bluuebunny/crossref_metadata_2025 huggingface dataset:
Green Across the Board: Board Games as Tools for Dialogue and Simplified Environmental Communication
Authors: Fjællingsdal Kristoffer S. , Klöckner Christian A.
Published: June 2020

Background. Board games are a promising, yet rarely used arena for learning about environmental issues. Existing research suggests that they are highly innovative communication tools that make complex sustainability problems more salient and easily understandable. To date, little to no research exists where several environment-themed board games have been compared in a single study.

Method. 17 respondents were invited to board game nights where they were tasked to play an environmental board game of their choosing. The respondents were then invited to participate in subsequent focus group interviews about their gameplay experience and learning outcomes.

Results. 5 focus group interviews were transcribed and subjected to a qualitative thematic analysis, revealing 2 main themes; the first revolving around board games as simplified environmental simulations and the second revolving around the players’ perceptions of their own impact on the game board.

Conclusion. Our results suggest that board games can be highly effective tools in some aspects of environmental communication. Limitations of the study and suggestions for future research are discussed.
Sex Difference on the Importance of Veiling: A Cross-Cultural Investigation
Authors: Pazhoohi Farid , Kingstone Alan
Published: June 2020

Veiling is an ancient cultural practice endorsed by religion, social institutions, and laws. Recently, there have been adaptive arguments to explain its function and existence. Specifically, it is argued that veiling women is a form of male mate guarding strategy, which aims to increase sexual fidelity by decreasing overt displays of his mate’s physical attractiveness, thereby helping to secure his reproductive success. Furthermore, it is suggested that such mate retention strategies (veiling) should be more important when child survival is more precarious, as cues to sexual fidelity support higher paternal investment. Using publicly available data from the PEW Research Center encompassing 26,282 individuals from 25 countries, we tested the hypotheses that men should be more supportive of women’s veiling and this support should be more important in harsher environments, particularly those with poor health and high mortality rates, where paternal care is presumably more important. Our results show that men were more supportive of veiling than women, and this support increased as the environments became harsher. Overall, these findings support the male mate retention argument as well as the idea that the practice of veiling is sensitive to environmental differences.
The Effects of Establishing Intimacy and Consubstantiality on Group Discussions About Climate Change Solutions
Authors: Bloomfield Emma Frances , Van Swol Lyn M. , Chang Chen-Ting , Willes Stephanie , Ahn Paul Hangsan
Published: June 2020

The many obstacles to productive climate change communication necessitate new approaches. Based on science communication strategies that promote engagement rather than knowledge transfer, we assigned participants ( N = 329) to randomized chat groups that discussed similarities between group members (intimacy condition) or information about climate change (information condition). This study combined Linguistic Inquiry and Word Count (LIWC) and rhetorical analysis and found that groups in the intimacy condition were more likely to exhibit commonality than groups in the information condition. This study offers practical strategies for having productive discussions on controversial scientific topics such as climate change.
An Ethico-Onto-Epistemological Approach to Literacy Research
Authors: Song Ah-Young
Published: June 2020

Entanglements among humans, nonhuman objects, and spatial matter in a research site necessitate greater attention to the interwoven and sometimes invisible connections across relational bodies. This piece comments on how reevaluating approaches to participant observations in qualitative research can lead to better understandings of the dynamic interconnectedness among participants, researchers, and observational tools. Drawing from the theory of thinking without method, this research explores the complexity of documentation in an out-of-school literacy setting and argues that ethico-onto-epistemology can highlight intersections between literacy researchers and technological attachments.
An integrated sleep and anxiety intervention for anxious children: A pilot randomized controlled trial
Authors: Clementi Michelle A , Alfano Candice A
Published: June 2020

Sleep-related complaints hold complex reciprocal relationships with anxiety and are a pervasive, distressing feature of childhood generalized anxiety disorders (GAD). Although evidence suggests purely anxiety-focused treatments reduce some sleep problems of anxious children, interventions that directly target both anxiety and sleep might produce superior outcomes in both domains. Targeted Behavioral Therapy (TBT), developed for co-morbid sleep and anxiety problems, demonstrated initial efficacy in a small case series but has not been directly compared to anxiety-focused treatment. The current pilot study used a randomized controlled design to compare TBT to “gold standard” cognitive-behavioral therapy (CBT) for anxiety among n = 20 children (ages 6–12) with primary GAD. Multi-informant measures of anxiety and sleep (including actigraphy) were obtained at baseline, post-treatment, and 6-month follow-up. Results indicated significant improvements (based on moderate to large effect sizes) in anxiety and subjective sleep in both treatment groups at post-treatment. Improvements were maintained at 6-month follow-up. Objective sleep onset latency also decreased marginally for both groups at post-treatment (based on small effect size). Findings provide preliminary support for the feasibility and potential utility of anxiety-focused interventions for improving some sleep-related problems among anxious youth. Future studies including large samples are needed.
Experiences of weight stigma in everyday life: An ecological momentary assessment study
Authors: Potter Lindsey , Meadows Angela , Smyth Joshua
Published: June 2020

