bluuebunny/crossref_metadata_2025 huggingface dataset:
Ignorance or culture war? Christian nationalism and scientific illiteracy
Authors: Perry Samuel L. , Baker Joseph O. , Grubbs Joshua B.
Published: April 2021

Religiously conservative Americans consistently demonstrate lower scientific literacy than other Americans. Some argue, however, that Americans’ scientific literacy is contingent on subcultural conflict, showing differences in scientific literacy that emerge only on religiously contested scientific claims. Building on these insights, we find that the most salient factor explaining Americans’ divergence on contested (though not on uncontested) scientific claims is not religious commitment or conservatism per se, but an ideology that seeks political—and consequently epistemic—dominance: Christian nationalism. National data show that Christian nationalism is unassociated with Americans’ answers on questions about uncontested scientific knowledge. However, Christian nationalism is the strongest predictor of incorrect answers on questions about religiously contested scientific claims. Contemporary “culture war” debates over science have little to do with outright ignorance of science, nor are they strictly about religiosity or theological conservatism. Rather, disputes over science and religion reflect politically motivated denials of scientific facts that threaten Christian nationalism’s claims to epistemic and cultural authority.
Anti-science Misinformation and Conspiracies: COVID–19, Post-truth, and Science & Technology Studies (STS)
Authors: Prasad Amit
Published: April 2021

COVID–19 has not only resulted in nearly two and a half million deaths globally but it has also spawned a pandemic of misinformation and conspiracies. In this article I examine COVID–19 misinformation and conspiracies in the United States (US). These misinformation and conspiracies have been commonly argued to be anti-science. I argue, although it is important to rebut false information and stop their spread, social scientists need to analyse how such anti-science claims are discursively framed and interpreted. Specifically, I show how the framing of the anti-science conspiracies utilise the credibility of science and scientists. I also explore how the COVID–19 misinformation and conspiracies were given different meaning among different social groups. The article is divided into three sections. In the first section I analyse the discursive emplotment of the Plandemic video that had Dr Judy Mikovits presenting several COVID–19 conspiracy theories and went viral before it was taken down from major social media platforms. I show how the video draws on the credibility of science, scientists, and scientific journals to present misinformation and conspiracies claims against vaccination, mask wearing, etc. The second section explores how COVID–19 misinformation and conspiracies were interpreted among the African-American community by drawing on the history of black community’s experiences in the US and as such how their interpretations stand in contrast to the interpretations of the COVID–19 misinformation and conspiracies among the White community. The last section analyses the role of STS in engaging with anti-science and post-truth issues and emphasises the need to excavate genealogies of the present even with regard to misinformation and conspiracies.
Point of Care Neonatal Ultrasound in Late-Onset Neonatal Sepsis
Authors: Yengkhom Rameshwor , Suryawanshi Pradeep , Murugkar Rahul , Gupta Bhavya , Deshpande Sujata , Singh Yogen
Published: April 2021

Background and Objectives:

Point of care neonatal ultrasound is a useful tool in evaluation of heart, brain, lungs, and abdomen in neonatal sepsis. The objective of our study was to perform bedside ultrasound screening of heart, brain, lungs, and abdomen in neonates with late onset culture positive sepsis and study the patterns of abnormalities and also their role in change of patient management.

Methods:

This prospective observational study was conducted at a tertiary level neonatal care unit from March 2017 to May 2018. All neonates with suspected late onset sepsis on the basis of clinical and laboratory findings underwent point of care neonatal ultrasound of heart, brain, lungs, and abdomen.

Results:

Of 153 suspected and eligible late-onset neonatal sepsis (LONS) cases, 67 (44%) had positive blood culture and were analyzed. Of this 67 neonates, 30 (45%) had abnormal neurosonography, 38 (57%) had abnormal cardiac output, 14 (20%) had abnormal cardiac contractility, 17 (25%) had abnormal pulmonary pressure, 18 (27%) had pulmonary arterial hypertension, 19 (28%) had pneumonia, and 7 (10%) had free fluid in abdomen. Clinical management was changed in 26 (39%) neonates.

Conclusion:

Bedside point of care neonatal ultrasound is a useful tool in assessment of heart, brain, lungs, and abdomen in a LONS. It could help in making appropriate decisions in the management, and therefore potentially reduce morbidity and mortality.
An Analysis of Digital Media Data to Understand Parents’ Concerns During the COVID-19 Pandemic to Enhance Effective Science Communication
Authors: Torres Alicia , Kelley Claire , Kelley Sarah , Piña Gabriel , Garcia-Baza Isai , Griffith Isabel
Published: April 2021

Science and health journalists have incorporated digital media as a source for their daily news production process, but little is known about the potential impacts of using digital media data to inform the news production process in the context of a global pandemic, where information is rapidly changing. During the COVID-19 pandemic, families have struggled to ensure economic stability and good health as well as their children’s learning and development. The Child Trends News Service sought to broaden access to science-based information to support families during the pandemic through television news, testing whether digital media can be used to understand parents’ concerns, misconceptions, and needs in real time. This article presents that digital media data can supplement traditional ways of conducting audience research and help tailor relevant content for families to garner an average of 90 million views per report.
The Perceptions of Patients, Families, Doctors, and Nurses Regarding Malignant Bone Tumor Disclosure in China: A Qualitative Study
Authors: Luo Chunmei , Lei Lei , Yu Yao , Luo Yu
Published: April 2021

Introduction

Withholding the malignant bone tumors disclosure from patients is common in China. The purpose of the study was to explore the perceptions of patients, families, doctors, and nurses regarding the disclosure of malignant bone tumors in China.

