bluuebunny/crossref_metadata_2025 huggingface dataset:
Open government and citizen empowerment in authoritarian states
Authors: Kurmanov Bakhytzhan , Knox Colin
Published: June 2022

The introduction of open government has been used in many countries to improve the transparency, accountability of the state, and promote participation by citizens in collaborative governance. Its potential for public services improvement, citizen empowerment, and a positive impact on reducing corruption have attracted scholarly attention. Set alongside this, open government initiatives have facilitated greater access to information which can be used to hold governments to account and, in so doing, build trust between citizens and the state. While open government principles sit easily in democratic systems, some authoritarian states have also adopted this concept. This raises two questions. First, is there evidence that open collaboration, as the most developed form of open government, has empowered citizens in autocracies? Second, and more generally, why would authoritarian regimes seek to adopt open government when the concepts of autocracy and openness are antithetical? This paper attempts to address these questions using three case study countries in Central Asia: Kazakhstan, Uzbekistan, and Kyrgyzstan which adopted open government policies. It finds evidence of co-optation, network authoritarianism, and state unresponsiveness/resistance to citizens’ inputs.
Incidence of (Osteo)Chondral Lesions of the Ankle in Isolated Syndesmotic Injuries: A Systematic Review and Meta-Analysis
Authors: Dahmen Jari , Jaddi Sohaib , Hagemeijer Noortje C. , Lubberts Bart , Sierevelt Inger N. , Stufkens Sjoerd A.S. , d’Hooghe Pieter , Kennedy John G. , Calder James D. F. , DiGiovanni Christopher W. , Kerkhoffs Gino M. M. J.
Published: June 2022

Objective

To determine and compare the incidence rate of (osteo)chondral lesions of the ankle in patients with acute and chronic isolated syndesmotic injuries.

Design

A literature search was conducted in the PubMed (MEDLINE) and EMBASE (Ovid) databases from 2000 to September 2021. Two authors independently screened the search results, and risk of bias was assessed using the MINORS (Methodological Index for Non-Randomized Studies) criteria. Studies on acute and chronic isolated syndesmotic injuries with pre-operative or intra-operative imaging were included. The primary outcome was the incidence rate with corresponding 95% confidence intervals (CIs) of (osteo)chondral lesions of the ankle in combined and separate groups of acute and chronic syndesmotic injuries. Secondary outcomes were anatomic distribution and mean size of the (osteo)chondral lesions.

Results

Nine articles (402 syndesmotic injuries) were included in the final analysis. Overall (osteo)chondral lesion incidence was 20.7% (95% CI: 13.7%-29.9%). This rate was 22.0% (95% CI: 17.1-27.7) and 24.1% (95% CI: 15.6-35.2) for acute and chronic syndesmotic injuries, respectively. In the combined acute and chronic syndesmotic injury group, 95.4% of the lesions were located on the talar dome and 4.5% of the lesions were located on the distal tibia. (Osteo)chondral lesion size was not reported in any of the studies.

Conclusions

This meta-analysis shows that (osteo)chondral lesions of the ankle are present in 21% of the patients with isolated syndesmotic injuries. No difference in incidence rate was found between the different syndesmotic injury types and it can be concluded that the majority of lesions are located on the talar dome.

PROSPERO Registration Number:

CRD42020176641
The Influence of North American Ownership on the Business, Management, and Communication Model of Spanish Professional Football: A Case Study of Real Club Deportivo Mallorca (2016–2021)
Authors: Ginesta Xavier , Faedo Nahuel I.
Published: June 2022

The objective of this article is to analyze the changes in the management model of RCD Mallorca, a LaLiga football club, with the arrival of a new, North American majority shareholder (ACQ Legacy Partners LLC) in 2016. It also analyzes journalists’ perception of the new ownership. Our method is a case study design, using qualitative methodological triangulation: a focus group discussion with non-sports executives of the entity, non-participant observation, in-depth interviews with the CEO of RCD Mallorca and its Director of Communication, as well as semi-structured interviews with journalists that regularly cover the club’s information. The results show how the club has developed its management model from one focused on the short-term to a rational and analytical one that incorporates long-term planning. Meanwhile, journalists criticize that they are experiencing a process of disintermediation, since the club ends up competing with them in content creation thanks to the potential of the new digital environment.
Is Nonoperative Treatment Appropriate for All Patients With Type 1 Tibial Spine Fractures? A Multicenter Study of the Tibial Spine Research Interest Group
Authors: Shimberg Jilan L. , Leska Tomasina M. , Cruz Aristides I. , Ellis Henry B. , Patel Neeraj M. , Yen Yi-Meng ,   Tibial Spine Research Interest Group, Schmale Gregory A. , Mistovich R. Justin , Fabricant Peter D. , Ganley Theodore J. , Green Daniel W. , Johnson Benjamin , Kushare Indranil , Lee R. Jay , McKay Scott D. , Milbrandt Todd A. , Rhodes Jason , Sachleben Brant , Traver Jessica L.
Published: June 2022

Background:

Type 1 tibial spine fractures are nondisplaced or ≤2 mm–displaced fractures of the tibial eminence and anterior cruciate ligament (ACL) insertion that are traditionally managed nonoperatively with immobilization.

