bluuebunny/crossref_metadata_2025 huggingface dataset:
EGFR-mutated advanced lung cancer. Data from a single institution, the Hospital of Leon, in Spain
Authors: Delgado Sillero Irene , Lopetegui Lia Nerea , Sánchez Cousido Luis Felipe , Rojas Piedra Mariam , Távara Silva Blanca , Garrido Onecha Maria Luisa , Medina Valdivieso Soledad , Alonso Horcajo Nieves , Díez Tascón Cristina , López González Ana , Castañón López Carmen , Pedraza Lorenzo Manuela , García Palomo Andrés , Martín Vicente , Diz Tain Pilar
Published: March 2022

Introduction

10–16% of non-small cell lung cancer (NSCLC) cases have the epidermal growth factor receptor (EGFR) amplified and/or mutated. Studies show that EGFR tyrosine kinase inhibitors (TKIs) significantly prolong progression-free survival (PFS) in patients with advanced NSCLC compared to those treated with platinum-based chemotherapy (CT) doublets. Our aim is to perform a real-world survival analysis of patients treated with TKI as first-line therapy at the Hospital of Leon (CAULE) in Spain. The impact on global survival rates and responses to clinical and histopathological factors were also analyzed.

Material and methods

We retrospectively reviewed patients diagnosed with EGFR-mutated NSCLC who received treatment with EGFR-TKI in the Department of Oncology at the University of Leon Health Center complex between March 2011 and June 2018. Data was analyzed with Kaplan-Meier and Cox regression models to show overall survival (OS), progression-free survival (PFS), and the associated variables.

Results

53 patients were included in the study, 50% (n = 27) were treated with gefitinib, 32% (n = 18) with erlotinib and 10% (n = 6) with afatinib. The median OS and PFS were 27.7 months (95% CI: 21–33.8 months) and 18 months (95% CI 14.25–21.89 months), respectively. The variables associated with OS and with PFS were exon19 deletion as a protective factor and presence of extrathoracic metastasis as a risk factor. The most frequent adverse effects were rash, diarrhea, asthenia, and conjunctivitis.

Conclusions

Real-world analysis of this data confirms that treatment with TKI is beneficial for patients diagnosed with EGFR-mutated NSCLC. Our OS outcomes were similar to those reported in clinical trials.
The Association Between Duration of School Garden Exposure and Self-Reported Learning and School Connectedness
Authors: Lohr Abby M. , Bell Melanie L. , Coulter Kiera , Marston Sallie , Thompson Moses , Carvajal Scott C. , Wilkinson-Lee Ada M. , Gerald Lynn B. , Korchmaros Josephine
Published: March 2022

When students feel connected to their school, they experience positive health and academic outcomes. In contrast, school disengagement is a predictor of dropout, delinquency, and substance use. School garden programming has the potential to help children achieve academic outcomes and feel connected to their school. Unfortunately, most school garden research has been conducted with white, affluent study participants. We describe the results of a secondary analysis utilizing data from an evaluation of a university-supported community school garden program (CSGP). Using a cross-sectional survey study design, we examined the impact of school garden programming in Title I schools on primarily Latino/a (Hispanic) elementary student self-reported learning and feelings of school connectedness by comparing students with ≤1 year exposure to those with >1 year. Social cognitive theory formed the conceptual basis for the analysis. Duration of school garden exposure did not have a significant association with self-reported learning or feelings of school connectedness. Regardless of past exposure, fifth-grade students, females, and those who identify as Latino/a (Hispanic) felt that school garden programming improved their learning. Latino/a (Hispanic) students who participate in school garden programming may also feel a greater sense of connection to their teachers and peers at school. Qualitative results demonstrated that most students enjoyed spending time in the garden and indicated that participating in the program helped them learn new things and feel connected to their school. If individuals who may be disadvantaged because of systemic racism, such as Latino/a (Hispanic) students, can benefit from school garden programming, such interventions should be further investigated and prioritized.
Performance portability in a real world application: PHAST applied to Caffe
Authors: Martínez Pablo Antonio , Peccerillo Biagio , Bartolini Sandro , García José M , Bernabé Gregorio
Published: March 2022

This work covers the PHAST Library’s employment, a hardware-agnostic programming library, to a real-world application like the Caffe framework. The original implementation of Caffe consists of two different versions of the source code: one to run on CPU platforms and another one to run on the GPU side. With PHAST, we aim to develop a single-source code implementation capable of running efficiently on CPU and GPU. In this paper, we start by carrying out a basic Caffe implementation performance analysis using PHAST. Then, we detail possible performance upgrades. We find that the overall performance is dominated by few ‘heavy’ layers. In refining the inefficient parts of this version, we find two different approaches: improvements to the Caffe source code and improvements to the PHAST Library itself, which ultimately translates into improved performance in the PHAST version of Caffe. We demonstrate that our PHAST implementation achieves performance portability on CPUs and GPUs. With a single source, the PHAST version of Caffe provides the same or even better performance than the original version of Caffe built from two different codebases. For the MNIST database, the PHAST implementation takes an equivalent amount of time as native code in CPU and GPU. Furthermore, PHAST achieves a speedup of 51% and a 49% with the CIFAR-10 database against native code in CPU and GPU, respectively. These results provide a new horizon for software development in the upcoming heterogeneous computing era.
Experimental and numerical investigations of slip behavior for combined loaded full-complement cylindrical roller bearings
Authors: Stuhler Patrick , Wolf Marius , Romeser Maximilian , Nagler Nadine , Fatemi Arshia
Published: March 2022