Weight stigma and discrimination have been linked to negative health outcomes. Most research on this topic is retrospective, which may not accurately capture day-to-day experiences. The current used ecological momentary assessment to examine weight stigma and discrimination in everyday life. Participants answered ecological momentary assessments about the nature, frequency, and contextual details of weight stigma and discrimination. Over the course of the study, only eight episodes of weight stigma and discrimination were reported. Given that prior ecological momentary assessment studies reported substantially more frequent weight stigma and discrimination, possible explanations for the findings and implications for future research are discussed.
Smartphone interactions and mental well-being in young adults: A longitudinal study based on objective high-resolution smartphone data
Authors: Dissing Agnete Skovlund , Hulvej Rod Naja , Gerds Thomas A. , Lund Rikke
Published: June 2020

Aims: To investigate the effects of objectively measured smartphone interactions on indicators of mental well-being among men and women in a population of young adults. Methods: A total of 816 young adults (mean±SD age 21.6±2.6 years; 77% men) from the Copenhagen Network Study were followed with objective recordings of smartphone interactions from calls, texts and social media. Participants self-reported on loneliness, depressive symptoms and disturbed sleep at baseline and in a four-month (interquartile range 75–163 days) follow-up survey. Multiple linear regression was used to analyse the association between smartphone interactions and mental well-being separately for men and women. Results: A higher number of smartphone interactions was associated with lower levels of loneliness at baseline and the same pattern appeared for depressive symptoms, although this was less pronounced. A high level of smartphone interaction was associated with lower levels of disturbed sleep for men, but not for women. In follow-up analyses, a high versus low level of smartphone interaction was associated with an increase in loneliness and depressive symptoms over time for women, but not for men. Conclusions: Smartphone interactions are related to better mental well-being, which may be attributed to the beneficial effects of an underlying social network. Over time, accommodating a large network via smartphone communication might, however, have negative effects on mental well-being for women.
Emotion Recognition and Perceived Social Support in Young People Who Offend
Authors: Wilcox Maria , Frude Neil , Andrew Liz
Published: June 2020

Young people who offend appear stuck in a cycle of adverse experiences, low levels of social support and emotional skill deficits. Yet these factors have not been extensively researched with young people who offend. The current study aimed to develop the understanding of emotion recognition ability and perceived social support in young people who offend and to explore the relationship between these variables. A total of 50 young people who offend were recruited through three Youth Offending Teams and 50 age, gender, ethnicity, socio-economic status and academically matched young people without a known offending history were recruited from a college and youth service in the same geographical area. All participants completed a demographic questionnaire, the Toronto Alexithymia Scale, a Facial Emotion Recognition Task, a Verbal Emotional Prosody Recognition Task and the Multidimensional Scale of Perceived Social Support. Failing to support the hypotheses, statistical analyses failed to show that, relative to the controls, young people who offend had significantly higher levels of alexithymia, lower levels of perceived social support or lower ability to recognise others’ emotions. However, relative to the controls, young people who offend did show significantly lower ability to recognise fear through verbal prosody. Of particular interest, looked after status, which was more commonly reported among young people who offend (38%) than controls (4%), was the predominant factor associated with all outcome variables. Thus looked after status, rather than offending status in isolation, is more associated with difficulties in identifying and describing feelings, ability to recognise others’ emotions and levels of perceived social support. In addition, significant correlations were found between (1) alexithymia and perceived social support, (2) the ability to recognise others’ emotions and perceived social support and (3) the ability to recognise emotions from facial expressions and verbal prosody. Theoretical and clinical implications of the study findings are discussed and areas for future research are suggested.
Assessing marine operations with a Markov-switching autoregressive metocean model
Authors: Paterson Jack , Thies Philipp R , Sueur Roman , Lonchampt Jérôme , D’Amico Federico
Published: June 2020

This article presents a metocean modelling methodology using a Markov-switching autoregressive model to produce stochastic wind speed and wave height time series, for inclusion in marine risk planning software tools. By generating a large number of stochastic weather series that resemble the variability in key metocean parameters, probabilistic outcomes can be obtained to predict the occurrence of weather windows, delays and subsequent operational durations for specific tasks or offshore construction phases. To cope with the variation in the offshore weather conditions at each project, it is vital that a stochastic weather model is adaptable to seasonal and inter-monthly fluctuations at each site, generating realistic time series to support weather risk assessments. A model selection process is presented for both weather parameters across three locations, and a personnel transfer task is used to contextualise a realistic weather window analysis. Summarising plots demonstrate the validity of the presented methodology and that a small extension improves the adaptability of the approach for sites with strong correlations between wind speed and wave height. It is concluded that the overall methodology can produce suitable wind speed and wave time series for the assessment of marine operations, yet it is recommended that the methodology is applied to other sites and operations, to determine the method’s adaptability to a wide range of offshore locations.
Slipping Off or Turning the Tide? Gender Equality in European Union’s External Relations in Times of Crisis
Authors: Muehlenhoff Hanna L , van der Vleuten Anna , Welfens Natalie
Published: June 2020

