bluuebunny/crossref_metadata_2025 huggingface dataset:
CD4+CD28null T cells are expanded in moderately active systemic lupus erythematosus and secrete pro-inflammatory interferon gamma, depending on the Disease Activity Index
Authors: Kosmaczewska Agata , Ciszak Lidia , Stosio Malgorzata , Szteblich Aleksandra , Madej Marta , Frydecka Irena , Wiland Piotr , Szmyrka Magdalena
Published: April 2020

Background

Pathogenic CD4+CD28null cells are characterized by inflammatory cytokine synthesis and tropism to the inflamed tissues. Recent studies showed the involvement of CD28null T cells in a severe clinical outcome of lupus. However, their role in moderately active disease is still unresolved.

Methods

We examined the levels of circulating CD4+CD28null cells and CD8+CD28null suppressor T cells. We also compared the CD4+CD28null and CD4+CD28+ T-cell functional properties, including the expression of interferon gamma (IFN-γ) and Ki67 among systemic lupus erythematosus (SLE) patients ( n = 20) and healthy controls ( n = 20). All the patients were under immunosuppressive treatment and exhibited moderate SLE activity (median SLE Disease Activity Index (SLEDAI) = 6).

Results

In patients, we found elevated CD4+CD28null and unchanged levels of suppressor CD8+CD28null T cells. There was no difference between patients and controls in IFN-γ and Ki67-expressing CD4+, CD4+CD28+, and CD4+CD28null T cells, except for higher IFN-γ levels in CD4+CD28+ T cells in SLE. In each studied group, we observed a higher preponderance of IFN-γ- and Ki67-expressing cells among CD4+CD28null T cells and lower levels of IFN-γ in CD4+CD28null T cells compared to the CD28+ subset. Similarly, Ki67 intensity was decreased in healthy CD4+CD28null cells, whereas in patients, comparably high expression was observed in both subsets. IFN-γ intensity in CD4+CD28null T cells correlated with SLEDAI.

Conclusion

SLE with a moderately active clinical course is characterized by peripheral blood expansion of CD4+CD28null T cells and a normal abundance of suppressor CD8+CD28null T cells. The demonstration that these pathogenic CD4+ T cells, despite the lack of CD28, maintain the ability to produce pro-inflammatory IFN-γ positively correlated with disease activity as well as relatively high proliferative capacity may suggest their potentially predictive role in SLE flares.
Time as a source of struggle and resilience in homeless families
Authors: Fraenkel Peter
Published: April 2020

A common myth about families living in homeless shelters is that they are laconically and contentedly waiting around for housing, financial support through welfare or jobs, and other resources and services. Nothing could be further from the truth. Single parents in shelters dealing with inequities incurred by poverty are busy trying to procure housing, jobs, and other resources while managing children’s behavior and homework, and while attempting to maintain the family’s sense of relational and emotional integrity. Thirty-six African American, Afro-Caribbean, and Latinx families living in a New York City shelter were interviewed about the time challenges they face and their means of coping with those challenges. Six themes emerged: (1) franticness, time pressure, and sense of having not enough time; (2) the temporal unpredictability of daily life; (3) the unpredictability of time to live in shelter; (4) anxious waiting for next steps toward employment and housing; (5) the shelter’s control of time; and (6) the importance of family time and strategies used to sustain it. These findings are discussed using theoretical perspectives about the elements of temporal behavior, as well as research on time and personal agency, and recommendations are made for professionals working to support homeless families, especially around their temporal challenges.
Culture and Demography: A Micro Level Study Between Two Communities Residing in the City of Kolkata, West Bengal
Authors: Kalam Mir Azad , Mishra Archana , Pal Saptamita , Roy Subho
Published: April 2020

We aimed to study the demographic patterns of two contrasting communities, namely Bengali Hindu and Bihari Hindu groups, residing in adjacent clusters in the city of Kolkata, West Bengal. The former were the original inhabitants of Kolkata and the latter were a migrant group from the state of Bihar. We collected data from 164 ever-married females (Bengali [84] and Bihari [80]). Data on household information, demographic variables, and marital distance and preferences were collected using a well-tested schedule/questionnaire from ever-married females of both the groups. Some in-depth interviews were conducted on the participants to get information on the reasons for sex preference in childbirth, preference in selecting mates, determining the age at marriage, and so on. Results showed that both the groups differ with respect to sex ratio and child sex ratio, marital preference, marriage distance, and fertility. It appeared from the study that despite the physical proximity between these two groups, their demographic traits differed sharply. We concluded from this study that the differences in demographic traits between these two groups may be attributed to contrasting cultural attributes of these two communities.
Digitalization and the geographies of production: Towards reshoring or global fragmentation?
Authors: Butollo Florian
Published: April 2020