Method

Semistructured interviews were conducted with 25 cases, consisting of 69 participants (14 patients, 25 family members, 17 doctors, and 13 nurses), and the transcripts were analysed using Colaizzi’s (1978) descriptive phenomenological analysis process.

Results

Five themes were identified: (1) doctors preferred to inform the family members first, (2) family members’ decisions depended on different situations, (3) the patients agreed that disclosure should be different for each person/personally, (4) care from nurses reduced the overreaction of patients, and (5) key points improve the informing quality.

Discussion

Family participatory cancer disclosure and multidisciplinary teams could improve the quality of cancer disclosure. Culturally congruent health care and culturally sensitive interventions in cancer disclosure are suggested.
Complexifying Facilitation by Immersing in Lived Experiences of on-the-fly Facilitation
Authors: van Laere Joeri , Lindblom Jessica , de Wijse-van Heeswijk Marieke
Published: April 2021

Background:

Describing the role of a facilitator often results in to-do lists resembling a recipe or a laundry list to follow. Such lists fail to grasp the inherent complexity of facilitation and are not very useful in guiding facilitators when, why and if they should intervene in the unfolding live performance of that day.

Aim:

To develop a deeper understanding of on-the-fly facilitation by analyzing rich empirical accounts of in-situ facilitation episodes.

Intervention:

Six facilitation episodes were through purposeful sampling selected from a body of hundreds of interventions in forty-seven performed crisis management training exercises in Swedish municipalities. Each full-day crisis management simulation-game had between fifteen and fifty participants involving politicians, administrative managers and crisis management staff.

Method:

An auto-hermeneutical phenomenological analysis of six lived experiences of facilitation episodes was conducted to understand what the facilitator observed and how a facilitation intervention was applied.

Results:

On-the-fly-facilitation is instantaneous, but draws simultaneously on awareness of the past, present and future. Facilitation needs are foreseen during design and they influence current attentiveness and coaching. Unfolding game-play needs to be grasped quickly. Potential future consequences of intervening or not intervening are evaluated within a limited window of opportunity. Due to these circumstances, facilitation is multi-skilled, arbitrary and fallible. Such muddiness of on-the-fly facilitation requires courage from the facilitator.

Conclusions:

In order to better understand how facilitation skills and roles actually are performed, the facilitation literature desperately needs a larger number of rich empirical accounts of interesting in-situ facilitation. Elaborate analysis of such lived experiences could develop understanding as to how available skills, situational circumstances as well as the unfolding interaction between players and facilitators actually develop into a facilitation intervention. This could generate more complex theoretical understanding of how to apply facilitation skills, in addition to theories that list what skills a facilitator should master.
Design of an Impulse-Debriefing-Spiral for Simulation Game Facilitation
Authors: Schwägele Sebastian , Zürn Birgit , Lukosch Heide K. , Freese Maria
Published: April 2021

Background.

Simulation gaming sessions can be understood as a sequence of briefing, game play, and debriefing - with feedback loops and iterative steps in between. Often, these sessions are supported by a facilitator, who organizes the session, sets learning goals, and guides the players through briefing, game play and debriefing ( Taylor, Backlund & Niklasson, 2012 ), which we call facilitation. Debriefing is a vital part of the facilitation process, as according to Crookall (2010) and Kriz (2010) , it facilitates learning. Contrary to many traditional models that locate the debriefing phase at the very end of a simulation gaming session, we conceptualize debriefing as reflection moments during the whole session, in which participants have the opportunity to reflect on their game play, experiences, and learnings. Facilitation is the process of enabling participants to address challenging situations of the game play, and make connections between the game play and the real environment the game refers to throughout the simulation gaming session.

Method & Results.

We analysed existing debriefing literature within the Simulation & Gaming journal. This review revealed that many existing approaches do not sufficiently consider changing needs of participants during a simulation gaming session to allow for a direct reflection on what is happening. Instead, a large number of debriefing approaches focus on a post-action reflection only. Moreover, the approaches analysed in our article often are abstract and only provide scarce practical recommendations. In addition to the literature review, we draw conclusions from observations of our own work in and with simulation gaming sessions. Based on the related and our own work, we propose a new model for simulation game facilitation, which better connects moments of reflection with the game play - the Impulse-Debriefing-Spiral.

Conclusions.

