OCS prescription for a new/ongoing exacerbation within 6 weeks in adults (HR 1.11 (95% CI 1.01–1.21), p=0.030), but not children. Penicillins, but not macrolides, were associated with a reduction in the odds of a subsequent asthma/wheeze consultation compared to OCS alone, in both adults and children.

Conclusion

Antibiotics were frequently prescribed in relation to asthma exacerbations, contrary to guideline recommendations. Overall, the routine addition of antibiotics to OCS in the management of asthma exacerbations appeared to confer little clinical benefit, especially when considering the risks of antibiotic overuse.
Modeling of vehicle CO2 emissions and signal timing analysis at a signalized intersection considering fuel vehicles and electric vehicles
Authors: Zhao Hong-Xing , He Rui-Chun , Yin Na
Published: January 2021

Background

An intersection is an area with more energy consumption and emissions by motor vehicles, and the energy consumption and emissionsof vehicles at intersections should be reduced in road planning and traffic control to improve the urban traffic environment.

Objectives

In order to analyze the influence of signal timing on CO2 emission of traffic flow under the mixed traffic environment of fuel vehicles and electric vehicles.

Methods

A set of CO2 incremental emission models is established to estimate the CO2 emissions of fuel vehicles and electric vehicles at signalized intersections. Then, a signal timing model with minimum CO2 emissions is established, and the influence of signal timing with minimum CO2 emissions on vehicle control delay and stop rates under different traffic conditions is analyzed.

Conclusions

The case study shows that optimizing of the timing parameters of intersections from the perspective of vehicle CO2 emissions is different from the perspective of control delay or stop rate; the model’s timing optimization will effectively balance the CO2 emissions generated by vehicles during the acceleration, deceleration and idling stages, essentially achieving a comprehensive consideration of vehicle control delay and stop rates. When the road section speed and the mixed proportion of electric vehicles are low, the timing results tend to reduce the vehicle delay at intersections, but when the road section speed and the mixed proportion of electric vehicles are high, the timing results tend to reduce the vehicle stop rate.
Hearing and vision care provided to older people residing in care homes: a cross-sectional survey of care home staff
Authors: Andrusjak Wendy , Barbosa Ana , Mountain Gail
Published: January 2021

Background

Hearing and vision loss in older people has been proven to affect physical and mental health and increase the speed of cognitive decline. Studies have demonstrated that certain practices and improved staff knowledge increase the effective care of residents’ ears and eyes, yet it is not known which practices are being implemented in care homes. This study aimed to identify the gaps in staff knowledge regarding hearing and vision difficulties in older residents, and which practices known to improve ear and eye care in older care home residents are not commonly implemented in care homes in England.

Methods

This study used a cross-sectional survey design. Survey questions were informed by the existing literature and were focused on practices, staff knowledge, and other aspects that have shown to affect residents’ hearing and vision care. A convenience sample of care home staff were recruited from care homes across England between November 2018 and February 2019 via email and in paper format. Descriptive statistics and Chi-Square analysis were applied to identify the factors influencing the care being provided to care home residents.

Results

A total of 400 care home staff responded from 74 care homes. The results revealed that less than half of staff respondents reported to use screening tools to identify hearing (46%) and vision impairments (43.8%); that care homes rarely have access to other assistive devices for hearing (16%) and vision loss (23.8%), and that audiology services do not regularly assess care home residents (46.8%). A majority of staff who responded were not confident in ear and eye care. Responses were found to be influenced by the respondents’ job role, length of time working in care homes and also the care home type. Findings confirmed a lack of standardised practice and the importance of shared communication for promulgation of best practice.

