bluuebunny/crossref_metadata_2025 huggingface dataset:
Using machine learning to predict post-operative depth of focus after cataract surgery with implantation of Tecnis Symfony
Authors: Liu Yang , Wei David , Bai Tao , Luo Jie , Wood Jennifer , Vashisht Ashank , Zhang Shumin , Xuan Jianwei , Kattan Michael , Coplan Paul
Published: February 2021

Objective:

To predict post-operative depth of focus (DoF) using machine learning techniques after cataract surgery with Tecnis Symfony implantation and determine associated impact factors.

Methods:

This was a retrospective cohort study among patients receiving Tecnis Symfony implantation, an extended-range-of-vision intraocular lens, during October 2016–January 2020 at Daqing Oilfield General Hospital, China. Four different predictive models were used to predict good post-operative DoF (⩾2.5 D): Extreme Gradient Boost (XGBoost), random forest (RF), LASSO penalized regression, and multivariable logistic regression (MLR). Apriori algorithm was employed to further explore the association between patient attributes and DoF.

Results:

A total of 182 unique cases (143 patients) were included. The XGBoost model produced the best predictive accuracy compared to RF, LASSO, and MLR models. Overall performance of the best fitting XGBoost model was as follows: accuracy = 70.3%, AUC = 80.2%, sensitivity = 65.5%, and specificity = 87.5%. The Apriori algorithm identified six preoparative attributes with substantial effects on good post-operative DoF: low anterior chamber depth (ACD) (1.9 to <2.5 mm), smaller pupil size (1.7 to <2.5 mm), low-to-mid axial length (21 to <23 mm), minimum astigmatism degree (−0.2 to 0 diopter), low IOP (9 to <12 mmHg), and medium lens target refractive error (−0.5 to <−0.25 diopter).

Conclusions:

Machine Learning models were able to predict good post-operative DoF among cataract patients receiving a Tecnis Symfony ocular lens implantation. The accuracy of the model was above 70%. The Apriori algorithm identified six preoperative attributes with a strong association with post-operative DoF.
Evaluation of the effect of topical tacrolimus 0.03% versus cyclosporine 0.05% in the treatment of dry eye secondary to Sjogren syndrome
Authors: Moawad Pavly , Shamma Rehab , Hassanein Dina , Ragab Gaafar , El Zawahry Omar
Published: February 2021

Purpose:

To compare the effect of topical application of tacrolimus 0.03% eyedrops versus cyclosporine 0.05% in Sjogren syndrome subjects with severe dry eyes.

Design:

A prospective single-blinded simply randomized controlled study.

Methodology:

60 Sjogren patients were randomized into Group A: 30 patients were instructed to put tacrolimus 0.03% eyedrops in one eye for 6 months and placebo eyedrops in the other eye, ( N = 30, 44.9 ± 12.58 years). Group B: 30 patients were instructed to put cyclosporine 0.05% eyedrops in one eye for 6 months and placebo eyedrops in the other eye ( N = 30, 49.4 ± 12.92 years). Main outcome measures: Patients were evaluated at day 0, 90, and 180 for Ocular Surface Disease Index Questionnaire (OSDI), frequency of use of artificial tears, average fluorescein tear break up time (TBUT), ocular surface staining scores, Schirmer I test, meibum quality, and expressibility scores.

Results:

Upon comparing both eyedrops, the mean value of OSDI decrease was 38.25 ± 18.29% versus 31.69 ± 18.57% ( p-value 0.09), SICCA score decrease was 2.97 ± 1.92 versus 2.27 ± 2.02 ( p-value 0.124) the decrease in artificial tear substitute use was 3.90 ± 2.22 versus 3.63 ± 1.92 ( p-value 0.616), increase in Schirmer I values were 4.10 ± 4.21 and 4.26 ± 2.00 ( p-value 0.590) in eyes treated with tacrolimus and cyclosporine respectively. Neither of them affected meibum quality or expressibility scores.

Conclusion:

Both tacrolimus and cyclosporine significantly improved patient symptoms, frequency of artificial tears use and ocular surface staining compared to placebo-controlled eyes. However, no significant difference regarding the efficacy of both eyedrops at the end of 6 months treatment of severe dry eyes of Sjögren syndrome patients.

Trial registration:

ClinicalTrials.gov. Identifier: NCT03865888.
Scleral fixation of Carlevale intraocular lens: A new tool in correcting aphakia with no capsular support
Authors: Georgalas Ilias , Spyropoulos Dimitrios , Gotzaridis Stratos , Papakonstantinou Evangelia , Kandarakis Stylianos , Kanakis Menelaos , Karamaounas Aristotelis , Petrou Petros
Published: February 2021

Purpose:

To report the clinical outcomes of the use of a novel specially designed scleral fixated intraocular lens, the Carlevale intraocular lens (carlevale IOL, Soleko, Italy) for the correction of aphakia in the absence of capsular support of variable etiology.

