bluuebunny/crossref_metadata_2025 huggingface dataset:
“I Didn’t Know People With Disabilities Could Grow Up to Be Adults”: Disability History, Curriculum, and Identity in Special Education
Authors: Mueller Carlyn O.
Published: March 2021

The present qualitative interview study explored disability identity development, a unique aspect of identity, and its relationship to school and special education. Adults with disabilities ( n = 9) reflected on their schooling experiences in special education through a life history interview and semi-structured interview about their schooling experiences. The participants identified a lack of disability representation in curriculum, lack of connections to disability community, and lack of teachers and school community members as important factors to their sense of disconnection from disability identity and distancing themselves from their disability label during school. This study suggests the power and potential of special education to develop disability community and identity in students with disabilities. Implications for future research and practice are discussed.
Gender, Parenting, and The Rise of Remote Work During the Pandemic: Implications for Domestic Inequality in the United States
Authors: Dunatchik Allison , Gerson Kathleen , Glass Jennifer , Jacobs Jerry A. , Stritzel Haley
Published: March 2021

We examine how the shift to remote work altered responsibilities for domestic labor among partnered couples and single parents. The study draws on data from a nationally representative survey of 2,200 US adults, including 478 partnered parents and 151 single parents, in April 2020. The closing of schools and child care centers significantly increased demands on working parents in the United States, and in many circumstances reinforced an unequal domestic division of labor.
Preventive Cardiovascular Care in Patients With HIV Infection in an Outpatient Clinic
Authors: Özdener-Poyraz Ayşe Elif , Vaidean Georgeta
Published: March 2021

Background:

People/patients living with human immunodeficiency virus (PLWH) are at an increased risk for atherosclerotic cardiovascular disease due to normal disease processes, antiretroviral medication adverse effects, and age-related comorbid conditions. Preventive cardiovascular (CV) screenings such as the need for statin, low-dose aspirin, or smoking cessation counseling are not well studied in PLWH.

Objectives:

To investigate whether there are differences in preventive CV care offered to patients with and without human immunodeficiency virus (HIV) infection in 1 outpatient clinic.

Methods:

This retrospective study enrolled 150 consecutive patients if they had at least 4 appointments in 2 years and they did not have a history and they do not have a history of CV events. A randomly selected sample of patients without HIV infection receiving primary care services in the same clinic were used as the control group and were enrolled using the same inclusion criteria.

Results:

More patients met statin criteria and were prescribed it in the HIV-negative arm [(70% vs. 24.67%; p < 0.0001); (89.52% vs. 54.05%; p < 0.0001)]. More patients in the HIV-negative arm met aspirin criteria and were prescribed it [(10.67% vs. 8.16%; p = 0.46); (50% vs. 33.3%; p = 0.33)]. There were more current smokers in the HIV-positive arm and a slightly greater number that received smoking cessation counseling [(38% vs. 11.33%; p < 0.0001); (82.46% vs. 76.47%; p = 0.58)].

Conclusion:

Our results found that PLWH receive less preventive CV care compared to non-HIV-infected patients in the same outpatient clinic. Increased efforts are needed to ensure PLWH are receiving primary preventive CV care they need.
Enhanced thermal conductivity of polyimide composite film filled with hybrid fillers
Authors: Li Ruiyi , Ding Chengcheng , Yu Juan , Wang Xiaodong , Huang Pei
Published: March 2021

In this article, the polyimide (PI) composite films with synergistically improving thermal conductivity were prepared by adding a few graphene nanoplatelets (GNP) and various hexagonal boron nitride (h-BN) contents into the PI matrix. The thermal conductivity of PI composite film with 1 wt% GNP and 30 wt% h-BN content was 1.21 W(m·k)−1, which was higher than that of the PI composite film with 30 wt% h-BN content (0.45 W(m·k)−1), the synergistic efficiency of GNP under various h-BN content (10 wt%, 20 wt%, and 30 wt%) were 1.70, 2.71, and 3.09, respectively. And it was found that the increased h-BN content can suppress the dielectric properties caused by GNP in the matrix. The dielectric permittivity and dielectric loss tangent of 1 wt% GNP/PI composite film were 10.69, 0.661 at 103 Hz, respectively, and that of the 30 wt% h-BN + GNP/PI composite film were 4.29 and 0.1367, respectively. Moreover, the mechanical properties of the PI composite film were suitable for practical applications. And the heat resistance index and the residual rate at 700°C of PI composite film increased to 326.8°C, 74.43%, respectively, and these of PI film were 292.6°C and 59.26%. Thus, it may provide a reference value for applying the filler hybridization/PI film in the electronic packaging materials.
Finite element model updating of a satellite honeycomb sandwich plate in structural dynamics
Authors: Aborehab Ali , Kamel Mohamed , Nemnem Ahmed Farid , Kassem Mohammed
Published: March 2021