The relationship between digitalization and the governance and geographies of global value chains has not been explored systematically. This contribution discusses how digitalization affects the variables that determine the localization of manufacturing, i.e. the substitution of work through automation, the deepening of the customer–producer relationship, the rationalization of distribution through digitalized logistics networks, and the increased modularization of supply chains through standardization and ‘platformisation’. The results of the theoretical exploration defy expectations of a straightforward ‘reshoring’ of production through the combined effects of automation and benefits through a co-localization of companies within their target markets. Tendencies that would support a stronger integration of production in advanced economies are instead being undercut by ongoing countertrends towards fragmentation. The contradictory tendencies of a geographical integration of manufacturing and target markets on the one hand and geographical fragmentation through sophisticated supply-chain organization on the other will affect the technologically facilitated processes of value chain restructuring in a sector-specific manner.
Two successful deliveries of healthy children by a young woman diagnosed and treated during induction and relapsed therapy for acute promyelocytic leukemia
Authors: Dang Chee Chean , Guan Yong Khee , Lau Ngee Siang , Chan Siok Yee
Published: April 2020

Introduction

Acute promyelocytic leukemia is an oncologic emergency. The limited cases reported in the literature have led to poor understanding of the safety of management of acute promyelocytic leukemia during pregnancy.

Case report

Herein is an acute promyelocytic leukemia case of a 22-year-old young pregnant woman who had various social problems. The patient was diagnosed with acute promyelocytic leukemia in her the second trimester of her first pregnancy. Management and outcome: She was treated with all-trans-retinoic acid with idarubicin and successfully delivered a healthy baby. She completed induction with idarubicin but defaulted her all-trans-retinoic acid, 6-mercaptopurine and methotrexate maintenance. She relapsed after one year and was salvaged with all-trans-retinoic acid high dose cytarabine and arsenic trioxide. She went into remission and had autologous stem cells collected and was planned for an autologous stem cell transplant but she defaulted. She relapsed when she was pregnant with her second baby during her third trimester (29+weeks) 10 months later. Salvage chemotherapy with arsenic trioxide, all-trans-retinoic acid and idarubicin was given. Patient underwent an emergency lower segment caesarian section at 31 weeks of pregnancy due to abnormal fetal cardiotocography. A healthy baby was delivered.

Discussion

This drug regimen is controversial during pregnancy owing to the teratogenic effects and fatal retinoic acid syndrome especially in early gestation. In this case, patient was started the induction therapy of all-trans-retinoic acid treatment at her second trimester during her first pregnancy.

Conclusion

Our lady demonstrated the possibility of using all-trans-retinoic acid and arsenic trioxide and chemotherapy during second and third trimester with successful pregnancy outcomes.
Adherence and adverse events of intraperitoneal chemotherapy in optimally debulked ovarian cancer patients: Real-life study
Authors: Ballesta-López Octavio , Albert-Marí Asunción , Borrell-García Carmela , Melián-Sosa Marcos , Salvador-Coloma Carmen , Santaballa-Bertrán Ana , Poveda-Andrés José Luis
Published: April 2020

Purpose

Intraperitoneal with intravenous chemotherapy (IP/IV) is the recommended option for patients with stage III cancer with optimally debulked (<1 cm residual) disease based on randomized controlled trials and showing important improvements in overall survival and progression free survival. However, its application has not been largely adopted due to its difficult administration that requires a trained nurse staff. The aim of this work was to study the completion and the toxicity of an IP outpatient chemotherapy regimen in optimally debulked stage III ovarian cancer patients.

Methods

A single-center, retrospective observational study in women with stage III ovarian cancer following optimal cytoreductive surgery (<1 cm) followed by IP/IV chemotherapy from 2009 to 2017. The IP/IV regimen was as it follows: IV paclitaxel 175 mg/m2 in 3 h, day 1; IP cisplatin (100 mg/m2—until December 2013—or 75 mg/m2), day 2; IP paclitaxel 60 mg/m2, day 8, each 21 days for six cycles.

Results

A total of 60 patients received IP/IV regimen. Of these, 41 patients (68.3%) completed the six IP chemotherapy cycles and 51 (84.9%) completed four or more cycles. Most of the adverse events reported were non-hematological and G1-2. There was no difference neither in adherence nor in the frequency of adverse events between both cisplatin groups. Despite a high rate of adverse events, IP chemotherapy can be delivered with a high completion rate and manageable toxicity to patients with optimally debulked ovarian cancer.
Medication use evaluation of the financial and clinical implications of ixazomib compared to bortezomib in the outpatient setting
Authors: Zink Katelyn A , Fajardo Susan
Published: April 2020