Methods:

This retrospective, non-comparative study included 169 eyes of 169 consecutive patients who underwent 3-port pars plana vitrectomy and scleral fixation on Carlevale IOL. Inclusion criteria were at least 6 months’ follow-up period, patients > 18 years old who underwent vitrectomy and Carlevale IOL placement for aphakia and inadequate capsular support

Results:

The median follow up period of 9 months (range 6–18 months). Mean post-operative BCVA at the last follow-up visit was 20/25 (0.09 ± 0.1 LogMAR), improving from a mean baseline BCVA of 20/80 (0.58 ± 0.49 LogMAR), a statistically significant change ( p = 0.0001). Regarding the post-operative complications, a transient rise in the IOP was observed in 28 patients (16.5%) and mild vitreous hemorrhage was observed in the immediate post-operative period in eight eyes (4.7%) and it spontaneously resolved within 3 weeks. All patients demonstrated good IOL position at the end of the follow-up without IOL capture. None of the patients required re-operation.

Conlcusion:

The present study represents the largest to date in evaluating the use of carlevale IOL in patients with aphakia and inadequate capsular support. The technique is safe and provides excellent post-operative IOL fixation without IOL capture in any of the patients studied.
Analysis of access flow using duplex ultrasonography and the ultrasound dilutional method
Authors: Bae Miju , Jeon Chang Ho , Han Miyeun , Jin Moran , Kim Hyo Jin
Published: February 2021

Background:

This study aimed to evaluate the correlation between duplex ultrasonography (DUS) and ultrasound dilution (UD) measurement’s results and determine the factors affecting the correlation of the measured values among other clinical factors in patients.

Methods:

This cross-sectional study was conducted from April 2020 to May 2020 and included 60 patients who visited our dialysis centre. The flow of the fistula was measured in the proximal brachial artery using DUS. While dialysis was performed on the same day, the access flow was measured using the UD method. The correlation and agreement between the access flows acquired by each measurement method were analysed. Similarly, the correlation was analysed by classifying the groups based on the predisposing factor, and statistically significant factors were observed through comparison.

Results:

Both measurements showed a moderate positive correlation ( r = 0.60, p < 0.01). The bias (mean of UD-DUS) between the two measurements was about 230 mL/min. When the measurement site of DUS was near the inflow artery and in the same anatomical section, a strong correlation with the measurement value of UD was observed (brachial based fistula: r = 0.85, radial based fistula: r = 0.87). Similarly, for patients without diabetes and those who regularly underwent access surveillance for the dialysis route, strong correlations were observed between the two measurements ( r = 0.79 and r = 0.88).

Conclusions:

Several factors can influence the correlation between UD and DUS. The findings showed a high correlation for DUS measurement sites within the same anatomical section as the inflow artery, patients without diabetes, and patients undergoing periodic surveillance.
Characteristics of Diabetic Ageing Patients in Nursing Homes: One Center Experience in Turkey
Authors: Ozturk Mehmet Akif , Gunturk Arzu , Kucukardali Yasar
Published: February 2021

Introduction:

Due to its widespread distribution and effects, type 2 diabetes is a frequently researched topic. However, the amount of information about type 2 diabetes in nursing homes residents is inadequate. The aim of this study is to elucidate on the frequency, treatments, comorbidities, and deaths of nursing home residents diagnosed with type 2 diabetes.

Materials and methods:

Type 2 diabetes was evaluated in 612 people accepted to nursing homes as residents between January 2005 and January 2013. Medical records, prescriptions, laboratory results, and comorbidities were evaluated statistically.

Results:

Approximately 26% (159) patients of the cohort had either preexisting type 2 diabetes during registration to nursing home or was diagnosed with it during the 8-year follow-up. The prevalence of DM was 25% in males and 26% in females. Average age was 75.7 ± 10.6 in diabetics and 76.7 ± 11.6 in non-diabetics. Hemoglobin, creatinine, triglycerides, HDL-cholesterol, and CRP values were not found to be different between the groups. Hypertension was diagnosed in 75% of diabetics versus 59% of non-diabetics, hyperlipidemia in 21% versus 7% ( P < .01); however, atrial fibrillation was more common in non-diabetics ( P = .022). There was no difference for survival rate between diabetic and non-diabetic groups ( P = .743).

Conclusion:

Approximately 1 out of 4 nursing home residents were found to have diabetes, with females being more affected then males. The survival rates both at the diabetic and non-diabetic patients were detected similar. Glucose, total cholesterol, LDL-cholesterol, and blood pressure values which can all impact survival should be closely watched from early on in the disease progress and their values should be optimized.
Management learning and the unsettled humanities: Introduction to the special issue
Authors: Johnsen Rasmus , Skoglund Annika , Statler Matt , Sullivan William M
Published: February 2021

This special issue engages with the unsettling of the humanities to further explore its relevance for management learning and education. It explores how themes traditionally belonging to the humanities have spurred critical inquiry and raised theoretical issues within other disciplines, following the crisis of the classical humanist ideal as ‘the measure of all things’. It focuses on how the tensions resulting from this crisis can be constructively thematized in the field of management and organization studies, and how the unsettling of the humanities’ privileged access to studying the ‘especially human’ can be taken into the classroom. In this manner, the special issue engages with questions related to the Anthropocene, posthumanism and transhumanism, and raises issues concerning the human possibilities for knowing, learning and living in entangled ways. Additionally, it helps us understand the critical role of the humanities in making sense of the reciprocities between imagination, information and the human crafting of meaningful knowledge.
The psychic life of gentrification: mapping desire and resentment in the gentrifying city
Authors: Seitz David K. , Proudfoot Jesse
Published: February 2021