The honeycomb sandwich structures have a crucial participation in aerospace industry, especially in the design of satellite structures due to their exceptional mechanical properties. The equivalent finite element modeling of such structures is initially presented through the implementation of modal analysis via the three-layered sandwich theory. Subsequently, the computational results are validated by carrying out an experimental modal testing. In addition, sensitivity analysis based upon design of experiments and parameters correlation, is executed for the sake of selecting the most appropriate design parameters for the optimization problem. Finally, finite element model updating of a honeycomb sandwich plate is thoroughly introduced using three optimization algorithms including genetic algorithms, adaptive-multiple optimization, and response surface method. A good agreement between the previously-mentioned optimization algorithms is obtained. Meanwhile, response surface method and its related design of experiments tool succeed in avoiding such time-consuming process and reduce the involved computational expense with an acceptable accuracy.
Identifying additional risk factors for arterial and venous thrombosis among pediatric antiphospholipid antibodies carriers
Authors: Sloan Elizabeth , Wright Tracey , Zuo Yu
Published: March 2021

Background

Antiphospholipid antibodies (aPL) have been extensively reported in children, but investigations into thrombotic risks associated with aPL positivity in pediatric patients is scarce. Positive aPL are not uncommon in pediatric connective tissue diseases (CTD), but identification and management of these patients is challenging due to lack of validated criteria and a paucity of data. In this study, we identify potential additional risk factors for thrombosis in a unique cohort of pediatric aPL positive carriers.

Methods

Retrospective chart review was performed on 491 pediatric patients with CTD seen in our institution from 2001 to 2019. Patients without persistently moderate to high titer aPL at least 12 weeks apart were excluded. Univariate analysis was performed to evaluate correlation between different risk factors and thrombotic events.

Results

Seventy-one aPL positive children with underlying CTD are included in this cohort. The majority (87%) are female and of Hispanic ethnicity (56%). Mean age of the cohort at the diagnosis of connective tissue disease is 12.7 (SD 2.6) years, and mean age of first positive aPL is 13.3 (SD 2.5) years. Average length of follow-up is 4.3 (SD 2.5) years. Four (5.6%) patients experienced arterial thrombosis, and 11 (15.5%) had venous thrombosis. Fifty-seven (80.3%) patients did not have any thromboembolic events. Among traditional risk factors and signs of endothelial injury, only Raynaud’s phenomena demonstrated significant association with arterial thrombosis (OR = 8.4, 95%CI 1.13–111, P = 0.039), and hypertension or anti-hypertensive use demonstrated significant association with venous thrombosis (OR = 8.387, 95%CI 1.2 – 94, P = 0.02).

Conclusion

Data from our cohort suggest that Raynaud’s phenomenon is a potential predictor of arterial thrombosis while the presence of hypertension or anti-hypertensive medication use is a potential predictor of venous thrombosis in aPL positive pediatric carriers. Further studies investigating pediatric aPL profiles and risk factors for development of thrombosis are needed to help guide clinicians in caring for these challenging patients.
Catastrophic antiphospholipid syndrome presented as ruptured papillary muscle during puerperium in a patient with systemic lupus erythematosus
Authors: Rato Inês Rueff , Barbosa Ana Rita , Afonso David João , Beça Sara
Published: March 2021

Introduction

Catastrophic antiphospholipid syndrome (CAPS) is a rare and serious phenomenon that requires prompt recognition and treatment.

Case Presentation

The authors present the case of a puerperal woman with systemic lupus erythematosus (SLE) admitted to the emergency room with headache, blurred vision, thoracic pain, and purpuric lesions on both ears. Echocardiogram revealed global decrease in left ventricular function while cardiac and inflammatory markers were elevated. Three days after admission she developed cardiogenic shock due to rupture of mitral papillary muscle which required emergent cardiac surgery, with replacement of the mitral valve; treatment with anticoagulation, high-dose glucocorticoids, and intravenous immunoglobulins were initiated. Cardiac and brain MRI revealed signs of ischemic lesions in both organs. Histopathology analysis of the placenta and papillary muscle showed signs of ischemia secondary to microvascular thrombosis. Based on the clinical demonstration of thrombosis in three organs, and the presence of lupus anticoagulant antibodies, a diagnosis of probable CAPS was established.

Conclusion

This case highlights the importance of a high level of suspicion of CAPS, particularly in patients with risk factors, and the value of immediate adequate treatment. Moreover, the rupture of a papillary muscle with histologically consistent signs of antiphospholipid syndrome expands the spectrum of involvement of this disease and should be considered as a rare but life-threatening possibility in patients with myocardial injury.
Improving Justice for American Indian and Rural Victims of Crime Through Community-Engaged Research
Authors: de Heer Brooke A. , Jones Lynn C. , Larsen Bethany , Runge Jennifer , Patton Sarah Young
Published: March 2021

Community-engaged research can be effective in directly improving justice for individuals and communities, and to guide policies and practices. Given the challenges to accessing some populations of interest, such as with rural victims of crime, community-engaged approaches provide a means to support ethical and culturally competent research that can improve justice in a meaningful way. In this article, we discuss a collaborative research partnership between academic researchers and a victim service agency that sought to connect rural victim advocacy with a data-driven research methodology for improved justice delivery in two communities with differing rural dynamics. Researchers and practitioners can benefit from recognizing the unique, yet varied, victimization experiences within rural communities, and an understanding of this variability among rural victims and contexts can inform justice practice. We provide best practice recommendations from both researcher and practitioner perspectives for the successful implementation of a project that serves victims in the community and through policy. Implications for justice-related policy and practice for rural and American Indian crime victims are discussed.
Are All Lockdown Teams Created Equally? Work Characteristics and Team Perceived Virtuality
Authors: Costa Patrícia L. , Handke Lisa , O’Neill Thomas A.
Published: March 2021