Hypothesis:

Type 1 fractures do not carry a significant risk of associated injuries and therefore do not require advanced imaging or additional interventions aside from immobilization.

Study Design:

Case series; Level of evidence, 4.

Methods:

We reviewed 52 patients who were classified by their treating institution with type 1 tibial spine fractures. Patients aged ≤18 years with pretreatment plain radiographs and ≤ 1 year of follow-up were included. Pretreatment imaging was reviewed by 4 authors to assess classification agreement among the treating institutions. Patients were categorized into 2 groups to ensure that outcomes represented classic type 1 fracture patterns. Any patient with universal agreement among the 4 authors that the fracture did not appear consistent with a type 1 classification were assigned to the type 1+ (T1+) group; all other patients were assigned to the true type 1 (TT1) group. We evaluated the rates of pretreatment imaging, concomitant injuries, and need for operative interventions as well as treatment outcomes overall and for each group independently.

Results:

A total of 48 patients met inclusion criteria; 40 were in the TT1 group, while 8 were in the T1+ group, indicating less than universal agreement in the classification of these fractures. Overall, 12 (25%) underwent surgical treatment, and 12 (25%) had concomitant injuries. Also, 8 patients required additional surgical management including ACL reconstruction (n = 4), lateral meniscal repair (n = 2), lateral meniscectomy (n = 1), freeing an incarcerated medial meniscus (n = 1), and medial meniscectomy (n = 1).

Conclusion:

The classification of type 1 fractures can be challenging. Contrary to prior thought, a substantial number of patients with these fractures (>20%) were found to have concomitant injuries. Overall, surgical management was performed in 25% of patients in our cohort.
Optical Coherence Tomography Angiography in Pediatric Retinal Disorders
Authors: Ponugoti Arathi , Baumal Caroline R. , Vajzovic Lejla
Published: June 2022

Purpose:

The rapid and noninvasive nature of optical coherence tomography angiography (OCTA) makes it a potentially valuable tool for imaging the retina in children. With the optimization of tabletop systems and the development of experimental handheld OCTA devices, there is expanded potential for OCTA in the clinic and the operating room. This article reviews the utility of OCTA in some of the most common pediatric retinal disorders.

Methods:

A thorough computerized PubMed search was performed to review relevant published journal articles to contextualize and identify the role of OCTA in common retinal disorders with vascular involvement affecting children. Pertinent results and findings from original investigations and case reports were summarized.

Results:

The ability to quickly collect both qualitative and quantitative information about retinal microvasculature, in both the clinic and operating room settings, with OCTA, has led to the uncovering of microvascular features and morphologic changes in many pediatric retinal disorders such as Coats Disease, familial exudative vitreoretinopathy, incontinentia pigmenti, sickle cell retinopathy, Stargardt Disease, X-linked juvenile retinoschisis, retinopathy of prematurity, diabetic retinopathy in type 1 diabetes, pediatric retinal tumors, and choroidal neovascularization.

Conclusions:

OCTA is a relevant tool to aid early detection, guide intervention, monitor treatment response, and understand pathogenesis in a number of pediatric retinal disorders.
Experimenting with fog: Environmental infrastructures, infrastructuring environments, and the infrastructure of infrastructure
Authors: Ojani Chakad
Published: June 2022

In coastal Peru, conservationists and scientists attend to fog as something that may be captured and transformed into water. This article draws on ethnographic fieldwork among Limeñan conservationists who tapped into this atmospheric phenomenon as an alternative water source for use in fog oasis ecosystem reforestation. As I demonstrate, experimental engagements with fog had reconfigured conservationists’ and other experimenters’ understanding about the connections between the atmosphere, vegetation, and the underground, thereby bringing into view a hitherto imperceptible environmental infrastructure of groundwater production. The infrastructural potentials of the landscape were in turn foregrounded by the conservationists through comparisons with other geographies well-known for their capacity to produce water. Against this backdrop, the article argues for renewed attention to the infrastructural as a comparative effect resulting from simultaneous fore/backgrounding. Rather than mere grounds for second-order processes, infrastructural relations can be understood as situated between foreground and background. As environmental calamities complicate the infrastructure–environment nexus, it is no longer clear what infrastructures consist of, nor what they are capable of doing. In this context, an understanding of infrastructures as comparative effects is useful for describing and speculatively amplifying potentially more sustainable infrastructural alternatives.
Microstructural and mechanical characterization of steel-DP780/Al-5052 joints formed using resistance element welding with concealed rivet cover
Authors: Cai Wanyue , Chen Qi , Wang Yijin , Dong Shijie , Luo Ping
Published: June 2022