Following the lead of artists and scholars in Black, feminist, psychoanalytic, and queer studies and geographies, this special issue and editorial call for greater scholarly attention to the conscious and unconscious emotional, psychic, and affective dimensions of urban gentrification. While geographical scholarship frequently gestures to gentrification as an affective scene, these connections are generally suggested rather than developed. We argue that psychoanalytic and affect theories have richly developed conceptual and explanatory paradigms that can help scholars make sense of the sometimes granular, mundane ways gentrification is both facilitated and contested. Our aim here is not to displace Marxist political economies of gentrification that support a right to the city, a body of work with political stakes that we also claim. Rather, our goal is to supplement political economy’s rather focused inquiry into gentrification’s ‘proper’ political-economic dimensions, in the hopes of offering further insight into gentrification’s libidinal economies, which are conditioned by racial capitalist social relations but also exceed them.
Handle with Care: Implementation of the List Experiment and Crosswise Model in a Large-scale Survey on Academic Misconduct
Authors: Jerke Julia , Johann David , Rauhut Heiko , Thomas Kathrin , Velicu Antonia
Published: February 2021

This research analyzes the effectiveness of the list experiment and crosswise model in measuring self-plagiarism and data manipulation. Both methods were implemented in a large-scale survey of academics on social norms and academic misconduct. As the results lend little confidence about the effectiveness of the methods, researchers are best advised to avoid them or, at best, to handle them with care.
Learning Laparoscopic Surgery Skills With a 4K Ultra-High Definition 2D vs a Three-Dimensional HD Laparoscopic System: Results From a Prospective Randomized Trial
Authors: Thomaschewski Michael , Jürgens Thorsten , Keck Tobias , Laubert Tilman , Benecke Claudia
Published: February 2021

Background. In minimally invasive surgery (MIS), the loss of stereoscopic depth perception in a two-dimensional (2D) representation is most challenging. Recently introduced 4K ultrahigh definition (UHD) 2D optical systems could potentially facilitate the learning and use of compensation mechanisms for the loss of depth perception. However, the role of the new 4K technology against three dimensional (3D) in learning and implementation of MIS remains unknown. The aim of this trial was to determine the influence of 4K UHD 2D vs 3D HD representation on the acquisition of MIS skills. Methods. This was a prospective randomized study involving 62 MIS-inexperienced study participants. We compared a laparoscopic 4K UHD 2D (system A) vs a laparoscopic 3D HD system (system B) for differences in learning MIS skills using the Lübeck Toolbox (LTB) video box trainer. We evaluated participants’ performance regarding the repetitions required to reach the goal of each LTB task. Results. Comparing systems A and B, participants using the laparoscopic 3D system required fewer repetitions to achieve goals of LTB tasks No. 1 ( P = .0048) and No. 3 ( P = .0014). In contrast, for LTB tasks No. 2 and No. 4, no significant difference could be determined between both groups. Conclusion. Our results indicated that MIS basic skills can be learned quicker using a 3D HD system vs a 4K UHD 2D system. However, for MIS tasks in confined spaces, the learning speed with 4K UHD 2D imaging seems to be comparable to a 3D HD system.
Leading in Times of Crisis
Authors: Brion Corinne
Published: February 2021

In educational organizations, any situation that disrupts the education process and makes it inoperable is defined as a crisis. This teaching case study is relevant to practicing and prospective principals and administrators because it raises issues related to leading in times of crisis. Specifically, this scenario addresses the role school culture plays in lifting teachers’ and students’ morale while also enhancing student learning. This scenario takes place during the COVID-19 pandemic at a time when schools were suddenly mandated to deliver instruction remotely. In this case study, the author provides a framework designed to create intentionally inviting school cultures. Creating inviting school cultures should always be the goal of leaders, but it is even more crucial in times of crisis.
Using the Emanuel Framework to Explore the Ethical Issues Raised in a Participatory Visual Research Project in Rural South Africa
Authors: Treffry-Goatley Astrid , Moletsane Relebohile , de Oliveira Tulio , Seeley Janet , Lessells Richard
Published: February 2021

Participatory visual research can offer critical insight into the experiences of those most affected by health issues. As these methods are increasingly used to research sensitive topics, there is a need for a clear ethical framework to guide best practice on the part of researchers and research ethics committees. Here we reflect on a project where we used digital storytelling as a participatory visual methodology to explore HIV treatment adherence in rural South Africa, with a focus on the ethical issues we encountered during the lifetime of the project. To ground our reflections, we use the framework for ethical research developed by Emanuel et al., and the adaptation of this framework for social science proposed by Wassenaar and Mamotte. We suggest that fellow PVM practitioners and REC members draw on this holistic framework to support the optimal application of PVM in health research.
Radial Nerve Palsy: Nerve Transfer Versus Tendon Transfer to Restore Function
Authors: Patterson J. Megan M. , Russo Stephanie A. , El-Haj Madi , Novak Christine B. , Mackinnon Susan E.
Published: February 2021

Background:

Radial nerve injuries cause profound disability, and a variety of reconstruction options exist. This study aimed to compare outcomes of tendon transfers versus nerve transfers for the management of isolated radial nerve injuries.

