bluuebunny/crossref_metadata_2025 huggingface dataset:
Exoskeleton robots for lower limb assistance: A review of materials, actuation, and manufacturing methods
Authors: Hussain Fahad , Goecke Roland , Mohammadian Masoud
Published: July 2021

The field of robot-assisted physical rehabilitation and robotics technology for providing support to the elderly population is rapidly evolving. Lower limb robot aided rehabilitation and assistive technology have been a focus for the engineering community during the last three decades as several robotic lower limb exoskeletons have been proposed in the literature as well as some being commercially available. Numerous manufacturing techniques and materials have been developed for lower limb exoskeletons during the last two decades, resulting in the design of a variety of robot exoskeletons for gait assistance for elderly and disabled people. One of the most important aspects of developing exoskeletons is the selection of the most appropriate proper material. The material selection strongly influences the overall weight and performance of the exoskeleton robot. The most suitable fabrication method for material is also an important parameter for the development of lower limb robot exoskeletons. In addition to the materials and manufacturing methods, the actuation method plays a vital role in the development of these robot exoskeletons. Even though various materials, manufacturing methods and actuators are reported in the literature for these lower limb robot exoskeletons, there are still avenues of improvement in these three domains. In this review, we have examined various lower limb robotic exoskeletons, concentrating on the three main aspects of material, manufacturing, and actuation. We have focused on the advantages and drawbacks of various materials and manufacturing practices as well as actuation methods. A discussion on future directions of research is provided for the engineering community covering the material, manufacturing and actuation methods.
Constraint-following servo control for an underactuated mobile robot under hard constraints
Authors: Fu Duo , Huang Jin , Shangguan Wen-Bin , Yin Hui
Published: July 2021

This article formulates the control problem of underactuated mobile robot as servo constraint-following, and develops a novel constraint-following servo control approach for underactuated mobile robot under both servo soft and hard constraints. Servo soft constraints are expressed as equalities, which may be holonomic or non-holonomic. Servo hard constraints are expressed as inequalities. It is required that the underactuated mobile robot motion eventually converges to servo soft constraints, and satisfies servo hard constraints at all times. Diffeomorphism is employed to incorporate hard constraints into soft constraints, yielding new soft constraints to relax hard constraints. By this, we design a constraint-following servo control based on the new servo soft constraints, which drives the system to strictly follow the original servo soft and hard constraints. The effectiveness of the proposed approach is proved by rigorous proof and simulations.
Set-membership state estimators based on cooperative output injections
Authors: Meslem Nacim
Published: July 2021

To estimate validated bounds on the actual state vector of uncertain non-linear systems, cooperative output injections methods are proposed in this contribution. The aim of the output injections is to design set-membership state estimators that ensure the order-preserving property between the lower, actual and upper state trajectories. Based on a special sensors placement, continuous-time and event-triggered output injections are proposed to cope with the conservatism of the classical bounding system methods. Furthermore, based on some properties of monotone dynamical systems, the convergence of the proposed set-membership state estimators is shown. It is worth pointing out that the proposed set-membership state estimation method allows one: on one hand, to avoid the conservatism related to the use of similarity transformations usually required in the framework of interval observer design approaches, and on the other hand, to circumvent the pessimism accumulation related to the wrapping effect of set-valued iterative numerical schemes.
The landscape of systemic lupus erythematosus in Brazil: An expert panel review and recommendations
Authors: Klumb Evandro Mendes , Scheinberg Morton , Souza Viviane Angelina de , Xavier Ricardo Machado , Azevedo Valderilio Feijo , McElwee Elizabeth , Restrepo Mariana Rico , Monticielo Odirlei André
Published: July 2021

Purpose

The objective of this review is to address the barriers limiting access to diagnosis and treatment of systemic lupus erythematosus (SLE) and lupus nephritis (LN) in Brazil, specifically for patients in the public healthcare system, arguably those with the least access to innovation.

Design

A selected panel of Brazilian experts in SLE/LN were provided with a series of relevant questions to address in a multi-day conference. During the conference, responses were discussed and edited by the entire group through numerous drafts and rounds of discussion until a consensus was achieved.

Results

The authors propose specific and realistic recommendations for implementing access to innovative diagnostic tools and treatment alternatives for SLE/LN in Brazil. Moreover, in creating these recommendations, the authors strived to address barriers and impediments for technology adoption. The multidisciplinary care required for SLE/LN necessitates the collective participation of all involved stakeholders.

Conclusion

A great need exists to expand the adoption of innovative diagnostic tools and treatments for SLE/LN not only in Brazil but also in most countries, as access issues remain an urgent demand. The recommendations presented in this article can serve as a strategy for new technology adoption in other countries in a similar situation.
The necessity defence and anthropogenic global warming protests: The times they are a-changin’
Authors: Brogan Michael
Published: July 2021

The Extinction Rebellion protests of 2019 and 2020 resulted in peaceful protesters being charged for a range of minor, non-violent criminal offences. The defence to those charges is necessity, a defence tightly restricted in its use by the courts. This article argues that in the specific context of minor criminal offences committed during anthropogenic global warming (AGW) protests, necessity must be reconceptualised. This is particularly so given the growing international recognition of that defence in AGW protest matters, the increasing state prohibition on protest and the unique manner in which AGW protests subvert the strict application of the rule of law.
A Contemporary Clinicopathologic Analysis of Primary Urothelial Carcinoma of the Urethra Without Concurrent Renal Pelvic, Ureteral, or Bladder Carcinoma
Authors: Chen Fengming , Joshi Shreyas , Carthon Bradley C. , Osunkoya Adeboye O.
Published: July 2021