We provide a holistic understanding of debriefing that helps facilitators when implementing simulation games for learning purposes. Our model, called the Impulse-Debriefing-Spiral, conceptualizes the role of facilitation between briefing and debriefing throughout the whole process of a simulation gaming session - starting with its planning to reacting on emerging needs of the participants in between, up to closing the session as last step before transferring new knowledge and competencies into a new context (learning transfer).
Lessons From Critical Race Theory: Outdoor Experiential Education and Whiteness in Kinesiology
Authors: Gauthier Viviane Soa , Joseph Janelle , Fusco Caroline
Published: April 2021

Background: Outdoor experiential education (OEE) is often presented as a neutral and equitable curricular practice with positive learning outcomes. However, few studies have examined the experiences of racialized and queer White settler students or the representation of Whiteness in OEE curricular documents. Purpose: This article explores Whiteness, racialization, and Indigenous erasure in OEE as an undergraduate curricular practice at a Kinesiology program in a Canadian university. Methodology/Approach: Using critical race theory, a critical discourse analysis of six types of documents used to advertise and organize the outdoor experiential courses was combined with five semi-structured interviews with undergraduate students. Findings/Conclusions: This study demonstrates that students must negotiate Whiteness and settler colonialism to participate in OEE. Three main findings include the following: (a) The imagined student is wealthy and White, (b) students both assimilate to and resist codes of Whiteness, and (c) curricular documents and practices promote Eurocentricity and erase Indigeneity. Implications: OEE presents an opportunity for students preparing to become workers and educators in sport and recreation to learn about Whiteness, racialization, and Indigeneity. Kinesiology program design can use student narratives to shift from supposedly neutral curricular documents and pedagogies to ones that expose and work toward dismantling Eurocentricity.
An experimental approach on energy dissipation of bolted joints using a modified oscillator device
Authors: Li Yikun , Hao Zhiming , Du Qiang , Xing Minglu , Dou Linlong , Li Yifei
Published: April 2021

A modified and simplified oscillator device is designed and manufactured to investigate the effects of contact roughness and bolt arrangements on energy dissipation caused by joint damping. Three types of surface roughness and five different bolt arrangements are discussed. Identification of Iwan model based on experimental data is carried out. It is indicated that rough surface dissipates more energy than smooth one. Specimens with more bolts dissipate relatively more energy. When bolt number is consistent, the series type dissipates more energy than the parallel type. Experimental data show a good stability and accuracy of the proposed oscillator device. The identified Iwan model provides a good conformity with the reconstructed hysteresis loop. The four-parameter Iwan model can well describe the damping property of joints with different surface roughness and bolt arrangements.
Feasibility of preemptive pharmacogenetic testing in colorectal cancer patients within a community oncology setting
Authors: Luczak Tiana S , Schillo Paul J , Renier Colleen M , Waring Stephen C , Friday Bret B
Published: April 2021

Introduction

Pharmacogenetics, in hand with precision medicine in oncology, represents an opportunity to holistically tailor a patient’s treatment regimen using both somatic and germline variants to improve efficacy and decrease toxicity. Colorectal cancer patients represent a population with frequent use of fluoropyrimidine and irinotecan and are an ideal opportunity for implementation of preemptive pharmacogenetics as evidence supports pharmacogenetic testing for DPYD and UGT1A1 to reduce fluoropyrimidine and irinotecan toxicities.

Methods

This was a single arm proof-of-concept study at a large community-based health system. Participants provided samples for pharmacogenetic testing via an external vendor prior to chemotherapy initiation and an oncology pharmacist was responsible for pharmacogenetic interpretation and pharmacogenetic-guided therapeutic recommendation to the treating provider.

Results

A total of 24 (60%) participants had a UGT1A1 variant. All participants (100%) were DPYD*1/*1. Results were available and interpreted for 29/40 (72.5%) participants prior to scheduled chemotherapy initiation (p value <0.014). Of the participants whose results were available in 5 weekdays or less (n = 23), 20 (87%) were communicated with the treating provider prior to scheduled chemotherapy administration. A total turnaround time of 5 days or less was significantly associated with PGx feasibility in a community-based oncology clinic (p = 0.03).

Conclusions

In conclusion, we were able to show that implementation of preemptive pharmacogenetic testing into a community oncology clinic with results interpretation available prior to scheduled initiation of chemotherapy was feasible. As pharmacogenetic testing in oncology expands, pharmacists should be prepared to optimize supportive medication regimens as well as chemotherapy with pharmacogenetic results.
The imaginary friends of my friends: Imagined contact interventions which highlight supportive social norms reduce children’s antirefugee bias
Authors: Smith Elaine M. , Minescu Anca
Published: April 2021

Fostering inclusive attitudes among children in host classrooms is key to integrating refugee children. A field experiment tests the prejudice reduction effects of a teacher-led activity integrating imagined intergroup contact and normative influence. To enhance the effectiveness of imagined contact, scenarios include supportive ingroup norms. In 29 classes, 545 children ( Mage = 10.88, SD = 0.96) were randomly assigned to one of five conditions: standard imagined contact, imagined contact encouraged by family, class peers, or religious ingroups, or a control. Children in all norm-framed imagined contact conditions had significantly less antirefugee bias compared with the control. The class-peer norm frame significantly reduced affective and cognitive facets of bias. The family norm frame reduced affective bias, and the religious norm frame reduced cognitive bias. Standard imagined contact did not differ from the control. Potential mediating pathways are explored. These findings illustrate the utility of incorporating norms into imagined contact interventions to reduce antirefugee bias among schoolchildren.
Study of EHR-mediated workflows using ethnography and process mining methods
Authors: Grando M Adela , Vellore Vaishak , Duncan Benjamin J , Kaufman David R , Furniss Stephanie K , Doebbeling Bradley N , Poterack Karl A , Miksch Timothy , Helmers Richard A
Published: April 2021