The European Union has faced several crises in the past decades, including the economic and financial crisis, Brexit, a migration, climate change and security crisis, and the latest COVID-19 crisis. In this context, feminist scholars have shown how the causes and effects of the economic and financial crisis are strongly gendered. Generally, this literature suggests that crises can open a window of opportunity for gender considerations but may also promote policies which exacerbate gendered inequalities. Yet, the impact of crises on the attention to gender equality in European Union’s external relations is still unknown. This is surprising, as the European Union has promised to mainstream gender in all external policies, and understands itself to be a normative power and gender actor in world politics. This Special Issue analyses how the European Union’s identification of crisis and its policy responses to crisis in different external policy fields are gendered. The introduction situates the Special Issue within existing scholarship, theorises the central concepts of this Special Issue – crisis, gender (equality) and the European Union identities – and highlights how the different contributions advance our understanding of how gender figures in European Union’s external relations in past, current and future times of crisis.
Current methods, outcomes and challenges for the treatment of hand fractures
Authors: Boeckstyns Michel E. H.
Published: June 2020

In treating hand fractures, we have to make a proper decision about conservative treatment versus surgical intervention and decide on individual surgical methods. This article reviews recent publications, technical advances, and outcome measures in treating metacarpal fractures, phalangeal fractures, complex fractures of the proximal interphalangeal joints, bony mallet fingers, and fractures of the thumb. My personal preferences and considerations are presented. At the end, the current challenges that hand surgeons are facing in treating frequent phalangeal and metacarpal fractures are discussed.
Low-Frequency Vibration Promotes Tumor Necrosis Factor-α Production to Increase Cartilage Degeneration in Knee Osteoarthritis
Authors: Yu Peng-Ming , Lin Yang , Zhang Chi , Wang Hai-Ming , Wei Quan , Zhu Si-Yi , Wei Qing-Chuan , Wang Zhi-Gang , Pan Hong-Xia , Huang Ri-Dong , He Cheng-Qi
Published: June 2020

Objective

Low-frequency vibration accelerates cartilage degeneration in knee osteoarthritis (KOA) rat model. In this article, we investigated whether whole-body vibration (WBV) increases cartilage degeneration by regulating tumor necrosis factor-α (TNF-α) in KOA.

Design

Proteomics analysis was used to filter candidate protein from synovial fluid (SF) in KOA people after WBV. Enzyme-linked immunosorbent assay (ELISA) was used to estimate changes in TNF-α levels in SF. The C57 mice and TNF-α knock-out mice were sacrificed for the KOA model and WBV intervention. The cartilage was tested by ELISA, histology, terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL), immunohistochemistry, and reverse transcriptase polymerase chain reaction. Luciferase activity test in vitro study was conducted to confirm the relationship between TNF-α and the candidate protein.

Results

Differentially expressed proteins were enriched in the glycolytic process, glucose catabolic, and regulation of interleukin-8 (IL-8) secretion processes. Phosphoglycerate kinase, triosephosphate isomerase 1, T cell immunoglobulin- and mucin-domain-containing molecules 2, fumarylacetoacetate hydrolase (FAH), and TNF were the hub node. TNF-α expression increased in SF after WBV ( P < 0.05). The cartilage was more degenerated in the TNF-α−/− mice group compared to controls. A significant change was observed in collagen II and FAH ( P < 0.05). TNF-α expression improved in C57 mice ( P < 0.05). Apoptosis of chondrocytes was inhibited in TNF-α−/− mice by the TUNEL test. Luciferase activity significantly increased in TNF-α + FAH-Luc cells ( P < 0.05).

Conclusion

A novel mechanism underlying WBV-triggered cartilage degeneration was found in KOA that demonstrated the critical regulatory function of TNF-α and FAH during WBV.
Dickkopf-3 (DKK3) Signaling in IL-1α-Challenged Chondrocytes: Involvement of the NF-κB Pathway
Authors: Conde Javier , Ruiz-Fernandez Clara , Francisco Vera , Scotece Morena , Gómez Rodolfo , Lago Francisca , Gonzalez-Gay Miguel Angel , Pino Jesús , Mobasheri Ali , Gualillo Oreste
Published: June 2020

Objective

Osteoarthritis (OA) is an age-related biomechanical and low-grade inflammometabolic disease of the joints and one of the costliest and disabling forms of arthritis. Studies on matrix-degrading enzymes such as metalloproteases, which are implicated in the increased catabolism of extracellular matrix, are of paramount relevance. DKK3 is a member of DKK family and is best known for its role in cancer. Although there is some information about the participation of DKK3 in cartilage pathophysiology and on metalloproteases regulation, in particular, little is known about DKK3 signaling mechanisms. Thus, the aim of this study is to explore how DKK3 regulates matrix metalloproteinase-13 (MMP-13) expression.

Design

Gene, protein expression and protein phosphorylation in primary human chondrocytes and ATDC5 mouse cells were assessed by RT-qPCR and Western blot analysis. Further studies on DKK3 activity were performed by targeting DKK3 gene with a specific siRNA.