Methods:

A retrospective chart review of 30 patients with isolated radial nerve injuries treated with tendon transfers and 16 patients managed with nerve transfers was performed. Fifteen of the 16 patients treated with nerve transfer had concomitant pronator teres to extensor carpi radialis brevis tendon transfer for wrist extension. Preoperative and postoperative strength data, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and quality-of-life (QOL) scores were compared before and after surgery and compared between groups.

Results:

For the nerve transfer group, patients were significantly younger, time from injury to surgery was significantly shorter, and follow-up time was significantly longer. Both groups demonstrated significant improvements in grip and pinch strength after surgery. Postoperative grip strength was significantly higher in the nerve transfer group. Postoperative pinch strength did not differ between groups. Similarly, both groups showed an improvement in DASH and QOL scores after surgery with no significant differences between the 2 groups.

Conclusions:

The nerve transfer group demonstrated greater grip strength, but both groups had improved pain, function, and satisfaction postoperatively. Patients who present early and can tolerate longer time to functional recovery would be optimal candidates for nerve transfers. Both tendon transfers and nerve transfers are good options for patients with radial nerve palsy.
Patient accrual and understanding of informed consent in a two-stage consent design
Authors: Vickers Andrew J , Vertosick Emily A , Carlsson Sigrid V , Ehdaie Behfar , Kim Scott Y H
Published: February 2021

Background:

We previously introduced the concept of “two-stage” (or “just-in-time”) informed consent for randomized trials with usual care control. We argued that conducting consent in two stages—splitting information about research procedures from information about the experimental intervention—would reduce the decisional anxiety, confusion, and information overload commonly associated with informed consent. We implemented two-stage consent in a low-stakes randomized trial of a mindfulness meditation intervention for procedural distress in patients undergoing prostate biopsy. Here, we report accrual rates and patient understanding of the consent process.

Methods:

Patients approached for consent for the biopsy trial were asked to complete the standard “Quality of Informed Consent” questionnaire to assess their knowledge and understanding of the trial.

Results:

Accrual was excellent with 108 of 110 (98%) patients approached for consent signing first-stage consent. All 51 patients randomized to the experimental arm and who later presented for biopsy signed second-stage consent and received the mindfulness intervention. Quality of Informed Consent data were available for 48 patients assigned to the mindfulness treatment arm and 44 controls. The mean Quality of Informed Consent score was similar in the meditation and control arms with and overall mean of 75 (95% confidence interval = 74–76) for the knowledge section and 86 (95% confidence interval = 81–90) for understanding, comparable to the normative scores of 80 and 88. On further analysis and patient interview, two of the Quality of Informed Consent questions were found to be misleading in the context of a two-stage consent study for a mindfulness intervention. Excluding these questions increased knowledge scores to 88 (95% confidence interval = 87–90).

Conclusion:

We found promising data that two-stage consent facilitated accrual without compromising patient understanding of randomized trials or compliance with allocated treatment. Further research is needed incorporating randomized comparison of two-stage consent to standard consent approaches, measuring patient anxiety and distress as an outcome, using suitable modifications to the Quality of Informed Consent questionnaire and trials with higher stakes.
Soft tissue abnormalities in Wassel Type VI radial polydactyly: a detailed anatomical study
Authors: Saito Susumu , Tsuge Itaru , Yamanaka Hiroki , Morimoto Naoki
Published: February 2021

Wassel VI radial polydactyly is associated with metacarpal adduction and radial deviation of the metacarpophalangeal joint of the ulnar duplicate. The soft tissue abnormalities responsible for these deformities were characterized using preoperative multi-planar three-dimensional ultrasound and intraoperative observation in four patients. In all patients, the abductor pollicis brevis and superficial head of the flexor pollicis brevis inserted into the radial first metacarpal, whereas the adductor pollicis and deep head of the flexor pollicis brevis inserted into the ulnar thumb. Aberrant location of the flexor pollicis longus and absence of the A1 pulley system was associated with severe radial deviation. An additional superficial thenar muscle along the ulnar metacarpal was associated with minimal metacarpal adduction. Uneven forces on the ulnar duplicate could be associated with these characteristic deformities and joint instability. Knowledge of these abnormalities allows better planning of surgery and further insight into this rare radial polydactyly configuration.

Level of evidence: II
Description of an integrated e-health monitoring system in a Portuguese higher education institution: the e.cuidHaMUstm program
Authors: Brandão Maria Piedade , Sa-Couto Pedro , Gomes Gonçalo , Beça Pedro
Published: February 2021

Background:

The World Health Organization and the International Labour Organization recognize that workplace health is not only affected by occupational hazards, but is mainly affected by social determinants and individual factors. An accelerated rise in noncommunicable diseases has fostered the importance of creating supportive environments and encouraging healthy behaviours. Therefore, an operational approach to making workplaces healthy and sustainable is needed. This paper describes the development of an e-Health monitoring program entitled ‘Integrated eHealth Monitoring System for Health Management in Universities’ (e.cuidHaMUsTM) as a possible solution to that operational approach.