Conclusion

This study has identified that some practices known to facilitate ear and eye care are not commonly applied in a sample of English care homes. It has also shown that care home staff knowledge of ear and eye care is inconsistent. The information derived from this survey can be used to inform guidelines for best practice and inform needs for future research.
Urine albumin dipstick independently predicts cardiovascular and renal outcomes among rural Thai population: a 14-year retrospective cohort study
Authors: Aiumtrakul Noppawit , Phichedwanichskul Kitinan , Saravutthikul Surapong , Ottasat Kamonwan , Visuthitepkul Kesinee , Jaruthiti Thitinat , Jinawong Sarita , Chanthowong Kwanchanok , Pengsritong Varot , Horadee Nattawinee , Jitudomtham Chotip , Pruekprasert Torpathom , Tawatkiratipol Thakorn , Chokjutha Tunjira , Pongpripoom Panuwat , Wiwatwarapon Chirayu , Sriyarun Pirawich , Homrossukhon Natcha , Kittithaworn Annop , Kaewput Wisit , Rangsin Ram , Satirapoj Bancha
Published: January 2021

Background

Albuminuria is an established risk marker for both cardiovascular and renal outcomes. In this study, we expected to use portable and inexpensive test strips to detect urine albumin level for risk stratification in cardiovascular and renal outcomes among rural Thai community.

Objective

To evaluate the relationship between urine albumin dipstick and cardiovascular and renal complications in rural Thai population.

Methods

We conducted a retrospective study in 635 rural Thai adults who tested urine albuminuria by using commercial urine albumin dipstick and the Micral-albumin test II strips at baseline. The subjects were divided into normoalbuminuria (albumin < 20 mg/L), microalbuminuria (albumin 20–200 mg/L), or macroalbuminuria (Urine dipstick at least 1+ or albumin > 200 mg/L). We collected data on the incidences of primary composite outcomes including cardiovascular or renal morbidity and mortality. Incident density and cox regression were analyzed to evaluate the association between albuminuria status and primary composite outcome.

Results

During an average 14-year follow-up, 102 primary composite events occurred including 59 (13.1%), 32 (20.6%) and 11 (39.3%) among 452, 155, and 28 subjects with normoalbuminuria, microalbuminuria, and macroalbuminuria, respectively. Incident densities of primary composite outcome were elevated continually according to the degree of albuminuria (9.36, 17.11 and 38.12 per 1000 person-years). Compared with the subjects without albuminuria, subjects with microalbuminuria and macroalbuminuria at baseline had higher risk for primary composite outcome in univariate model. After multivariate analysis was performed, the effect of macroalbuminuria was only persisted with 3.13-fold risk (adjusted HR 3.13; 95% CI 1.40–6.96, P= 0.005).

Conclusion

Albuminuria from semi-quantitative methods is an important factor predicting cardiovascular and renal risk among subjects in Thai rural population. Our findings support to also incorporating urine albumin dipstick into assessments of cardiovascular risk in the general population.
Validation of the Chinese version of the low physical activity questionnaire (LoPAQ) with ActiGraph accelerometer in hemodialysis patients
Authors: Huang Rui , Zhang Haifen , Yang Yan , Fang Nina , Liu Qian , Ma Jun , Wang Min , Shi Ling , Tao Xingjuan
Published: January 2021

Background

Valid instruments for measuring physical activity at the low end of the physical activity range and producing quantitative results are required among dialysis patients who are extremely inactive. This study aimed to translate and adapt a Chinese version of the low physical activity questionnaire (LoPAQ) and to examine its reliability and validity among hemodialysis patients.

Methods

This was a cross-sectional study. The LoPAQ was translated into Chinese and culturally adapted following the standardized questionnaire adaptation process. Participants wore an ActiGraph for seven consecutive days and were asked to complete the Chinese version of the LoPAQ (C-LoPAQ) following the ActiGraph monitoring period. The criterion validity of the C-LoPAQ was examined with accelerometers using Spearman’s correlation coefficients. Bland-Altman plots were adopted to determine the absolute agreement between methods. The test-retest reliability was analyzed using the intraclass correlation coefficient (ICC).

Results

Eighty-five hemodialysis patients had valid accelerometers and C-LoPAQ data. The total walking time reported on LoPAQ was correlated with step counts by ActiGraph (rho = 0.47, p < 0.01). A moderate correlation was also observed between the C-LoPAQ and the ActiGraph-measured physical activity for total calories (rho = 0.44, p < 0.01). There was a fair correlation between ActiGraph-measured sedentary time and C-LoPAQ-measured inactive time (rho = 0.22, p < 0.05). The test-retest reliability coefficients of C-LoPAQ ranged from 0.30 to 0.66.