In the past decade, several new therapies have been approved for use in multiple myeloma, including the novel oral agent, ixazomib. Ixazomib, like bortezomib and carfilzomib, is a proteasome inhibitor, a class of agents that are a mainstay of treating multiple myeloma in both the frontline and relapsed settings. Ixazomib is administered orally and offers many potential advantages over the subcutaneous or intravenous administration of bortezomib. In this single-center, retrospective medication use evaluation, adult patients with multiple myeloma receiving either ixazomib or bortezomib in the outpatient setting were assessed to evaluate financial implications and tolerability. A total of 28 patients were included. The total wholesale acquisition cost for one cycle of ixazomib was $9942, and $6412 for bortezomib. Average reimbursement per cycle was $9205 for ixazomib and $5664 for bortezomib. Secondarily, the incidence of interruption in therapy was evaluated. Ixazomib was associated with a slightly higher incidence of interruption compared to bortezomib, 42.9% and 35.7%, respectively. It is notable that ixazomib has similar drug reimbursement rates to bortezomib, but slightly higher rates of interruption in therapy. In conclusion, if tolerable for the patient, ixazomib may offer a financially acceptable alternative for the treatment of multiple myeloma.
Identifying consumers’ profile and factors associated with the valorization of pulque: A traditional fermented beverage in Central Mexico
Authors: Rojas-Rivas Edgar , Cuffia Facundo
Published: April 2020

The aims of this work were to (i) identify the consumers’ profile of pulque through their consumption frequency and their sensory perception of this beverage and (ii) identify the factors that contribute to the valorization of pulque among Mexican consumers. A survey was designed and conducted with 221 consumers in pulque-selling locations (pulquerías) in a place of Central Mexico. Consumers were characterized according to their consumption frequency. Factors associated with the valorization of pulque were identified through Binary Logistic Regression model. Two types of consumers were identified: Frequent Consumers and Not Frequent Consumers. Both groups were comprised mostly of men, including students with medium to high levels of education. However, the first group showed more traditional and conservative behavior patterns since there was a higher proportion of consumers with a low educational level ( p < 0.05) and they had more years of consumption, spend more time in the selling locations, and preferred “natural pulque.” The second group of consumers was comprised mostly ( p < 0.05) of women, including students with a high educational level who prefer “cured pulque.” In this sense, our results showed that gender and time spent in the pulquerías together with sensory, cultural, and functional characteristics associated with the beverage influence its valorization among consumers. These results can help both producers and marketers to classify segments of consumers according to their preferences and consumption patterns in order to revalorize the pulque market. Finally, it is necessary to highlight that young consumers with high educational level show interest in this beverage, since for years its consumption has been associated with low-income populations.
Contextualized understanding of depression: A vignette study among the !Xun and Khwe of South Africa
Authors: den Hertog Thijs N , Maassen Eva , de Jong Joop T V M , Reis Ria
Published: April 2020

Colonial misconceptions about the absence of depression and the lack of a psychologization of distress among Africans have long been refuted. However, cultural variation in depression in terms of symptomatic expression, conceptualization, explanatory models, and social responses is widely acknowledged. Insight into the cultural variation of depression is useful for providing appropriate care; however, few studies have explored cultural understandings of depression in African settings. In a depression vignette study of two displaced and marginalized San communities in South Africa, we conducted 20 semistructured interviews to explore causal interpretations and strategies for coping. Causal interpretations consisted of several dimensions, including life struggles and physical, psychological, and spiritual interpretations. Respondents primarily focused on life struggles in terms of socioeconomic and interpersonal problems. They described coping strategies as primarily addressing negative emotional and psychological affect through social support for relief, comfort, distraction, or advice on coping with the situation and emotions. In addition, religious coping and professional support from a social worker, psychologist, support group, or medications were mentioned. Findings illustrate that depression should be understood beyond individual suffering and be situated in its immediate social environment and larger sociopolitical setting. Interventions for depression therefore may benefit from a multilevel approach that addresses socioeconomic conditions, strengthens local resources, and fosters collaboration among locally appropriate informal and formal support structures.
Treating immigrant patients in psychiatric emergency rooms
Authors: Collazos Francisco , Malagón-Amor Ángeles , Falgas-Bague Irene , Qureshi Adil , Gines Jose Maria , del Mar Ramos Maria , McPeck Samantha , Hussain Isra , Wang Ye , Alegría Margarita
Published: April 2020

We examine whether patient variables (geographic origin, gender, Spanish language proficiency) and subjective clinician aspects in emergency department psychiatric encounters (diagnostic certainty, clinician’s comfort level with patient) are associated with diagnosis and the use of coercive measures. Using a descriptive cross-sectional design, we recorded 467 visits (400 foreign-born and 67 native-born patients) in hospital psychiatry emergency rooms (ERs) in Barcelona between 2007 and 2015. We first assessed the association of patient variables and subjective clinician aspects of psychiatric encounters with service use outcomes and with mental illness diagnosis. Fitted logistic models predicted the likelihood of service use outcomes and estimated the propensity of receiving each diagnosis. The null model evaluated the role of patient’s geographical origin, while the full model evaluated the additional roles of patient’s gender and language, the clinician’s assessment of the influence of culture in diagnosis, and clinician comfort with two outcomes: patient’s diagnosis and use of coercive measures in the ER. Women were less likely to receive coercive measures or intramuscular medications compared to men. Significant ethnic/racial and gender differences were found in receiving certain diagnoses. Additionally, a patient’s lower Spanish proficiency was correlated with a higher probability of receiving a psychosis diagnosis. The clinician’s level of diagnostic certainty was also positively correlated with increasing clinician-reported comfort with patient. Overall, ethnic factors and the subjective aspects of psychiatric encounters were found to influence diagnosis and the use of coercive measures. Cultural competency programs and interpreter services within psychiatric ER settings should thus be required.
A short remark on the nonlinear oscillator with a damping term
Authors: Yao Shaowen , Cheng Zhibo
Published: April 2020