Results

DKK3 expression was found to be higher in OA human chondrocytes than healthy cells, being its expression decreased in interleukin-1α (IL-1α)-stimulated cells. DKK3 knockdown increased the induction of MMP-13 elicited by IL-1α in human and mouse chondrocytes and after the analysis of different signalling pathways, we observed that NF-κB pathway was involved in the regulation of MMP-13 expression by DKK3.

Conclusions

Herein we have demonstrated, for the first time, that DKK3 gene silencing exacerbated NF-κB activation, resulting in an increased IL-1α-driven induction of MMP-13. Our results further confirm that DKK3 may play a protective role in OA by attenuating NF-κB activation and the subsequent production of metalloproteases.
Ephemerality as Data Prevention: Values for an Ethics of Ephemeral Mobile Media
Authors: Welsh Sarah
Published: June 2020

Mobile media is a chief driver of digitizing locational information, geotags, and photos that are produced and collected as we communicate with and exist within our networks. But when these data are stored and recorded—in quantities that far exceed any of our abilities to manage—mobile technology denies our ability to actively forget. This article argues that digital ephemerality via mobile applications (i.e. Snapchat, Signal, Confide, and Facebook Messenger Secret) has emerged because of the granular possibilities for data retention enabled by mobile devices. Together these applications move towards a practice of preventing data from being stored and shared. In response, “data prevention” is proposed as an ethical framework for ephemeral mobile media, and is theorized with an eye toward the distributed agency inherent to networks. This ethics is positioned within a framework of distributed agency across stakeholders that draws most directly from actor–network theory, and three commonly articulated values—trust, transparency, and privacy—are proposed. These values help to define a system of networked practices within ephemeral mobile media that requires consideration of both human and non-human actors. Building sustainable ephemeral technologies necessitates aligning shared values amongst divergent stakeholders. The article concludes by motioning to LIMITS research, where data prevention might be included, linking and further intensifying shared values across technical and social concerns.
Emergence of undifferentiated urothelial carcinoma after pembrolizumab treatment for patient with invasive urothelial bladder cancer: A case report
Authors: Hasegawa Moto , Hasegawa Go , Ikeda Yohei , Hara Noboru , Nishiyama Tsutomu
Published: June 2020

An 83-year-old man received pembrolizumab treatment after anticancer chemotherapy with gemcitabine and cisplatin for advanced bladder cancer. Pathological findings revealed invasive urothelial carcinoma with squamous differentiation before treatment. After seven courses of pembrolizumab treatment, the tumor disappeared. After 15 courses of the treatment, the tumor regrew. Pathological findings revealed invasive undifferentiated urothelial carcinoma consisting of relatively small tumor cells of the same size as lymphocytes, negative for neuroendocrine markers. Programmed death-ligand 1 expressions in tumor tissue changed from positive before treatment to negative after pembrolizumab treatment.
How China’s image affects Chinese products in a partisan-motivated US market
Authors: Yang Chen
Published: June 2020

By proposing a dual-perspective model of attitude formation related to Chinese products, the survey of 592 adults investigated how Americans’ evaluation and purchase intention of Chinese products can be influenced by China’s image driven by a synergy of US politics and mass media. Younger people and minorities had better evaluation of and more intention to purchase Chinese products. A better country image of China contributed to more positive products beliefs and stronger purchase intention. Republicans engaged in partisan-motivated reasoning in their purchase intention, while Democrats converged with nonpartisan audiences. More social media use resulted in stronger purchase intention, while partisan media failed to make an impact on product beliefs and purchase intention. The findings suggested that although Americans’ judgment and purchase intention of Chinese products is affected by individual’s preexisting perception of China, only Republicans are prone to partisan-motivated reasoning of Chinese products. Social media use could lead to more acceptance of Chinese products, but conservative and liberal media seem to make little impact on this matter.
Fragmented industrial structure and fragmented resistance in Korea’s digital game industry
Authors: Kim Changwook , Lee Sangkyu
Published: June 2020

This article is part of the special issue Creative Labor in East Asia. By exploring specific politico-economic and institutional, conditions promoting actually existing precarity in Korean digital game labor, this study aims to examine how the industrial and institutional conditions of precarity affect digital game workers’ subjectivity. Under this theoretical and empirical consideration, the study first delineates how the rapid industrial transition to the mobile game market happens in relation to the Korean government’s deregulation policy on that particular market. It then scrutinizes the ways in which this industrial shift deepens labor precarity, promotes degradation of skills, and ultimately fragments workers in the digital game industry. Based on this structural analysis, it argues that the fragmented industrial structure of the digital game industry in Korea not only actually fosters contrasting labor subjectivities but also promotes fragmented resistances among Korean digital game workers. By critically evaluating both possibilities and limitations of the recent firm-centered union movements created by digital game workers, the study ultimately concludes that finding a way to connect organized unions to unorganized freelance workers is absolutely necessary to actually transform “precarity” into “solidarity.”
Examination of the Quality of Interactions as Observed in Childcare Centers and Reported by Early Childhood Educators
Authors: Duval Stéphanie , Bouchard Caroline , Lemay Lise , Cantin Gilles
Published: June 2020