Rapid ethnography and data mining approaches have been used individually to study clinical workflows, but have seldom been used together to overcome the limitations inherent in either type of method. For rapid ethnography, how reliable are the findings drawn from small samples? For data mining, how accurate are the discoveries drawn from automatic analysis of big data, when compared with observable data? This paper explores the combined use of rapid ethnography and process mining, aka ethno-mining, to study and compare metrics of a typical clinical documentation task, vital signs charting. The task was performed with different electronic health records (EHRs) used in three different hospital sites. The individual methods revealed substantial discrepancies in task duration between sites. Specifically, means of 159.6(78.55), 38.2(34.9), and 431.3(283.04) seconds were captured with rapid ethnography. When process mining was used, means of 518.6(3,808), 345.5(660.6), and 119.74(210.3) seconds were found. When ethno-mining was applied instead, outliers could be identified, explained and removed. Without outliers, mean task duration was similar between sites (78.1(66.7), 72.5(78.5), and 71.7(75) seconds). Results from this work suggest that integrating rapid ethnography and data mining into a single process may provide more meaningful results than a siloed approach when studying of workflow.
Factors that Influence the Individual Research Output of University Professors: The Case of Ecuador, Peru, and Colombia
Authors: Armijos Valdivieso Pablo , Avolio Alecchi Beatrice , Arévalo-Avecillas Danny
Published: April 2021

The study analyzed the factors that influence the individual research output of university professors in Ecuador, Peru, and Colombia, using multinomial logistic regression technique. Results showed that previous research publications are the main factor that explains subsequent research production. Age, academic rank, time invested on research, resource allocation, recognition, and research leaders have also a direct effect on research output. A comprehensive model is proposed and implications for universities authorities are discussed.
Decreased Implant Survival is Associated With Younger Patients Undergoing Total Knee Arthroplasty
Authors: Anatone Alex J. , Richardson Shawn S. , Kahlenberg Cynthia A. , Gausden Elizabeth B. , Figgie Mark P. , Blevins Jason L.
Published: April 2021

Background: Younger patients are undergoing total knee arthroplasty (TKA) at increasing rates and may face multiple revisions during their lifetimes due to mechanical complications or infections. Questions/Purposes: We sought to compare the early complication rates and revision-free implant-survival rates across age groups of patients undergoing TKA, with particular focus on implant survival in younger patients. Methods: We conducted a retrospective analysis of data taken from a national insurance database on patients who underwent primary TKA from 2007 to 2015. Kaplan–Meier curve survival analysis and log rank test were performed to evaluate revision rates in 7 age groups (younger than 40, 40–49, 50–59, 60–69, 70–79, 80–89, and 90 or more years of age). Complication rates were compared to rates in the age 60 to 79 years age groups using multiple logistic regression, controlling for baseline demographics and comorbidities. Results: There were 114,698 patients included in the analysis. Patients in the younger than 40 years, 40 to 49 years, and 50 to 59 years age groups had increased rates of early mechanical complications; 90-day readmission rates were significantly higher in those age groups as well. Revision-free implant survival at 5 years was significantly worse in patients younger than 60 years of age, particularly those less than 40 years, who had a 77% revision-free implant-survival rate at 5 years. Conclusions: Younger patients had a higher risk of early revision after TKA, as well as an increased rate of mechanical complications and readmissions at 90 days. These outcomes suggest more study is needed to better understand these discrepancies and to better guide preoperative counseling for young patients considering TKA.
Rethinking the Coronal Anatomic Axis of the Distal Tibia for Intramedullary Nail Placement: A Cadaveric Study
Authors: Aneja Arun , Marquez-Lara Alejandro , Luo T. David , Teasdall Robert J. , Isla Alexander , Albano Ashley , Halvorson Jason J. , Carroll Eben A.
Published: April 2021

Background: Recent studies have reported that targeting a center-center position at the distal tibia during intramedullary nailing (IMN) may result in malalignment. Although not fully understood, this observation suggests that the coronal anatomic center of the tibia may not correspond to the center of the distal tibia articular surface. Questions/Purposes: To identify the coronal anatomic axis of the distal tibia that corresponds to an ideal start site for IMN placement utilizing intact cadaveric tibiae. Methods: IMN placement was performed in 9 fresh frozen cadaveric tibiae. A guidewire was used to identify the ideal start site in the proximal tibia and an opening reamer allowed access to the canal. Each nail was then advanced without the use of a reaming rod until exiting the distal tibia plafond. Cadaveric and radiographic measurements were performed to determine the center of the nail exit site in the coronal plane. Results: Cadaveric and radiographic measurements identified the IMN exit site to correspond with the lateral 59.5% and 60.4% of the plafond, respectively. Conclusions: Tibial nails inserted using an ideal start site have an endpoint that corresponds roughly to the junction of the lateral and middle third of the plafond. Further studies are warranted to better understand the impact of IMN endpoint placement on the functional and radiographic outcomes of tibia shaft fractures.
Exploring Condom Use Behaviors Among African American Adolescent Boys in the Deep South
Authors: Chambliss Jessica Thames , Evans Retta , Bolland Anneliese , Wingate Martha S. , Bolland John M.
Published: April 2021