Primary urothelial carcinoma (UCa) of the urethra is relatively uncommon, and the underlying pathogenesis has not been well characterized, especially in the absence of concurrent UCa at other sites. A search for cases of primary UCa of the urethra was conducted. Patients with concurrent UCa of the renal pelvis, ureter, or bladder at the time of diagnosis of the primary tumor were excluded. Clinicopathologic and follow-up data were obtained. A total of 35 cases from 30 patients (27 male and 3 female) were included in the study. The mean patient age at the initial diagnosis was 71 years (range: 41-90 years). Cases were composed of high-grade UCa (26 of 35 = 74%), low-grade UCa (4 of 35 = 11%), and UCa in situ (5 of 35 = 14%). Invasion was present in 14 of 26 (54%) cases of high-grade UCa. Interestingly, 23 of 30 (77%) patients had a previous history of UCa including 7 (30%) cases with divergent differentiation or variant histology. Follow-up data were available in 23 patients with a mean duration of 26.7 months (range: 0.6-87 months). Eleven patients (31%) died of metastatic UCa. This is one of the largest studies to date of primary UCa of the urethra without concurrent UCa of the renal pelvis, ureter, or bladder. Previous history of UCa of the bladder, especially with divergent differentiation or variant histology is conceivably a key risk factor for developing subsequent primary UCa of the urethra. These findings are important for the development of surveillance protocols and therapeutic strategies.
How Can Implementation of a Large-Scale Patient Safety Program Strengthen Hospital Safety Culture? Lessons From a Qualitative Study of National Patient Safety Program Implementation in Two Public Hospitals in Brazil
Authors: Caldas Bárbara do Nascimento , Portela Margareth Crisóstomo , Singer Sara Jean , Aveling Emma-Louise
Published: July 2021

Large-scale (e.g., national) programs could strengthen safety culture, which is foundational to patient safety, yet we know little about how to optimize this potential. In 2013, Brazil’s Ministry of Health launched the National Patient Safety Program, involving hospital-level safety teams and targeted safety protocols. We conducted in-depth qualitative case studies of National Patient Safety Program implementation in two hospitals, with different readiness, to understand how program implementation affected enabling, enacting, and elaborating processes that produce and sustain safety culture. For both hospitals, external mandates were insufficient for enabling hospital-level action. Internal enabling failures (e.g., little safety-relevant senior leadership) hindered enactment (e.g., safety teams unable to institute plans). Limited enactment and weak elaboration processes (e.g., bureaucratic monitoring) failed to institutionalize protocol use and undermined safety culture. Optimizing the safety culture impact of large-scale programs requires effective multi-level enabling and capitalizing on the productive potential of interacting national- and local-level influences.
A possible interaction between favipiravir and methotrexate: Drug-induced hepatotoxicity in a patient with osteosarcoma
Authors: Demir Emre , Sütcüoğlu Osman , Demir Beril , Ünsal Oktay , Yazıcı Ozan
Published: July 2021

Introduction

Favipiravir is an antiviral agent that is recently used for SARS-CoV2 infection. The drug-drug interactions of favipiravir especially with chemotherapeutic agents in a patient with malignancy are not well known.

Case report

The patient diagnosed with metastatic osteosarcoma was given high dose methotrexate treatment, and favipiravir was started on the third day of the treatment with suspicion of SARS-CoV2 infection. Grade 3 hepatotoxicity developed after favipiravir. Management & outcome: The acute viral hepatitis panel and autoimmune liver disease panel were negative. The ultrasound of the abdomen was unremarkable for any hepatobiliary pathology. The all viral and hepatobiliary possible etiological factors were ruled out. The patient’s liver enzymes increased just after (12 hours later) the initiation of favipiravir, and we diagnosed toxic hepatitis caused by favipiravir-methotrexate interaction. Therefore, methylprednisolone 1 mg/kg dose was started for a presumed diagnosis of toxic hepatitis. Hepatotoxicity completely regressed after favipiravir was discontinued.

Discussion

Favipiravir may inhibit methotrexate elimination by inhibiting aldehyde oxidase and its sequential use may cause hepatotoxicity in this case. The clinicians should keep in mind possible drug interactions while using new antiviral agents against SARS-CoV2 like favipiravir.
Feline cystadenomatosis affecting the ears and skin of 57 cats (2011–2019)
Authors: Loft Klaus E , Soohoo Julie , Simon Brooke , Lange Christian E
Published: July 2021

Objectives

This study aimed to understand epidemiological factors associated with feline cystadenomatosis, including signalment and papillomavirus PCR status. Cystadenomatosis is an uncommon condition primarily involving the ceruminous and apocrine skin and ear glands.

Methods

This was a retrospective case series. Clinical records from 2011 to 2019 from a tertiary referral hospital in Boston, MA, USA were screened for cases, and case data were re-evaluated and analyzed. The total patient pool contained 65,385 individual cats, of which 797 were referred to the dermatology service. Medical records and biopsy specimens were reviewed; the information collected included signalment, clinical signs, physical examination and diagnostic tests, comorbidities and histopathologic findings. PCR was performed on biopsy specimens to test for papillomavirus DNA.

