bluuebunny/crossref_metadata_2025 huggingface dataset:
How would you like your Turkish coffee? Tourist experiences of Turkish coffee houses in Istanbul
Authors: Yiğit Serkan , Şahin Perçin Nilüfer
Published: July 2021

Purpose

The purpose of this study is to examine and understand the experiences of tourists in the Turkish coffee houses in Istanbul, Turkey.

Design/methodology/approach

In this study, a qualitative case study method was used to analyze tourists’ comments with user-generated content technique by analyzing tourists’ comments. The data used in the study was collected through TripAdvisor, which is considered one of the most famous websites with tourist reviews and comments, between 20 May and 10 June 2020 from tourists’ reviews (n:219).

Findings

The findings show that Turkish coffee house experiences are heterogeneous based on the dimensions of coffee characteristics, place, satisfaction, recommendation and revisit intention, value/price and value-added experience. Moreover, value-added experience includes some sub-themes such as a memorable experience, authentic experience and culture learning experience.

Originality/value

There are some studies on Turkish coffee and Turkish coffee culture in the literature, but there have been no empirical studies investigating the Turkish coffee house experiences of tourists. For this reason, this study aims to examine and understand the experiences of tourists in Turkish coffee houses. Therefore, it is believed that this study will fill the current gap in the literature on tourists’ experiences of Turkish coffee houses.
GeoForge: investigating integrated virtual reality and personalized websites for collaboration in middle school science
Authors: Brenner Corinne , DesPortes Kayla , Ochoa Hendrix Jessica , Holford Mandë
Published: July 2021

Purpose

This paper aims to describe the design and user testing of GeoForge, a multiple-player digital learning experience for middle school that leverages virtual reality (VR) and individualized websites for learning concepts in planetary science. This paper investigates how specific instructional design choices and features of the technology fostered collaborative behaviors.

Design/methodology/approach

GeoForge was implemented in 3 middle school classrooms with a total of 220 students. Learners used GeoForge in class in groups of 3–4 to learn about planetary science. A mixed-methods approach examined collaboration using classroom observations, teacher interviews, student surveys and student artifacts. Using Jeong and Hmelo-Silver’s (2016) seven affordances of technology for collaborative learning, this paper identifies ways in which features of GeoForge supported collaborative behaviors.

Findings

Instructional design which combined VR and the digital science journal (DSJ) helped foster collaboration. Some collaborative behaviors were especially notable in classrooms that did not regularly practice these skills. Segmenting tasks in the DSJ, clarifying instructions to articulate ideas, showing other group members’ responses onscreen and enabling multiuser VR environments contributed to collaborative behaviors and a satisfying learning experience as observed and documented through multiple methods.

Originality/value

GeoForge successfully integrated VR and personalized websites in a classroom planetary science lesson, an approach which balanced instructional design and logistical challenges while creating opportunities for collaboration.
System dynamics for humanitarian operations revisited
Authors: Besiou Maria , Van Wassenhove Luk N.
Published: July 2021

Purpose

The purpose of this study is to show that the current complexity of humanitarian operations has only increased the usefulness of system dynamics (SD) in helping decision-makers better understand the challenges they face.

Design/methodology/approach

A critical analysis to evaluate how SD methodology has been applied to humanitarian operations.

Findings

Today's humanitarian operations are characterized by huge complexity given the increased number of stakeholders, feedback loops, uncertainty, scarce resources and multiple objectives. The authors argue that SD's tools (causal-loop diagram, data layer, simulation model) have the capacity to appropriately capture this complexity, thereby enhancing intuition and understanding.

Originality/value

Researchers and practitioners hesitate to use system dynamics when data is missing. The authors suggest alternatives to deal with this common situation.
Future strategies for promoting tourism and petroleum heritage in Khuzestan Province, Iran
Authors: Amirkhani Sahar , Torabi Farsani Neda , Moazzen Jamshidi Homa
Published: July 2021

Purpose

Industrial tourism not only strives to preserve industrial heritage, but can also be a strategy for being familiar with the history of industry and attracting tourists to new destinations. This paper examines the issue of promoting petroleum industrial tourism in the case of Khuzestan, Iran. The research aims at determining appropriate strategies for promoting petroleum industrial tourism.

Design/methodology/approach

The data were analysed through a strengths, weaknesses, opportunities, and threats (SWOT) model.

Findings

The results revealed the competitive strategy as the best. Lastly, strategies such as: concentric diversification, joint venture strategy, conglomerate diversification and horizontal diversification were proposed as key solutions. The results support the view that establishing an exploratory ecomuseum in the territory of Khuzestan Province can be a suitable concentric diversification strategy towards petroleum industrial sustainable tourism in the future.

Originality/value

The main originality of this paper includes linking tourism with the petroleum (oil and natural gas) industry and its natural landscapes for the first time in a case study. Therefore, the results of this research can extend the literature in this regards. Moreover, this paper attracts tourists to visit natural landscapes of petroleum heritage.
A generative design approach for modular construction in congested urban areas
Authors: Wei Yuxi , Choi Hyungjoo , Lei Zhen
Published: July 2021

Purpose

Modular construction is widely adopted and used in the construction industry to improve construction performance with respect to both efficiency and productivity. The evaluation of design options for modular construction can be iterative, and thus automation is required to develop design alternatives. This research aims to explore the potential of utilizing the generative design approach to automate modular construction for residential building structures in urban areas such as New York City.