This paper examines the roller slip behavior of full-complement cylindrical roller bearings under different radial eccentric load, radial load direction, axial load, speed and temperature. For this purpose, 2240 roller slip measurements are carried out with a coil attached coaxially to the roller set and a roller body equipped with a diametrical magnet. The evaluation is carried out using an improved evaluation system, which includes both the frequency and amplitude proportionality of the induced voltage. Overall, the roller slip decreases with radial loading in the direction of gravity and with increasing axial load, speed and oil temperature. To explain the physical relationships, which are responsible for these changes, a comparison with results of multibody simulation of the bearing with an advanced modeling of contacts, lubrication and friction is carried out.
‘When you delete Tinder it’s a sign of commitment’: leaving dating apps and the reproduction of romantic, monogamous relationship practices
Authors: Vares Tiina
Published: March 2022

In recent years there has been increasing academic attention to forms and practices of disconnection to social networking sites. However, there has been limited attention to non-use/departures, particularly with dating apps. In this article I draw on 27 interviews with previous and current users of dating apps to explore their practices of leaving/deleting their dating apps. For the majority of participants, leaving a dating app was due to ‘success’ in finding a relationship. For others, it was the ‘failure’ to find a relationship. I suggest that this highlights not only the centrality of finding/not finding a relationship to dating app use and departure, but also a particular construction of relationships: romantic, sexually exclusive/monogamous and life-long. This was the case for the majority of participants who identified as heterosexual, gay, lesbian, bisexual and queer and indicates the reproduction and valuing of a particular relationship form and practice for diverse users.
Political equality, plural voting, and the leveling down objection
Authors: Peña-Rangel David
Published: March 2022

I argue that the consensus view that one must never level down to equality gives rise to a dilemma. This dilemma is best understood by examining two parallel cases of leveling down: one drawn from the economic domain, the other from the political. In the economic case, both egalitarians and non-egalitarians have resisted the idea of leveling down wages to equality. With no incentives for some people to work hard social productivity will likely decline, further lowering people's wages and thus leaving everybody all-things-considered worse off as a result—hence “never level down.” On the other hand, however, the argument against leveling down does not appear to pass muster in the political sphere: denying political equality in the form of “one person, one vote” (OPOV), for example, by giving a higher share of voting power to people with, say, more education seems straightforwardly objectionable, even if such a voting scheme would improve the outcomes of all people, including those who are ultimately left with fewer votes. Thus, a fundamental tension arises: we can either endorse the widely-affirmed “never-level-down” thesis, which says that sacrificing people's well-being exclusively for the sake of promoting equality can never be the right thing to do, or we can endorse the principle of “one person, one vote.” But we cannot do both. I defend this dilemma against a view I call the compatibility view: roughly, that because OPOV is strictly necessary to advance some weighty, non-egalitarian interest people have, accepting OPOV as a principle of justice is compatible with one's rejection of leveling down.
Complementary and Alternative Medicine Online Learning Intervention for Oncology Healthcare Providers: A Mixed-Methods Study
Authors: Baydoun Mohamad , Levin Gregory , Balneaves Lynda G. , Oberoi Devesh , Sidhu Aven , Carlson Linda E.
Published: March 2022

Introduction:

With the increased usage of complementary approaches in oncology comes the need for its integration into healthcare professional (HCP) education. The purpose of this single-arm, mixed-methods study was to examine the feasibility and benefits of a brief complementary and alternative medicine (CAM) learning intervention for improving HCP knowledge, attitudes, and practices regarding CAM use in cancer care, and explore the experiences of participating HCPs.

Methods:

HCPs from the Tom Baker Cancer Centre in Alberta, Canada, were invited to participate in 3 online interactive learning modules that reviewed: (1) basic CAM information, (2) HCP-patient CAM communication, and (3) evidence-based CAM decision support. The study survey consisted of attitude (n = 14), knowledge (n = 31), and practice (n = 31) items, administered at baseline and two-months post-intervention. Semi-structured interviews were conducted with a subset of participants.

Results:

Approximately 300 HCPs were invited to participate, of which 105 expressed interest in the study (35%), and 83 of them consented to participate (79%). The intervention completion rate was 73% (61/83 HCPs). There was a significant pre-post change in HCPs’ attitudes and, to a lesser extent, knowledge and practices related to CAM (8/14 attitude items changed pre-post compared to 13/31 knowledge items and 5/31 practice items), in which more HCPs reported patients should be assisted in making complementary therapy (CT) decisions, exhibited greater knowledge about CAM, and more often engaged in a CAM-related clinical practice. Qualitative findings supported the beneficial effects of the modules, with HCPs describing themselves as being more likely to ask patients about their CAM use and referring them to credible CAM resources. Nonetheless, the majority did not feel adequately prepared to make recommendations about specific CTs, even after the intervention.