Results

The cystadenomatosis population consisted of 57 cases (7.1% of total cases referred to the dermatology service) with 105 affected ears. Twenty-seven cases (48 ears) were confirmed via histopathology; four cats (7%) exhibited clinically cystic lesions on the periocular, periorbital and perianal regions; only one cat did not have pinnal lesions. Domestic shorthair cats were most often affected. Relative risk for cystadenomatosis was 2.24 times higher in male cats. In 48 cats (84.2%), ears were bilaterally affected. Seven cats (12.3%) had malignant neoplasia, which included: inflamed adenocarcinoma (n = 5); mast cell tumor (n = 1); or squamous cell carcinoma (n = 1). PCR testing on biopsy specimens from 24 cats revealed feline papillomavirus type 2 DNA in only four cats.

Conclusions and relevance

Cystadenomatosis was more prevalent in senior non-purebred cats, over-represented in male cats and did not appear to be associated with papillomavirus, feline infectious peritonitis, feline immunodeficiency virus/feline leukemia virus status or other identifiable illnesses. Further studies are needed to investigate the causes of cystadenomatosis.
Changes in Invasiveness and Latent Infection Rate Associated with Switching the Approach in Total Hip Replacement
Authors: Kijima Hiroaki , Tateda Kenji , Yamada Shin , Nagoya Satoshi , Fujii Masashi , Kosukegawa Ima , Kawano Tetsuya , Miyakoshi Naohisa , Yamashita Toshihiko , Shimada Yoichi
Published: July 2021

Purpose:

Muscle-sparing approaches for total hip replacement (THR) involve learning curves. This study aimed to clarify changes in invasiveness and infection rate with changes in approach.

Methods:

One surgeon changed the approach of THR from Dall’s approach (Dall) to anterolateral modified Watson-Jones approach (OCM). Another changed from Dall to a direct anterior approach (DAA). Another 3 surgeons changed from posterolateral approach (PL) to OCM. Subjects were 150 cases, comprising the last 25 cases with conventional approaches and the first 25 cases with new approaches (Dall to OCM: 25 + 25; Dall to DAA: 25 + 25; PL to OCM: 25 + 25 cases). Differences in operative time, bleeding volume, hospital stay, haemoglobin (Hb), white blood cell count, lymphocyte count, creatine kinase (CK) and C-reactive protein (CRP) were investigated.

Results:

In the change from Dall to OCM, only hospital stay decreased. In the change from Dall to DAA, hospital stay and CRP decreased, but bleeding volume increased. In the change from PL to OCM, operative time, CRP and CK decreased, but Hb also decreased. Cases with lymphocyte count <1000/μL or lymphocytes comprising <10% of total white blood cells at around day 4 after surgery were defined as latent infection cases. In these cases, operative time was longer, Hb was lower and CK was higher.

Conclusion:

Introducing muscle-sparing approaches improved many markers of invasiveness, but some items deteriorated. In the early stages of introducing a new approach, choosing cases without obesity and without high muscle volume may reduce the risk of infection.
Performance of textured spherical thrust hybrid bearing operating with shear thinning and piezoviscous lubricants
Authors: Agrawal Nitin , Sharma Satish C
Published: July 2021

Improving the lubricating performance of tribo-pairs using engineering textured surfaces has been the main focus of tribology research in recent years. The use of a suitably designed micro-texture on the bearing surface may have a beneficial effect on the performance of fluid film bearings. In the present paper, a mathematical model of a hybrid spherical thrust bearing is developed considering the effect of shear thinning and piezoviscous behaviour of a lubricant. The modified Reynolds equation for a hybrid spherical thrust bearing configuration together with a restrictor flow equation for a capillary restrictor is solved using a finite-element method. In this work, the effect of various micro-textures shapes (spherical, circular, conical and square) and non-Newtonian lubricant behaviour having shear thinning and piezoviscous effects are analysed. The numerically simulated result shows a strong dependence on the combined effect of shear thinning and piezoviscous lubricant behaviour and a chosen geometric shape of a texture. The frictional power loss is seen to reduce nearly by 24.05%, and the stiffness gets enhanced by 11.08%.
Processes of Multiprofessional Child Protection Decision Making in Hospital Settings: Systematic Narrative Review
Authors: Alfandari Ravit , Taylor Brian J.
Published: July 2021

The aim of this systematic narrative literature review is to explore empirical evidence as to how a multiprofessional approach to child protection decision making is implemented in hospitals settings. Child protection cases where there is a suspicious serious injury suspected sexual abuse or serious neglect are often investigated in hospital, involving a number of relevant professions. Five electronic bibliographic databases were used for the search. To be included in the review studies had to be published in a peer-reviewed journal, report on empirical research, be available full text in English, and have used an identifiable research design. The search was restricted to 10 years, from January 1, 2010, to December 31, 2019, and retrieved 6,934 studies. The review includes 26 studies undertaken in 10 countries. In all the hospital-based settings studied, child protection decision-making tasks were assigned to a designated multiprofessional team. However, there was remarkable diversity in models of team structure, regulation of workflow, structured procedures, and standardized tools through which practice was carried out. Research focused on evaluating the teams’ effectiveness in fulfilling their duties which were, first and foremost, the identification of possible child maltreatment. The analysis identifies various systemic approaches and quality improvement methods to promote effective team-based decision-making processes in hospitals. The interactional aspect of collaborative team-based practice was generally missing from the published research. This article discusses next steps for the development of practice, policy, and research to enhance useful multiprofessional child protection team working in hospitals.
LINC00942 Promotes Tumor Proliferation and Metastasis in Lung Adenocarcinoma via FZD1 Upregulation
Authors: Wang Ronghua , Wang Xiuyun , Zhang Jingtao , Liu Yanpei
Published: July 2021