Risky sexual behaviors among adolescents can increase adverse outcomes including unplanned pregnancy or contraction or transmission of disease. Adolescents who engage in risky sexual activities are at increased risk for adverse health and social outcomes compared to those who do not engage. Despite declines in adolescent pregnancy and birth rates, the diagnosis of sexually transmitted infections (STIs) is steadily increasing among adolescents. Moreover, African American adolescent boys in the United States, specifically in the southeastern region are disproportionally at greater risk for STIs, and STI diagnosis within this population has increased over time, compared to their white counterparts. This study sought to identify factors associated with condom use among adolescent boys in the Deep South. Using data from the Mobile Youth Survey, a longitudinal adolescent community-based survey, this study assessed the relationship between personal, behavioral, and environmental factors and condom use among African American adolescent boys (14–19 years). Younger participants (14–15 and 16–17) were more likely to use a condom during the last sexual intercourse compared to older participants (18–19 years). High positive attachment to boy/girlfriend was associated with increased condom use. The number of sexual partners, age at their first sexual encounter, recent sexual behavior, and having an STI were also associated with increased condom use among participants. The study provides further insights into factors associated with condom use among African American adolescent boys and results can inform the development of sexual health interventions.
Does Digital Nerve Injury Affect Range of Motion Recovery After Zone 2 Flexor Tendon Repair?
Authors: Keane Grace , Stonner Macyn , Pet Mitchell A.
Published: April 2021

Background

Evidence surrounding the impact of concomitant digital nerve injury on the outcome of zone 2 flexor tendon repair is sparse and conflicting. The purpose of this study is to assess the impact of digital nerve injury on the range of motion recovery after zone 2 flexor tendon repair. We hypothesized that digital nerve injury is independently associated with decreased motion after zone 2 flexor digitorum profundus (FDP) repair.

Methods

This is a single-institution, multisurgeon retrospective analysis of patients treated with primary zone 2 FDP repair. Patients with or without digital nerve injuries were included. Patients with fracture, extensor tendon injury, dysvascularity, follow-up duration of less than 10 weeks, and younger than 15 years were excluded. The primary outcome measure was Strickland percentage at the last therapy visit. Bivariate analysis was performed using simple linear regression. These results were used to guide backward stepwise multivariable analysis of qualifying exploratory variables.

Results

Forty-one patients with a total of 54 zone 2 FDP injuries qualified. Mean follow-up duration was 24 ± 10 weeks, and mean age was 38 ± 18 years. Thirty-three digits had a concomitant digital nerve injury, 26 digits had multidigit involvement, and 42 digits had combined FDP and flexor digitorum superficialis (FDS) injuries. Both older age and concomitant FDS injury exhibited independent relationships with poorer range of motion outcomes ( P < .05). Digital nerve injury, follow-up duration, gender, and multidigit involvement did not influence final digital motion.

Conclusions

In patients undergoing zone 2 FDP repair, concomitant digital nerve injury is not independently associated with poorer postoperative active range of motion.
Multilevel feature fusion dilated convolutional network for semantic segmentation
Authors: Ku Tao , Yang Qirui , Zhang Hao
Published: April 2021

Recently, convolutional neural network (CNN) has led to significant improvement in the field of computer vision, especially the improvement of the accuracy and speed of semantic segmentation tasks, which greatly improved robot scene perception. In this article, we propose a multilevel feature fusion dilated convolution network (Refine-DeepLab). By improving the space pyramid pooling structure, we propose a multiscale hybrid dilated convolution module, which captures the rich context information and effectively alleviates the contradiction between the receptive field size and the dilated convolution operation. At the same time, the high-level semantic information and low-level semantic information obtained through multi-level and multi-scale feature extraction can effectively improve the capture of global information and improve the performance of large-scale target segmentation. The encoder–decoder gradually recovers spatial information while capturing high-level semantic information, resulting in sharper object boundaries. Extensive experiments verify the effectiveness of our proposed Refine-DeepLab model, evaluate our approaches thoroughly on the PASCAL VOC 2012 data set without MS COCO data set pretraining, and achieve a state-of-art result of 81.73% mean interaction-over-union in the validate set.
Systemic gene expression profiles according to pain types in individuals with chronic spinal cord injury
Authors: Morrison Debra , Arcese Anthony A , Parrish Janay , Gibbs Katie , Beaufort Andrew , Herman Paige , Stein Adam B , Bloom Ona
Published: April 2021