A nonlinear oscillator with a damping term can model many nonlinear vibration problems. This short remark insights into its physical understanding by the variational principle, which is established by the semi-inverse method. The dissipative energy involved in the variational formulation can be explained by the two-scale thermodynamics. Taylor series method is used to solve its frequency-amplitude relation.
Vibration analysis of the axle bearings considering the combined errors for a high-speed train
Authors: Liu Jing , Li Xinbin , Yu Wennian
Published: April 2020

Axle bearings are critical elements of high-speed trains. Although the quality and precision of axle bearings have been significantly improved, the manufacturing errors, such as the roundness and waviness errors, cannot be eliminated during their manufacturing processes. The axle bearings with the roundness and waviness errors have great influences on vibration performances of the high-speed trains. To obtain an in-depth understanding of the vibrations caused by the axle bearing with the combined errors considering both the roundness and waviness errors. This work conducts an improved analytical model for a high-speed train considering the axle bearings with the combined errors, which cannot be formulated by the previous train model considering single roundness or waviness errors. The combined errors are defined to include both the roundness and waviness errors. A new multiple cosine function is presented to model the combined errors. The time-depended force excitations produced by the combined errors are also considered in the dynamic model. A track irregularities model is utilized to formulate the road spectrum displacement excitations from the rail and roadbed. The influences of the error amplitude and order on the vibrations of high-speed train are analyzed. The results for the single roundness error model, single waviness error model, and combined errors model are compared to represent the superiority of proposed model. It depicts that this work can provide a more reasonable analytical method for understanding the vibrations of high-speed train considering the axle bearings with the combined manufacturing errors compared to the reported single error models.
My experience of living with nonfluent/agrammatic variant primary progressive aphasia: Adaptations and strategies to improve quality of life
Authors: Douglas Joanne T
Published: April 2020

Primary progressive aphasia is a major clinical presentation of frontotemporal lobar degeneration and is a young-onset disorder characterized by deteriorating language skills. There is currently no cure for primary progressive aphasia, nor is it possible to slow the course of the underlying progressive brain degeneration. Hence the chief goal of treatment is palliative. Although the inability to employ language at one’s previous level represents a significant functional impairment for those affected, there is a dearth of information about how to make meaningful improvements to the quality of life of people in the early stages of primary progressive aphasia. I have a clinical diagnosis, supported by imaging, of the nonfluent/agrammatic variant of primary progressive aphasia and am under the care of a multidisciplinary medical team. This report is based on my ongoing experience and describes the development and implementation of an evolving set of targeted strategies and adaptations designed to enhance the quality of life of a person in the early stages of this disorder.
Success of Students Screened as Twice-Exceptional as a Function of Major Selection and Academic Strength
Authors: Snyder Kelly H. , McClurg Virginia M. , Wu Jiaju , McCallum R. Steve
Published: April 2020

In this study, the success of 6,054 college students screened as twice-exceptional (2e; i.e., those with significantly discrepant math vs. reading scores on the ACT [formerly, American College Test] or SAT [formerly, Scholastic Aptitude Test]) was examined based on major selection and type of potential learning disability using a screening technique proposed by McCallum et al. There were no differences in high school grade point average, college grade point average, or first-year retention rates between students screened as 2e who had a major in line with their academic strength versus those who did not ( p >  .05). However, students screened as 2e based on an exceptionally high math score but a lower reading score yielded statistically significantly higher rates of retention ( p <  .05) than students screened as 2e with the reverse pattern of scores (i.e., gifted in reading with a potential learning disability in math). Implications for screening 2e students are discussed.
Three-dimensional models of breast cancer–fibroblasts interactions
Authors: Singh Sunil , Tran Sydnie , Putman Justin , Tavana Hossein
Published: April 2020

Tumor microenvironment is a complex niche consisting of cancer cells and stromal cells in a network of extracellular matrix proteins and various soluble factors. Dynamic interactions among cellular and non-cellular components of the tumor microenvironment regulate tumor initiation and progression. Fibroblasts are the most abundant stromal cell type and dynamically interact with cancer cells both in primary tumors and in metastases. Cancer cells activate resident fibroblasts to produce and secrete soluble signaling molecules that support proliferation, migration, matrix invasion, and drug resistance of cancer cell and tumor angiogenesis. In recent years, various forms of three-dimensional tumor models have been developed to study tumor–stromal interactions and to identify anti-cancer drugs that block these interactions. There is currently a technological gap in development of tumor models that are physiologically relevant, scalable, and allow convenient, on-demand addition of desired components of the tumor microenvironment. In this review, we discuss three studies from our group that focus on developing bioengineered models to study tumor-stromal signaling. We will present these studies chronologically and based on their increasing complexity. We will discuss the validation of the models using a CXCL12-CXCR4 chemokine-receptor signaling present among activated fibroblasts and breast cancer cells in solid tumors, highlight the advantages and shortcomings of the models, and conclude with our perspectives on their applications.