Resistance element welding (REW) with a concealed rivet cover (Q235) was used to join steel-DP780 and Al-5052. The macroscopic morphology and the microstructure were observed using optical microscopy and scanning electron microscopy. The mechanical properties of the joint were also tested. The results show that the intermetallic compound (IMC) formed at the Q235/Al interface is FeAl3, while the IMCs formed at the DP780/Al interface are Fe2Al5 and FeAl3. The welding current has a significant influence on the nugget size, peak load, average hardness of aluminum heat-affected zone, and the bearing area of the aluminum plate. There are three fracture models of the countersunk rivet REW joint under a tensile-shear force: the interface failure fracture model, the fusion pullout failure fracture model, and the heat-affected zone failure fracture model. At a welding current of 18 kA, the nugget pullout failure mode is observed, and the best mechanical properties of the joint are obtained. The shear resistance of the joint can reach up to 5712 N.
A Bipedicled Lip Switch Flap From the Upper Lip for Delayed Re-Do Total Lower Lip Reconstruction: A Case Report
Authors: O’Neill Elizabeth S. , Lee Subin , Bonett Andrew , Seu Michelle Y. , Dorafshar Amir H.
Published: June 2022

Several different techniques have been described for reconstructing vermilion lip defects. The key to successful reconstruction of the vermilion is to restore the original esthetic landmarks and appearance of the lip while preserving function. We present a case of a 49-year-old patient with a history of lower lip squamous cell carcinoma who presented to our institution status post resection and reconstruction with Bernard-von Burow cheek advancement flaps with Webster modification at an outside hospital. Her main complaint was the lack of lower lip vermillion and loss of lip height. This new defect was repaired using a bipedicled lip switch flap from the upper to lower lip. To our knowledge, this is the first time this technique has been reported in the literature to reconstruct a total vermilion lower lip defect. A bipedicled lip switch flap offers an alternative, reliable method for the repair of large vermilion lip defects that can produce satisfactory esthetic and functional outcomes.
Introduction to a review series on COVID-19 and the hematologist
Authors: Ortel Thomas L. , Berliner Nancy
Published: June 2022

Since the COVID-19 pandemic began over 2 years ago, its global impact has been enormous. Our growing understanding of the pathophysiology of this disease has particular links to hematology. Introduced by Ortel and Berliner, this Review Series provides up-to-date overviews of the many areas in which COVID-19 has implications for hematology practice.
Effects of a history of headache and migraine treatment on baseline neurocognitive function in young athletes
Authors: McCarthy Lily , Hannah Theodore C. , Li Adam Y. , Schupper Alexander J. , Hrabarchuk Eugene , Kalagara Roshini , Ali Muhammad , Gometz Alex , Lovell Mark R. , Choudhri Tanvir F.
Published: June 2022

Objective/background

Despite the prevalence of concussions in young athletes, the impact of headaches on neurocognitive function at baseline is poorly understood. We analyze the effects of a history of headache treatment on baseline ImPACT composite scores in young athletes.

Methods

A total of 11,563 baseline ImPACT tests taken by 7,453 student-athletes ages 12-22 between 2009 and 2019 were reviewed. The first baseline test was included. There were 960 subjects who reported a history of treatment for headache and/or migraine (HA) and 5,715 controls (CT). The HA cohort included all subjects who self-reported a history of treatment for migraine or other type of headache on the standardized questionnaire. Chi-squared tests were used to compare demographic differences. Univariate and multivariate regression analyses were used to assess differences in baseline composite scores between cohorts while controlling for demographic differences and symptom burden.