Design/methodology/approach

The proposed research methodology is investigated for a systematic approach to parametrize design parameters for modular construction layout design as well as incorporate design rules/parameters into modularizing design layouts in a Building Information Modeling (BIM) environment. Based on current building codes and necessary inputs by the user, the proposed approach enables providing recommendations in a generative design method and optimizes construction processes by performing analytical calculations.

Findings

The generative design has been found to be efficient in generating layout designs for modular construction based on parametric design. The integration of BIM and generative design can allow industry practitioners to fast generate design layout with evaluations from constructability perspectives.

Originality/value

This paper has proposed a new approach of incorporating generative design with BIM technologies to solve module layout generations by considering design and constructability constraints. The method can be further extended for evaluating modular construction design from manufacturability and assembly perspectives.
An unintended ecological benefit from human intervention: The enhancement of carbon storage in seagrass meadows
Authors: Watanabe Kenta , Kuwae Tomohiro
Published: July 2021

Human interventions have had unintended consequences for the diverse functions of various ecosystems. Hydrological interventions have the potential to alter vegetated habitats in coastal nearshore ecosystems, but little is known about the impacts on organic carbon (Corg) sequestration, which plays an important role in climate change mitigation.

We examined the effects of past human interventions through artificial inlet opening in a lagoonal seagrass meadow. The sediment profiles of geological and biogeochemical characteristics were measured to obtain the historical changes in the lagoon environment and Corg accumulation rates.

Isotopic and elemental signatures and diatom assemblages showed that the interventions increased the duration of seawater exchanges and the extent of the seagrass meadow. Corg accumulation rates increased more than 1.9‐fold after the intervention, resulting in additional Corg storage in the seagrass meadow during last 64 years.

Synthesis and applications. Artificial opening of tidal inlet can potentially provide unintended ecological benefits, such as increased carbon sequestration in seagrass meadows. Hydrological interventions could be undertaken intentionally as a potential active intervention to sequester carbon, as well as control flood risk and provide other benefits to people in estuarine systems. Our results illustrate that physical factors such as improving salinity conditions and mineral particle supply have an impact on the feasibility of hydrological interventions for enhancing carbon sequestration. We propose that biogeochemical–physical coupled approach will help stakeholders to evaluate the ecological and social risks and synergies of implementing hydrological interventions.
Sudden unexpected death due to spontaneous pneumothorax caused by ruptured bilateral pulmonary bullae
Authors: Liu Zhanzhan , Liu Yinhua , Wu Maowang , Zhu Xuyang , Xu Xiang
Published: July 2021

Sudden unexpected death due to pneumothoraces caused by spontaneous rupture of bilateral pulmonary bullae is rare. This article reports the case of a 16‐year‐old girl who experienced this rare phenomenon without any precipitating factors. The patient did not have a history of chest pains or smoking but experienced chest tightness in the early morning and collapsed and died 4 h later. Autopsy identified the cause of death to be bilateral pneumothoraces and massive bilateral pulmonary collapse (atelectasis) due to ruptured apical bullae of the bilateral lungs. No injuries or other significant pathological findings were identified. A low body mass index (16.5) may have been a risk factor for the spontaneous tension pneumothoraces. In some situations, genetic counseling and testing may be helpful in identifying a heritable process associated with spontaneous pneumothoraces.
Functional and structural properties of soy 11S globulin: Influence of reverse micelle extraction
Authors: Yao Fei , Chen Fu‐sheng , Du Yan , Zhang Qian , Zhu Ting‐wei
Published: July 2021

The effect of the reverse micelle extraction method (RMEM) on the physicochemical properties of soy 11S globulin was studied and compared with that of the traditional alkali solution–acid precipitation method (ASAPM). The results showed that the β‐sheet structure content of soy 11S globulin obtained by RMEM was lower, while the β‐turn structure content was higher compared with that obtained by ASAPM. Furthermore, the protein unfolding degree and surface hydrophobicity were lower than those observed using ASAPM. Therefore, RMEM better maintained the natural molecular structure of soy 11S globulin. The thermodynamic and rheological properties of soy 11S globulin obtained by these two methods were further compared, showing that the highest denaturation temperature and transition heat of soy 11S globulin extracted using ASAPM were different from those obtained using RMEM. Furthermore, soy 11S globulin extracted by RMEM showed stronger heat resistance and a higher denaturation temperature than that extracted by ASAPM. The final storage modulus and frequency sweep results showed that the gel formed by soy 11S globulin obtained using RMEM had high storage modulus and loss modulus.