Conclusion:

The current study suggests that online CAM learning offers a feasible and potentially promising intervention for improving oncology HCP knowledge, attitudes, and practices regarding CAM, warranting further investigation. This study highlights a need for institutional resources to help HCPs fully integrate CT decision support into cancer patient care. A coordinated evidence-based CAM program at cancer centers may help ensure that all patients’ CAM-related needs are properly attended to.
Salter-Harris Type III Fracture of the Distal Phalanx: A Rare Juxtaphyseal Variant
Authors: Testa Edward J. , Marcaccio Stephen E. , Kosinski Lindsay R. , Jones Matthew C. , Katarincic Julia A.
Published: March 2022

Juxtaphyseal fractures of the distal phalanges of upper extremity digits are most commonly of the Salter-Harris II variety and occur most commonly in the thumb. The diagnosis of this injury is essential as it may present as an open fracture with a nailbed injury (“Seymour fracture”). However, an intra-articular, epiphyseal fracture may also occur and mimic a mallet deformity or Seymour fracture. Prompt diagnosis is essential to rule out an open fracture and obtain anatomical alignment and stability to attempt to reduce complications such as physeal arrest. Here, we present a patient with a displaced Salter-Harris type III fracture of his thumb distal phalanx and review his management and early-term outcome. We present this case to bring attention to this rare and unique injury, review the available literature, and discuss management and outcomes.
Surgical Demographics of Acute Hand Compartment Syndrome
Authors: Williams Derrick W. , Dyer George S. M. , von Keudell Arvind , Zhang Dafang
Published: March 2022

Background:

We aimed to describe the demographic, injury-related, and treatment-related characteristics of patients who undergo fasciotomies for acute hand compartment syndrome.

Methods:

A cohort of 53 adult patients with acute hand compartment syndrome treated with fasciotomy at 2 tertiary care referral centers over a 10-year time period from January 1, 2006, to June 30, 2015, were retrospectively identified. We reviewed the electronic medical record for patient-related variables (eg, age, sex, smoking status, diabetes mellitus), injury-related variables (eg, mechanism of injury, presence of fractures), and treatment-related variables (eg, compartments released, number of operations, use of split-thickness skin grafts, and time from injury to surgery).

Results:

The mean age of our cohort was 45 years, and 33 patients (62%) were men. The mechanism of injury varied widely, but the most common causative mechanisms were crush injury (25%), prolonged decubitus (17%), and infection (11%). Associated hand fractures were present in 15 (28%) patients. The surgically released compartments varied; the dorsal interosseous compartments (83%), thenar compartment (75%), and hypothenar compartment (74%) were most frequently released, while the adductor pollicis compartment (43%) and Guyon canal (28%) were least frequently released.

Conclusions:

The demographics of acute hand compartment syndrome have evolved in the last 25 years compared with the prior literature, partly as a result of the opioid epidemic leading to a rise in “found down” compartment syndrome. Treating providers should recognize crush injury, prolonged decubitus, and infection as the most common causes of acute hand compartment syndrome.
Quality prediction of internal thread cold extrusion based on genetic algorithm optimized BP neural network
Authors: Hou Hong-Ling , Zhang Guang-Peng , Chen Xin , Zhao Yong-Qiang
Published: March 2022

The extrusion process parameters have a great impact on the quality of the extrusion thread. In order to ensure the extrusion quality and the smooth progress of the extrusion process, a prediction model based on BP-GA neural network is established. The model takes the diameter of the bottom hole, extrusion speed, and friction coefficient as the input layer, and the extrusion torque, extrusion temperature, and tooth height as the output layer. After training the model with sample data, the extrusion internal thread quality prediction is carried out. The results show that the BP-GA neural network prediction model has a high accuracy in predicting the extrusion torque, extrusion temperature and tooth height rate during the cold extrusion of internal threads. The error between the experimental value and the predicted value of the extrusion torque is between 10% and 15%, the experimental value of the extrusion temperature is consistent with the predicted value, and the error between the experimental value and the predicted value of the tooth height rate is less than 5%. The BP-GA neural network prediction model can accurately predict the extrusion temperature, extrusion torque, and tooth height rate, providing a new way for the re-search of internal thread cold extrusion technology.
Performance enhancement of an evacuated tubes solar collector using Forchheimer’s saturated porous media with embedded nanofluid
Authors: Duwairi Hamzeh M , Alrbai Mohammad , Al-Dweik Mohammad B
Published: March 2022