Background:

Long non-coding RNAs (lncRNAs) have been reported to play important roles in the progression of human cancers. Herein, bioinformatic analysis identified that LINC00942 was a highly overexpressed lncRNA in lung adenocarcinoma (LUAD). The present study aimed to explore the roles and possible molecular mechanisms of LINC00942 in LUAD.

Methods:

First, on the basis of TCGA database, the expression and prognosis of LINC00942 were analyzed in LUAD tissues. Then, si-LINC00942 was transfected into A549 and H1299 cells to knockdown the expression of LINC00942. Cell viability was detected by MTT assay. Flow cytometry was used to analyze cell apoptosis. The expressions of PCNA, Bax, Bcl-2, and wnt/β-catenin pathway proteins were detected by western blotting. Dual-luciferase reporter assay was used to evaluate the regulatory relationship between LINC00942 and miR-5006-5p, or miR-5006-5p and FZD1.

Results:

We discovered that LINC00942 was up-regulated in LUAD tissues compared with adjacent tissues. Besides, we found the increased LINC00942 expression was associated with poor survival. In addition, silencing of LINC00942 suppressed the proliferation, migration, invasion and facilitated the apoptosis of A549 and H1299 cells. Moreover, silencing of LINC00942 repressed the expression of PCNA, Bcl-2, and enhanced Bax expression in A549 and H1299 cells. Mechanically, LINC00942 exerted its effects via enhancing Wnt signaling. LINC00942 functioned as competing endogenous RNA (ceRNA) by binding to miR-5006-5p, upregulating the expression of FZD1, which was a direct target of miR-5006-5p.

Conclusion:

Our findings indicated that LINC00942/miR-5006-5p/FZD1 axis played important roles in LUAD growth through enhancing Wnt signaling. LINC00942/miR-5006-5p/FZD1 axis might serve as a potential biomarker and therapeutic target for LUAD treatment.
Secretory phospholipase A2 in SARS-CoV-2 infection and multisystem inflammatory syndrome in children (MIS-C)
Authors: Kuypers Frans A , Rostad Christina A , Anderson Evan J , Chahroudi Ann , Jaggi Preeti , Wrammert Jens , Mantus Grace , Basu Rajit , Harris Frank , Hanberry Bradley , Camacho-Gonzalez Andres , Manoranjithan Shaminy , Vos Miriam , Brown Lou Ann , Morris Claudia R
Published: July 2021

Secretory phospholipase 2 (sPLA2) acts as a mediator between proximal and distal events of the inflammatory cascade. Its role in SARS-CoV-2 infection is unknown, but could contribute to COVID-19 inflammasome activation and cellular damage. We present the first report of plasma sPLA2 levels in adults and children with COVID-19 compared with controls. Currently asymptomatic adults with a history of recent COVID-19 infection (≥4 weeks before) identified by SARS-CoV-2 IgG antibodies had sPLA2 levels similar to those who were seronegative (9 ± 6 vs.17 ± 28 ng/mL, P = 0.26). In contrast, children hospitalized with severe COVID-19 had significantly elevated sPLA2 compared with those with mild or asymptomatic SARS-CoV-2 infection (269 ± 137 vs. 2 ± 3 ng/mL, P = 0.01). Among children hospitalized with multisystem inflammatory syndrome in children (MIS-C), all had severe disease requiring pediatric intensive care unit (PICU) admission. sPLA2 levels were significantly higher in those with acute illness <10 days versus convalescent disease ≥10 days (540 ± 510 vs. 2 ± 1, P = 0.04). Thus, sPLA2 levels correlated with COVID-19 severity and acute MIS-C in children, implicating a role in inflammasome activation and disease pathogenesis. sPLA2 may be a useful biomarker to stratify risk and guide patient management for children with acute COVID-19 and MIS-C. Therapeutic compounds targeting sPLA2 and inflammasome activation warrant consideration.
The biobehavioral impacts of sexual violence: Findings from an acute repeat survivor of vaginal rape
Authors: Anderson Katherine M , Ghosh Mimi , Karris Maile Y , Capozzi Eleanor , Granger Douglas A , Stockman Jamila K
Published: July 2021

Background:

Individuals who have experienced repeat sexual violence victimization face adverse mental and physical health outcomes, including immune and stress response functioning. We aim to further understand repeat sexual violence victimization to develop responsive and appropriate treatment for survivors of sexual violence.

Methods:

We present the immunological and contextual findings of a participant ( N = 1) who experienced repeat sexual violence victimization during her enrollment in The THRIVE Study, a prospective case–control study of women aged 14–45 years, who have experienced recent consensual vaginal penetration (“controls”) or forced vaginal penetration (“cases”). Participants complete a survey, HIV/sexually transmitted infection, and pregnancy testing, blood sampling for C-reactive protein and adrenocorticotrophic hormone, collection of cervicovaginal fluid for immunological biomarkers, and self-collection of saliva samples for cortisol measurements, across study visits (Baseline, 1, and 3 months).