Practical Application

In this study, the effects of two different extraction methods on structural and functional properties of soy 11S globulin, such as thermodynamics and rheology, were investigated. We can know the 11S globulin extracted using the reverse micelle environment was more heat‐resistant and heat‐induced gel quality of 11S globulin was improved by the reverse micelle environment. These results will provide theoretical basis that would help determine the potential applications of soy 11S globulin in the food system.
Occurrence of hypertension during third‐line anlotinib is associated with progression‐free survival in patients with squamous cell lung cancer (SCC): A post hoc analysis of the ALTER0303 trial
Authors: Shi Jianhua , Chen Guimin , Wang Haitao , Wang Xiuxiu , Han Baohui , Li Kai , Wang Qiming , Zhang Li , Wang Zhehai , Cheng Ying , He Jianxing , Shi Yuankai , Chen Weiqiang , Luo Yi , Wu Lin , Wang Xiuwen , Nan Kejun , Jin Faguang , Dong Jian , Li Baolan , Liu Zhian
Published: July 2021

Background

There is a lack of targeted therapeutic options for squamous cell lung cancer (SCC). Accelerated hypertension is an issue with many targeted therapies for lung cancer. This study aimed to analyze the efficacy of anlotinib, based on progression‐free survival (PFS) and overall survival (OS) in patients with SCC, stratified by hypertension and Eastern Cooperative Oncology Group (ECOG) score.

Methods

This was a post hoc analysis of a multicenter, double‐blind, phase III ALTER0303 randomized controlled trial. Only patients with SCC were included. The occurrence of hypertension during the study period was defined according to CTCAE 4.03. OS and PFS were the primary and secondary endpoints, respectively. The patients were stratified according to hypertension and ECOG score, respectively.

Results

The median PFS in the patients who developed hypertension was longer than in those who did not (7.2 (95% CI: 3.5–11.0) versus 3.2 (95% CI: 1.2–5.3) months, p = 0.001; HR (95% CI), 0.4 (0.2–0.8)). In the ECOG 0 patients, the median PFS in the patients who developed hypertension versus those who did not was 5.6 vs. 1.8 months, respectively (Figure 2(d)). In the ECOG 1 patients, the median PFS in the patients who developed hypertension versus those who did not was 7.0 (95% CI: 3.0–11.0) vs. 4.8 (95% CI: 1.2–8.5) months (p = 0.043). No statistically significant differences were found in OS in the stratified analyses.

Conclusions

The occurrence of hypertension might be a clinical indicator predicting the efficacy of third‐line anlotinib treatment in patients with SCC.
Comparison of perioperative and survival outcomes between sublobar resection and lobectomy of patients who underwent a second pulmonary resection
Authors: Yao Xingxin , Zheng Difan , Yuan Chongze , Tao Xiaoting , Peng Yizhou , Zhang Yawei , Sun Yihua
Published: July 2021

Background

Repeat pulmonary resection is widely accepted in clinical practice. This study aimed to compare sublobar resection (segmentectomy or wedge resection) with lobectomy in the treatment of patients who underwent a second pulmonary resection.

Methods

This study retrospectively included patients who underwent lobectomy or sublobar resection for second pulmonary resection. 1:1 propensity score matching (PSM) was performed to balance selection bias. Clinicopathological features, perioperative and survival outcomes of lobectomy and sublobar resection were compared.

Results

A total of 308 patients who underwent second pulmonary resection were identified: 71 (23.1%) who underwent lobectomy and 237 (76.9%) who underwent sublobar resection. After PSM, 58 patients for each group were selected with well‐balanced clinicopathological characteristics. In patients who underwent sublobar resection, significantly shorter chest tube duration (days) (median, 4 vs. 2, p < 0.001) and postoperative hospital stay (days) (median, 6 vs. 4, p < 0.001) were observed. There was no significant difference in overall survival between these two groups after the second and first surgery (p = 0.65, p = 0.98), respectively. Subgroup analysis according to the type of the first resection showed consistent results.

Conclusions

Sublobar resection may be considered as an alternative option for second pulmonary resection due to its perioperative advantages and similar survival outcomes compared with lobectomy.
Pseudocirrhosis due to liver metastasis from lung adenocarcinoma
Authors: Shijubou Naoki , Sumi Toshiyuki , Keira Yoshiko , Shiraishi Hideaki , Nagahisa Yuta , Matsuura Keigo , Sekikawa Motoki , Yamada Yuichi , Nakata Hisashi , Chiba Hirofumi
Published: July 2021

Pseudocirrhosis is a radiological diagnosis of cirrhosis without histological evidence and occurs as a complication of liver metastases from solid tumors. A 50‐year‐old man without any previous history of liver disease was diagnosed with adenocarcinoma of the left upper lung lobe and liver metastasis. After chemotherapy, the liver metastases shrank; however, over time, the liver shrank and showed cirrhosis‐like morphological changes. His performance status deteriorated due to ascites and leg edema, and chemotherapy was terminated. Physicians treating lung adenocarcinoma with liver metastases should be aware that pseudocirrhosis is a rare but important complication that can worsen performance status (PS) and hinder treatment continuation.
Patient and public involvement in contemporary large intensive care trials: Protocol for a meta‐epidemiological study
Authors: Barot Emily , Kjær Maj‐Brit Nørregaard , Collet Marie , Crescioli Elena , Rasmussen Bodil Steen , Estrup Stine , Mortensen Camilla Bekker , Vesterlund Gitte Kingo , Sivapalan Praleene , Anthon Carl Thomas , Bruun Camilla Rahbek Lysholm , Poulsen Lone Musaeus , Møller Morten Hylander , Perner Anders , Granholm Anders
Published: July 2021

Background

Patient and public involvement (PPI) in randomized clinical trials (RCTs) has increased in recent years but remains the exception rather than the rule. We aim to assess the frequency and extent of PPI in large, contemporary RCTs conducted in an intensive care setting.