Conclusions

The C-LoPAQ demonstrated moderate validity for measuring low levels of physical activity, especially walking, and total kilocalories of physical activity among hemodialysis patients in China.
Bilateral symmetrical deep gray matter involvement and leptomeningeal enhancement in a child with MOG-IgG-associated encephalomyelitis
Authors: Shen Weibing , Zhang Yaner , Zhou Chenguang , Shen Yaoyao
Published: January 2021

Background

Currently, myelin oligodendrocyte glycoprotein (MOG)-IgG-associated encephalomyelitis (MOG-EM) is regarded as an independent inflammatory demyelinating disease. Magnetic resonance imaging (MRI) abnormalities occur in 44.4% of patients with MOG-EM. However, symmetrical deep gray matter involvement with leptomeningeal enhancement is rarely described in the literature.

Case presentation

A 3-year-old boy was admitted to our hospital because of acute onset fever, headache, vomiting and disturbance of consciousness. Neurological examination showed somnolence, neck stiffness and positive Kernig’s sign. Brain MRI demonstrated bilateral symmetrical lesions in the basal ganglia and thalamus as well as diffuse leptomeningeal enhancement along the sulci of bilateral hemisphere. Cerebrospinal fluid analysis demonstrated increased cell count (7 cells/mm3, mononuclear cells dominant) and protein (1.17 g/L) without glucose and chloride abnormality. Work-up for infectious and autoimmune causes, serum MOG IgG was positive by cell based assay. Therefore, a diagnosis of MOG-EM was established according to the international recommendatory criteria in 2018. He was administrated with intravenous methylprednisolone followed by oral corticosteroids and had recovered completely within 1 week.

Conclusions

In the setting of meningoencephalitis-like clinical presentation with bilateral symmetrical deep gray matter involvement, MOG-EM should be distinguished from other infectious and autoimmune disorders, such as Epstein-Barr virus (EBV) encephalitis, Japanese encephalitis and Anti-NMDA receptor (NMDAR) encephalitis. Besides, aseptic meningitis associated with leptomeningeal enhancement may be an atypical phenotype of MOG-EM.
Bibliometric analysis of bacterial central nervous system infection research in Southeast Asia
Authors: Jalipa Francis Gerwin U. , Sy Marie Charmaine C. , Espiritu Adrian I. , Jamora Roland Dominic G.
Published: January 2021

Background

The status of research and scientific outputs with regards to bacterial central nervous system (CNS) infection in southeast Asia (SEA) is unknown. This study aimed to analyze and compare bacterial CNS infection research output of SEA countries in terms of bibliometric indices.

Methods

The major electronic databases (MEDLINE, Scopus, Embase, CENTRAL, Clinicaltrials.gov and WPRIM) were searched for studies on bacterial CNS infection in SEA until August 31, 2020. Frequencies, percentages and Spearman’s rho correlations were used.

Results

There was a total of 648 unique studies on bacterial CNS infection in SEA and it was 657 when double-counted (collaborative studies between SEA countries). Thailand (n=148, 22.5%) and Vietnam (n=142, 21.6%) had the highest number of publications. The most common type of research publication was the case report / case series (n=160, 24.7%). Tuberculous meningitis/tuberculoma (n=176, 26.7%) was the most common topic. This study showed that the %GDP for research and development (R&D) was associated with a higher number of research output. However, the GDP per capita was not associated with any of the bibliometric indices. The total number of neurologists was associated with all of the bibliometric analysis.