Results:

The case study participant, aged 18 years upon enrollment, experienced sexual trauma before four of five study visits. Trends in the mental health indicators demonstrate reciprocal fluctuations in adverse mental health and resilience in accordance with revictimization and circumstantial changes. Suppressed immune biomarkers appear to correlate with increased adverse mental health, while mental health recovery trends with immunological recovery. The participant presents with dysregulated hypothalamic–pituitary–adrenal axis diurnal profile.

Conclusions:

This profile illustrates the intra-individual biobehavioral impact of experience with revictimization over the course of 6 months, capturing experiences that are rarely studied either longitudinally or with the depth of the current research. The findings underscore the value of monitoring cervicovaginal immune functioning and hypothalamic–pituitary–adrenal axis dysregulation in coordination with changes in mental health over the course of repeated sexual trauma.
NH4I-mediated sp3 C-H cross-dehydrogenative coupling of benzylamines with 2-methylquinoline for the synthesis of E-2-styrylquinolines
Authors: Li Xue , Huang Bin , Wang JiangWei , Zhang YuanYuan , Liao WeiBo
Published: July 2021

Without any metal catalyst, a simple and efficient method for the synthesis of E-2-styrylquinolines through sp3 C-H cross-dehydrogenative coupling of benzylamines with 2-methylquinolines mediated by NH4I under air is successfully developed. The oxidative olefination proceeded through deamination and sp3 C–H bond activation. A plausible mechanism is proposed for the construction of E-2-styrylquinolines.
Effects of 4-week small-sided games vs. high-intensity interval training with changes of direction in female collegiate basketball players
Authors: Zeng Jinshu , Xu Jing , Xu Yuanhong , Zhou Wu , Xu Fei
Published: July 2021

The aim of the study was to investigate the effects of 4-week small-sided games (SSG) and high-intensity interval training with changes of direction (HIT-COD) on physical performance and specific technical skills in female collegiate basketball players.

Nineteen players were divided into SSG (n = 9) and HIT-COD (n = 10) groups, that performed either SSG or HIT-COD three times per week for 4 weeks during the pre-season. Players’ heart rate (HR) and perceived exertion responses (RPE) were assessed during the intervention. Before and after the intervention period, performances were assessed with 30-15 intermittent fitness test (30-15IFT), repeated sprint ability (RSA) test, modified agility T-test (MAT), countermovement jump (CMJ), 20-m sprint, shooting accuracy test, 1 min shooting test, passing test, defensive movement test and control dribble test.

Both training interventions led to similar physiological and perceived exertion responses, showing no significant differences in HR ( P = .49, d = 0.2) and RPE ( P = .77, d = 0.1) between groups. Significant improvements were observed in 30-15IFT (SSG: 4.1%, d = 1.5; HIT-COD: 4.2%, d = 1.7), RSAmean (SSG: −2.2%, d = 1.0; HIT-COD: −1.9%, d = 1.0), RSAbest (SSG: −2.0%, d = 0.9; HIT-COD: −2.1%, d = 1.1), MAT (SSG: −7.2%, d = 1.7; HIT-COD: 5.7%, d = 1.5), defensive movement test (SSG: −5.1%, d = 2.1; HIT-COD: −5.8%, d = 1.8) and control dribble test (SSG: −3.4%, d = 1.0; HIT-COD: −2.6%, d = 1.0). The only significant group × time interaction was found ( P = .032, [Formula: see text] = 0.24), with SSG improving 1 min shooting (22.4%, d = 1.0) and HIT-COD performing slightly worse (−2.6%, d = 0.1) after a 4-week intervention.

The current study suggests that using SSG is more effective than HIT-COD for female collegiate basketball players in pre-season, since SSG improves physical performance and basketball-specific movements as well as shooting abilities after a 4-week intervention.
Underweight and obesity are strong predictors of clinical outcomes in patients with ankylosing spondylitis: data from the Smart-phone SpondyloArthritis Management System
Authors: Hu Lidong , Ji Xiaojian , Wang Yiwen , Man Siliang , Liu Xingkang , Wang Lei , Zhu Jian , Cheng Jidong , Huang Feng
Published: July 2021

Background:

The aim of this study was to examine the impact of underweight, overweight and obesity on clinical outcomes and treatment responses to biologics in Chinese patients with ankylosing spondylitis (AS).

Methods:

Body mass index (BMI) was available in 1074 patients from the Smart-phone SpondyloArthritis Management System. Patients were categorized into four groups based on BMI: underweight, normal weight, overweight and obesity. Multivariable median regression analyses examined the effect of underweight and obesity on clinical outcomes and treatment response to biologics.

Results:

Among 1074 patients with AS, normal weight accounted for 49.1%, while underweight, overweight, and obesity for 8.1%, 30.1%, and 12.0%, respectively. Compared to patients with normal weight, patients with underweight, overweight and obesity had an increased disease activity, while patients with underweight and obesity had a significantly poor Bath Ankylosing Spondylitis Functional Index and Assessment of Spondyloarthritis International Society Health Index scores. For tumor necrosis factor (TNF)-α inhibitor users, BMI was found to be negatively correlated with changes in disease activity in the multivariate regression model (all p < 0.05). Besides, the patients using TNF-α inhibitor in the overweight or obesity categories were much less likely to achieve a significant reduction on disease activity during follow-up period in the multivariate regression model (all p < 0.05), taking these with normal-weight patients as a reference.