Methods and design

We will conduct a meta‐epidemiological study of RCTs conducted in intensive care settings published since 2019 and assess their use of PPI. We will extract trial characteristics and verify the use of PPI with trial authors unless specifically stated in the published paper. The primary outcome will be the proportion of trials that use PPI. Secondary outcomes will explore which groups are consulted, at which stage of the trial process this occurs, and by what means these opinions are collected and implemented.

Discussion

This meta‐epidemiological study will provide an important insight into the use of PPI in large, contemporary intensive care trials. We wish to reveal ways in which patient involvement could be incorporated more broadly and purposefully here and help to empower clinicians, researchers and patients to collaborate further on future research processes and goals.
Effects of Maryland’s global budget revenue model on emergency department utilization and revisits
Authors: Galarraga Jessica E. , DeLia Derek , Huang Jim , Woodcock Cynthia , Fairbanks Rollin J. , Pines Jesse M.
Published: July 2021

Background

In 2014, Maryland (MD) implemented a “global budget revenue” (GBR) program that prospectively sets hospital budgets. This program introduced incentives for hospitals to tightly control volume and meet budget targets. We examine GBR’s effects on emergency department (ED) visits, admissions, and returns.

Methods

We performed an interrupted time‐series analysis with difference‐in‐differences comparisons using 2012 to 2015 Healthcare Cost Utilization and Project data from MD, New York (NY), and New Jersey (NJ). We examined GBR’s effects on ED visits/1,000 population, admissions from the ED, and ED returns at 72 h and 9 days. We also examined rates of admission, intensive care unit (ICU) stay, and in‐hospital mortality among returns. To evaluate racial/ethnic and payer outcome disparities among ED returns, we performed a triple differences analysis.

Results

ED visits decreased with GBR adoption in MD relative to NY and NJ, by five and six visits/1,000 population, respectively. ED admissions declined relative to NY and NJ, by 0.6% and 1.8%, respectively. There was also a post‐GBR decline in ED returns by 0.7%. Admissions among returns declined by 2%, while ICU and in‐hospital mortality among returns remained relatively stable. ED return outcomes varied by racial/ethnic and payer group. Non‐Hispanic Whites and non‐Hispanic Blacks experienced a similar decline in returns, while returns remained unchanged among Hispanics/Latinos, widening the disparity gap. Payer group disparities between privately insured and Medicare, Medicaid, and uninsured individuals improved, with the disparity reduction most pronounced among the uninsured.

Conclusions

GBR adoption was associated with lower ED utilization and admissions. ED returns and admissions among returns also decreased, while mortality and ICU stays among returns remained stable, suggesting that GBR has not led to adverse patient outcomes from fewer admissions. However, changes in ED return disparities varied by subgroup, indicating that improvements in care transitions may be uneven across patient populations.
Surrogacy and uterus transplantation using live donors: Examining the options from the perspective of ‘womb‐givers’
Authors: Mullock Alexandra , Romanis Elizabeth Chloe , Begović Dunja
Published: July 2021

For females without a functioning womb, the only way to become a biological parent is via assisted gestation—either surrogacy or uterus transplantation (UTx). This paper examines the comparative impact of these options on two types of putative ‘womb‐givers’: people who provide gestational surrogacy and those who donate their uterus for live donation. The surrogate ‘leases’ their womb for the gestational period, while the UTx donor donates their womb permanently via hysterectomy. Both enterprises involve a significant degree of self‐sacrifice and medical risk in order to enable another person(s) to become a parent by either providing gestational labour or enabling the other person to undertake gestation themselves. In this paper, we explore the burdens and the benefits from the perspective of the womb‐giver in order to inform ethical debate about assisted gestation. This is a perspective that is often neglected in the bioethical discourse. With both surrogacy and UTx, when success follows the womb‐giver’s sacrifice, the key benefit is delivered to the intending parent(s), but as this article examines, the womb‐giver may also enjoy some unique (relational) benefits as a result of their sacrifice. Ultimately, the choice of how a womb‐giver lends assistance in gestation will impact on their bodily autonomy; some will prefer to carry a pregnancy and others to donate their uterus. We argue that the perspective of the womb‐giver is crucial and thus far has not been afforded sufficient consideration in ethical discussion.
ICD‐11 ‘mixed depressive and anxiety disorder’ is clinical rather than sub‐clinical and more common than anxiety and depression in the general population
Authors: Shevlin Mark , Hyland Philip , Nolan Emma , Owczarek Marcin , Ben‐Ezra Menachem , Karatzias Thanos
Published: July 2021

Background

The new International Classification of Diseases was published in 2018 (ICD‐11; World Health Organization, 2018) and now includes ‘Mixed depressive and anxiety disorder’ (6A73: MDAD) designated as a mood disorder. This disorder is defined by symptoms of both anxiety and depression occurring more days than not, for a period of two weeks, and neither set of symptoms considered separately reaches a diagnostic threshold for either disorder. However, to date no study has examined the validity of these guidelines in a general population sample.