Conclusion

Bacterial CNS infection research output in SEA countries was low in terms of quantity. The %GDP for R&D was associated with the number of research publications. The total number of neurologists was associated with all of the bibliometric indices.
Implementation of a fetal ultrasound telemedicine service: women’s views and family costs
Authors: Smith V. J. , Marshall A. , Lie M.L.S , Bidmead E. , Beckwith B. , Van Oudgaarden E. , Robson S. C.
Published: January 2021

Background

The complexity of fetal medicine (FM) referrals that can be managed within obstetric units is dependent on the availability of specialist ultrasound expertise. Telemedicine can effectively transfer real-time ultrasound images via video-conferencing. We report the successful introduction of a fetal ultrasound telemedicine service linking a specialist fetal medicine (FM) centre and a remote obstetric unit.

Methods

Over a four-year period from October 2015, all women referred for FM consultation from the obstetric unit were seen via telemedicine, excluding cases where invasive testing, intrauterine therapy or cardiac anomalies were anticipated. The outcomes measured included the indication for FM referral; scan duration and image and sound quality during the consultation. Women’s perceptions of the telemedicine consultation and estimated costs to attend the FM centre were measured by a structured questionnaire completed following the first telemedicine appointment during the Phase 1 of the project.

Results

Overall, 297 women had a telemedicine consultation during Phase 1 (pilot and evaluation) and Phase 2 (embedding and adoption) of the project, which covered a 4 year period 34 women completed questionnaires during the Phase 1 of the study. Travel to the telemedicine consultation took a median (range) time of 20 min (4150), in comparison to an estimated journey of 230 min (120,450) to the FM centre. On average, women would have spent approximately £28 to travel to the FM centre per visit. The overall costs for the woman and her partner/ friend to attend the FM centre was estimated to be £439.

Women were generally satisfied with the service and valued the opportunity to have a FM consultation locally.

Conclusions

We have demonstrated that a fetal ultrasound telemedicine service can be successfully introduced to provide FM ultrasound of sufficient quality to allow fetal diagnosis and specialist consultation with parents. Furthermore, the service is acceptable to parents, has shown a reduction in family costs and journey times.
Clinical aspects for differential diagnosis of Kawasaki disease shock syndrome: a case control study
Authors: Park Woo Young , Lee Sang Yun , Kim Gi Beom , Song Mi Kyoung , Kwon Hye Won , Bae Eun Jung , Choi Eun hwa , Park June Dong
Published: January 2021

Background

Because of the absence of a specific diagnostic test and pathognomonic clinical features, physicians must rely on the presence of specific clinical criteria and laboratory data that support the diagnosis of KD. To help clinicians distinguish KD, KDSS, septic shock, and TSS earlier, we suggest differential diagnosis and treatment guideline.

Methods

Medical records of immunocompetent patients who were admitted to the pediatric department with a diagnosis of KDSS, septic shock or TSS (SS group) were retrospectively reviewed. In addition, KD patients were selected by seasonal matching to each case of KDSS patient by date of admission (± 2 weeks).

Results

There were 13 patients with KDSS, 35 patients with SS group, and 91 patients with KD. In comparison between KDSS and septic shock group, KDSS group had significantly higher rate of coronary aneurysm incidence, and higher left ventricle dysfunction rate. In comparison between KDSS and TSS, patients with KDSS had a significantly higher erythrocyte sedimentation rate (ESR) and significantly lower creatinine. Receiver operation characteristic curve revealed that the optimal ESR cut off value for determining the KDSS was 56.0 (sensitivity 75.0%, specificity of 100.0%) and the optimal creatinine cut off value for determining the TSS was 0.695 (sensitivity 76.9%, specificity 84.6%).

Conclusions

Clinical symptoms, laboratory finding, echocardiography, and culture studies can be used to differentiate KD, KDSS, septic shock and TSS.
Healthcare access barriers for FARC ex-combatants in Colombia: qualitative perspectives from healthcare providers and FARC health promoters
Authors: Reynolds Christopher W. , Aguiar Leonar G. , Arbelaez Christian , Restrepo Carlos Gómez , Patiño Andres , Carranza Heidy , Pileika Lindsey , Duarte Andrés
Published: January 2021

Background

Following the 2016 Peace Agreement with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate more than 13,000 guerrilla fighters into its healthcare system. Despite a subsidized healthcare insurance program and the establishment of 24 Espacios Territoriales de Capacitación y Reincorporación (ETCRs—Territorial Spaces for Training and Reintegration) to facilitate this transition, data has shown that FARC ex-combatants access care at disproportionately lower rates, and face barriers to healthcare services.