Conclusions:

Both underweight and obesity except for overweight were associated independently with worse disease activity, physical function and health status. Overweight and obesity might impact on treatment responses to biologics in patients with AS. This argues that weight management, to maintain it at a normal level, should be one of the disease management strategies in patients with AS.
Satisfaction and Performance of the International Faculty: To What Extent Emotional Reactions and Conflict Matter?
Authors: Ghasemy Majid , Muhammad Farhah , Jamali Jamshid , Roldán José Luis
Published: July 2021

Guided by affective events theory (AET), our inquiry aims at examining the relationships among affective work events, affective states, affect-driven behaviors, and attitudes of international faculty working in the Malaysian institutions of higher learning. Specifically, the impacts of interpersonal conflict, as a work event, on international faculty’s affective states were in focus. In addition, the mediating role of job performance, as an affect-driven behavior, on the relationship between affective states and job satisfaction, as an attitude, was examined. Data were collected from 152 respondents and partial least squares structural equation modeling (PLS-SEM) was applied to estimate the proposed theoretical model. Our model was examined from an explanatory-predictive perspective and exhibited a high level of out-of-sample predictive power. In addition, the results of the analysis highlighted the role of interpersonal conflict in causing affective states and affective states in causing job satisfaction. However, empirical evidence was not provided for the mediating role of job performance within the proposed model. Finally, given the fluctuating nature of the affective states, a robustness check verified the nonlinear relationship between positive affect and job performance. Implications of the findings, limitations, and recommendations were elaborated.
What Are the Salient and Memorable Green-Restaurant Attributes? Capturing Customer Perceptions From User-Generated Content
Authors: Park Eunhye , Kwon Junehee , Chae Bongsug (Kevin) , Kim Sung-Bum
Published: July 2021

This study aims to survey user-generated content (UGC) from diners in certified green restaurants, discover the green images they recall, and demonstrate the usefulness of applying a probabilistic topic model to comprehend customers’ perceptions. Postvisit online reviews ( N = 28,098), in the form of unstructured texts from the TripAdvisor.com website, were used to find freely recalled green-restaurant images. These data were preprocessed with a structural topic model (STM) algorithm to select 51 relevant categories of images. These image categories were compared with the findings of previous studies to discover unique restaurant attributes. Furthermore, a topic-level network and a green-restaurant network were drawn to discover the most easily recallable image categories and their attributes. This machine-learning-based approach improved the reproducibility of unstructured data analyses, overcoming the subjectivity of qualitative data analysis. Theoretical and practical implications are offered for topic modeling methodology along with marketing strategies for restaurateurs.
IJCE relaunch: Setting course for an era of global, open and online education to promote inclusiveness, address grand challenges, break boundaries, and spur innovation
Authors: Shi Jinghuan , Coates Hamish
Published: July 2021

Imaginative and robust education research has an enormous role to play in helping promote inclusiveness, address grand challenges, break boundaries and spur innovation. The International Journal of Chinese Education (IJCE) has been renovated, rejuvenated and relaunched to set course for an era of global, open and online education. We review the pressing need for high-quality education research, IJCE's relaunch, characteristics and future directions, review recent papers, and explore options for engaging with IJCE.
Calcitonin Gene-Related Peptide Influences Bone-Tendon Interface Healing Through Osteogenesis: Investigation in a Rabbit Partial Patellectomy Model
Authors: Chen Huabin , Lu Hongbin , Huang Jianjun , Wang Zhanwen , Chen Yang , Zhang Tao
Published: July 2021

Background:

Calcitonin gene-related peptide (CGRP), which has been shown to play an important role in osteogenesis during fracture repair, is also widely distributed throughout the tendon and ligament. Few studies have focused on the role of CGRP in repair of the bone-tendon interface (BTI).

Purpose:

To explore the effect of CGRP expression on BTI healing in a rabbit partial patellectomy model.

Study Design:

Controlled laboratory study.

Methods:

A total of 60 mature rabbits were subjected to a partial patellectomy and then randomly assigned to CGRP, CGRP-antagonist, and control groups. In the CGRP-antagonist group, the CGRP receptor antagonist BIBN4096BS was administered to block CGRP receptors. The patella–patellar tendon complex was harvested at 8 and 16 weeks postoperatively and subjected to radiographic, microlaser Raman spectroscopy, histologic, and biomechanical evaluation.

Results:

Radiographic data showed that local CGRP expression improved the growth parameters of newly formed bone, including area and volumetric bone mineral density ( P < .05 for both). Raman spectroscopy revealed that the relative bone mineral composition increased in the CGRP group compared with in the control group and the CGRP-antagonist group ( P < .05 for both). Histologic testing revealed that the CGRP group demonstrated better integration, characterized by well-developed trabecular bone expansion from the residual patella and marrow cavity formation, at the 8- and 16-week time points. Mechanical testing demonstrated that the failure load, ultimate strength, and stiffness in the CGRP group were significantly higher than those in the control group ( P < .05 for all), whereas these parameters in the CGRP-antagonist group were significantly lower compared with those in the control group at 16 weeks after surgery ( P < .05 for all).