Methods

Using Goldberg et al.’s (2017) guidelines regarding measurement of depression and anxiety, this study used factor mixture modelling (FMM) to examine the validity of the ICD‐11 criteria of MDAD. Symptom endorsement rates are provided as well as demographic predictors and somatization outcomes.

Results

Fit indices suggested the two‐factor four‐class solution was the best balance between model complexity and model fit. The results did not support a class that is subsyndromal to both anxiety and depression. On the contrary, we suggest that there exists a ‘Comorbid’ class that represents endorsement of both anxiety and depression symptoms at a higher level when compared to both ‘anxiety’ and ‘depression’ groups. Demographic predictors, as well as somatization and functional impairment outcomes, provided support for this FMM solution.

Conclusions

The ‘Comorbid’ group was the largest symptomatic group and had the highest levels of both anxiety and depression symptoms. Importantly, this group was larger than either the ‘anxiety’ or ‘depression’ group and was associated with high levels of functional impairment and somatization.
EBV‐positive HIV‐associated diffuse large B cell lymphomas are characterized by JAK/STAT (STAT3) pathway mutations and unique clinicopathologic features
Authors: Chapman Jennifer R. , Bouska Alyssa C. , Zhang Weiwei , Alderuccio Juan Pablo , Lossos Izidore S. , Rimsza Lisa M. , Maguire Alanna , Yi Shuhua , Chan Wing C. , Vega Francisco , Song Joo Y.
Published: July 2021

Even in the era of highly active combination antiretroviral therapy (cART), patients with HIV have a disproportionate risk of developing aggressive lymphomas that are frequently Epstein‐Barr virus (EBV)‐related. Here, we investigate HIV‐associated diffuse large B‐cell lymphoma (HIV‐DLBCL) and compare EBV‐positive and EBV‐negative cases. HIV‐DLBCL were identified from two academic medical centres and characterised by immunohistochemistry, EBV status, fluorescence in situ hybridisation, cell of origin determination by gene expression profiling, and targeted deep sequencing using a custom mutation panel of 334 genes. We also applied the Lymphgen tool to determine the genetic subtype of each case. Thirty HIV‐DLBCL were identified, with a median patient age of 46 years and male predominance (5:1). Thirteen cases (48%) were EBV‐positive and 14 (52%) EBV‐negative. Nine of the 16 tested cases (56%) had MYC rearrangement, three (19%) had BCL6 (two of which were double hit MYC/BCL6) and none had BCL2 rearrangements. Using the Lymphgen tool, half of the cases (15) were classified as other. All HIV‐DLBCL showed mutational abnormalities, the most frequent being TP53 (37%), MYC (30%), STAT3 (27%), HIST1H1E (23%), EP300 (20%), TET2 (20%), SOCS1 (17%) and SGK1 (17%). EBV‐negative cases were mostly of germinal centre B‐cell (GCB) origin (62%), showed more frequent mutations per case (a median of 13·5/case) and significant enrichment of TP53 (57% vs. 15%; P = 0·046), SGK1 (36% vs. 0%; P = 0·04), EP300 (43% vs. 0%; P = 0·02) and histone‐modifying gene (e.g. HIST1H1E, HIST1H1D, 79% vs. 31%; P = 0·02) mutations. EBV‐positive cases were mostly of non‐GCB origin (70%), with fewer mutations per case (median 8/case; P = 0·007), and these tumours were enriched for STAT3 mutations (P = 0·10). EBV‐positive cases had a higher frequency of MYC mutations but the difference was not significant (36% vs. 15%; P = 0·38). EBV‐association was more frequent in HIV‐DLBCLs, arising in patients with lower CD4 counts at diagnosis (median 46·5 vs. 101, P = 0·018). In the era of cART, approximately half of HIV‐DLBCL are EBV‐related. HIV‐DLBCL are enriched for MYC rearrangements, MYC mutations and generally lack BCL2 rearrangements, regardless of EBV status. Among HIV‐DLBCL, tumours that are EBV‐negative and EBV‐positive appear to have important differences, the latter arising in context of lower CD4 count, showing frequent non‐GCB origin, lower mutation burden and recurrent STAT3 mutations.
Diagnostic accuracy of Ara h 2 for detecting peanut allergy in children
Authors: Kansen Hannah M. , van Erp Francine C. , Meijer Yolanda , Gorissen Dianne M.W. , Stadermann Marike , van Velzen Maartje F. , Keusters Willem R. , Frederix Geert W.J. , Knulst André C. , van der Cornelis K. , Le Thuy‐My
Published: July 2021

Background

Specific IgE to Ara h 2 is a diagnostic test for peanut allergy which may reduce the need for double‐blind placebo‐controlled food challenges (DBPCFC); however, guidance for using Ara h 2 in place of DBPCFCs has not been validated.

Objective

To prospectively evaluate 1) diagnostic accuracy of previously published Ara h 2 cut‐off levels to diagnose peanut allergy in children and 2) costs.

Methods

A consecutive series of 150 children age 3.5 to 18 years was evaluated in secondary and tertiary settings in the Netherlands. sIgE to Ara h 2 was the index test, and oral peanut ingestion was the reference test. Oral peanut ingestion was home or supervised introduction for Ara h 2 ≤ 0.1, DBPCFC for 0.1–5.0 and open food challenge for ≥5.0. Costs were calculated using financial healthcare data.