Impact statement

Tumor stroma plays an important role in progression of cancers to a fatal metastatic disease. Modern treatment strategies are considering targeting tumor stroma to improve outcomes for cancer patients. A current challenge to develop stroma-targeting therapeutics is the lack of preclinical physiologic tumor models. Animal models widely used in cancer research lack human stroma and are not amenable to screening of chemical compounds for cancer drug discovery. In this review, we outline in vitro three-dimensional tumor models that we have developed to study the interactions among cancer cells and stromal cells. We describe development of the tumor models in a modular fashion, from a spheroid model to a sophisticated organotypic model, and discuss the importance of using correct physiologic models to recapitulate tumor-stromal signaling. These biomimetic tumor models will facilitate understanding of tumor-stromal signaling biology and provide a scalable approach for testing and discovery of cancer drugs.
Current perspectives on the cellular and molecular features of epigenetic ageing
Authors: Raj Kenneth , Horvath Steve
Published: April 2020

It has been noted for quite some time that DNA methylation levels decline with age. The significance of this change remained unknown until it became possible to measure methylation status of specific sites on the DNA. It was observed that while the methylation of some sites does indeed decrease with age, that of others increase or remain unchanged. The application of machine learning methods to these quantitative changes in multiple sites, allowed the generation of a highly accurate estimator of age, called the epigenetic clock. The application of this clock on large human epidemiological data sets revealed that discordance between the predicted (epigenetic age) and chronological age is associated with many age-related pathologies, particularly when the former is greater than the latter. The epigenetic clock clearly captures to some degree, biological features that accompany the ageing process. Despite the ever-increasing scope of pathologies that are found to be associated with accelerated epigenetic ageing, the basic principles that underlie the ticking of the clock remain elusive. Here, we describe the known molecular and cellular attributes of the clock and consider their properties, and proffer opinions as to how they may be connected and what might be the underlying mechanism. Emerging from these considerations is the inescapable view that epigenetic ageing begins from very early moments after the embryonic stem cell stage and continues un-interrupted through the entire life-course. This appears to be a consequence of processes that are necessary for the development of the organism from conception and to maintain it thereafter through homeostasis. Hence, while the speed of ageing can, and is affected by external factors, the essence of the ageing process itself is an integral part of, and the consequence of the development of life.

Impact statement

The field of epigenetic ageing is relatively new, and the speed of its expansion presents a challenge in keeping abreast with new discoveries and their implications. Several reviews have already addressed the great number of pathologies, health conditions, life-style, and external stressors that are associated with changes to the rate of epigenetic ageing. While these associations highlight and affirm the ability of epigenetic clock to capture biologically meaningful changes associated with age, they do not inform us about the underlying mechanisms. In this very early period since the development of the clock, there have been rather limited experimental research that are aimed at uncovering the mechanism. Hence, the perspective that we proffer is derived from available but nevertheless limited lines of evidence that together provide a seemingly coherent narrative that can be tested. This, we believe would be helpful towards uncovering the workings of the epigenetic clock.
Ultrasound-guided catheter-directed foam sclerotherapy can be safely applied for the treatment of great saphenous varicose veins in elderly patients
Authors: Kahraman Nail , Özsin Kadir K
Published: April 2020

Objectives

Although many published series have shown the results of ultrasound-guided catheter-directed foam sclerotherapy, little is known about the outcomes and complications in older patients.

Methods

A total of 152 patients older than 65 years (group 1: 61.8% male, mean age 69.0 ± 4.5 years) and 244 patients younger than 65 years (group 2: 48.8% male, mean age 45.7 ± 11.2 years) were included in the study. Ultrasound-guided catheter-directed foam sclerotherapy was performed in patients with great saphenous vein valvular incompetence and saphenofemoral junction incompetence. Occlusion status was recorded by ultrasonography. Venous clinical severity score and visual analog score were calculated pre- and post-intervention.

Results

Complete occlusion rate of the great saphenous vein at 12 months post-procedure for the groups 1 and 2 was 86.4% and 86.3%, respectively. Venous clinical severity score and visual analog score were signiﬁcantly different before ultrasound-guided catheter-directed foam sclerotherapy and four weeks after ultrasound-guided catheter-directed foam sclerotherapy ( p < 0.001) in both the groups. There were no observed major complications in both the groups.