Team virtuality has been mostly conceptualized as structural features, such as the percentage of time team members communicate via technology. However, the perception of distance and of information deficits (team perceived virtuality, TPV) may be an indispensable construct to understand virtual teams’ functioning. The lockdowns imposed on most countries due to COVID-19 created virtual teams with high degrees of structural virtuality. With structural virtuality held constant among teams, we explore configurations of work characteristics (autonomy, interdependence, and organizational support) that influence TPV. With a sample of 296 multinational workers, a Latent Profile Analysis identified four distinct profiles of those work characteristics. Those profiles related differently to TPV. Contrary to previous findings, interdependence seems to play an important role in these teams high in structural virtuality when their autonomy is also high, highlighting the pivotal role of frequent interaction among team members, under conditions of high structural virtuality.
Clinical and Descriptive Study of Orofacial Clefts in Colombia: 2069 Patients From Operation Smile Foundation
Authors: Espinosa Alejandro Silva , Martinez Julio Cesar , Molina Yubahhaline , Gordillo María Alejandra Bermúdez , Hernández Daniel Ramos , Rivera Daniela Zárate , Olmos Blanka Pacheco , Ramírez Nathaly , Arias Liliana , Zarate Andres , Diana Marcela Diaz Q. , Collins Andrew , Cepeda Álvaro Mauricio Herrera , Balcazar Ignacio Briceño
Published: March 2021

Objective:

To describe the population of patients with cleft lip and/or palate (CL/P) in terms of cleft phenotypes, gender, age, ethnic group, family history, clinical presentation (syndromic vs nonsyndromic), some environmental and behavioral factors, and some clinical features.

Design:

Descriptive retrospective study.

Setting:

Patients attending the genetics counseling practice in Operation Smile Foundation, Bogotá, Colombia, for over 8 years.

Participants:

No screening was conducted. All patients requiring clinical genetics assessment in Operation Smile Foundation were included in the study.

Results:

Left cleft lip and palate (CLP) and nonsyndromic forms were the most frequent types of malformations in this population. Psychomotor retardation and heart disease were the most frequent comorbidities in these patients. A low proportion of mothers exposed to passive smoking during pregnancy was observed and low birth weight accounted for an important number of cases. Aarskog, velocardiofacial, and orofaciodigital syndromes were the most frequent syndromic forms of CLP in this population.

Conclusions:

In this study, the most frequent type of CL/P was the nonsyndromic complete left CLP. Aarskog, velocardiofacial, and orofaciodigital syndromes were the most frequent syndromic forms of CL/P in this population.
Preserving without conserving: Memoryscopes and historically burdened heritage
Authors: Sutton John
Published: March 2021

Rather than conserving or ignoring historically burdened heritage, RAAAF intervene. Their responses are striking, sometimes dramatic or destructive. Prompted by Rietveld’s discussion of the Luftschloss project, I compare some other places with difficult pasts which engage our embodied and sensory responses, without such active redirection or disruption. Ross Gibson’s concept of a ‘memoryscope’ helps us identify distinct but complementary ways of focussing the forces of the past. Emotions and imaginings are transmitted over time in many forms. The past is not easily washed, blasted or sliced away. By considering other settings and modes of encounter, we can recognise and applaud the novelty of RAAAF’s interventions while urging further attention to the variable dynamics and rhythms of remembering and of sociomaterial residues.
Pemigatinib-induced nail changes – A case report
Authors: Trudeau Nicolle A , Lawton Jessica M , Patel Nirav D
Published: March 2021

Introduction

Pemigatinib is an FGFR inhibitor that is one of few second-line treatment options for cholangiocarcinoma. Nail toxicities were common in the phase 2 study evaluating the safety and efficacy of pemigatinib.

Case report

We describe a 54-year-old female with a history of stage IV cholangiocarcinoma presenting for a follow-up visit after completing Cycle 4 of pemigatinib. The patient had been having significant nail changes to her fingernails and toenails, which has led to her great toenails falling off. Management and outcome: The patient was prescribed betamethasone dipropionate 0.05% cream to help with her nail changes and instructed to continue vinegar and hot water soaks that she had already been doing. It was discussed that if this did not help with her nail changes, treatment may have to be held for 2 weeks to allow her nails to heal.

Discussion

Nail changes are a common side effect with pemigatinib and should be monitored closely for the need for temporary disruption in therapy.
Long-Run Effects in Dynamic Systems: New Tools for Cross-Lagged Panel Models
Authors: Shamsollahi Ali , Zyphur Michael J. , Ozkok Ozlem
Published: March 2021

Cross-lagged panel models (CLPMs) are common, but their applications often focus on “short-run” effects among temporally proximal observations. This addresses questions about how dynamic systems may immediately respond to interventions, but fails to show how systems evolve over longer timeframes. We explore three types of “long-run” effects in dynamic systems that extend recent work on “impulse responses,” which reflect potential long-run effects of one-time interventions. Going beyond these, we first treat evaluations of system (in)stability by testing for “permanent effects,” which are important because in unstable systems even a one-time intervention may have enduring effects. Second, we explore classic econometric long-run effects that show how dynamic systems may respond to interventions that are sustained over time. Third, we treat “accumulated responses” to model how systems may respond to repeated interventions over time. We illustrate tests of each long-run effect in a simulated dataset and we provide all materials online including user-friendly R code that automates estimating, testing, reporting, and plotting all effects (see https://doi.org/10.26188/13506861 ). We conclude by emphasizing the value of aligning specific longitudinal hypotheses with quantitative methods.
Beyond listening: the value of co-research in the co-construction of narratives
Authors: Lyndon Sandra , Edwards Becky
Published: March 2021