Results

Unadjusted analyses demonstrated that HA was associated with increased symptoms (β=2.30, 95% CI: 2.18-2.41, p<.0001), decreased visual memory (β=-1.35, 95% CI: -2.62 to -0.43, p=.004), and increased visual motor speed (β=0.71, 95% CI: 0.23-1.19, p=.004) composite scores. Baseline scores for verbal memory, reaction time, and impulse control were not significantly different between cohorts. Adjusted analyses demonstrated similar results with HA patients having greater symptom burden (β=1.40, 95% CI: 1.10-1.70, p<.0001), lower visual memory (β=-1.25, 95% CI: -2.22 to -0.27, p=.01), and enhanced visual motor speed (β=0.60, 95% CI: 0.11-1.10, p=.02) scores.

Conclusion

HA affected symptom, visual motor speed, and visual memory ImPACT composite scores. Visual memory scores and symptom burden were significantly worse in the HA group while visual motor speed scores were better, which may have been due to higher stimulant use in the HA group. The effects of HA on visual motor speed and visual memory scores were independent of the effects of the increased symptom burden.
Improving ambulance care for children suffering acute pain: a qualitative interview study
Authors: Whitley Gregory Adam , Hemingway Pippa , Law Graham Richard , Siriwardena Aloysius Niroshan
Published: June 2022

Background

Pain is a highly complex sensory and emotional experience. When a child suffers acute pain through illness or injury, they are often transported to hospital by ambulance. Pre-hospital pain management in children is poor, with 61% of children receiving suboptimal pain management. Consequences of poor pain management include the risk of developing post-traumatic stress disorder and altered pain perception. We aimed to identify clinicians’ perceptions of barriers, facilitators and potential improvements for the management of pre-hospital acute pain in children.

Methods

Qualitative face to face semi-structured recorded interviews were performed in one large UK ambulance service. Audio files were transcribed verbatim with thematic analysis used to generate themes. NVivo 12 was used to support data analysis. Findings were combined with existing evidence to generate a driver diagram.

Results

Twelve ambulance clinicians participated, including 9 registered paramedics and 3 emergency medical technicians. Median (IQR) age was 43.50 (41.50, 45.75) years, 58% were male, median (IQR) experience was 12 (4.25, 15.50) years and 58% were parents. Several themes relating to barriers and facilitators were identified, including physical, emotional, social, organisational, environmental, management, knowledge and experience. Improvement themes were identified relating to management, organisation and education. These data were combined to create a driver diagram; the three primary drivers were 1) explore methods to increase rates of analgesic administration, including utilising intranasal or inhaled routes; 2) reduce fear and anxiety in children, by using child friendly uniform, additional non-pharmacological techniques and more public interaction and 3) reduce fear and anxiety in clinicians, by enhancing training and optimising crew mix.

Conclusions

The quality of care that children receive for acute pain in the ambulance service may be improved by increasing rates of analgesic administration and reducing the fear and anxiety experienced by children and clinicians. Future research involving children and parents would be useful to determine the most important outcome measures and facilitate intervention development.
Out of hospital cardiac arrest: experience of a bystander CPR training program in Karachi, Pakistan
Authors: Khan Uzma Rahim , Khudadad Umerdad , Baig Noor , Ahmed Fareed , Raheem Ahmed , Hisam Butool , Khan Nadeem Ullah , Hock Marcus Ong Eng , Razzak Junaid Abdul
Published: June 2022

Background

Nearly 90% of out-of-hospital cardiac arrest (OHCA) patients are witnessed, yet only 2.3% received bystander cardiopulmonary resuscitation (CPR) in Pakistan. This study aimed to determine retention of knowledge and skills of Hands-Only CPR among community participants in early recognition of OHCA and initiation of CPR in Karachi, Pakistan.

Methods

Pre and post-tests were conducted among CPR training participants from diverse non-health-related backgrounds from July 2018 to October 2019. Participants were tested for knowledge and skills of CPR before training (pre-test), immediately after training (post-test), and 6 months after training (re-test). All the participants received CPR training through video and scenario-based demonstration using manikins. Post-training CPR skills of the participants were assessed using a pre-defined performance checklist. The facilitator read out numerous case scenarios to the participants, such as drowning, poisoning, and road traffic injuries, etc., and then asked them to perform the critical steps of CPR identified in the scenario on manikins. The primary outcome was the mean difference in the knowledge score and skills of the participants related to the recognition of OHCA and initiation of CPR.

Results

The pre and post-tests were completed by 652 participants, whereas the retention test after 6 months was completed by 322 participants. The mean knowledge score related to the recognition of OHCA, and initiation of CPR improved significantly (p < 0.001) from pre-test [47.8/100, Standard Deviation (SD) ±13.4] to post-test (70.2/100, SD ±12.1). Mean CPR knowledge after 6 months (retention) reduced slightly from (70.2/100, ±12.1) to (66.5/100, ±10.8). CPR skill retention for various components (check for scene safety, check for response, check for breathing and correct placement of the heel of hands) deteriorated significantly (p < 0.001) from 77.9% in the post-test to 72.8% in re-test. Participants performed slightly better on achieving an adequate rate of chest compressions from 73.1% in post-test to 76.7% in re-test (p 0.27).