Results

A conclusive reference test was performed in 113 children (75%). Sixty‐four children (57%) had peanut allergy, as confirmed by a DBPCFC (27/47) or an open challenge (37/50). Forty‐nine children (43%) were considered peanut‐tolerant after peanut introduction (19/19), a DBPCFC (20/47) or an open challenge (10/50). Area under the curve for Ara h 2 was 0.94 (95% CI 0.90–0.98). The diagnostic flow chart correctly classified 26/26 (100%; 84–100) of children with Ara h 2 ≤ 0.1 as peanut‐tolerant and 34/35 (97%; 83–100) of children with Ara h 2 ≥ 5.0 as peanut‐allergic. At a cut‐off of ≤0.1 and ≥5.0, a sensitivity of respectively 100% (93–100) and 53% (38–67) was observed and a specificity of 53% (38–67) and 98% (87–100). Mean annual costs of the flow chart were estimated as €320‐€636 per patient lower than following national allergy guidelines.

Conclusions

In this diagnostic accuracy study, which did not take into account pretest probability, we have validated previously published Ara h 2 cut‐off levels which are associated with peanut tolerance and allergy.
Caecal diverticulitis can be misdiagnosed as acute appendicitis: a systematic review of the literature
Authors: Uhe Isabelle , Meyer Jeremy , Viviano Manuela , Naiken Surrennaidoo , Toso Christian , Ris Frédéric , Buchs Nicolas C.
Published: July 2021

Aim

Caecal diverticulitis (CD) is an uncommon condition which can be misdiagnosed as acute appendicitis due to similar clinical presentations. Further, its management varies among medical centres. The aim of this study was to review cases of patients with CD, to identify the factors differentiating CD from acute appendicitis and to provide a summary of existing diagnostic methods and therapeutic alternatives regarding its management.

Methods

This systematic review was conducted in accordance with the PRISMA guidelines and the AMSTAR2 checklist. We searched MEDLINE and Embase from inception until 1 October 2018 for original publications reporting cases of CD.

Results

Out of the 560 identified studies, 146 publications (988 patients) were included in the qualitative synthesis. Most frequent symptoms of CD were right iliac fossa pain (93.2%), nausea and/or vomiting (35.4%) and fever (26.9%). A total of 443 patients (44.8%) underwent radiological imaging, which reported CD in 225 patients (22.8%). For the other patients, the diagnosis was obtained by surgical exploration (73.9%). Among patients diagnosed with CD by imaging, 67 (29.8%) underwent surgery and 158 (70.2%) were treated conservatively. Among patients who underwent surgical exploration, treatment consisted most frequently of right hemi‐colectomy (33%), appendectomy (18.8%) and diverticulectomy with appendectomy (16.3%).

Conclusion

CD can be misdiagnosed as acute appendicitis, therefore resulting in unnecessary surgical exploration. The review of the literature starting from 1930 highlights the critical role of medical imaging in supporting the clinician to diagnose this condition and administer adequate treatment.
Cytological diagnosis of microfilariae in clinically unsuspected cases: A retrospective review of 12 cases
Authors: Gupta Deepika , Gupta Prajwala , Jain Swasti , Rahar Seema
Published: July 2021

Background

Filariasis is a major health problem in India. Despite the high prevalence, microfilariae are rarely found in cytology smears. Most of the cases are incidentally found, solely or in association with other pathologies.

Aims and Objectives

This study was undertaken to analyse the prevalence and cytological findings of cases of incidentally found microfilariae in cytology smears (fine needle aspiration cytology [FNAC]/exfoliative cytology) from different parts of the body.

Materials and Methods

This was a retrospective study over 3 years, in which cases of microfilariae in aspirates from swelling of different locations, body fluids, and pap smears were reviewed, and the clinicopathological data analysed.

Results and Analysis

Out of 11 530 cases of FNAC, 8700 cases of fluid cytology, and 9000 of conventional cervicovaginal smears, 12 cases (0.04%) of incidental findings of microfilariae were documented in cytology smears. The cases were diagnosed from lymph node (one case), hand (one case), scrotal area (one case), axilla (one case), breast (one case), subcutaneous tissue (three cases), urine (three cases), and Pap smear (one case). We found eosinophilia in one case (8.3%) of filarial lesions. We found two cases of incidental findings of microfilariae in association with malignant lesions.

Conclusion

Cytology smear examination can play an important role in diagnosing occult filariasis in clinically unsuspected cases in association with other pathologies.
Utility of the Milan system for reporting salivary gland cytopathology during rapid on‐site evaluation (ROSE) of salivary gland aspirates
Authors: Kakkar Aanchal , Kumar Mukin , Subramanian Priyadarsani , Zubair Arshad , Kumar Rajeev , Thakar Alok , Jain Deepali , Mathur Sandeep R. , Iyer Venkateswaran K.
Published: July 2021

Objective

Rapid on‐site evaluation (ROSE) is a fine needle aspiration (FNA) technique for ensuring sampling adequacy and triaging samples. The Milan system for reporting salivary gland cytopathology (MSRSGC) is a standardised reporting system which aims to improve risk stratification. There is scant literature on the diagnostic value and agreement of MSRSGC on ROSE with final cytological diagnosis in salivary gland FNAs. We aimed to assess the concordance of MSRSCG categorisation and diagnosis on ROSE with final cytological and histological diagnosis.