Methods:

We developed the program e.cuidHaMUsTM that proposes to detect risk behaviours related to noncommunicable diseases and to implement problem-solving measures by establishing a health-promoting workspace in a Portuguese higher education institution. Based on the ‘I-Change’ conceptual model, our program provides personalized feedback; improves health-related knowledge, attitude and good practices; and encourages actions to promote healthy lifestyles through individual health capacitation. Focusing on evaluation as an activity that generates knowledge, the e.cuidHaMUsTM program aggregates all the relevant health information, shares the results with decision-makers and evaluates health-related policy changes in the workplace.

Discussion:

This paper presents the design of the e.cuidHaMUsTM program, the development of an eHealth web platform to share information between the different stakeholders, and a questionnaire to evaluate the health status of higher education institution workers (e.cuidHaMUs.QueST®). Also, the procedures for data collection and analysis are outlined. The e.cuidHaMUsTM program can enhance health surveillance through cross-sectional and longitudinal studies and provide scientific evidence to support the envisioned interventions and promotions of healthy lifestyles. This program is an effort to incorporate a holistic culture of health-promoting workspace in higher education institution policies.
Risk Factors for Plantar Fasciitis in Physically Active Individuals: A Systematic Review and Meta-analysis
Authors: Hamstra-Wright Karrie L. , Huxel Bliven Kellie C. , Bay R. Curtis , Aydemir Burcu
Published: February 2021

Context:

Plantar fasciitis (PF) is a common condition in active individuals. The lack of agreement on PF etiology makes treatment challenging and highlights the importance of understanding risk factors for preventive efforts.

Objective:

The purpose of this systematic review and meta-analysis was to determine what factors may put physically active individuals at risk of developing PF.

Data Sources:

CENTRAL, CINAHL, EMBASE, Gray Lit, LILACS, MEDLINE (PubMed), ProQuest, Scopus, SPORTDiscus, and Web of Science were searched through April 2018 and updated in April 2020.

Study Selection:

Studies were included if they were original research investigating PF risk factors, compared physically active individuals with and without PF, were written in English, and were accessible as full-length, peer-reviewed articles.

Study Design:

Systematic review and meta-analysis.

Level of Evidence:

Level 3, because of inconsistent definitions and blinding used in the included observational studies.

Data Extraction:

Data on sample characteristics, study design and duration, groups, PF diagnosis, and risk factors were extracted. The methodological quality of the studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology statement. When means and standard deviations of a particular risk factor were presented 2 or more times, that risk factor was included in the meta-analysis.

Results:

Sixteen studies were included in the systematic review and 11 risk factors in the meta-analysis. Increased plantarflexion range of motion (weighted mean difference [MD] = 7.04°; 95% CI, 5.88-8.19; P < 0.001), body mass index (MD = 2.13 kg/m2; 95% CI, 1.40-2.86; P < 0.001; I2 = 0.00%), and body mass (MD = 4.52 kg; 95% CI, 0.55-8.49; P = 0.026) were risk factors for PF.

Conclusion:

Interventions focused on addressing a greater degree of plantarflexion range of motion, body mass index, and body mass and their load on the force-absorbing plantar surface structures may be a good starting point in the prevention and treatment of active individuals with PF.
Introducing the autonomous employee category: The chance to create a flexible and secure employment relationship?
Authors: Erikson Merle
Published: February 2021

In 2018, the Estonian Ministry of Social Affairs came up with idea of introducing a new category of employee – the autonomous employee – in Estonia. This concept is based on Article 17(1) of the Working Time Directive, which allows derogations from the scope of the Directive for managing executives or other persons with autonomous decision-taking powers. The implementation of the concept of the autonomous employee has been seen as a panacea that makes the organisation of working time more flexible and the regulation relevant to practical needs. However, according to the case law of the European Court of Justice, the scope of Article 17(1) is very narrow. The article examines the concept of the autonomous employee, the nature and organisation of autonomous work, mainly based on EU law, as well as the Finnish Working Hours Act and amendments to the Estonian Sports Act, both of which entered into force in 2020.
Agricultural automation: A strategic dilemma of a rich Indian farmer
Authors: Srivastava Shashi Kant
Published: February 2021

Mr. Jang Bahadur Singh Bagga, a wealthy farmer based in one of the most prosperous states in India, Punjab, was deep in thought pondering over a problem that was occupying his mind. In the face of the havoc caused by COVID-19, Prime Minister Narendra Modi on 24 March 2020 announced a 3-week unprecedented nation-wide lockdown with just 4-hour notice period. Though Bagga realized that the lockdown was a necessary step to arrest the pandemic, nonetheless he was extremely worried because it was nearly time for him to harvest his wheat crop. His worry turned to panic when the lockdown was extended further for another 15 days, and then another 2 weeks, and gradually to over 2 months. While some of the restrictions had been lifted now, the problem was far from solved as most of the migrant labor that worked in the fields had returned to their villages with no signs of them returning to work soon. With crops standing in his fields, waiting to be harvested, Bagga was faced with a dilemma—should he invest in modern machinery for his agricultural activity or stick to manual labor, as was the common practice in the country? The case is suitable to teach MBA students MS Excel, information technology concepts, and business economics. It is also well-suited for executive education. The case is in the form of a story, enabling course participants to engage in experiential learning through decision-making. The learners are also provided details of the actual process of farming in India as also the necessary data to support decision-making.
Patterns of Admission and Clinical Outcomes Among Patients Admitted to Medical Intensive Care Unit of a Teaching and Referral Hospital, Northwest Ethiopia
Authors: Tesema Hailemariam Getachew , Lema Girmay Fitiwi , Mesfin Nebiyu , Fentie Demeke Yilkal , Arefayne Nurhusen Riskey
Published: February 2021