Pain affects most individuals with traumatic spinal cord injury (SCI). Major pain types after SCI are neuropathic or nociceptive, often experienced concurrently. Pain after SCI may be refractory to treatments and negatively affects quality of life. Previously, we analyzed whole blood gene expression in individuals with chronic SCI compared to able-bodied (AB) individuals. Most participants with SCI reported pain (N = 19/28). Here, we examined gene expression of participants with SCI by pain status. Compared to AB, participants with SCI with pain had 468 differentially expressed (DE) genes; participants without pain had 564 DE genes (FDR < 0.05). Among DE genes distinct to participants with SCI with pain, Gene Ontology Biological Process (GOBP) analysis showed upregulated genes were enriched in categories related to T cell activation or inflammation; downregulated genes were enriched in categories related to protein proteolysis and catabolism. Although most participants with pain reported multiple pain types concurrently, we performed a preliminary comparison of gene expression by worst pain problem type. Compared to AB, participants with SCI who ranked neuropathic (N = 9) as worst had one distinct DE gene (TMEM156); participants who ranked nociceptive (N = 10) as worst had 61 distinct DE genes (FDR < 0.05). In the nociceptive group, the GOBP category with the lowest P-value identified among upregulated genes was “positive regulation of T cell activation”; among downregulated genes it was “receptor tyrosine kinase binding”. An exploratory comparison of pain groups by principal components analysis also showed that the nociceptive group was enriched in T-cell related genes. A correlation analysis identified genes significantly correlated with pain intensity in the neuropathic or nociceptive groups (N = 145, 65, respectively, Pearson’s correlation r > 0.8). While this pilot study highlights challenges of identifying gene expression profiles that correlate with specific types of pain in individuals with SCI, it suggests that T-cell signaling should be further investigated in this context.
Approximation of noisy data using multivariate splines and finite element methods
Authors: Lamichhane Bishnu P , Harris Elizabeth , Le Gia Quoc Thong
Published: April 2021

We compare a recently proposed multivariate spline based on mixed partial derivatives with two other standard splines for the scattered data smoothing problem. The splines are defined as the minimiser of a penalised least squares functional. The penalties are based on partial differential operators, and are integrated using the finite element method. We compare three methods to two problems: to remove the mixture of Gaussian and impulsive noise from an image, and to recover a continuous function from a set of noisy observations.
Risk strategy analysis for an online rental problem of durable equipment with a transaction cost
Authors: Xin Chunlin , Zhang Jianwen , Wang Ziping
Published: April 2021

This study introduces the second-hand market into the famous ski-rental model, presents an online rental problem of durable equipment with a transaction cost, and designs an optimal deterministic competitive strategy. The traditional competitive analysis is based on the worst-case scenario; hence, its results are too conservative. Even though investors want to manage and control their risks in reality, in some cases, they are willing to undertake higher risk to obtain greater benefits. Considering this situation, this study designs a risk strategy combining the decision makers’ risk tolerance with certain and probabilistic forecasts. Numerical analysis shows that the proposed risk strategy can improve the competitive ratio. This study introduces the idea of risk compensation into traditional competitive analysis and designs strategies for online rental of durable equipment based on forecast. The decision maker selects a strategy according to risk tolerance and forecast. If the forecast is correct, then a reward is obtained; otherwise, the risk is guaranteed to be within the decision maker’s risk tolerance. The optimal restricted ratio, that is, the competitive ratio of a risk strategy, is less than the optimal competitive ratio of a deterministic strategy. Therefore, the performance of the proposed risk strategy is better than a deterministic strategy. At the same time, the risk strategy based on the probabilistic forecast represents an extension of the strategy based on a certain forecast. In other words, the risk strategy based on a certain forecast is a special case of the risk strategy based on the probabilistic forecast.
Acute liver failure following paracetamol overdose
Authors: Arshad Mohammed Asif , Bangash Mansoor Nawaz
Published: April 2021

Background

Acute liver failure is a rare syndrome comprising a coagulopathy of liver origin, jaundice and encephalopathy in a patient with no prior history of liver disease. Paracetamol overdose is the leading cause of acute liver failure in the United Kingdom and often presents with extrahepatic organ dysfunction requiring critical care. Presentation: We present the case of a patient with hyper acute liver failure secondary to paracetamol overdose. Management and discussion: Management focused on ensuring the correct diagnosis had been made, administering N-acetyl cysteine, fluid resuscitation and broad spectrum antimicrobials. Early intubation and transfer to a transplant centre were undertaken following development of hepatic encephalopathy. Neuroprotective measures and hypertonic saline were instituted to reduce the risk of intracranial hypertension. High dose haemofiltration was also started to help reduce ammonia levels. Aggressive critical care therapies with specialised input results in good outcomes for patients admitted with paracetamol induced hyper acute liver failure. Liver transplant is reserved for those patients unlikely to survive with medical treatment alone.
Abdominal wall hernias
Authors: Rance Caroline , Jones Alun
Published: April 2021

An abdominal wall hernia is the abnormal protrusion of an intra-abdominal viscus, or part of a viscus, through a defect in the muscular and fascial layers of the abdominal wall. A prompt and thorough assessment must be carried out in order to differentiate hernias, particularly those containing bowel, from other causes of abdominal swelling. Abdominal wall hernias are one of the commonest types of hernia that a GP will encounter in their daily practice. This article discusses the diagnosis, differential diagnosis and management of commonly presenting abdominal wall hernias.
Potentially inappropriate proton-pump inhibitor prescription in the general population: a claims-based retrospective time trend analysis
Authors: Muheim Leander , Signorell Andri , Markun Stefan , Chmiel Corinne , Neuner-Jehle Stefan , Blozik Eva , Ursprung Pascale , Rosemann Thomas , Senn Oliver
Published: April 2021

Background:

Proton-pump inhibitors (PPI) are among the most prescribed drugs worldwide, and a large body of evidence raises concerns about their inappropriate use. Previous estimates of inappropriate use varied due to different definitions and study populations.