Methods

This prospective study included consecutive salivary gland FNAs for which ROSE was performed over a six‐month period. MSRSGC category and diagnosis on ROSE were compared with the final cytological diagnosis and MSRSGC category, and histopathological diagnosis, where available.

Results

Sixty salivary gland aspirates were included. The adequacy rate with ROSE was 100%. Using the MSRSGC classification during ROSE, 26 (43.2%) samples were categorised as benign neoplasm, 21 (35%) as malignant neoplasm, 9 (15%) as non‐neoplastic, and one each (1.7%) belonged to the remaining four categories. MSRSGC categorisation on ROSE concurred with final the cytological diagnosis in 58/60 cases (96.7%). Discrepancies in MSRSGC categories on ROSE included one atypia of undetermined significance with final report as non‐neoplastic, and one non‐diagnostic as suspicious for malignancy. Good correlation of MSRSGC categories on ROSE with final histopathological diagnosis (88.9% concordance) was also noted.

Conclusions

MSRSGC on ROSE shows good concordance with final cytology and histopathology diagnosis, indicating that categorisation according to MSRSGC has utility in ensuring that adequate material is obtained and triaged appropriately for the diagnosis of salivary gland aspirates.
Bortezomib‐based therapy for newly diagnosed multiple myeloma patients ineligible for autologous stem cell transplantation: Czech Registry Data
Authors: Sandecká Viera , Pour Luděk , Špička Ivan , Minařík Jiří , Radocha Jakub , Jelínek Tomáš , Heindorfer Adriana , Pavlíček Petr , Sýkora Michal , Jungová Alexandra , Kessler Petr , Wróbel Marek , Starostka David , Ullrychová Jana , Stejskal Lukáš , Štork Martin , Straub Jan , Pika Tomáš , Brožová Lucie , Ševčíková Sabina , Maisnar Vladimír , Hájek Roman
Published: July 2021

Objectives

This study compared the use of bortezomib in different combination regimens in newly diagnosed multiple myeloma (NDMM) patients who were transplant ineligible.

Patients and Methods

We analyzed data from the Registry of Monoclonal Gammopathies (RMG) of the Czech Myeloma Group (CMG) to provide real‐world evidence of outcome for 794 newly diagnosed MM transplant ineligible patients. The most frequently used regimen was VCd (bortezomib‐cyclophosphamide‐dexamethasone) (47.5%) over VMP (bortezomib‐melphalan‐prednisone) (21.7%), BDd (bortezomib‐doxorubicin‐dexamethasone) (9.8%), and VTd (bortezomib‐thalidomide‐dexamethasone) (2.9%).

Results

The overall response rate (ORR) was 69.2% (478/691), including 12.6% (≥ CR); 34.7% very good partial responses (VGPR); and 21.9% partial responses (PR). Among triplet regimens, VMP was the most effective regimen compared to VCd, BDd, and VTd. Median PFS was 22.3 vs. 18.5 vs. 13.7 vs. 13.8 mo, (P = .275), respectively, and median OS was 49 vs. 41.7 vs. 37.9 vs. 32.2 mo (P = .004), respectively. The most common grade 3‐4 toxicities were anemia in 17.4% and infections in 18% of patients.

Conclusion

Our study confirmed that bortezomib‐based treatment is effective and safe in NDMM transplant ineligible patients, especially VMP, which was identified as superior between bortezomib‐based induction regimens not only in clinical trials, but also in real clinical practice.
Demystifying individual heterogeneity
Authors: Forsythe Amy B. , Day Troy , Nelson William A.
Published: July 2021

Among‐individual variation in vital rates, such as mortality and birth rates, exists in nearly all populations. Recent studies suggest that this individual heterogeneity produces substantial life‐history and fitness differences among individuals, which in turn scale up to influence population dynamics. However, our ability to understand the consequences of individual heterogeneity is limited by inconsistencies across conceptual frameworks in the field. Studies of individual heterogeneity remain filled with contradicting and ambiguous terminology that introduces risks of misunderstandings, conflicting models and unreliable conclusions. Here, we synthesise the existing literature into a single and comparatively straightforward framework with explicit terminology and definitions. This work introduces a distinction between potential vital rates and realised vital rates to develop a coherent framework that maps directly onto mathematical models of individual heterogeneity. We suggest the terms “fixed condition” and “dynamic condition” be used to distinguish potential vital rates that are permanent from those that can change throughout an individual's life. To illustrate, we connect the framework to quantitative genetics models and to common classes of statistical models used to infer individual heterogeneity. We also develop a population projection matrix model that provides an example of how our definitions are translated into precise quantitative terms.
Taxonomic and phylogenetic β‐diversity of freshwater fish assemblages in relationship to geographical and climatic determinants in North America
Authors: Qian Hong , Cao Yong , Chu Cindy , Li Daijiang , Sandel Brody , Wang Xianli , Jin Yi
Published: July 2021

Aim

A full understanding of the origin and maintenance of β‐diversity patterns in a region requires understanding of: (1) the relationships of both taxonomic and phylogenetic β‐diversity (TBD and PBD, respectively) and their respective turnover and nestedness components with geographical and environmental distances; (2) the relative importance of the turnover and nestedness components of β‐diversity; and (3) the relationships between PBD measures representing different evolutionary depths. Here, we investigate all these aspects of β‐diversity simultaneously for freshwater fishes in North America.