Background

The intensive care unit (ICU) is a health care delivery service for patients who are in critical condition with potentially recoverable diseases. Patients can benefit from more detailed observation, monitoring and advanced treatment than other wards or department. The care is advancing but in resource-limited settings, it is lagging far behind and mortality is still higher due to various reasons. Therefore, we aimed to determine the admission patterns, clinical outcomes and associated factors among patients admitted medical intensive care unit (MICU).

Methods

A retrospective cross-sectional study was conducted based on a record review of logbook and charts of patients admitted from September, 2015 to April, 2019. Data were entered and analysed using SPSS version 20. Both bivariate and multivariate logistic regression analyses were used and a P-value < 0.05 was considered statistically significant.

Results

A total of 738 patients were admitted to medical intensive care unit (MICU) during September, 2015 - April, 2019. Five hundred and four patients (68%) of all intensive care unit (ICU) admissions had complete data. Out of the 504 patients, 268 (53.2%) patients were females. Cardiovascular disease 182(36.1%) was the commonest categorical admission diagnosis. The overall mortality rate was 38.7%. In the multivariate analysis, mortality was associated with need for mechanical ventilation (AOR = 5.87, 95% CI: 3.24 - 10.65) and abnormal mental status at admission (AOR = 2.8, 95% CI: 1.83-4.29). Patients who had stay less than four days in MICU were 5 times more likely to die than those who has stay longer time (AOR= 5.58, 95% CI: 3.58- 8.69).

Conclusions

The overall mortality was considerably high and cardiovascular diseases were the most common cause of admission in MICU. Need for mechanical ventilator, length of intensive care unit stay and mental status at admission were strongly associated with clinical outcome of patients admitted to medical intensive care unit.
Trans-Tubular Translaminar Microscopic-Assisted Nucleotomy for Lumbar Disc Herniations in the Hidden Zone
Authors: Abdelrahman Hamdan , Seyed-Emadaldin Sadat , Krajnovic Branko , Ezzati Ali , Abdelgawaad Ahmed Shawky
Published: February 2021

Study Design:

A prospective cohort study in a high-flow spine center in Germany.

Objectives:

This study aimed to evaluate clinical outcomes and complications of the trans-tubular translaminar microscopic-assisted percutaneous nucleotomy in cases of cranially migrated lumbar disc herniations (LDH).

Methods:

Between January 2013 and January 2018, 66 consecutive patients with cranio-laterally migrated LDH were operated upon. The following outcome measures were evaluated: (1) Visual Analog Scale (VAS) for leg and back pain; (2) Oswestry Disability Index (ODI) and Macnab´s criteria. All patients were operated upon with trans-tubular Translaminar Microscopic-assisted Percutaneous Nucleotomy (TL-MAPN). Perioperative radiographic and clinical evaluations were reported. The mean follow-up period was 32 months.

Results:

The mean age was 59 years. L4/L5 was the commonest affected level (27 patients). The mean preoperative VAS for leg pain was 6.44 (±2.06), improved to 0,35 (±0.59) postoperatively. Dural injury occurred in 1 patient, treated with dural patch. Improved neurological function was reported in 41/44 Patients (neurological improvement rate of 93%) at the final follow up. There was a significant improvement in the mean ODI values, from 50.19 ± 4.92 preoperatively to 10.14 ± 2.22 postoperatively (P < 0.001). Sixty four out of 66 patients (96%) showed an excellent or good functional outcome according to Macnab´s criteria. No recurrent herniations were observed.

Conclusion:

The translaminar approach is a viable minimal invasive technique for cranially migrated LDH. The preservation of the flavum ligament is one of the main advantages of this technique. It is an effective, safe and reproducible minimally invasive surgical alternative in treatment of cranially migrated LDHs.
Does Instrumentation of the Fractured Level in Thoracolumbar Fixation Affect the Functional and Radiological Outcome?
Authors: Mohammed Riaz , Carrasco Roberto , Verma Rajat , Siddique Irfan , Mohammad Saeed , Elmalky Mahmoud
Published: February 2021

Study Design:

Retrospective comparative study.

Objectives:

To compare radiological and functional outcomes of patients with fixation constructs utilizing pedicle screw stabilization at the fracture level (FL group) versus patients with non-fracture level (NFL group) fixation in single level fractures of the thoracolumbar junction (T11-L1).

Methods:

53 patients of whom fracture level screw was used in 34 (FL group) were compared to 19 patients in NFL group. Radiological parameters analyzed were sagittal index, bi-segmental kyphosis (Cobb) angle and degree of vertebral height restoration. Prospectively collected patient reported functional outcomes and post-operative complications were also studied. Stepwise regression analysis adjusted by age, gender and functional scores was performed to account for the small numbers and unequal sizes of the groups.