In this article, we discuss how co-research – two researchers working together at each stage of the research process – can be used to analyse narratives created from qualitative interviews (drawing on Brown and Gilligan’s Listening Guide). We argue that co-research affords a richness and depth of analysis and propagates multiple, layered interpretations through a process of co-reflection. To illustrate our approach, we present an analysis of two case studies from the ‘From Adversity to University’ project, a longitudinal qualitative study evaluating the effectiveness of a bridging module as a way into higher education for students who have been affected by homelessness in England. We co-reflect on how our participants, our relationship with our participants and our relationship with each other as researchers has changed over time. We conclude that a co-researcher approach to analysing narratives is textually and emotionally enriching, as the co-constructed multiple interpretations transform not just the analysis of the text but also the relationship between researchers and their participants in new and unexpected ways.
Existence theory: Outline for a theory of social behaviour
Authors: Baert Patrick , Morgan Marcus , Ushiyama Rin
Published: March 2021

This article introduces ‘existence theory’ as a new approach to sociological theory and research. Existence theory starts from the assumption that people organise their lives around a limited set of existential milestones. Cultural expectations are such that without the accomplishment of those milestones, individuals may experience their lives as incomplete. Examples of milestones can include the attainment of formal education, a lasting partnership and the creation of a family, but in general the milestones which are important to individuals and their precise articulation will depend on a variety of cultural and structural factors. The achievement of existential milestones often depends on that of other existential milestones, thereby producing what we call an ‘existential ladder’. The article also elaborates on the significance of ‘existential urgency’ in that, due to a variety of factors (some biological, some cultural and structural), there are time limits on when certain existential milestones ought to be achieved by. In contemporary society, we note that individuals seem to have more choice about which milestones are important to them and when they can be achieved, although we emphasise that this flexibility is unevenly distributed. This then provides a steppingstone towards an elaboration of the power dynamics and inequalities underlying both the experience and the achievement of existential milestones. Finally, this paper shows how existence theory helps to reflect on a variety of social phenomena of contemporary significance: populism in politics, forced migration, and the coronavirus pandemic.
Giant Celiac Artery Pseudoaneurysm in a Case of Chronic Pancreatitis: A Rare Case Report With Literature Review
Authors: Chapa Uday Kumar , Dutta Souradeep , Abhinaya Reddy , Jain Ankit , Kalyanasundaram Aravind , Munuswamy Hemachandren , Ramakrishnaiah Vishnu Prasad Nelamangala
Published: March 2021

Pancreatic pseudoaneurysms though uncommon can result in life-threatening spontaneous acute gastrointestinal or intraperitoneal hemorrhage. Celiac artery pseudoaneurysm in a background of chronic pancreatitis is a very rare event. Digital Subtraction Angiography is an important adjunct in the diagnosis and follow-up with the advantage of providing therapeutic options along with giving other details regarding the site, size, and flow characteristics. It has replaced emergency surgical procedures with the added advantage of fewer postoperative complications and lower morbidity and mortality. An urgent surgical intervention remains the only option when such endovascular management fails, not feasible, or is unavailable. Surgical options include proximal arterial ligation or a pancreatic resection, depending on the location of the pseudoaneurysm. We report a case of a 35-year-old gentleman, a known patient of chronic pancreatitis, who presented to our emergency with clinical features of hypovolemic shock and was diagnosed to have celiac artery pseudoaneurysm. Following a failed endovascular coiling, he was successfully managed with operative celiac artery ligation.
Tear strength of a laminated fabric for stratospheric airship under uniaxial and biaxial tests
Authors: Chen Yonglin , Li Shuai , Fu Gongyi
Published: March 2021

Envelopes are main structures of stratospheric airships. They are usually made of laminated fabrics and prone to tearing, so it is significant to study their tear strengths. This paper aims to investigate the tear strength of an envelope for stratospheric airships by uniaxial and biaxial tear tests. Three uniaxial tear specimens and 15 biaxial tear specimens under five different stress ratios (warp stress vs weft stress) were tested, and their tear strengths were measured. Two-dimensional digital speckle correlation method was used to obtain specimens’ strain contours. The test results show that the average tear strength of uniaxial specimens is 32.99 N/mm, over 20% higher than those of biaxial specimens, ranging from 25.50 N/mm to 27.25 N/mm. It reveals that weft stress reduces the tear strength; nevertheless, the stress ratios slightly affect the tear strength. Besides, the strain contours clearly show three zones in each specimen – the low-strain zone, the high-strain zone, and the medium-strain zone. Depending on the strain contours and previous research on imperfect composite materials, we inferred that the crack-tip stress concentration factor of a uniaxial specimen is lower than that of a biaxial specimen. It explains the difference in tear strength between uniaxial and biaxial specimens. These findings suggest using biaxial tear test to measure the tear strength of an SSA’s envelope.
‘I Am That Girl’: Media reportage, anonymous victims and symbolic annihilation in the aftermath of sexual assault
Authors: Oldfield Jessica C , McDonald Dave
Published: March 2021