Methods

Semi-structured interviews were conducted with FARC health promoters and healthcare providers working in ETCRs to determine healthcare access barriers for FARC ex-combatants. Analysis was completed with a qualitative team-based coding method and barriers were categorized according to Julio Frenk’s Domains of Healthcare Access framework.

Results

Among 32 participants, 25 were healthcare providers and 7 self-identified as FARC health promoters. The sample was majority female (71.9%) and worked with the FARC for an average of 12 months in hospital, health center, medical brigade, and ETCR settings. Our sample had experiences with FARC across 16 ETCRs in 13 Departments of Colombia. Participants identified a total of 141 healthcare access barriers affecting FARC ex-combatants, which affected healthcare needs, desires, seeking, initiation and continuation. Significant barriers were related to a lack of resources in rural areas, limited knowledge of the Colombian health system, the health insurance program, perceived stigma, and transition process from the FARC health system.

Conclusions

FARC ex-combatants face significant healthcare access barriers, some of which are unique from other low-resource populations in Colombia. Potential solutions to these barriers included health insurance provider partnerships with health centers close to ETCRs, and training and contracting FARC health promoters to be primary healthcare providers in ETCRs. Future studies are needed to quantify the healthcare barriers affecting FARC ex-combatants, in order to implement targeted interventions to improve healthcare access.
Effectiveness of reverse total shoulder arthroplasty for primary and secondary fracture care: mid-term outcomes in a single-centre experience
Authors: Schwarz AM , Hohenberger GM , Sauerschnig M , Niks M , Lipnik G , Mattiassich G , Zacherl M , Seibert FJ , Plecko M
Published: January 2021

Background

The introduction of reverse total shoulder arthroplasty (RSA) as a treatment option in complex proximal humeral fractures, has significantly extended the surgical armamentarium.

The aim of this study was to investigate the mid-term outcome following fracture RSA in acute or sequelae, as well as salvage procedures. It was hypothesized that revision RSA (SRSA) leads to similar mid-term results as primary fracture treatment by RSA (PRSA).

Methods

This retrospective study describes the radiological and clinical mid-term outcomes in a standardized single-centre and Inlay design. Patients who underwent RSA in fracture care between 2008 and 2017 were included (minimum follow-up: 2 years, minimum age: 60 years).

The assessment tools used for functional findings were range of motion (ROM), Visual Analogue Scale, absolute (CS) plus normative Constant Score, QuickDASH, and Subjective Shoulder Value. All adverse events as well as the radiological results and their clinical correlations were statistically analysed (using p < .05and 95% confidence intervals).

Results

Following fracture RSA, 68 patients were included (mean age: 72.5 years, mean follow-up: 46 months). Forty-two underwent primary RSA (PRSA), and 26 underwent revision RSA (SRSA). Adverse advents were observed in 13% (n = 9/68).

No statistically significant results were found for the scores of the PRSA and SRSA groups, while the failed osteosynthesis SRSA subgroup obtained statistically significantly negative values for ROM subzones (flexion: p = .020, abduction: p = .020). Decreased instances of tubercle healing were observed for the in PRSA group relative to the SRSA group (p = .006). The absence of bony healing of the tubercles was related to significant negative clinical and subjective outcomes (all scores: p < .05, external rotation: p= .019). Significant postoperative improvements were evaluated in the SRSA group (CS: 23 to 56 at mean, p = .001), the time from index surgery to operative revision revealed no associations in functional findings.

Conclusions

RSA is an effective option in severe shoulder fracture management with predictable results for salvage as well as first-line treatment. Promising mid-term functional results, reasonable implant survival rates, and high patient satisfaction can be achieved.