Conclusions

With low complication rate and acceptable total occlusion rate, ultrasound-guided catheter-directed foam sclerotherapy can be considered a reliable treatment for older patients.
Pediatric acute appendicitis: Searching the diagnosis in portal vein
Authors: Aydin Sonay , Ucan Berna
Published: April 2020

Introduction

Acute appendicitis is the most common reason for emergency abdominal surgery in the pediatric population. Ultrasound (US) is a widely used modality to diagnose acute appendicitis. The aim of this study was to evaluate the effectiveness of portal vein diameter and flow velocity in acute appendicitis diagnosis.

Methods

Portal vein diameter and flow velocity were measured in children who were referred to radiology with a clinical diagnosis of acute appendicitis. The largest appendix diameter and leukocyte count of the patients were recorded. A control group was created which consisted of healthy children, and their portal vein diameter and flow velocities were also measured.

Results

The median age of the population was 10 years (range, 3–17 years). Mean portal vein diameter was 7.53 ± 1.55 mm in the control group, 7.92 ± 1.88 mm in the other diagnosis group, and 8.76 ± 1.91 mm in the acute appendicitis group. Mean portal vein diameter was significantly higher in the acute appendicitis group (p = 0.001). Median portal vein flow velocity was 17 cm/s (10–29 cm/s) in the control group, 18.3 cm/s (8–27 cm/s) in the other diagnosis group, and 20.5 cm/s in the acute appendicitis group. Median portal vein flow velocity was significantly higher in the acute appendicitis group (p = 0.00).

Conclusion

Detecting an increase in portal vein diameter and/or flow velocity in equivocal cases may support other clinical signs associated with acute appendicitis. Portal vein diameter and flow velocity can serve as additional diagnostic markers in acute appendicitis cases.
Ethical issues in the care of people with dementia
Authors: Parker Joshua
Published: April 2020

Dementia is a syndrome characterised by cognitive decline, memory loss and progressive functional impairment. It is increasingly common, and is largely managed in the community. The nature of dementia leads to many deep philosophical problems that bear on the various ethical issues that arise for clinicians caring for these patients. This article explores these ethical issues with a focus on promoting autonomy and making best interests decisions. Everyday ethical issues including truth telling, restraint and limitations of freedom, abuse and vulnerability are considered. Ethical issues generated by the use of assistive technologies and finally confidentiality are also, briefly, considered. Although this article cannot give specific ‘right answers’ to the myriad ethical issues confronting GPs working with people with dementia, it does aim to highlight productive lines of thought in navigating such issues.
“Fake Tan” or “Fake News”?
Authors: Meyer Georg , Amano Kinjiro , Xiao Kaida , Wuerger Sophie
Published: April 2020

We estimated Trump’s skin colour from 70 internet images and also from the “twitter tan line” image (February 8, 2020; Twitter). We then compared the estimated skin colours with two existing data sets of skin colours: the range of skin tans that occur naturally in the Caucasian population and the range skin colours brought about by a sunless tan. We find that Trump’s skin colour is close to the edge of the natural skin tan gamut and firmly within the gamut of a sunless skin tan. The skin colour above Trump’s tan line is outside of the naturally occurring range of skin colours, even outside the skin tan of nonmelanized albinos. The latter finding is consistent with the hypothesis that part of the image may have been digitally distorted.
Physical activity attenuates cardiovascular risk and mortality in men and women with and without the metabolic syndrome – a 20-year follow-up of a population-based cohort of 60-year-olds
Authors: Ekblom-Bak Elin , Halldin Mats , Vikström Max , Stenling Andreas , Gigante Bruna , de Faire Ulf , Leander Karin , Hellénius Mai-Lis
Published: April 2020

Aims

The purpose of this study was to analyse the association of leisure-time physical activity of different intensities at baseline, and cardiovascular disease incidence, cardiovascular disease mortality and all-cause mortality in a population-based sample of 60-year-old men and women with and without established metabolic syndrome, for more than 20 years of follow-up. A secondary aim was to study which cardiometabolic factors may mediate the association between physical activity and long-term outcomes.

Methods

A total of 3693 participants (53% women) underwent physical examination and laboratory tests, completed an extensive questionnaire at baseline 1997–1999 and were followed until their death or until 31 December 2017. First-time cardiovascular disease events and death from any cause were ascertained through regular examinations of national registers.

Results

Metabolic syndrome prevalence was 23.0%. In metabolic syndrome participants, light physical activity attenuated cardiovascular disease incidence (hazard ratio = 0.71; 95% confidence interval 0.50–1.00) compared to sedentary (reference) after multi-adjustment. Moderate/high physical activity was inversely associated with both cardiovascular disease and all-cause mortality, but became non-significant after multi-adjustment. Sedentary non-metabolic syndrome participants had lower cardiovascular disease incidence (0.47; 0.31–0.72) but not significantly different cardiovascular disease (0.61; 0.31–1.19) and all-cause mortality (0.92; 0.64–1.34) compared to sedentary metabolic syndrome participants. Both light and moderate/high physical activity were inversely associated with cardiovascular disease and all-cause mortality in non-metabolic syndrome participants (p<0.05). There were significant variations in several central cardiometabolic risk factors with physical activity level in non-metabolic syndrome participants. Fibrinogen mediated the protective effects of physical activity in non-metabolic syndrome participants.