In the wake of movements such as #MeToo, greater scrutiny has been brought to bear on the everyday nature of sexual violence. This has manifested in a global phenomenon of survivors speaking out publicly across a diverse range of platforms. This article explores one such Australian case that went on to become highly publicised against the backdrop of #MeToo. In May 2013, an 18-year-old woman named Saxon Mullins met 21-year-old Luke Lazarus on the dancefloor of a nightclub in the inner Sydney suburb of Kings Cross. Lazarus claimed he was the part-owner of the club and offered to take her to a VIP area. Instead, he led her to a dark alley and had sexual intercourse with her. Mullins has always described this as non-consensual. In 2018, after a complex legal process comprising two trials, both of which were overturned in response to successful appeals, the New South Wales Court of Appeal ordered against a third trial on the basis that it would be oppressive and unfair to Lazarus. In response, following widespread media interest in the case, Mullins spoke out publicly in 2018 on a national current affairs program, Four Corners. While the sidelining of victims from formal criminal justice processes has been widely documented, we explore how this can also occur in media coverage accompanying a case. Identifying a shift in the status afforded to the victim in the wake of her speaking out publicly, we argue that this raises broad questions about the impact of victim anonymity provisions and highlights how a survivor’s capacity to speak out in the wake of institutional failures is highly contingent. A tension between the tangible value of anonymity, set against the perverse effect of once again silencing victims, is a dilemma that remains unresolved.
Swinging for the Fences Versus Advancing the Runner: Culture, Motivation, and Strategic Decision Making
Authors: Chuang Roxie , Ishii Keiko , Kim Heejung S. , Sherman David K.
Published: March 2021

This research investigated cross-cultural differences in strategic risky decisions in baseball—among professional baseball teams in North America and Japan (Study 1) and among baseball fans in the United States and Japan (Study 2—preregistered). Study 1 analyzed archival data from professional baseball leagues and demonstrated that outcomes reflecting high risk-high payoff strategies were more prevalent in North America, whereas outcomes reflecting low risk-low payoff strategies were more prevalent in Japan. Study 2 investigated fans’ strategic decision making with a wider range of baseball strategies as well as an underlying reason for the difference: approach/avoidance motivational orientation. European American participants preferred high risk-high payoff strategies, Japanese participants preferred low risk-low payoff strategies, and this cultural variation was explained by cultural differences in motivational orientation. Baseball, which exemplifies a domain where strategic decision making has observable consequences, can demonstrate the power of culture through the actions and preferences of players and fans alike.
Supplementation of green coffee bean extract in healthy overweight subjects increases lean mass/fat mass ratio: A randomized, double-blind clinical study
Authors: Sudeep HV , Shyam Prasad K
Published: March 2021

Objective:

In this study, we have demonstrated that supplementation of a complex of chlorogenic acid isomers (CGA-7TM) could significantly mitigate the risk of obesity in healthy overweight subjects.

Method:

In a double-blind, placebo-controlled clinical study, healthy overweight (body mass index ⩾ 25 to <30 kg/m2) male and female subjects ( N = 71) were randomly allocated to receive 500 mg CGA-7 or placebo daily for 12 weeks. Changes in body weight and body mass index were recorded alongside vital signs and anthropometric measurements at week 4, 8 and 12. Body composition was assessed at baseline and the end of treatment using dual-energy X-ray absorptiometry. Safety analysis included serum biochemical and haematological assessments and measurement of vital signs. In addition, any adverse or serious adverse events were recorded during the study.

Results:

Sixty subjects completed the study. Mean body weight and body mass index were significantly reduced in CGA-7 group as compared to placebo ( p < 0.001). CGA-7 group showed significant changes in body fat (%), fat mass and lean mass in comparison with placebo group (1.38% ± 1.4% vs −0.22% ± 0.86%, 1.97 ± 1.44 kg vs −0.39 ± 1.31 kg; 0.81 ± 1.20 kg vs −0.13 ± 0.97 kg, p < 0.001). Consumption of CGA-7 significantly improved the serum lipid profile. Importantly, CGA-7 consumption in humans had no adverse effects and was well tolerated during the study. The blood biochemical and haematological parameters marginally varied in the treatment groups throughout the study.

Conclusion:

To conclude, this study provides scientific validation of the functionality of green coffee bean extract and recommends the safety of the supplementation in healthy individuals.
Hip Fractures Before and During the COVID-19 Pandemic: Comparative Demographics and Outcomes
Authors: Nazemi Alireza K. , Al-Humadi Samer M. , Tantone Ryan , Hays Thomas R. , Bowen Stephen N. , Komatsu David E. , Divaris Nicholas
Published: March 2021

Introduction:

During the height of the COVID-19 pandemic in New York, hip fractures requiring operative management continued to present to Stony Brook University Hospital. Given the novelty of SARS-CoV-2, there is recent interest in the pandemic and its relationship to orthopedic operative outcomes. This retrospective cohort study compared outcomes for operative hip fractures in patients prior to and during the COVID-19 pandemic at a level 1 academic center. Materials and Methods: Data was collected on patients age 18 years or older who underwent operative management for hip fractures performed from January 21, 2019 to July 1, 2019 (pre-pandemic) or from January 21, 2020 to July 1, 2020 (pandemic). COVID-19 status, demographics and outcomes were analyzed.