This study aimed to describe the quality of interactions between early childhood educators (ECEs) and children, as observed in childcare centers and as reported by early childhood educators ( N = 15) working with 5 year-old children. To assess ECEs’ practices related to the quality of these interactions as observed in childcare centers (theories-in-use), the Classroom Assessment Scoring System (CLASS) was used. This tool is structured around three domains: emotional support, group organization, and instructional support. Semi-structured interviews were conducted with ECEs to collect data on their reported practices related to the quality of these interactions (espoused theories). The observational data showed that the quality of emotional support and group organization was average-to-high, and these domains were also most often referred to in the participants’ comments. On the contrary, the quality of instructional support was rated average-to-low. Correspondingly, this domain was not often referred to in the participants’ comments. These results are discussed in light of the tensions and gaps brought out between the ECEs’ theories-in-use and espoused theories and lead to recommendations for professional development aimed at improving the quality of ECE–child interactions in childcare centers and, in particular, the instructional support provided therein.
Effects of Perceived Risk and Patient Anxiety on Intention to Use Community Healthcare Services in a Big Modern City
Authors: Sang Hui , Cheng Jiuqing
Published: June 2020

In Shanghai, one of the biggest modern cities in the world, community-based health care providers are largely underutilized. As a result, valuable medical resources are wasted. The present study examined the relationship between the variables of perceived risk and patient anxiety on intentions to use community health clinics, because these two variables are closely related to decision making. A survey measuring these variables was distributed near community health clinics in Shanghai ( n = 869), and structural equation models were constructed to analyze the data. Results show that patient anxiety was associated with contracting diseases and positively related to the intention to seek services from community-based providers, whereas their perceived risk of these providers had a negative relationship with such an intention. Moreover, the knowledge that some community clinics were not as good as large hospitals was positively related to perceived risk. Policy implications are discussed based on the findings.
Experiential Learning in the Classroom: The Impact of Entrepreneurial Pitches for Global Health Pedagogy
Authors: Ezezika Obidimma , Gong Jenny
Published: June 2020

Traditional experiential learning techniques have been incorporated into public health curricula in the past; however, research has demonstrated the need for more applied and innovative approaches to experiential learning. We introduced an entrepreneurial pitch project where students had the opportunity to design and present technological and social innovations to an external panel of judges. We then evaluated the impact of such pitches on experiential learning by conducting semistructured, face-to-face interviews with student participants. The interview transcripts were analyzed in light of Kolb’s experiential learning theoretical framework. The results of the study indicated that the process of preparing and delivering entrepreneurial pitches was rewarding for students and enhanced their learning experience. The process provided students with concrete experiences and demonstrated elements of abstract conceptualization and active experimentation. However, the results also illustrated that the entrepreneurial pitch process could be strengthened by the addition of critical self-reflection activities. Through the results of this study, we have created a narrative on how entrepreneurial pitches might foster experiential learning in global health pedagogy and provided recommendations for course designers and instructors to consider in maximizing experiential learning for students.
Developing and Validating Metamodels of a Microsimulation Model of Infant HIV Testing and Screening Strategies Used in a Decision Support Tool for Health Policy Makers
Authors: Soeteman Djøra I. , Resch Stephen C. , Jalal Hawre , Dugdale Caitlin M. , Penazzato Martina , Weinstein Milton C. , Phillips Andrew , Hou Taige , Abrams Elaine J. , Dunning Lorna , Newell Marie-Louise , Pei Pamela P. , Freedberg Kenneth A. , Walensky Rochelle P. , Ciaranello Andrea L.
Published: June 2020

Background. Metamodels can simplify complex health policy models and yield instantaneous results to inform policy decisions. We investigated the predictive validity of linear regression metamodels used to support a real-time decision-making tool that compares infant HIV testing/screening strategies. Methods. We developed linear regression metamodels of the Cost-Effectiveness of Preventing AIDS Complications Pediatric (CEPAC-P) microsimulation model used to predict life expectancy and lifetime HIV-related costs/person of two infant HIV testing/screening programs in South Africa. Metamodel performance was assessed with cross-validation and Bland-Altman plots, showing between-method differences in predicted outcomes against their means. Predictive validity was determined by the percentage of simulations in which the metamodels accurately predicted the strategy with the greatest net health benefit (NHB) as projected by the CEPAC-P model. We introduced a zone of indifference and investigated the width needed to produce between-method agreement in 95% of the simulations. We also calculated NHB losses from “wrong” decisions by the metamodel. Results. In cross-validation, linear regression metamodels accurately approximated CEPAC-P-projected outcomes. For life expectancy, Bland-Altman plots showed good agreement between CEPAC-P and the metamodel (within 1.1 life-months difference). For costs, 95% of between-method differences were within $65/person. The metamodels predicted the same optimal strategy as the CEPAC-P model in 87.7% of simulations, increasing to 95% with a zone of indifference of 0.24 life-months ( ∼ 7 days). The losses in health benefits due to “wrong” choices by the metamodel were modest (range: 0.0002–1.1 life-months). Conclusions. For this policy question, linear regression metamodels offered sufficient predictive validity for the optimal testing strategy as compared with the CEPAC-P model. Metamodels can simulate different scenarios in real time, based on sets of input parameters that can be depicted in a widely accessible decision-support tool.
Effect of continuous intraoperative infusion of methoxamine on renal function in elderly patients undergoing gastrointestinal tumor surgery: a randomized controlled trial
Authors: Guo Xiaowei , Hu Jie , Xiao Hanbing , Liu Tianyu , Niu Zheng , Wang Min , Qi Dunyi
Published: June 2020

Background

Acute renal injury (AKI) caused by hypotension often occurs in elderly patients after gastrointestinal tumor surgery. Although vasoactive drugs can increase effective filtration pressure, they may increase renal vascular resistance and reduce renal blood flow. The effect of methoxamine on renal function is not clear.