Conclusion

Physical activity of different intensities attenuated cardiovascular risk and mortality in 60-year old men and women with metabolic syndrome during a 20-year follow-up.
Bereavement in the year before a first myocardial infarction: Impact on prognosis
Authors: Wei Dang , Janszky Imre , Ljung Rickard , Leander Karin , Chen Hua , Fang Fang , Li Jiong , László Krisztina D
Published: April 2020

Background

Death of the spouse in middle and old age is associated with an increased risk of cardiovascular and total mortality, particularly during the months after the loss. Knowledge regarding the effect of bereavement on prognosis in acute myocardial infarction (AMI) is limited. We analysed whether bereavement the year before the AMI is associated with prognosis.

Methods

We studied first AMI patients who participated in the Stockholm Heart Epidemiology Program (N = 1732). During or shortly after the hospitalization, patients or their family members completed a questionnaire regarding bereavement, sociodemographic, clinical and lifestyle factors; five months after their first infarction, surviving patients attended a clinical examination. Participants were followed for cardiovascular events and mortality for a median of 14 years.

Results

Overall bereavement, that is, death of a close friend or family member (including spouse/partner), the year before the first AMI was not associated with the combined outcome of non-fatal recurrent AMI and death due to ischaemic heart diseases. However, exposure to the loss of the spouse/partner was associated with an increased risk of the outcome (adjusted hazard ratio and (95% confidence interval): 1.55 (1.06–2.27)). We found no evidence that psychiatric disorders or blood lipids, glucose, coagulation and inflammatory markers mediated this association.

Conclusions

Loss of spouse/partner the year before the first AMI was associated with an increased risk of the combination of non-fatal recurrent AMI and death due to ischaemic heart disease. If confirmed by others, the findings may be informative for tertiary prevention of AMI.
Weighing the odds: Assessing underdiagnosis of adult obesity via electronic medical record problem list omissions
Authors: Kapoor Akshat , Kim Juhee , Zeng Xiaoming , Harris Susie T , Anderson Andrew
Published: April 2020

Background

Obesity is a continuing national epidemic, and the condition can have a physical, psychological, as well as social impact on one’s well-being. Consequently, it is critical to diagnose and document obesity accurately in the patient’s electronic medical record (EMR), so that the information can be used and shared to improve clinical decision making and health communication and, in turn, the patient’s prognosis. It is therefore worthwhile identifying the various factors that play a role in documenting obesity diagnosis and the methods to improve current documentation practices.

Method

We used a retrospective cross-sectional design to analyze outpatient EMRs of patients at an academic outpatient clinic. Obese patients were identified using the measured body mass index (BMI; ≥30 kg/m2) entry in the EMR, recorded at each visit, and checked for documentation of obesity in the EMR problem list. Patients were categorized into two groups (diagnosed or undiagnosed) based on a documented diagnosis (or omission) of obesity in the EMR problem list and compared.

Results

A total of 10,208 unique patient records of obese patients were included for analysis, of which 4119 (40%) did not have any documentation of obesity in their problem list. Chi-square analysis between the diagnosed and undiagnosed groups revealed significant associations between documentation of obesity in the EMR and patient characteristics.

Conclusion

EMR designers and developers must consider employing automated decision support techniques to populate and update problem lists based on the existing recorded BMI in the EMR in order to prevent omissions occurring from manual entry.
Patients’ self-assessed sleep as a nursing tool during hospital care: A pilot study
Authors: Gellerstedt Linda , Rydell Karlsson Monica , Medin Jörgen , Kumlin Maria
Published: April 2020

Sleep in hospital is considered a challenge from both a patient and a nursing perspective. To enable nurses to promote patients’ sleep during hospital care it is essential to have valid, reliable and useful sleep assessment tools at hand. The aim of the present study was to evaluate and compare the outcomes of objectively estimated sleep and self-reported sleep quality. Data were collected through continuous wrist-worn actigraphy and completion of the Richards–Campbell Sleep Questionnaire (RCSQ) in a pilot study on 25 patients during hospital care. A correlation between mean values for the two assessments was shown for the second night but not for the third night of assessment, and it was concluded that the two assessments might capture different dimensions of sleep. Furthermore, based on a high response rate and an evident feasibility in a nursing context the RCSQ may facilitate person-centered care.
Tax Effects of Treaty Shopping and OECD’s BEPS Implications
Authors: Shukla Gaurav , Pandey Suesh Kumar , Lingam Shiu
Published: April 2020