The evacuated tube solar collector is a proper choice for converting solar energy into heat since it is efficient, practical, and cost-effective. In the current study, the role of nanofluid in porous medium was numerically investigated to improve the performance of a solar collector model and the potential to store energy. The governing equations for the suggested model were solved analytically in the fully developed region using the Forchheimer model. The investigation of the impact on temperature fluctuation in the solar collector was done by considering several factors such as medium porosity, pore diameter, nanoparticles with respect to the solid volume ratio, system pressure, and conduit radius. The governing equations for the entrance region were expressed in a non-dimensional form and solved using the finite difference method (FDM), with the resulting non-dimensional differential equation solved using MATLAB software. Various parameters, such as Prantel number (Pr) and fluid velocity, were examined, and the findings were shown in various diagrams. For the fully developed region, an analytical solution was obtained, and the findings were presented using the Mathematica® software. The results demonstrate that utilizing nanofluid and porous media improves the performance of the evacuated tube when compared to sole use of water. It was found that the temperature difference across the solar tube was enhanced by 10%–20%. In addition to that, the performance of the evacuated tube solar collector showed around 10% enhancement in the obtained temperature difference in cold months, when nanofluids were added. Also, the comparison between nanofluids using Forchheimer model shows that the best nanofluid was AL2O3. The best results had a significant effect on the solid volume fraction rate of nanoparticles in nanofluids obtained at low Reynolds and Prandtl numbers. Where the higher the fraction, the higher the heat transfer, the higher the resulted temperature.
Smart three-dimensional processing of unconstrained cave scans using small unmanned aerial systems and red, green, and blue-depth cameras
Authors: Zhang Guoxiang , Moyes Holley , Chen YangQuan
Published: March 2022

This article focuses on a novel three-dimensional reconstruction system that maps large archeological caves using data collected by a small unmanned aircraft system with red, green, and blue-depth cameras. Cave sites often contain the best-preserved material in the archeological record. Yet few sites are fully mapped. Large caves environment usually contains complex geometric structures and objects, which must be scanned with long overlapped camera trajectories for better coverage. Due to the error in camera tracking of such scanning, reconstruction results often contain flaws and mismatches. To solve this problem, we propose a framework for surface loop closure, where loops are detected with a compute unified device architecture accelerated point cloud registration algorithm. After a loop is detected, a novel surface loop filtering method is proposed for robust loop optimization. This loop filtering method is robust to different scan patterns and can cope with tracking failure recovery so that there is more flexibility for unmanned aerial vehicles to fly and record data. We run experiments on public data sets and our cave data set for analysis and robustness tests. Experiments show that our system produces improved results on baseline methods.
Educational practice in Switzerland: Searching for diversity-engaged leadership
Authors: Magno Cathryn , Becker Anna , Imboden Marion
Published: March 2022

Despite the uptick in awareness of racial and other sociocultural diversity owing to recent social movements particularly in the United States but also in many countries in Europe, deep understanding of identity and bias is lacking and remedies for policy and practice inequities in the education sector remain. Steadily increasing racial and linguistic heterogeneity demands better understanding on the part of school leaders—and the larger school staff—to redress inequity and improve schooling for all students. This study utilized in-depth interviews to gather secondary school leaders’ perspectives on, and level of engagement with, diversity in Fribourg, Switzerland. Findings revealed that school leaders are, overall, inadequately prepared to tackle difficult, identity-charged conversations or to confront their own positionality and subjectivity vis-à-vis newcomer students. Recommendations are made for aspiring and current school leaders to become active by practicing diversity-engaged leadership.
A single institution pre-/post-comparison after introduction of an external urinary collection device for female medical patients
Authors: Jasperse Nathan , Hernandez-Dominguez Oscar , Deyell Jacob S , Prasad Janani P , Yuan Charlene , Tomy Meril , Kuza Catherine M , Grigorian Areg , Nahmias Jeffry
Published: March 2022

Background

External urinary collection devices (EUCDs) may serve as an alternative to indwelling urinary catheters (IUCs) and decrease the rate of catheter associated urinary tract infections (CAUTIs). PureWick® is a novel female EUCD; however, no study has definitively proven benefit regarding reduction of CAUTIs.

Aim

We sought to compare the CAUTI rate and IUC days before and after availability of the PureWick® EUCD at a single institution. We provide a descriptive analysis of female medical patients receiving an EUCD.

Methods

A retrospective review of adult female patients admitted to a single institution on a medical service who received an IUC and/or an EUCD was performed. Patients who received an IUC in the 3 months before EUCD availability (PRE) were compared to patients who received an IUC and/or EUCD in the 12 months after (POST).

Results

Out of 848 female patients, 292 received an EUCD in the POST cohort and overall, 656 received an IUC (259 (100%) PRE vs. 397 (67.4%) POST). Compared to the PRE cohort, the POST cohort had a higher number of IUC days (median, 3 vs 2 days, p = 0.001) and a higher rate of CAUTI (infections per 1000 catheter days, 9.3 vs 2.3, p = 0.001). The rate of UTI associated with EUCD use was 9.8 infections per 1000 device days.

Discussion

While EUCDs might appear to be a promising alternative to IUCs for female patients, this single center pre-/post-analysis found that both the number of IUC days and the CAUTI rate increased after introduction of a female EUCD.
Outcomes of elbow fracture-dislocations treated with and without an Internal Joint Stabilizer of the Elbow (IJS-E): A retrospective cohort study
Authors: Sheth Mihir , Price Matthew Bent , Taylor Tristen , Mitchell Scott
Published: March 2022

Background

The internal joint stabilizer of the elbow (IJS-E) adds to techniques for maintaining reduction of elbow fracture-dislocations while allowing early motion. Literature on this device is limited to small case series.

Methods

Retrospective comparison of function, motion and complications in patients who sustained elbow fracture-dislocations reconstructed with (30 patients) and without (34 patients) an IJS-E by a single surgeon. The minimum follow up was 10 weeks.