Conclusion:

Increasing the local concentration of CGRP in the early stages of BTI healing enhanced osteogenesis in a rabbit partial patellectomy model and promoted healing of the BTI injury, whereas treatment using a CGRP antagonist had the opposite effect. However, exogenous CGRP expression did not induce novel bone remolding.

Clinical Relevance:

CGRP may have potential as a new therapy for BTI injuries or may be added to postoperative regimens to facilitate healing.
The Development of Empathy and Associated Factors during Medical Education: A Longitudinal Study
Authors: Kötter Thomas , Kiehn Leevke , Obst Katrin Ulrike , Voltmer Edgar
Published: July 2021

Purpose:

In this longitudinal study, we investigated the development of empathy during medical education and assessed potential predictors of empathy at different time points in the course of medical studies.

Methods:

In our longitudinal study, starting in 2011, we surveyed medical students at Lübeck Medical School, Germany at the beginning of their course of study and after 2, 4, and 6 years ( t0- t3) using standard instruments for empathy (Jefferson Scale of Empathy, Student Version, JSE-S), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), stress (Perceived Medical School Stress scale), and behavior and experience patterns (Arbeitsbezogene Verhaltens- und Erlebensmuster [Work-related Behavior and Experience Patterns]).

Results:

A total of 43 students completed all surveys. The cross-sectional samples for the different survey time points comprised between n = 220 and 658 students. We observed a slight, but statistically significant, increase of empathy scores from t0 to t3 ( t(43) = −3.09, P < .01). Across all analyses, a preference for a people-oriented specialty was associated with a higher JSE-S sum score, as well as being female, whereas we saw a negative association between HADS depression and JSE-S scores.

Conclusion:

In our study, empathy scores were shown to be relatively stable during medical education with a tendency to increase. In line with previous research, individuals preferring a people-oriented specialty and women showed higher empathy scores.
The search for hard-rock kappa (κ) in NGA-East: A semi-automated method for large, challenging datasets in stable continental regions
Authors: Ktenidou Olga-Joan , Abrahamson Norman A , Silva Walter J , Darragh Robert B , Kishida Tadahiro
Published: July 2021

This article describes the work undertaken within the Next Generation Attenuation (NGA)-East project with the aim of estimating κ0 (the site-specific component of the high-frequency decay parameter, κ) for rock sites in Central and Eastern North America (CENA), using the project’s shallow crustal dataset. We introduce a methodology to address the numerous challenges in CENA: a large dataset in a low-seismicity stable continental region, with poor magnitude and distance coverage, undesirable recording sensor characteristics (low sampling rates leading to poor high-frequency resolution), high uncertainty in the regional stress drop, and lack of site-specific velocity characterization. We use two band-limited κ estimation approaches, the acceleration and displacement spectrum (AS and DS), applied above and below the source corner frequency ( fc), respectively. For band-limited approaches, the key requirement is an estimate of fc, which—apart from the event magnitude readily available in the flatfile—also heavily depends on the highly uncertain stress drop. By considering lower and upper bounds on regional stress drop, we propose a new method to quickly and automatically screen such very large datasets to identify all possible recordings for which band-limited κ approaches can be used. Combining them produces better-quantify estimates of κ and its epistemic uncertainties for this challenging dataset. The mean κ0 values combining the two methods are 13 ± 23 ms for horizontal ground motion.
Effective diagnosis by real-time PCR of herpes simplex diffuse endotheliitis that is similar in appearance to fungal keratitis: case series
Authors: Todokoro Daisuke , Hosogai Mayumi , Nakano Satoko , Akiyama Hideo
Published: July 2021

Purpose

Herpes simplex diffuse endotheliitis with accompanying feathery infiltration is difficult to diagnose due to corneal findings that are similar to fungal keratitis. This case series reports on the effectiveness of using real-time polymerase chain reaction (PCR) to diagnose herpes simplex diffuse endotheliitis that is similar in appearance to fungal keratitis.

Methods

After extracting corneal smear sample DNA, samples were then applied to two independent PCR assays, a qualitative multiplex 24-pathogen strip PCR assay, and a quantitative real-time PCR assay of herpes simplex virus type 1 (HSV-1).

Results

All 3 cases showed ciliary injection, feathery infiltration in the corneal stroma and hypopyon, which are corneal findings similar to that observed for fungal keratitis. Retrocorneal plaques, which showed clear boundaries between the corneal endothelial surfaces and retrocorneal plaques in anterior segment optical coherence tomography, were observed in 2 out of 3 cases. Corneal scraping was performed in all cases, followed by initiation of antifungal treatment. However, real-time PCR of the corneal scraping detected 6.0 × 106, 1.0 × 105 and 5.0 × 105 copies/μg glyceraldehyde 3-phosphate dehydrogenase (GAPDH) of HSV-1 DNA per each microgram of the samples. Fungi were not cultured in any of the cases. After switching the medication from antifungal to antiviral, the feathery corneal infiltration was cured with only mild scarring.