Results:

Back pain score was significantly lower in the FL group ( P < 0.025). Core Outcome Measures Index scores and leg pain scores, though low in the FL group, were not statistically significant. The regression analysis showed that the inclusion of the fracture-level screw was independently associated with a greater change in sagittal index and vertebral height restoration post-operatively. Sagittal index was maintained through to final follow up as well. The bi-segmental Cobb’s angle correction was not associated with fracture-level screw construct. There was no significant difference between the groups for revision surgery, deep infection, implant failure or length of hospital stay.

Conclusion:

The inclusion of the fracture-level pedicle screws in the fixation construct significantly improves the immediate and final measured radiological parameters, with improved functional scores in single level unstable vertebral fractures of the thoracolumbar junction.
Toxicity assessment of gold ions and gold nanoparticles to golden perch larvae (Macquaria ambigua)
Authors: Shuster Jeremiah , Rea Maria A.D. , Nidumolu Bhanu , Kumar Anupama
Published: February 2021

Golden perch (Macquaria ambigua) is a freshwater game-fish native to central and southeast Australia. Larvae of this fish species were used in two different types of experiments to evaluate the effects of short-term exposures (up to 6 days) to aqueous gold, 5 nm gold nanoparticles (AuNPs), or 50 nm AuNPs. Relative to the control, increased gold concentrations corresponded with yolk-sac edema (swelling). Larvae exposed to 50 μM of 5 nm AuNPs had yolk-sacs that were ~1.5 times larger resulting in the appearance of bent notochords. After two days of exposure, 100% mortality was observed. Total mortalities were <25% in the other larvae–gold systems, suggesting that these larvae can quickly adapt to the presence of gold. In terms of an oxidative stress response, the larvae from all systems did not express high enzymatic activity. The state of the gold determined how much could be taken up (or immobilised) by a larva. Aqueous gold and 5 nm AuNPs easily pass through cells; therefore, larvae exposed to these forms of gold contained the highest concentrations. Scanning electron microscopy confirmed that cells comprising the epithelium and fins contained AuNPs. Aqueous gold was reduced to nanometre-scale particles within cells. Comparatively, 5 nm AuNPs appeared to be aggregated within cells forming clusters hundreds of nanometres in size. On the contrary, 50 nm AuNPs were not observed within cells but were detected within larvae by (single particle) inductively coupled plasma mass spectroscopy, suggesting that these AuNPs were probably taken up through the mouth or gills. The results of the present study demonstrate that exposure to AuNPs had adverse effects on developing golden perch larvae. Additionally, these effects were dependent on the size of the AuNPs.
Thrombotic Complications in COVID-19 Patients: Low Incidence of Thrombotic Complications Among Critically Ill COVID-19 Patients in Singapore
Authors: Lim Cheryl XQ , Tan Chuen Wen , Fan Bingwen Eugene , Teo Winnie , Tung Moon Ley , Shafi Humaira , Christopher Dheepa , Zheng Shuwei , Peh Wee Ming , Chan Stephrene , Chong Vanessa CL , Gallardo Christian Aledia , Chang Cheng Chieh Ray , Ling Li Min , Tan Jing Yuan , Lee Ken Cheah Hooi , Phua Ghee Chee , Cherng Benjamin , Low Jenny Guek-Hong , Ho Vui Kian , Prasad Vishnu , Wong Lester Jung Long , Chee Yen-Lin , Ong Kiat Hoe , Lee Lai Heng , Ng Heng Joo , Yap Eng Soo
Published: February 2021

Objective

Arterial and venous thrombosis are reported to be common in critically ill COVID-19 patients.

This study aims to describe the thrombotic and bleeding rates in COVID-19 patients admitted to intensive care units (ICU) in Singapore.

Design

Retrospective observational study involving all consecutive adult COVID-19 patients who required ICU admission between 23 January 2020 and 30 April 2020.

Setting

National multicenter study involving all eight public hospitals in Singapore.

Patients

111 consecutive COVID-19 patients who required ICU admission were included.

Measurements and Main Results

Primary outcome was any venous or arterial thrombotic events occurred in ICU. Other measures included (1) the overall, venous and arterial thrombotic events throughout the hospitalisation, (2) major and minor bleeding events. The overall thrombotic rate in ICU was 11.7% (n=13), with 1.8% (n=2) venous and 9.9% (n=11) arterial events. The overall thrombotic rates throughout hospitalisation, censored at 30 April 2020, increased to 18.0% (n=20) with 6.3% (n=7) venous and 11.7% (n=13) arterial events. Major and minor bleeding rates were 14.8% (n=16) and 3.7% (n=4), respectively. Two-third of the patients received pharmacological thromboprophylaxis in ICU.

Conclusions

Critically ill COVID-19 patients in Singapore have lower VTE but higher arterial thrombosis rates with higher bleeding manifestations than other reported cohorts. Standard thromboprophylaxis may be sufficient to prevent thrombotic complications in patients with similar demographics.