Results

The mean follow up was 16 ± 17 months. The mean final flexion arc did not differ between the two groups, however patients without an IJS achieved greater pronation. There were no differences in mean Mayo Elbow Performance, Quick-DASH and pain scores. Five patients (17%) underwent IJS-E removal. The rates of capsular releases for stiffness after 12 weeks and recurrent instability were similar.

Conclusions

The use of an IJS-E to supplement traditional repair of elbow fracture-dislocations does not appear to affect final function or motion, and appears to be effective in reducing the risk of recurrent instability in a group of patients deemed high risk. However, its use is weighed against a 17% rate of removal at early follow up and possibly inferior forearm rotation.

Level of Evidence

Retrospective Cohort study, Level 3
Simulation-Based Port Competition: Feasibility and Implementation of an Agent-Based Framework
Authors: De Winne Koen
Published: March 2022

The objective of this article is to discuss the feasibility and implementation of an agent-based computational framework for game-theoretical port competition. There are many different determinants which influence the competitive position of a seaport at any time. And as a consequence of this complexity, simple calculations or solution methods are not possible. This article elaborates a generic and modular framework for modeling and simulating the competition between multiple, heterogeneous port players. First, the article briefly detects some elements that are useful and necessary to develop a meaningful agent-based framework. Priority elements are determined and it is considered which elements can be passed on to extensions of the framework. Second, some important aspects of the application of the agent-based methodology for the port sector are explained. Third, a limited number of examples of modules of the proof of concept are developed. Particular attention is paid to the modularity and extensibility of the agent-based framework in order to allow the users of the framework to fine-tune the choices in their simulation model. Finally, in a fourth part of this article, recommendations are formulated for the further development and enrichment of the framework.
Driving Forces in Elementary School Counseling Advocacy: A Phenomenological Investigation of Advocates’ Experiences
Authors: Berger Carolyn , Blalock Sarah , Goodman-Scott Emily , Brown Emily
Published: March 2022

Although the literature contains many recommendations for professional advocacy for school counseling, there is a dearth of research providing clear and contemporary evidence of effective strategies for advocating for elementary school counseling. In response to this gap in the literature, we conducted a phenomenological qualitative study of 13 professionals who successfully advocated for elementary school counseling positions or roles. We outline research-informed elementary school counseling advocacy strategies identified by participants, centering around three themes: (a) looking inward and developing one’s advocacy skills, (b) working with stakeholders, and (c) using data to advocate. We include implications for practice and research.
Radiocapitellar Contact Characteristics After Osteochondral Defect Repair Using a Novel Hybrid Reconstructive Procedure
Authors: Dee Derek T. , Hung Victor T. , Schamblin Connor J. , Lupica Gregory M. , Hitchens Hunter R. , McGarry Michelle H. , Lee Thay Q.
Published: March 2022

Background:

Many procedures to reconstruct osteochondral defects of the elbow radiocapitellar (RC) joint lack versatility or durability or do not directly address the subchondral bone structure and function.

Purpose/Hypothesis:

To biomechanically characterize the RC joint contact area, force, pressure, and peak pressure before and after reconstruction of osteochondral defects using a novel hybrid reconstructive procedure. It was hypothesized that the procedure would restore the contact characteristics to the intact condition.

Study Design:

Controlled laboratory study.

Methods:

A total of 10 cadaveric elbows (mean age 67 ± 2.7 years) were dissected to isolate the humerus and radial head. RC contact area, contact force, mean contact pressure, and peak contact pressure were measured with the elbow at 45° of flexion and neutral forearm rotation at compressive loads of 25, 50, and 75 N. Osteochondral defects 8 and 11 mm in diameter were created at the center of the capitellum; the defects were then reconstructed with a titanium fenestrated threaded implant, countersunk in the subchondral bone, with an acellular dermal matrix allograft sutured in place on top of the implant. Five conditions (intact, 8-mm defect, 8-mm repair, 11-mm defect, and 11-mm repair) were tested and results were compared using repeated-measures analysis of variance.

Results:

Both 8- and 11-mm defects significantly increased RC mean contact pressure at all compressive loads ( P ≤ .008) and significantly increased peak contact pressure at compressive loads of 50 and 75 N ( P < .002) compared with the intact condition. Repair of the 8-mm defect significantly decreased RC mean contact pressure at 25- and 50-N loads ( P ≤ .009) and significantly decreased peak contact pressure at 50- and 75-N loads ( P ≤ .035) compared with the defect condition. Repair of the 11-mm defect decreased mean contact pressure significantly at all compressive loads ( P ≤ .001) and peak contact pressure at 50- and 75-N loads ( P < .044) compared with the defect condition.

Conclusion:

RC joint contact pressure was restored to intact conditions while avoiding increased peak contact pressure or edge loading after repairing osteochondral defects related to osteochondrosis with a novel hybrid reconstruction technique.

Clinical Relevance:

This hybrid procedure that addresses the entire osteochondral unit may provide a new treatment option for osteochondral defects.
The “Chiang Mai Lean Forward” Radiographic View for Acromioclavicular Joint Injuries: A Cadaveric Study
Authors: Phornphutkul Chanakarn , Rajchawiang Korakod
Published: March 2022

Background:

Operative treatment is suggested for unstable type 3 acromioclavicular (AC) joint injuries; however, there is no clear consensus regarding the definition of an unstable type 3 injury. We propose a new radiographic method, the “Chiang Mai lean forward” view, to verify horizontal displacement in an unstable AC joint injury.