Methods

After obtaining written informed consent, 180 elderly patients undergoing elective gastrointestinal tumor surgery were randomly allocated into two groups: M group (continuous infusion of methoxamine at 2 μg/kg/min) and N group (continuous infusion of normal saline). The patients’ mean arterial pressure was maintained within 20% of baseline by a continuous infusion of methoxamine or normal saline. Maintenance fluid was kept at 5 mL/kg/h. According to Kidney disease improve global outcome (KDIGO) guidelines, creatinine was measured at 1, 2 and 7 days after operation, and urine volume at 6, 12 and 24 h after operation was measured to evaluate the occurrence of AKI. 162 patients were included in the final data analysis.

Results

Significant differences in the incidence of postoperative Acute kidney injury (M group: 7.5%; N group: 18.3%;P < 0.05), the frequency of hypotension (M group: 1 [1–3]; N group: 3 [1–5];P < 0.05), and the duration of intraoperative hypotension (M group: 2[0–10]; N group: 10 [5–16];P < 0.05) were identified between the groups. Multivariate logistic regression analyses demonstrated that preoperative creatinine and the frequency of intraoperative hypotension were the common factors leading to the occurrence of postoperative AKI. The results of Cox multivariate analysis showed that age and AKI were independent risk factors for 30-day death.

Conclusion

Compared with the intraoperative continuous infusion of placebo and methoxamine, continuous infusion of 2 μg/kg/min methoxamine reduced the incidence of postoperative AKI and other clinical complications in elderly patients undergoing gastrointestinal surgery by raising blood pressure and improved the prognosis of patients.

Trial registration

Trial registration: Chinese Clinical Trial Registry,ChiCTR1900020536, registered 7 January, 2019,
Subacute transverse myelitis with optic symptoms in neuroborreliosis: a case report
Authors: Opielka Mikolaj , Opielka Witold , Sobocki Bartosz Kamil , Starzynska Anna
Published: June 2020

Background

Subacute transverse myelitis is one of the late manifestations of neuroborreliosis with only a few cases described to the present day.

Case presentation

We present magnetic resonance imaging, cerebrospinal fluid, and electroneurography findings of a young female patient suffering from neuroborreliosis-associated transverse myelitis with a wide constellation of symptoms including papilloedema. Magnetic resonance imaging of the cervical spine has shown an enlargement of the spinal cord in the mid-cervical region. Cerebrospinal fluid findings included lymphocytic pleocytosis, increased levels of anti - Borrelia antibodies, and increased intrathecal anti -Borrelia antibody index. Following the 28-day course of intravenous ceftriaxone, the patient attained complete recovery.

Conclusions

Subacute transverse myelitis in the course of neuroborreliosis should be considered in the differential diagnosis of patients with abnormal magnetic resonance scans of the spinal cord, lymphocytic pleocytosis, and intrathecal antibody production, especially in the tick-endemic areas, even if the tick bite was not reported. Infrequent accompanying symptoms such as papilloedema are diagnostically challenging and cannot be treated as clinching evidence.
How does the EQ-5D-5L perform in asthma patients compared with an asthma-specific quality of life questionnaire?
Authors: Szentes Boglárka L. , Schultz Konrad , Nowak Dennis , Schuler Michael , Schwarzkopf Larissa
Published: June 2020

Background

Asthma patients experience impairments in health-related quality of life (HRQL). Interventions are available to improve HRQL. EQ-5D-5L is a common generic tool used to evaluate health interventions. However, there is debate over whether the use of this measure is adequate in asthma patients.

Methods

We used data from 371 asthma patients participating in a pulmonary rehabilitation (PR) program from the EPRA randomized controlled trial. We used four time points: T0 randomization, T1 start PR, T2 end PR, T3 3 months follow-up. We calculated floor and ceiling effects, intra-class correlation (ICC), Cohen’s d, and regression analysis to measure the sensitivity to changes of EQ-5D-5 L (EQ-5D index and Visual Analog Scale (VAS)) and the disease-specific Asthma Quality of Life Questionnaire (AQLQ). Furthermore, we estimated the minimally important difference (MID). Based on the Asthma Control Test (ACT) scores, we defined three groups: 1. ACT-A (ACT> 19) controlled asthma, 2. ACT-B (14 < ACT≤19) not well-controlled asthma, and 3. ACT-C (ACT≤14) very poorly controlled asthma.