Level of evidence

Level III.
Musculoskeletal pathology as an early warning sign of systemic amyloidosis: a systematic review of amyloid deposition and orthopedic surgery
Authors: Wininger Austin E. , Phelps Brian M. , Le Jessica T. , Harris Joshua D. , Trachtenberg Barry H. , Liberman Shari R.
Published: January 2021

Background

Transthyretin and immunoglobulin light-chain amyloidoses cause amyloid deposition throughout various organ systems. Recent evidence suggests that soft tissue amyloid deposits may lead to orthopedic conditions before cardiac manifestations occur. Pharmacologic treatments reduce further amyloid deposits in these patients. Thus, early diagnosis improves long term survival.

Questions/purposes

The primary purpose of this systematic review was to characterize the association between amyloid deposition and musculoskeletal pathology in patients with common orthopedic conditions. A secondary purpose was to determine the relationship between amyloid positive biopsy in musculoskeletal tissue and the eventual diagnosis of systemic amyloidosis.

Methods

We performed a systematic review using PRISMA guidelines. Inclusion criteria were level I-IV evidence articles that analyzed light-chain or transthyretin amyloid deposits in common orthopedic surgeries. Study methodological quality, risk of bias, and recommendation strength were assessed using MINORS, ROBINS-I, and SORT.

Results

This systematic review included 24 studies for final analysis (3606 subjects). Amyloid deposition was reported in five musculoskeletal pathologies, including carpal tunnel syndrome (transverse carpal ligament and flexor tenosynovium), hip and knee osteoarthritis (synovium and articular cartilage), lumbar spinal stenosis (ligamentum flavum), and rotator cuff tears (tendon). A majority of studies reported a mean age greater than 70 for patients with TTR or AL positive amyloid.

Conclusions

This systematic review has shown the presence of amyloid deposition detected at the time of common orthopedic surgeries, especially in patients ≥70 years old. Subtyping of the amyloid has been shown to enable diagnosis of systemic light-chain or transthyretin amyloidosis prior to cardiac manifestations.

Level of evidence

Level IV.
Efficacy of surgical repair for the functional restoration of injured facial nerve
Authors: Li Li , Fan Zhaomin , Wang Haibo , Han Yuechen
Published: January 2021

Background

Early surgical repair to restore nerve integrity has become the most commonly practiced method for managing facial nerve injury. However, the evidence for the efficacy of surgical repair for restoring the function of facial nerves remains deficient. This study evaluated the outcomes of surgical repair for facial nerve lesions.

Methods

This retrospective observational study recruited 28 patients with the diagnosis of facial nerve injury who consecutively underwent surgical repairs from September 2012 to May 2019. All related clinical data were retrospectively analyzed according to age, sex, location of the facial nerve lesion, size of the facial nerve defect, method of repair, facial electromyogram, and blink reflex. Facial function was then stratified with the House-Brackmann grading system pre-operation and 3, 9, 15, and 21 months after surgical repair.

Results

The 28 patients enrolled in this study included 17 male and 11 female patients with an average age of 34.3 ± 17.4 years. Three methods were applied for the repair of an injured facial nerve, including great auricular nerve transplantation in 15 patients, sural nerve grafting in 7 patients, and hypoglossal to facial nerve anastomosis in 6 patients. Facial nerve function was significantly improved at 21 months after surgery compared with pre-operative function (P = 0.008). Following surgical repair, a correlation was found between the amplitude of motor unit potential (MUP) and facial nerve function (r = -6.078, P = 0.02). Moreover, the extent of functional restoration of the facial nerve at 21 months after surgery depended on the location of the facial nerve lesion; lesions at either the horizontal or vertical segment showed significant improvement(P = 0.008 and 0.005), while no functional restoration was found for lesions at the labyrinthine segment (P = 0.26).

Conclusions

For surgical repair of facial nerve lesions, the sural nerve, great auricular nerve, and hypoglossal-facial nerve can be grafted effectively to store the function of a facial nerve, and MUP may provide an effective indicator for monitoring the recovery of the injured nerve.