Results:

Overall, 159 patients with hip fractures were included in this study, 103 in the 2019 group and 56 in the 2020 group. Within the 2019 group, there was a significantly greater proportion of female patients compared to 2020 (p = 0.0128). The length of hospital stay was shorter for the 2020 group by 1.84 days (p = 0.0138). COVID-19 testing was positive in 4 (7.1%) patients in the 2020 group, negative for 22 patients (39.3%), and the remaining 30 patients in the 2020 group (53.7%) were not tested during their admission. There were no other significant differences in demographics or outcomes between the 2019 and 2020 groups.

Discussion:

The COVID-19 pandemic did not significantly alter most aspects of care for hip fracture patients at our institution. Interestingly, postoperative pulmonary outcomes were not affected by the pandemic.

Conclusions:

In this study, a significantly higher proportion of males presented with hip fractures in the pandemic group. In addition, the average length of hospital stay was shorter during the COVID-19 pandemic. Further research is needed to understand the nuances that may lead to improved care for patients with hip fractures during a pandemic.
Predicting Candida Infection in Pediatric Intensive Care Unit using Candida Score in a Low-Resource Setting
Authors: Risandy Dicky Ari , Rusmawatiningtyas Desy , Makrufardi Firdian , Herini Elisabeth Siti , Nurnaningsih
Published: March 2021

Candida infection was previously thought to be rare in intensive care. With the increased use of broad-spectrum antibiotics, the incidence of candida infection increased significantly. Case-control study was done in patients ≤18 years of age treated for 3 days or more in Pediatric Intensive Care Unit (PICU) Dr. Sardjito General Hospital, Yogyakarta from January 2014 to December 2016. Overall, 43 children were included in this study as a case group with positive candida culture and 43 children as a control group with no candida culture. Cut off point of candida score is ≥3 from our subjects. The area under curve (AUC) value for cut off ≥3 was moderate (0,72). Candida score ≥3 has an odd ratio (OR) 6.8 (95% CI 2.4-18.6) with P < .05. All of confounding factors in candida infection have no association with P > .05. Candida score can be used as predictor of candida infection in PICU.
Glass-bottled drinking water: a time capsule to study the historic presence of hazardous chemicals using effect-based methods
Authors: Lundqvist Johan , Persson Kenneth M. , Oskarsson Agneta
Published: March 2021

Background

Contamination of drinking water by hazardous chemicals can be associated with human health risks. Recent studies using effect-based in vitro methods have demonstrated that a large part of the observed toxic effects are caused by unknown chemicals. In this study, we have used a panel of effect-based methods to study the presence of chemical contaminants in a unique material; glass-bottled Swedish tap water collected during the 1990s. These water samples were compared to drinking water from the same source waters and drinking water facilities, yet collected about 25 years later, in 2020.

Results

Samples were concentrated by solid phase extraction and evaluated for the following activities; estrogen receptor activity, androgen receptor activity, antiandrogenic activity, aryl hydrocarbon receptor activity, and oxidative stress response. We observed aryl hydrocarbon receptor activities in almost all studied samples and estrogen receptor activity in three out of ten studied samples. No activities were observed for androgen receptor activity, antiandrogenic activity or oxidative stress response. In general, observed activities were more frequent and higher in the water samples collected during the 1990s as compared to the corresponding samples collected in 2020.

Conclusions

This study demonstrates that it is possible to conduct an effect-based evaluation of the presence of hazardous chemicals in drinking water, with as small starting volume as 330 mL, by using miniaturized bioassays. Further, by comparing the glass-bottled water samples with newly collected water samples from the same drinking water treatment facilities, our results indicate that the presence of aryl hydrocarbon receptor and estrogen receptor activating compounds in the drinking water has decreased over the approximately quarter of a century that is separating the two sampling occasions. This difference could be due to improved raw water quality and/or improved treatment efficiency in the treatment plants.
Glycocalyx components affect platelet function, whole blood coagulation, and fibrinolysis: an in vitro study suggesting a link to trauma-induced coagulopathy
Authors: Britten Martin W. , Lümers Laura , Tominaga Kenji , Peters Jürgen , Dirkmann Daniel
Published: March 2021

Background

The mechanisms of trauma induced coagulopathy (TIC) are considered multifactorial. Amongst others, however, shedding of the endothelial glycocalyx resulting in increased concentrations of glycocalyx fragments in plasma might also play a role. Thus, we hypothesized that shedded glycocalyx components affect coagulation and may act as humoral mediators of TIC.

Methods

To investigate effects of heparan sulfate, chondroitin sulfate, syndecan-1, versican, and thrombomodulin we added these fragments to in vitro assays of whole blood from healthy volunteers to yield concentrations observed in trauma patients. Platelet function, whole blood coagulation, and fibrinolysis were measured by standard coagulation tests, impedance aggregometry (IA), and viscoelastic tests (VET). To assess dose-response relationships, we performed IA with increasing concentrations of versican and VET with increasing concentrations of thrombomodulin.