Results

Only the EQ-5D index showed ceiling effects at T2 and T3 (32%). ICC (between T0 and T1) was moderate or good for all measures. Cohen’s d at T2 and T3 was better at differentiating between ACT-A and ACT-B than between ACT-B and ACT-C. The EQ-5D index showed moderate effect sizes (0.63–0.75), while AQLQ showed large effect sizes (0.74–1,48). VAS was responsive to pronounced positive and negative ACT changes in every period, and AQLQ mostly to the positive changes, whereas the EQ-5D index was less responsive. We estimated a MID of 0.08 for the EQ-5D index, 12.3 for VAS, and 0.65 for AQLQ.

Conclusion

All presented HRQL tools had good discriminatory power and good reliability. However, EQ-5D-5 L did not react very sensitively to small changes in asthma control. Therefore, we would suggest using supplementary measures in addition to EQ-5D-5 L to evaluate asthma-specific interventions more comprehensively.

Trial registration

German Clinical Trial Register, DRKS00007740 (date of registration: 05/15/2015), https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00007740. The registration took place prospectively.
Bilateral synovial chondromatosis of the elbow in an adolescent: a case report and literature review
Authors: Mo Jianming , Pan Jie , Liu Yun , Feng Wenyu , Li Boxiang , Luo Kai , Mo Weijia , Lin Huahao , Liao Shijie
Published: June 2020

Background

Primary synovial chondromatosis is a rare benign disease that occurs in the joint mucosa.

Case presentation

In this case report, a 14-year-old gymnast sustained pain in both elbows for 2 months with limited elbow joint activity. The initial diagnosis of bilateral elbow synovial chondromatosis was performed by physical examination and imaging report. Later, the patient was treated with open surgery on both sides of the elbow, including all loose bodies were removed out and the proliferative synovia were cut off. Histopathology reports confirmed synovial chondromatosis.

Conclusions

The report introduced a case about synovial chondromatosis in bilateral elbow found in a 14-year-old girl, which is rarely involved in bilateral elbow and rarely found in adolescents. This case report aims to provide a treatment option for surgeons in similar situations.
High self-efficacy – a predictor of reduced pain and higher levels of physical activity among patients with osteoarthritis: an observational study
Authors: Degerstedt Åsa , Alinaghizadeh Hassan , Thorstensson Carina A. , Olsson Christina B.
Published: June 2020

Background

Self-efficacy is considered a core component in self-management. However, there is a lack of knowledge about the association between self-efficacy and health-related outcomes in osteoarthritis. The aim of this study was to investigate whether self-efficacy at baseline was associated with change over time in pain and physical activity after a supported osteoarthritis self-management programme.

Methods

A total of 3266 patients with hip or knee osteoarthritis attended this observational, register-based study. Self-efficacy was assessed using the Arthritis Self-Efficacy Scale. Pain was estimated on a visual analogue scale and physical activity by self-reporting number of days per week the patients were physically active ≥30 min. Data were self-reported at baseline and at follow-ups after 3 and 12 months. Analyses were performed using a mixed linear model analysis and are presented with an unadjusted and an adjusted model.

Results

High vs low self-efficacy for pain management at baseline resulted in reduced pain and increased physical activity at the follow-ups; least squares means and standard error were 37.43 ± 0.40 vs 44.26 ± 0.40, for pain, and 5.05 ± 0.07 vs 4.90 ± 0.08 for physical activity. High self-efficacy for management of other symptoms resulted in lower pain and higher physical activity at follow-up: 35.78 ± 0.71 vs 41.76 ± 0.71 for pain, and 5.08 ± 0.05 vs 4.72 ± 0.05 for physical activity. Patients with obesity reported lower activity levels at the follow-ups.

Conclusion

Self-efficacy at baseline was associated with change over time in pain and physical activity at 3 and 12 months after the supported osteoarthritis self-management programme. High self-efficacy had a positive effect on pain and physical activity, indicating the need for exploring and strengthening patients’ self-efficacy. Patients with obesity may need further interventions and support during a self-management programme to achieve an increase in physical activity.
Efficacy of throwing exercise with TheraBand in male volleyball players with shoulder internal rotation deficit: a randomized controlled trial
Authors: Moradi Mohsen , Hadadnezhad Malihe , Letafatkar Amir , Khosrokiani Zohre , Baker Julien S.
Published: June 2020

Background

The Glenohumeral internal-rotation deficit (GIRD) is related to the altered eccentric external-rotator (ER), the concentric internal-rotator (IR), muscle strength, and the ER: IR ratio. GIRD has been documented as a risk factor for shoulder injuries. However, few studies have investigated the effect of an exercise training on these parameters in athletes with GIRD. Therefore, the purpose of this study was to evaluate the effects of an 8-week throwing exercise with a TheraBand for retraining the rotator cuff on Electromyography (EMG) activity of selected muscles, rotator cuff muscle strength, the glenohumeral (GH) joint IR range of motion (ROM) and GH joint position sense in asymptomatic male volleyball players with GIRD.