Aims:

We aimed to measure the population-based incidence and time trends of PPI and potentially inappropriate PPI prescriptions (PIPPI) with a novel method, continuously assessing excessive cumulative doses based on clinical practice guidelines. We also assessed association of patient characteristics with PPI prescriptions and PIPPI.

Methods:

This was an observational study based on a large insurance claims database of persons aged >18 years with continuous claims records of ⩾12 months. The observation period was January 2012 to December 2017. We assessed the incidence and time trends of PPI prescriptions and PIPPI based on doses prescribed, defining ⩾11.5 g of pantoprazole dose equivalents during any consecutive 365 days (average daily dose >31 mg) as inappropriate.

Results:

Among 1,726,491 eligible persons, the annual incidence of PPI prescriptions increased from 19.7% (2012) to 23.0% (2017), ( p = <0.001), and the incidence of PIPPI increased from 4.8% (2013) to 6.4% (2017), ( p = <0.001). Age, male gender, drugs with bleeding risk and multimorbidity were independent determinants of PIPPI ( p = <0.001 for all).

Conclusions:

This study provides evidence that one of the most prescribed drug groups is commonly prescribed inappropriately in the general population and that this trend is increasing. Multimorbidity and drugs with bleeding risks were strong determinants of PIPPI. Addressing PPI prescriptions exceeding guideline recommendations could reduce polypharmacy and improve patient safety.
On Western strategy towards Russia: From ‘Putin first’ to ‘democracy first’
Authors: Kubilius Andrius
Published: April 2021

The article analyses two distinct approaches that Western leaders have taken to relations with Putin’s Russia. It argues that the dominant approach of fostering good relations with Vladimir Putin, prioritising these over support for longer-term democratic change in Russia, has not brought any results and is damaging the interests of Russian society, neighbouring countries and the West. The article analyses the prerequisites for deep change in Russia and argues that there is a need for the EU to comprehensively review and change its strategy towards Russia, putting democracy at its core. It discusses in detail the deterrence, containment and transformation elements of a new EU strategy. The article emphasises that the strategic approach of ‘democracy first’ in relations with Russia also relates to the future of democracy in general and should be a priority of EU–US cooperation.
In Vitro and In Vivo Effects of Light Therapy on Cartilage Regeneration for Knee Osteoarthritis: A Systematic Review
Authors: Oliveira Sofia , Andrade Renato , Hinckel Betina B. , Silva Filipe , Espregueira-Mendes João , Carvalho Óscar , Leal Ana
Published: April 2021

Objective

To analyze the effects of light therapy (LT) on cartilage repair for knee osteoarthritis (OA) treatment.

Design

The PubMed, Embase, Scopus, and Web of Science databases were searched up to August 31, 2020 to identify in vitro and in vivo studies that analyzed the effects of LT on knee cartilage for OA treatment. The study and sample characteristics, LT intervention parameters and posttreatment outcomes were analyzed. Risk of bias was assessed using the Risk of Bias Assessment for Non-randomized Studies (RoBANS) tool.

Results

Three in vitro and 30 in vivo studies were included. Most studies were judged as high risk of performance and detection bias. Biochemical outcomes were analyzed for both i n vitro and in vivo studies, and histological and behavioral outcomes were analyzed for in vivo studies. LT reduced extracellular matrix (ECM) degradation, inflammation, and OA progression, promoting ECM synthesis. LT improved pain-like behavior in animal models, having no apparent effect on gait performance. There were conflicting findings of some of the biochemical, histological, and behavioral outcomes.

Conclusion

The included studies presented different strategies and LT parameters. LT resulted in positive effects on cartilage repair and may be an adequate therapy for OA treatment.
Subacute Thyroiditis and Heart Failure in a Patient Presenting With COVID-19
Authors: Mathews Sherin Elsa , Castellanos-Diaz Jessica , Srihari Ashok , Kadiyala Sushma , Leey-Casella Julio , Ghayee Hans K. , Ogunsakin Amie
Published: April 2021