Conclusions

Real-time PCR was an effective tool in diagnosing HSV diffuse endotheliitis with feathery infiltration. Topical corticosteroids in conjunction with oral and topical antivirals were an effective treatment.
Survey design and analysis considerations when utilizing misclassified sampling strata
Authors: Mitani Aya A. , Mercaldo Nathaniel D. , Haneuse Sebastien , Schildcrout Jonathan S.
Published: July 2021

Background

A large multi-center survey was conducted to understand patients’ perspectives on biobank study participation with particular focus on racial and ethnic minorities. In order to enrich the study sample with racial and ethnic minorities, disproportionate stratified sampling was implemented with strata defined by electronic health records (EHR) that are known to be inaccurate. We investigate the effect of sampling strata misclassification in complex survey design.

Methods

Under non-differential and differential misclassification in the sampling strata, we compare the validity and precision of three simple and common analysis approaches for settings in which the primary exposure is used to define the sampling strata. We also compare the precision gains/losses observed from using a disproportionate stratified sampling scheme compared to using a simple random sample under varying degrees of strata misclassification.

Results

Disproportionate stratified sampling can result in more efficient parameter estimates of the rare subgroups (race/ethnic minorities) in the sampling strata compared to simple random sampling. When sampling strata misclassification is non-differential with respect to the outcome, a design-agnostic analysis was preferred over model-based and design-based analyses. All methods yielded unbiased parameter estimates but standard error estimates were lowest from the design-agnostic analysis. However, when misclassification is differential, only the design-based method produced valid parameter estimates of the variables included in the sampling strata.

Conclusions

In complex survey design, when the interest is in making inference on rare subgroups, we recommend implementing disproportionate stratified sampling over simple random sampling even if the sampling strata are misclassified. If the misclassification is non-differential, we recommend a design-agnostic analysis. However, if the misclassification is differential, we recommend using design-based analyses.
Case series of idiopathic intracranial hypertension in three patients with immune-complex glomerulonephritis
Authors: Fischbach Felix , Scholz-Hehn Anne Deborah , Gerloff Christian , Pötter-Nerger Monika
Published: July 2021

Background

Idiopathic intracranial hypertension (IIH) is defined by an increased cerebrospinal fluid pressure in the absence of inflammation, structural obstructions, or mass lesions. Although the underlying pathogenesis of IIH is not fully understood, associations with specific risk factors as obesity, obstruction of cerebral venous sinuses, medications, endocrine or systemic conditions and chronic kidney disease have been described. Immune-complex glomerulonephritis as IgA-nephropathy is a frequent cause of chronic kidney failure, which was reported previously in one IIH patient. To date, there is no knowledge about the variable relation of immune-complex nephritis, kidney function and the course of IIH.

Case presentation

We report three cases (two females) of concurrent diagnosis of IIH and immune-complex glomerulonephritis. All patients presented with typical IIH symptoms of headache and visual disturbances. Two patients had been diagnosed with IgA-nephropathy only few weeks prior to IIH diagnosis. The third patient had been diagnosed earlier with terminal kidney failure due to a cryoglobulin glomerulonephritis.

Conclusion

We propose a possible link between renal deposition of immune-complexes and increased cerebrospinal fluid pressure. Pathophysiological hypotheses and clinical implications are discussed. We recommend clinical awareness and further systematic research to obtain more information on the association of IIH and immune-complex glomerulonephritis.
Violence and depression among pregnant women in Egypt
Authors: Ghoneim Hanan M. , Elprince Mohamed , Ali Tamer Yehia M. , Gharieb Waleed F. , Ahmed Amal A.
Published: July 2021

Background

Depression is a serious mental health disorder that might affect women in the childbearing period. Incidences increase during pregnancy as well as after delivery. Its association with intimate partner violence (defined as physical, sexual, or psychological harm by a current or former partner) has been reported in many countries. Data about this sensitive issue are lacking in Egypt. The aim of the study was to determine the relation between intimate partner violence and depression during pregnancy.

Methods

This was a case control study conducted at the outpatient clinics in Suez Canal University hospital, from January 2019 to March 2020. The study included two groups, the study group included women exposed to violence during the current pregnancy and a control one included women with no history of violence. Both groups were recruited according to the predetermined inclusion criteria (women aged 18-45 years, continuous marital relationship, no history of depression in current or previous pregnancies, and singleton pregnancy). Women were asked to complete the Arabic validated NorVold Domestic Abuse Questionnaire (measuring four types of abuse: emotional, physical, sexual, and violence in the health care system, the last one being excluded). Depression was evaluated using the Arabic validated form of the Edinburgh Postnatal Depression Scale (comprises 10 questions that represent patients’ feelings in the last 7 days). The main outcome measure was to assess the association between intimate partner violence and depression.

Results

We recruited 158 women in each group. Both groups were matched in their demographic characters. Although emotional violence was reported prominently among women exposed to IPV 87.9% (139/158), it was not significantly reported in depressed women (P value 0.084). Physical and sexual violence were significantly reported among depressed women (P value 0.022 and 0.001, respectively). There was a significant difference between women exposed to violence and those who were not exposed to violence in the total depression scores (13.63 ± 5.47 and 10.65 ± 5.44, respectively with a p value < 0.001). Emotional (p value < 0.001) and sexual violence (mild and severe with p value of 0.026 and 0.002 respectively) had significant roles as risk factors for depression during pregnancy in single regression and after control of other confounders.

Conclusion

There was a strong association between intimate partner violence and depression during pregnancy.