Results

Intrinsically activated clotting times (i.e., activated partial thromboplastin time and intrinsically activated VET with and without heparinase) were unaffected by any glycocalyx fragment. Thrombomodulin, however, significantly and dose-dependently diminished fibrinolysis as assessed by VET with exogenously added rt-PA, and increased rt-PA-induced lysis Indices after 30 (up to 108% of control, p <  0,0001), 45 (up to 368% of control, p <  0,0001), and 60 min (up to 950% of control, p <  0,0001) in VET. Versican impaired platelet aggregation in response to arachidonic acid (up to − 37,6%, p <  0,0001), ADP (up to − 14,5%, p <  0,0001), and collagen (up to − 31,8%, p <  0,0001) in a dose-dependent manner, but did not affect TRAP-6 induced platelet aggregation. Clotting time in extrinsically activated VET was shortened by heparan sulfate (− 7,2%, p = 0,024), chondroitin sulfate (− 11,6%, p = 0,016), versican (− 13%, p = 0,012%), and when combined (− 7,2%, p = 0,007).

Conclusions

Glycocalyx components exert distinct inhibitory effects on platelet function, coagulation, and fibrinolysis. These data do not support a ‘heparin-like auto-anticoagulation’ by shed glycosaminoglycans but suggest a possible role of versican in trauma-induced thrombocytopathy and of thrombomodulin in trauma-associated impairment of endogenous fibrinolysis.
The association between serum alanine aminotransferase and hypertension: A national based cross-sectional analysis among over 21 million Chinese adults
Authors: Jia Jiajing , Yang Ying , Liu Fangchao , Zhang Minjin , Xu Qin , Guo Tonglei , Wang Long , Peng Zuoqi , He Yuan , Wang Yuanyuan , Zhang Ya , Zhang Hongguang , Shen Haiping , Zhang Yiping , Yan Donghai , Ma Xu , Zhang Puhong
Published: March 2021

Background

Inconsistent results were found in the association between serum alanine aminotransferase (ALT) and hypertension among population-based studies. This study evaluated the association between ALT and hypertension among Chinese reproductive-age population by utilizing registration data from National Free Pre-pregnancy Checkups Project in 2016–2017.

Methods

The 21,103,790 registered participants were eligible for analysis, including women who were 20–49 years old and men who were 20–59 years old with available data for ALT and blood pressure (BP). Logistic regression was conducted to estimate odds ratio (OR) for the association between ALT and hypertension as a binary outcome. Linear regression was used to examine the association between ALT and BP as a continuous outcome.

Results

In total, 4.21% of the participants were hypertensive, and 11.67% had elevated ALT (> 40 U/L). Hypertension prevalence was 3.63% and 8.56% among participants with normal and elevated ALT levels. A strong linear relationship was found between serum ALT levels and the odds of hypertension after adjustment for potential confounders. The multivariable-adjusted ORs for hypertension were 1, 1.22 (1.21, 1.22), 1.67 (1.65 1.68), 1.78 (1.76, 1.80), and 1.92 (1.90, 1.94) in participants with ALT levels of ≤ 20, 20.01–40, 40.01–60, 60.01–80, and > 80 U/L, respectively. Systolic and diastolic BPs rose by 1.83 and 1.20 mmHg on average, for each 20 U/L increase in ALT (P for trend < 0.001). The association was consistent among subgroups and tended to be stronger among populations who are overweight (body mass index ≥ 24 kg/m2) (χ2 = 52,228, P < 0.001), alcohol drinking (χ2 = 100,730, P < 0.001) and cigarette smoking (χ2 = 105,347, P < 0.001).

Conclusions

Our cross-sectional analysis suggested a linear association between serum ALT and hypertension or BP, which indicated that abnormal liver metabolism marked by elevated serum ALT could play a role in hypertension or elevated BP condition.
Predicting the outcome of COVID-19 infection in kidney transplant recipients
Authors: Oto Ozgur Akin , Ozturk Savas , Turgutalp Kenan , Arici Mustafa , Alpay Nadir , Merhametsiz Ozgur , Sipahi Savas , Ogutmen Melike Betul , Yelken Berna , Altiparmak Mehmet Riza , Gorgulu Numan , Tatar Erhan , Ozkan Oktay , Ayar Yavuz , Aydin Zeki , Dheir Hamad , Ozkok Abdullah , Safak Seda , Demir Mehmet Emin , Odabas Ali Riza , Tokgoz Bulent , Tonbul Halil Zeki , Sezer Siren , Ates Kenan , Yildiz Alaattin
Published: March 2021

Background

We aimed to present the demographic characteristics, clinical presentation, and outcomes of our multicenter cohort of adult KTx recipients with COVID-19.

Methods

We conducted a multicenter, retrospective study using data of patients hospitalized for COVID-19 collected from 34 centers in Turkey. Demographic characteristics, clinical findings, laboratory parameters (hemogram, CRP, AST, ALT, LDH, and ferritin) at admission and follow-up, and treatment strategies were reviewed. Predictors of poor clinical outcomes were analyzed. The primary outcomes were in-hospital mortality and the need for ICU admission. The secondary outcome was composite in-hospital mortality and/or ICU admission.