Hypothesis:

A radiograph taken with the torso leaning forward would allow the detection of a higher proportion of AC joint injuries.

Study Design:

Descriptive laboratory study.

Methods:

A total of 20 shoulders from 10 fresh whole-body cadaveric specimens (mean age, 68.8 years) were tested at 3 different torso leaning angles (30°, 45°, and 60°) to determine the best position for projecting the x-ray beam. The shoulders were dissected sequentially starting with the AC ligament (stage 1), then additional sectioning of the partial coracoclavicular (CC) ligament with either the trapezoid ligament cut first (stage 2A) or the conoid ligament cut first (stage 2B), and finally complete sectioning of the CC ligament (stage 3). Radiography was performed after each stage to evaluate the degree of displacement of the anterior border of the acromion relative to the anterior border of the clavicle. Paired t tests were used to compare the degree of displacement at each stage to that of the shoulder before cutting.

Results:

Leaning at an angle of 30° provided better visualization of the AC joint in the “Chiang Mai lean forward” view. Compared with the intact condition, complete isolated cutting of the AC ligament produced 5.21 mm of horizontal displacement of the AC joint ( P < .0001), complete tearing of the AC ligament and partial cutting of the CC ligament resulted in a displacement of <12 mm (7.91 mm at stage 2A [ P = .0003] and 8.10 mm at stage 2B [ P = .0013]), and complete tearing of both the AC and the CC ligaments resulted in a displacement of 26.37 mm ( P < .0001).

Conclusion:

The “Chiang Mai lean forward” radiographic view is a potentially useful tool for determining the degree of the injury and the stability of the AC joint.
Understanding the Perspectives of Women Who Use Intravenous Drugs and are Experiencing Homelessness in an Urban Centre in Canada: An Analysis of Ethnographic Data
Authors: Kitson Cynthia , Haines Marlene , O’Byrne Patrick
Published: March 2022

Injection drug use has long been a topic of investigation, whether through a health or criminal justice lens. Whilst these bodies of literature offer important perspectives, missing from the extant literature is evidence, particularly involving women who use drugs, and more specifically evidence about the health beliefs of these women. To address this knowledge gap, we undertook an ethnographic study of homeless women in downtown Ottawa who inject drugs. This included interviews, observations, and artifact analyses. In this paper, we report on these ethnographic data to show the context and nature of the subjective lives of women who use injection drugs and their beliefs and perspectives on health. We use these data to make recommendations for nursing and healthcare practice moving forward.
Methodological Approaches to Cost-Effectiveness Analysis in Saudi Arabia: What Can We Learn? A Systematic Review
Authors: Maraiki Fatma , Bazarbashi Shouki , Scuffham Paul , Tuffaha Haitham
Published: March 2022

Objective

The recent establishment of the health technology assessment (HTA) entity in the Kingdom of Saudi Arabia (KSA) has resulted in increased interest in economic evaluation. The aim of this study is to evaluate the technical approaches used in published economic evaluations and the limitations reported by the authors of the respective studies that could affect the ability to perform economic evaluations in the KSA.

Methods

We conducted a systematic literature review of published economic evaluations performed for the KSA over the past 10 years. An electronic literature search of the PubMed, EMBASE, and Cochrane databases was performed. A CHEERS checklist was used to assess the quality of reporting. Reported limitations were classified into domains including the definition of perspectives, identification of comparators, estimation of costs and resources, and use of the incremental cost-effectiveness ratio threshold.

Results

Twelve evaluations were identified; most involved cost-effectiveness analysis (92%). Missing and unclear data were found within the CHEERS criteria. Regardless of the perspective used, most described the perspective as an “institutional” perspective (70%) and almost half were reclassified by the current reviewer (42%). Most did not clearly state the comparator (83%), and published model comparators were commonly used (50%). Resource estimation was mostly performed by the authors of the respective studies (67%), and costs were mostly obtained from hospital institutional data (75%). The lack of an established threshold for the country-specific willingness to pay was observed in 50% of the analyses.

Conclusions

Economic evaluations from the KSA are limited. Capacity building and country-specific HTA guidelines could improve the quality of evaluations to better inform decision making.

Highlights

Economic analysis of health technology should follow standard guidelines. Unfortunately, these guides are often underutilized, and our findings identify considerable missing, not clearly stated, or incomplete data within the analyses, which can weaken the impact of the recommendations. The limitations reported by the authors of the respective studies emphasize the suboptimal quality of the reporting. A lack of data was frequently identified and resulted in using “institutional” practice as a major source of data input for the analyses. In light of the call for the establishment of an HTA entity in the KSA, framing a standard analytic approach when conducting economic evaluations will support HTA in informing resource allocation decisions. We hope that our findings highlight the need for country-specific guidance to improve practice and enhance future research.
Global herpes zoster incidence, burden of disease, and vaccine availability: a narrative review
Authors: Pan Catherina X. , Lee Michelle S. , Nambudiri Vinod E.
Published: March 2022