This article evaluates the reasons as to why tax treaty abuse and specifically treaty shopping have been less mooted in the international tax landscape, before the experience of the global economic slowdown. Dawn of the 21st century witnessed the international community be much intensively focused on global transparency in tax matters, and nations more concerned about the revenue loss due to tax avoidance methods adopted globally. Further, the article tries to make a logical connection between the treaty shopping, tax avoidance and tax evasion, without getting deeply into the technicalities of Limitation on Benefits and Principal Purposes Test rules proposed by OECD in BEPS Action Plan 6.
Tracing modes of politics at the United Nations: Spatial scripting, intimidation and subversion at the Forum on Minority Issues
Authors: McConnell Fiona
Published: April 2020

This paper seeks to add empirical depth and conceptual nuance to how we understand the dynamics of geopolitical interactions. It does so by turning attention to the role of space in how modes of politics are articulated. The micro-spaces of international institutions are brought to the fore through an examination of how geopolitical actors of different prescribed statuses – state diplomats and representatives of minority communities – interact in the spaces of the UN Office at Geneva. Focusing on the UN Forum on Minority Issues the paper adopts an inductive approach to draw out dynamics of scripting, disruption, (in)visibility and affective atmospheres in this space. Three empirical snapshots of the eighth and ninth Forums are presented. The first focuses on spatial scripting within Room XX and examines experiences of sublime aesthetics and the cadences of the Forum’s proceedings. Attention then turns to the actions of particular states which interrupted minority speakers and engaged in spatial practices of intimidation. Third, the agency of minority representatives in asserting their presence through reclaiming space and small acts of subversion is examined. The paper concludes with a discussion of how to approach the often contradictory modes of politics articulated at the UN and the potential for further geographical investigation of this international institution.
Clinical study of endoscopic treatment of a sellar pituitary adenomas with sellar diaphragm defect
Authors: Jin Zhuoru , Wu Xinyu , Wang Yibao
Published: April 2020

Background

Invasive growth of pituitary macroadenomas to the suprasellar region occurs commonly. Pituitary adenomas show varying growth patterns when the sellar diaphragm is absent, and they are often confused with other common tumors in the sellar region. This article explores the clinical features of suprasellar pituitary adenomas with defects of the sellar diaphragm (SPADSD) and evaluates the efficacy of the endoscopic endonasal approach (EEA) for treatment of such tumors.

Methods

We performed a detailed examination of records from 19 patients collected prior to surgery. After relevant diseases were excluded, the tumor properties were evaluated according to imaging characteristics. Diagnoses were verified using EEA surgery. The concept of SPADSD was put forward. Postoperative recovery was followed to determine whether EEA is suitable for the treatment of such tumors.

Results

In the 19 patients with SPADSD, we found that the tumors were less stressed on the pituitary, and tumors in the suprasellar region often had irregular shapes. During surgery, we took extended supra-saddle approaches and confirmed that unrestricted growth of the tumor was caused by defects in the diaphragm of the sella turcica to the suprasellar region. Recovery was good after surgery, confirming the efficacy of EEA for treatment of these tumors.

Conclusion

SPADSD has different clinical features from those of other pituitary tumors and requires careful screening prior to surgery. Endoscopic surgery is the preferred procedure for this type of tumor.
Baby-box schemes in England: parent and practitioner experiences, and recommendations
Authors: Ball Helen L. , Taylor Catherine E.
Published: April 2020

Background

Programmes offering carboard baby boxes to parents in England began in some NHS Trusts in 2016. This study aimed to examine the strengths and weaknesses of English baby-box schemes as experienced by healthcare providers and parents.

Methods

An independent mixed-methods evaluation was conducted via telephone interviews and online surveys with healthcare providers and parents in all 7/9 NHS regions of England where baby-box schemes were established 2016–2019. Participants responded to requests circulated electronically by NHS Research & Design Departments, and infant health organisations in England. The objectives were to identify how parents and healthcare providers understood and experienced baby-box schemes implemented in England to date, and to produce recommendations for organisations considering involvement in future schemes.

Results

Baby-box schemes changed over time, and were complex to run and monitor. Both parents and practitioners were misinformed about their purpose and origins. Partnerships with a commercial box-provider reduced the investment needed to run a baby-box scheme, and offered potential benefits to staff regarding engagement with families via online education and face-to-face contact around handover of boxes, but carried unforeseen costs. Of particular concern was the box-provider’s access to parent personal details being promoted by NHS staff and parents’ lack of awareness; the hidden costs incurred by NHS facilities of running a box-scheme; and the costs incurred by parents in accessing their ‘free’ box. Sixteen recommendations are proposed for healthcare providers and organisations considering commercial - health-provider baby-box partnerships in future.

Conclusions

Many assumptions exist about the origins and purpose of baby-boxes; this misinformation needs correcting, especially as it relates to infant death reduction and safe infant sleep. Baby-box schemes take multiple forms from those motivated by social welfare to those motivated by commercial profit. The English experience of partnership schemes between healthcare facilities and commercial box-providers reveals some success stories, along with multiple points of ambiguity, unanticipated difficulty, and concerns for infant safety.