Location

North America north of Mexico (hereafter, North America).

Taxon

Freshwater fishes.

Methods

North America was divided into 360 watersheds. Using two sampling approaches (neighbourhood vs. pairwise), we quantified β‐diversity between fish assemblages using various metrics (representing total, turnover and nestedness components of TBD and PBD, and tip‐ vs. basal‐weighted PBD) and related them to geographical and climatic factors using correlation and regression analyses.

Results

Geographical patterns of total TBD and PBD and their components of turnover and nestedness for freshwater fish assemblages among neighbouring watersheds were highly congruent across North America. Geographical patterns of basal‐weighted PBD were generally opposite to those of tip‐weighted PBD. Metrics of β‐diversity were weakly associated with contemporary climatic variables. TBD and PBD were associated strongly to moderately with geographical distances and moderately with climatic distances. The relationships of metrics of β‐diversity to geographical distances were stronger than those to climatic distances in all cases.

Main conclusions

Geographical and ecological patterns are highly congruent between taxonomic and tip‐weighted PBD, but those between tip‐ and basal‐weighted PBD are greatly different, suggesting that evolutionary histories have played an important role in shaping β‐diversity. Our study suggests that geographical distance between watersheds is more important than climate similarity in determining β‐diversity between freshwater fish assemblages.
Cultural barriers, institutional distance, and spatial spillovers: Evidence from regional industrial evolution in China
Authors: Mao Qiliang , Mao Xianzhuang
Published: July 2021

This study empirically explores the formation of interregional cultural barriers that affect spatial spillovers within the framework of institutional distance based on evidence of regional industrial evolution in China. With dialect as the proxy of culture, this study finds that, first, regional cultural differences will hinder the spatial spillovers of industrial evolution, but the formation of cultural barriers is not only related to culture itself but also closely related to the formal institutional distance between regions. Second, when there is inter‐regional formal institutional distance, formal institutions are insufficient to shape the economic order, and cultural factors with the attributes of informal institutions will become an alternative arrangement to regulate inter‐regional interaction through trust and information mechanisms. The construction of mutual trust based on cultural affinity can reduce the uncertainty of inter‐regional interactions. However, this trust mechanism is regulated by formal institutions and will be significantly weakened with the reduction in formal institutional distance. In addition, information diffusion is easier in regions of cultural homogeneity. However, this information mechanism is often confined to a small social network, and it tends to be weaker as economic society becomes increasingly open and complex.
Collaborative updating of an organizational health literacy tool confirms medical librarians’ leadership roles
Authors: Grabeel Kelsey Leonard , Heidel R. Eric , Oelschlegel Sandy , Rudd Rima
Published: July 2021

Background

A librarian led task force at the University of Tennessee Medical Center sought to evaluate their medical centre's health literacy attributes utilizing a widely used tool. This research ultimately led to the update of the tool.

Objectives

To discuss the evaluation of health literacy attributes of health care organizations and detail the process of updating the Health Literacy Environment of Hospitals and Health Centers (HLEHHC) tool.

Methods

Subsequent to utilizing the HLEHHC, the task force was invited to assist in updating the tool. A collaborative was formed between the original author and task force. The collaborative performed an extensive literature review focused on emerging health literacy issues, reviewed each section and formulated changes.

Results

The collaborative update process yielded an improved instrument for assessing the extent to which a health care organization accommodates low health literacy patients.

Discussion

Through editing, creating new questions and rearranging the format, the HLEHHC was improved and updated.

Conclusion

The assessment conducted by the health literacy task force is helping shape changes in the organization. Medical librarians acted in leadership roles in the collaborative process of developing the new institutional assessment tool for health literacy (HLE2).
Food lifestyle patterns among contemporary food shoppers
Authors: Chen Lijun Angelia , House Lisa
Published: July 2021

To obtain a comprehensive picture of current food lifestyle patterns, this study aims to identify consumer segments with a focus on health‐related considerations, and to profile segmented consumers based on demographic characteristics. As an adaptation of the food‐related lifestyle instrument, consumer segmentation indicators in this study capture four dimensions: ways of shopping; importance of quality aspect; healthy eating; and health practice. Nationwide data targeting U.S. food shoppers were collected from June 2016 to November 2019 (N = 20,827). Latent class analysis, a probabilistic model‐based segmentation approach, identified five distinct food lifestyle segments: passionately involved consumers (11%), nutrition‐focused consumers (30%), moderately involved consumers (17%), convenience‐oriented consumers (21%), and uninvolved consumers (21%). This pattern has differences as well as similarities with the one reflecting U.S. food shoppers in 2003 and those identified in Europe. In addition, these segments are made up of consumers with different demographic and regional characteristics. U.S. census regions, such as East South Central and West South Central, where there is a higher obesity prevalence, tend to have a larger portion of uninvolved consumers and a smaller portion of highly involved consumers (passionately involved and nutrition‐focused consumers). The resulting food lifestyle segments, consumer profiling, and regional comparisons provide insights into effective marketing communication and consumer education on healthy eating.