Herpes zoster (HZ) is a neurocutaneous disease that causes significant morbidity worldwide. The disease is caused by the reactivation of the varicella-zoster virus (VZV), which leads to the development of a painful, vesicular rash and can cause complications such as post-herpetic neuralgia and vision loss. Globally, the incidence of HZ is increasing, and it incurs billions in cost annually to the healthcare system and to society through loss of productivity. With the advent of effective vaccines such as the live attenuated vaccine, Zostavax®, in 2006, and more recently the adjuvant recombinant subunit vaccine, Shingrix®, in 2017, HZ has become a preventable disease. However, access to the vaccines remains mostly limited to countries with developed economies, such as the United States and Canada. Even among countries with developed economies that license the vaccine, few have implemented HZ vaccination into their national immunization schedules due to cost-effectiveness considerations. In this review, we discuss the currently available HZ vaccines, landscape of HZ vaccine guidelines, and economic burden of disease in countries with developed and developing economies, as well as barriers and considerations in HZ vaccine access on a global scale.
Pharmacology update: pamidronate for hypertrophic pulmonary osteoarthropathy in palliative care
Authors: Faust Bethany , Parkinson Aaron , Baumrucker Steven J.
Published: March 2022

Hypertrophic pulmonary osteoarthropathy (HPOA) is a rare syndrome that causes clubbed fingers, periostitis, and synovial effusions. It can adversely impact a patient’s quality of life. It occurs secondary to pulmonary disease – most commonly pulmonary malignancy. The most effective treatment for HPOA is to treat the underlying disease, usually through surgical resection, chemotherapy, or radiation. However, symptomatic treatments rather than definitive treatments (surgical, chemotherapy, or radiation) are more appropriate for the palliative care patient. Pamidronate is a promising medication for the treatment of HPOA for its safety and rapid onset of action. Further research is indicated to determine whether pamidronate is consistently effective.
Integration of GWAS and transcriptome analyses to identify SNPs and candidate genes for aluminum tolerance in rapeseed (Brassica napus L.)
Authors: Zhou Huiwen , Xiao Xiaojun , Asjad Ali , Han Depeng , Zheng Wei , Xiao Guobin , Huang Yingjin , Zhou Qinghong
Published: March 2022

Background

The exchangeable aluminum (Al), released from the acid soils, is another addition to the environmental stress factors in the form of Al toxicity stress. Al stress affects the normal crop development and reduces the overall yield of rapeseed (Brassica napus L.). The response mechanism of plants to Al toxicity is complicated and difficult to understand with few QTL related studies in rapeseed under Al toxicity stress.

Result

Using 200,510 SNPs developed by SLAF-seq (specific-locus amplified fragment sequencing) technology, we carried out the genome-wide association analysis (GWAS) in a population of 254 inbred lines of B. napus with large genetic variation and Al-tolerance differences. There were 43 SNPs significantly associated with eight Al-tolerance traits in the seedling stage were detected on 14 chromosomes, and 777 candidate genes were screened at the flanking 100 kb region of these SNPs. Moreover, RNA-seq detected 8291 and 5341 DEGs (the differentially expressed gene) in the Al -tolerant line (ATL) and -sensitive line (ASL), respectively. Based on integration of GWAS and RNA-seq analysis, 64 candidate genes from GWAS analysis differentially expressed at least once in 6 h vs 0 h or 24 h vs 0 h conditions in ATL or ASL. Moreover, four out of sixty-four candidate genes (BnaA03g30320D, BnaA10g11500D, BnaC03g38360D and BnaC06g30030D) were differentially expressed in both 6 h and 24 h compared to 0 h (control) conditions in both lines. The proposed model based on the candidate genes excavated in this study highlighted that Al stress disturb the oxidation-redox balance, causing abnormal synthesis and repair of cell wall and ABA signal transduction, ultimately resulting in inhibition of root elongation.

Conclusions

The integration of GWAS and transcriptome analysis provide an effective strategy to explore the SNPs and candidate genes, which has a potential to develop molecular markers for breeding Al tolerant rapeseed varieties along with theoretical basis of molecular mechanisms for Al toxicity response of Brassica napus plants.
Time to complete hepatitis C cascade of care among patients identified during mass screening campaigns in rural Rwanda: a retrospective cohort study
Authors: Kamali Innocent , Shumbusho Fabienne , Barnhart Dale A. , Nyirahabihirwe Françoise , Gakuru Jean de la Paix , Dusingizimana Wellars , Nizeyumuremyi Esdras , Habinshuti Placide , Walker Stephen , Makuza Jean Damascene , Serumondo Janvier , Nshogoza Rwibasira Gallican , Ndahimana Jean d’Amour
Published: March 2022

Background

Since the discovery of direct-acting antivirals, treatment for hepatitis C virus (HCV) is increasingly accessible in low-resource settings, but quality of care in these settings is not known. We described progression through the cascade of care among individuals who screened positive for HCV antibodies during a mass screening campaign in Kirehe and Kayonza, two rural Rwandan districts, in September 2019.

Methods

This retrospective cohort study used routine clinical data to assess proportions of participants completing each stage of the cascade of care, including: (a) screening positive on rapid diagnostic test; (b) return of initial viral load results; (c) detectable viral load; (d) treatment assessment; (e) treatment initiation; (f) return of sustained virological response (SVR12) results; and (g) achieving SVR12. We proposed three indicators to assess timely care provision and used medians and interquartile ranges (IQR) to describe the time to complete the cascade of care.