Disclosures

No relevant conflicts of interest to declare.
Clonal Architecture Analysis of TET2 Identified Distinct Origins in Myelodysplastic Syndromes
Authors: Shi Zhongxun , Li Bing , Qin Tiejun , Xu Zefeng , Pan Lijuan , Qu Shiqiang , Huang Gang , Xiao Zhijian
Published: February 2021

Next-generation sequencing (NGS) has deepened our understanding of myelodysplastic syndromes (MDS). Genetic mutations of TET2 were common in MDS and were also detected in asymptomatic elder persons, which were defined as aged related clonal haematopoiesis (ARCH) and considered as a myelodysplastic syndrome precursor state. In this study, we analyzed the mutation profiles of TET2 in 770 newly-diagnosed MDS subjects. 73 mutations were found in 67 of 770(8.7%) subjects. 14.9% were frame shifts, 29.9% were nonsense, 44.8% were missense and 10.7% harbored 2 TET2 mutations. TET2MT subjects were older than TET2WT subjects (P=0.024) and the variant allele frequency (VAF) of TET2 was positively correlated with age (r=0.318, P=0.009). Clonal architecture was determined using a copy number-adjusted VAF difference between 2 mutation events in 49 TET2MT subjects with 2 or more mutations. 19 (38.3%) were TET2ancestral and 30(61.2%) were TET2subclonal. TET2ancestral subjects were significantly older than TET2WT subjects (P=0.013) while no difference was found between TET2subclonal subjects and TET2WT subjects (P=0.509). The frequency of cytosine-to-thymine (C→T) transition was significantly higher in TET2ancestralsubjects compared with TET2subclonal subjects (P=0.029), which was considered to be a somatic mutational signature of aging, indicating that MDS driven by TET2ancestral was likely derived from TET2MT ARCH. The most common upstream mutations in TET2subclonal subjects were U2AF1 (16.7%) and ASXL1 (13.3%), and the most common downstream mutations in TET2ancestral subjects were ASXL1 (21.1%) and RUNX1 (15.8%). TET2 mutations rarely existed alone in TET2ancestral subjects (14.3%) and were always accompanied by another mutations like U2AF1, SF3B1 and ASXL1, suggesting that the acquisition of another mutation led to the progress of ARCH to MDS in TET2ancestral subjects. TET2MT had no impact on survivals in overall cohort (P=0.218) while predicted poorer survivals in IPSS-R lower risk group (P=0.004). Additional ASXL1, U2AF1 and RUNX1 mutations in TET2MT subjects indicated poorer prognosis compared with TET2WT subjects (P=0.005; P=0.04; P<0.001) .There was no significant difference in OS of TET2MT subjects with different clonal architecture (P=0.76). Subjects with TET2 VAF≥30% had poorer survivals compared with TET2WT subjects (P=0.057). In conclusion, TET2MT MDS subjects with different clonal architectures may have different origins. TET2ancestral subjects may be derived from ARCH and progressed to MDS after secondary hits. The effects of TET2 mutation on the prognosis depended on the accompanying mutations and clonal burdens.

Disclosures

No relevant conflicts of interest to declare.
An Immune Score Model of the Bone Marrow Micro-Environment Predicts Survival in Chronic Lymphocytic Leukaemia
Authors: Liang Yang , Huang Han-ying , Wang Yun , Wang Weida , Lin Huan-xin
Published: February 2021

Background: Most prognostic and predictive models for survival of persons with chronic lymphocytic leukaemia (CLL) are based on clinical and laboratory co-variates and have AUCs of 0.65 to 0.74 indicating considerable inaccuracy. No current prognostic model uses data on immune state of the bone marrow micro-environment to predict survival.

Methods: We downloaded relevant data from International Cancer Genome Consortium (CLL-ES; N = 485) and Gene Expression Omnibus (GSE22762; N = 195) with survival data. We used a LASSO Cox regression model to build a survival prediction model based on the expression of immune-related genes in the bone marrow micro-environment. Immune cells corresponding to these immune genes were deduced Using CIBERSORT and compared in cohorts with different survival probabilities.

Results: An immune signature based on 9 immune-related genes were constructed in the training cohort (CLL-ES) and tested in a validation cohort (GSE22762). The AUCs of 1, 3 and 5 -year survivals were 0.83 [95% Confidence Interval, 0.63, 0.97], 0.79 [0.67, 0.89] and 0.82 [0.73, 0.90] in training and 0.66 [0.55, 0.79], 0.60 [0.50, 0.69] and 0.66 [0.58, 0.76]in the validation cohort. Subjects in the high-risk cohort identified by immune signature had significantly worse 5-year survival compared with those in low-risk cohort group (training cohort: 91% [87, 95%] vs. 99% [98, 100%], P <0.001; validation cohort: 61% [50, 71%] vs 81% [80, 82%], P = 0.003). Subjects with a low-risk immune signature had a higher proportion of CD4-postive T-cells, activated NK-cells compared with those in the high-risk cohort (p < 0.05).

Conclusion: The immune score model of the bone marrow micro-environment we developed accurately predicts survival of persons with CLL. These data suggest a role for immune cells in the bone marrow micro-environment on survival. The immune score we describe can be combined with other prediction models to improve accuracy.

Keywords

ICGC, GEO, chronic lymphocytic leukemia, immunity, prognostic model

Disclosures

No relevant conflicts of interest to declare.