A 67-year-old male was admitted with shortness of breath and diarrhea. His COVID-19 polymerase chain reaction test was positive, and he was found to be in acute heart failure. Troponin levels were elevated, echocardiogram showed ejection fraction of 24%, and his electrocardiogram was normal. Inflammatory markers were elevated. Further testing revealed suppressed thyroid-stimulating hormone and elevated free thyroxine (T4). Differential diagnosis at this point included possible myocarditis from the viral illness, exacerbation of heart failure from the viral infection or from thyrotoxicosis was considered. Patient’s heart failure improved with initiation of heart failure therapies; however, biochemically, his thyroid function tests (TFTs) did not improve, despite empiric methimazole. Thyroid antibody tests were unremarkable. Thyroid ultrasound showed mildly enlarged thyroid gland with no increased vascularity and 5-mm bilateral cysts. Thyroid dysfunction was attributed to subacute thyroiditis from COVID-19, methimazole was tapered, and prednisone was initiated. The patient’s TFTs improved. With the ongoing COVID-19 pandemic, it is imperative that clinicians keep a broad differential in individuals presenting with heart failure, and obtaining baseline TFTs may be reasonable. Rapid treatment of the underlying thyroiditis is important in these patients to improve the cardiovascular outcomes. In our experience, steroid therapy showed a rapid improvement in the TFTs.
Long-term trends of black carbon and particle number concentration in the lower free troposphere in Central Europe
Authors: Sun Jia , Hermann Markus , Yuan Ye , Birmili Wolfram , Collaud Coen Martine , Weinhold Kay , Madueño Leizel , Poulain Laurent , Tuch Thomas , Ries Ludwig , Sohmer Ralf , Couret Cedric , Frank Gabriele , Brem Benjamin Tobias , Gysel-Beer Martin , Ma Nan , Wiedensohler Alfred
Published: April 2021

Background

The implementation of emission mitigation policies in Europe over the last two decades has generally improved the air quality, which resulted in lower aerosol particle mass, particle number, and black carbon mass concentration. However, little is known whether the decreasing particle concentrations at a lower-altitude level can be observed in the free troposphere (FT), an important layer of the atmosphere, where aerosol particles have a longer lifetime and may affect climate dynamics. In this study, we used data from two high-Alpine observatories, Zugspitze-Schneefernerhaus (ZSF) and Jungfraujoch (JFJ), to assess the long-term trends on size-resolved particle number concentrations (PNCs) and equivalent black carbon (eBC) mass concentration separated for undisturbed lower FT conditions and under the influence of air from the planetary boundary layer (PBL) from 2009 to 2018.

Results

The FT and PBL-influenced conditions were segregated for both sites. We found that the FT conditions in cold months were more prevalent than in warm months, while the measured aerosol parameters showed different seasonal patterns for the FT and PBL-influenced conditions. The pollutants in the PBL-influenced condition have a higher chance to be transported to high-altitudes due to the mountainous topography, leading to a higher concentration and more distinct seasonal variation, and vice versa. The long-term trends of the measured aerosol parameters were evaluated and the decreased aerosol concentrations were observed for both FT and PBL-influenced conditions. The observed decreasing trends in eBC concentration in the PBL-influenced condition are well consistent with the reported trends in total BC emission in Germany and Switzerland. The decreased concentrations in the FT condition suggest that the background aerosol concentration in the lower FT over Central Europe has correspondingly decreased. The change of back trajectories in the FT condition at ZSF and JFJ was further evaluated to investigate the other possible drivers for the decreasing trends.

Conclusions

The background aerosol concentration in the lower FT over Central Europe has significantly decreased during 2009–2018. The implementation of emission mitigation policies is the most decisive factor and the decrease of the regional airmass occurrence over Central Europe also has contributed to the decreasing trends.
Increase of blood-brain barrier leakage is related to cognitive decline in vascular mild cognitive impairment
Authors: Li Man , Li Yue , Zuo Long , Hu Wenli , Jiang Tao
Published: April 2021

Background

Blood-brain barrier (BBB) breakdown, as an early biomarker for vascular mild cognitive impairment (vMCI), has only been validated by a few studies. The aim of this study was to investigate whether compromised BBB integrity is involved in vMCI patients, and detect the relationship between BBB breakdown and cognitive function. BBB leakage in vMCI was explored, and the relationship between BBB leakage and cognitive function was discussed in this study.

Methods

This is a cross-sectional study involving 26 vMCI patients and 21 sex- and age-matched healthy controls. Dynamic contrast-enhanced-magnetic resonance imaging was performed for all participants, to determine BBB leakage. Leakage volume, leakage rate, and fractional blood plasma volume (Vp) in the grey and white matter were evaluated. Neuropsychological tests were used to determine cognitive function. Leakage rate, leakage volume, and Vp in different brain locations, including deep grey matter, cortical grey matter, white matter hyperintensity, and normal-appearing white matter were compared between the two groups.

Results

Multivariable linear regression analyses revealed that in all regions of interest, the leakage rate was significantly higher in vMCI patients relative to controls. Leakage volume in normal-appearing white matter and white matter hyperintensity were significantly higher, while Vp in normal-appearing white matter, deep grey matter, and cortical grey matter were significantly lower in vMCI patients. Moreover, Montreal Cognitive Assessment scores decreased with the increase of leakage rate in white matter hyperintensity.

Conclusion

Increased BBB permeability was detected in vMCI patients and was related to cognitive decline, which suggested that BBB breakdown might be involved in cognitive dysfunction pathogenesis.