Results

Overall, 666 participants screened HCV positive, among them, 452 (68.1%) were female and median age was 61 years (IQR: 47, 70). Viral load results were returned for 537 (80.6%) participants of whom 448 (83.4%) had detectable viral loads. Of these, 398 (88.8%) were assessed for treatment, 394 (99%) were initiated, but only 222 (56.3%) had results returned for SVR12. Among those with SVR12 results, 208 (93.7%) achieved SVR12. When assessing timely care provision, we found 65.9% (95% CI: 62.0, 69.7) of initial viral load results were returned ≤ 30 days of screening; 45% (95% CI: 40.1, 49.8) of people with detectable viral load completed treatment assessment ≤ 90 days of initial viral load results; and 12.5% (95% CI: 9.2, 16.3) of SVR12 results were returned ≤ 210 days of treatment initiation among those who initiated treatment. The overall median time from screening to SVR12 assessment was 437 days.

Conclusion

Despite high rates of SVR12 among those who completed all stages of the cascade of care, we identified gaps and delays in the treatment cascade. Improving communication between viral load testing hubs and health facilities could reduce the turn-around time for viral load testing, and actively monitor timeliness of care provision could improve quality of HCV care.
Decreased acylated and total ghrelin levels in bipolar disorder patients recovering from a manic episode
Authors: Abdel Aziz Karim , Al-Mugaddam Fadwa , Sugathan Subi , Saseedharan Prashanth , Jouini Tarek , Elamin Mohamed Elhassan , Moselhy Hamdy , Aly El-Gabry Dina , Arnone Danilo , Karam Sherif M.
Published: March 2022

Background

To date, only few studies have investigated ghrelin levels in bipolar disorders, and all have exclusively measured acylated ghrelin, with none investigating total ghrelin (acylated and des-acylated). We aimed to investigate peripheral levels of acylated and total ghrelin in subjects experiencing a manic episode of bipolar disorder.

Methods

Peripheral levels of acylated and total ghrelin were measured in hospitalised medicated individuals recovering from a manic episode. Enzyme-linked immunosorbent assays (ELISA) were used to measure ghrelin levels in patients and compared with healthy controls. The relationship between ghrelin levels in bipolar disorder, self-reported hunger measures, demographic and clinical parameters was investigated with correlational analyses.

Results

Twenty-four subjects (15 males, 9 females) recovering from mania and 27 matched healthy controls (13 males, 14 females) were recruited for the study. Mean values of both acylated (187 vs.520 pg/mL) and total ghrelin (396 vs. 648 pg/mL) were significantly reduced in bipolar disorder (p = 0.001). Ghrelin levels correlated positively with markers of illness severity and negatively with prescribed mood stabilizers, second-generation antipsychotics, weight and body mass index.

Conclusion

Peripheral measurements of acylated and total ghrelin were both reduced in bipolar disorder patients compared to healthy controls. Whilst illness severity promotes higher ghrelin levels, pharmacological treatment and weight gain exercise the opposite effect.
Facilitators and barriers for lifestyle change in people with prediabetes: a meta-synthesis of qualitative studies
Authors: Skoglund Gyri , Nilsson Birgitta Blakstad , Olsen Cecilie Fromholt , Bergland Astrid , Hilde Gunvor
Published: March 2022

Background

The increasing prevalence of type 2 diabetes worldwide is a major global public health concern. Prediabetes is a reversible condition and is seen as the critical phase for the prevention of type 2 diabetes. The aim of this study is to identify and synthesize current evidence on the perceived barriers and facilitators of lifestyle change among people with prediabetes in terms of both initial change and lifestyle change maintenance.

Methods

A systematic literature search in six bibliographic databases was conducted in April 2021. Potential studies were assessed for eligibility based on pre-set criteria. Quality appraisal was done on the included studies, and the thematic synthesis approach was applied to synthesize and analyse the data from the included studies.

Results

Twenty primary studies were included, containing the experiences of 552 individuals. Thirteen studies reported participants perceived facilitators and barriers of lifestyle change when taking part in community-based lifestyle intervention programs, while seven studies reported on perceived facilitators and barriers of lifestyle change through consultations with health care professionals (no intervention involved).

Three analytical themes illuminating perceived barriers and facilitators for lifestyle change were identified: 1) the individual’s evaluation of the importance of initiating lifestyle change, 2) the second theme was strategies and coping mechanisms for maintaining lifestyle changes and 3) the last theme was the significance of supportive relations and environments in initiating and maintaining lifestyle change.

Conclusion

Awareness of prediabetes and the perception of its related risks affects the motivation for lifestyle change in people at risk of type 2 diabetes; but this does not necessarily lead to lifestyle changes. Facilitators and barriers of lifestyle change are found to be in a complex interplay within multiple ecological levels, including the interpersonal, intrapersonal, environmental and policy level. An integrated understanding and analysis of the perceived barriers and facilitators of lifestyle change might inform people with prediabetes, healthcare professionals, and policy makers in terms of the need for psychological, social, and environmental support for this population.