Results

One hundred nine patients (male/female: 63/46, mean age: 48.4 ± 12.4 years) were included in the study. Acute kidney injury (AKI) developed in 46 (42.2%) patients, and 4 (3.7%) of the patients required renal replacement therapy (RRT). A total of 22 (20.2%) patients were admitted in the ICU, and 19 (17.4%) patients required invasive mechanical ventilation. 14 (12.8%) of the patients died. Patients who were admitted in the ICU were significantly older (age over 60 years) (38.1% vs 14.9%, p = 0.016). 23 (21.1%) patients reached to composite outcome and these patients were significantly older (age over 60 years) (39.1% vs. 13.9%; p = 0.004), and had lower serum albumin (3.4 g/dl [2.9–3.8] vs. 3.8 g/dl [3.5–4.1], p = 0.002), higher serum ferritin (679 μg/L [184–2260] vs. 331 μg/L [128–839], p = 0.048), and lower lymphocyte counts (700/μl [460–950] vs. 860 /μl [545–1385], p = 0.018). Multivariable analysis identified presence of ischemic heart disease and initial serum creatinine levels as independent risk factors for mortality, whereas age over 60 years and initial serum creatinine levels were independently associated with ICU admission. On analysis for predicting secondary outcome, age above 60 and initial lymphocyte count were found to be independent variables in multivariable analysis.

Conclusion

Over the age of 60, ischemic heart disease, lymphopenia, poor graft function were independent risk factors for severe COVID-19 in this patient group. Whereas presence of ischemic heart disease and poor graft function were independently associated with mortality.
Epidemiology and outcomes of elderly patients requiring renal replacement therapy in the intensive care unit: an observational study
Authors: Salathé Cécile , Poli Elettra , Altarelli Marco , Bianchi Nathan Axel , Schneider Antoine Guillaume
Published: March 2021

Background

Renal replacement therapy (RRT) in critically ill patients is associated with high morbidity and mortality. The appropriateness of RRT initiation is sometimes questioned in elderly patients. Therefore, we sought to evaluate the long-term mortality, dialysis dependence and quality of life (QOL) of elderly patients who survived critical illness requiring RRT.

Methods

This is a monocentric observational study including all patients > 55 yo who received RRT for acute kidney injury in our intensive care unit (ICU) between January 2015 and April 2018. At the time of the study (May 2019), we assessed if they were still alive by cross referencing our hospital database and the Swiss national death registry. We sent survivors written information and, subsequently, contacted them over the phone. We obtained their consent for participation, asked about their dialytic status and performed an EQ-5D survey with visual analog scale (VAS). Results were stratified according to their age at the time of ICU admission (G1: “55–65 yo”; G2: “> 65–75 yo” and G3: “> 75 yo”). QOL in G3 patients were compared to G1 and G2 and to predicted values.

Results

Among the 352 eligible patients, 171 died during the index hospital admission. After a median follow-up time of 32.7 months (IQR 19.8), a further 62 had died (median time to death for ICU survivors 5.0 (IQR 15.0) months. Hence, 119 (33.6%) patients were still alive at the time of the study. We successfully contacted 96 (80.7%) of them and 83 (69.7%) were included in the study (G1: 24, G2: 44 and G3: 15). Only 6 (7.2%) were RRT dependent. Patients in G3 had lower EQ-5D and VAS scores than those in G1 and G2 (p < 0.01). These scores were also significantly lower than predicted values (p < 0.05).

Conclusions

RRT patients have a very high in-hospital and post discharge mortality. Among survivors, RRT dependency was low. Irrespective of baseline values, patients > 75 yo who survived ICU had a lower QOL than younger patients. It was lower than predicted according to age and sex. The appropriateness of RRT initiation in elderly patients should be discussed according to their pre-existing QOL and frailty.
Long-term safety and tolerability of eptinezumab in patients with chronic migraine: a 2-year, open-label, phase 3 trial
Authors: Kudrow David , Cady Roger K. , Allan Brent , Pederson Susan M. , Hirman Joe , Mehta Lahar R. , Schaeffler Barbara A.
Published: March 2021

Background

Eptinezumab, an anti-calcitonin gene-related peptide monoclonal antibody recently approved in the United States for preventive treatment of migraine in adults, was found to be well tolerated in double-blind, placebo-controlled studies in patients with episodic and chronic migraine. The objective of the PREVAIL study was to evaluate the long-term safety, immunogenicity, and impact on patient-reported outcomes of repeat doses of eptinezumab in patients with chronic migraine.

Methods

PREVAIL was an open-label, phase 3 trial comprising a 48-week treatment phase followed by a second 48-week treatment phase. Adults with chronic migraine received eptinezumab 300 mg by 30-min intravenous administration every 12 weeks for up to 8 doses. Patients were followed for 20 weeks after the final infusion (end-of-study visit at week 104).

Results

Overall, 128 adults (mean age, 41.5 years) with chronic migraine were included. During the 2 years, the most frequently reported treatment-emergent adverse events were nasopharyngitis (14.1%), upper respiratory tract infection (7.8%), sinusitis (7.8%), influenza (6.3%), bronchitis (5.5%), and migraine (5.5%). The rate of study-drug discontinuation due to adverse events was 6.3%, which included 3 patients with infusion-related hypersensitivity. The incidence of anti-eptinezumab antibodies peaked at week 24 and declined despite continued dosing, to nondetectable levels at week 104. Improvements in patient-reported outcomes were observed at first assessment (week 4) and generally sustained through week 104.

Conclusion

In adults with chronic migraine, eptinezumab 300 mg demonstrated a favorable safety profile, limited long-term immunogenicity, early and sustained reductions in migraine-related burden, and improvements in health-related quality of life over 2 years.

Trial registration

ClinicalTrials.gov (Identifier: NCT02985398).