Methods

Sixty male volleyball players with GIRD were randomized into either a training group or a control group. The experimental group underwent an 8-week throwing exercise with a TheraBand including 5 sessions of stretching and 3 sessions of strengthening exercises per week. The control group received an active self-exercise program. EMG (onset time and muscle activation), shoulder range of motion (ROMs), strength and GH joint position sense were all assessed pre and post trainings.

Results

There were statistically significant within-group differences in the EMG activity of the anterior deltoid (p = 0.005), middle deltoid (p = 0.007), posterior deltoid (p = 0.004), infraspinatus (p = 0.001) and supraspinatus (p = 0.001) muscles, IR ROM (p = 0.001), rotator cuff muscle strength ratio (p = 0.001), and GH joint position sense (p = 0.033) in the experimental group. A 2 × 2 analysis of variance with a mixed model design and independent and paired t-tests were used for statistical analysis.

Conclusions

Throwing exercise with a TheraBand improved shoulder muscle activation, IR ROM, rotator cuff muscle strength ratio and GH joint position sense in participants with GIRD. These findings may improve the treatment of GIRD in a clinical setting. Although the results are significant, further studies should follow up the long-term effects of the Throwing exercise with a TheraBand on GIRD.

Trial registration

Current Controlled Trials using the UMIN-RCT website with ID number of, UMIN000038416 “Retrospectively registered” at 2019/10/29.
Cardiovascular morbidity, diabetes and cancer risk among children and adolescents with severe obesity
Authors: Bendor Cole D. , Bardugo Aya , Pinhas-Hamiel Orit , Afek Arnon , Twig Gilad
Published: June 2020

Severe obesity among children and adolescents is a significant global public health concern. The prevalence has markedly increased over the last decades, becoming common in many countries. Overwhelming rates of obesity among youth have prompted efforts to identify an evidence-based immediate- and long-term cardiometabolic risk factor profile in childhood-onset severe obesity, and to highlight gaps that require further investigation. The PubMed database was systematically searched in accordance with PRISMA guidelines. The search yielded 831 results, of which 60 fulfilled stringent criteria and were summarized in this review. The definition of severe obesity was variable, with only one half the publications using the definition BMI > 120% of the 95th percentile. Point estimates of the prevalence of at least one cardiometabolic risk factor in children with severe obesity reportedly range from 67 to 86%. Cross-sectional studies indicate that children and adolescents with severe obesity are at greater risk than those with mild obesity for type 2 diabetes, hypertension, fatty liver disease and dyslipidemia, already at childhood and adolescence. Robust epidemiological data on the long-term risk and actual point estimates in adulthood are lacking for these diseases as well as for other diseases (coronary heart disease, stroke, chronic kidney disease and cancer). Recent longitudinal studies indicate an increased risk for cardiomyopathy, heart failure, cardiovascular mortality and all-cause mortality in adulthood for adolescents with severe obesity compared to those with mild obesity. Given the alarming increase in the prevalence of severe obesity, the persistence of adiposity from childhood to adulthood and the precarious course of young adults with chronic comorbidities, the economic and clinical services burden on the healthcare system is expected to rise.
Comparative cardiovascular safety of GLP-1 receptor agonists versus other glucose-lowering agents in real-world patients with type 2 diabetes: a nationwide population-based cohort study
Authors: Yang Chun-Ting , Yang Chen-Yi , Ou Huang-Tz , Kuo Shihchen
Published: June 2020

Background

Current evidence about the cardiovascular safety of glucagon-like peptide-1 receptor agonist (GLP-1ra) possesses limited generalizability to real-world patients with type 2 diabetes (T2D) in usual practice. This study aimed to investigate the comparative cardiovascular safety of GLP-1ra in comparisons with dipeptidyl peptidase-4 inhibitor (DPP-4i), sulfonylurea (SU), and insulin in a real-world population with T2D.

Methods

Adults with newly-diagnosed T2D were identified from Taiwan’s National Health Insurance Research Database in 2003–2014. A prevalent new-user cohort design was adopted to include a broad representation of real-world T2D patients being treated with GLP-1ra. The between-group comparability of baseline patient characteristics was achieved by matching on (1) initiation time of study drugs, (2) prior exposure to glucose-lowering agents, and (3) diabetes severity and complications, comorbidities, and concomitant cardiovascular medications using propensity scores. The primary outcome was a composite of cardiovascular disease (CVD) events and assessed up to the end of 2015. Cox modeling was employed to assess the association between study drugs and outcomes.

Results

A total of 3195 GLP-1ra stable users was identified in 2011-2014. 1893, 1829, and 1367 GLP-1ra stable users were 1:1 matched to DPP-4i, SU and insulin users, respectively. Compared to DPP-4i, SU and insulin, the use of GLP-1ra was associated with a lower risk of composite CVD events [hazard ratio (95% confidence interval) 0.73 (0.57–0.96), 0.76 (0.57–1.00), and 0.81 (0.62–1.07), respectively]. Subgroup analyses revealed that GLP-1ra versus DPP-4i yielded a greater cardiovascular benefit in those without established CVD versus those with established CVD.

Conclusions

This comparison study extends the supporting evidence for the cardiovascular safety of GLP-1ra to a broad spectrum of real-world T2D patients using GLP-1ra.