Conclusion

Community members with non-health backgrounds can learn and retain CPR skills, allowing them to be effective bystander CPR providers in OHCA situations. We recommend mass population training in Pakistan for CPR to increase survival from OHCA.
Independent risk factors of mortality in patients with sepsis receiving single-dose etomidate as an induction agent during rapid sequence intubation in a large tertiary emergency department in Thailand
Authors: Pansiritanachot Wasin , Ruangsomboon Onlak , Limsuwat Chok , Chakorn Tipa
Published: June 2022

Background

There is limited evidence regarding factors associated with mortality in septic patients receiving etomidate. This study aimed to determine independent pre-intubation factors predicting 28-day mortality in septic patients receiving single-dose etomidate as an induction agent during rapid sequence intubation (RSI).

Methods

This single-center retrospective cohort study included intubated septic patients receiving etomidate as an induction agent during RSI in the emergency department of Siriraj hospital, Bangkok, Thailand, between January 1st, 2016 and June 30th, 2020. Pre-intubation characteristics were compared between survivors and non-survivors. Independent risk factors associated with 28-day mortality were identified using the Cox proportional hazards regression model. Association between etomidate dosage and mortality was also determined.

Results

A total of 344 patients, 238 (69%) survivors and 106 (31%) non-survivors, were included in the analyses. The initial Cox hazards model identified a pre-intubation lactate level ≥ 4 mmol/L as an independent factor associated with mortality (adjusted Hazards ratio [aHR] 2.66, 95% confidence interval [CI] 1.55–4.56). After removing lactate level from the model due to limited lactate values in the data, cancer was also predictive of 28-day mortality (aHR 1.83, 95%CI 1.10–3.04), while patients with respiratory infections and underlying chronic lung disease were associated with lower mortality (aHR 0.54, 95%CI 0.37–0.80 and aHR 0.57, 0.33–0.96, respectively). Etomidate dosage was not associated with mortality in our study.

Conclusion

In septic patients who received a single dose of etomidate, a pre-intubation lactate level ≥ 4 mmol/L and cancer were associated with increased 28-day mortality, while respiratory infection and underlying chronic lung disease were associated with lower mortality. Physicians may take these factors into consideration when selecting induction agents for septic patients.
Practices among General Practitioners in Rheumatoid Arthritis (GEPRA-I): results of a region-wide online survey
Authors: Yailian Anne-Laure , Estublier Charline , Fontana Aurélie , Vignot Emmanuelle , Confavreux Cyrille , Chapurlat Roland , de Fréminville Humbert , Janoly-Dumenil Audrey
Published: June 2022

Background

To assess current practice regarding the management of rheumatoid arthritis patients among general practitioners of a French region, and their perception about the deployment of a multidisciplinary collaboration.

Methods

A cross-sectional online survey was sent to the general practitioners of a French region. The questionnaire comprised of 3 sections to collect data regarding 1/demographics, 2/practice and knowledge in rheumatoid arthritis, and 3/perception about the deployment of a multidisciplinary collaboration.

Results

1/A total of 247 general practitioners (M/F ratio: 1.4; mean age: 46.7 years) completed the survey. 2/More than half of general practitioners believed that their role was very or extremely important in disease diagnosis (72.5%), and management of comorbidities (67.2%). Among respondents, 6.1% considered that they did not face any difficulty concerning the patient management and 61.5% had already identified causes of non-adherence. 3/A total of 151 (61.1%) general practitioners were willing to participate in a multidisciplinary programme to improve medication adherence in rheumatoid arthritis.

Conclusions

General practitioners are motivated to contribute to an overall management of rheumatoid arthritis patients. Nevertheless, they need professional education about rheumatoid arthritis treatment and training in motivational interviews before getting involved in a multidisciplinary collaboration.
Internal hernia caused by bridge formation between the medial and lateral segments of the liver: a case report
Authors: Kanamori Kohei , Ogimi Takashi , Chan Lin Fung , Miyakita Hiroshi , Okada Kazutake , Kayano Hajime , Mori Masaki , Nakagohri Toshio , Koyanagi Kazuo , Yamamoto Seiichiro
Published: June 2022

Background

Despite numerous reports on ischemic bowel obstruction caused by internal hernia, no case presentation has been reported of an internal hernia caused by a bridge formed between the medial and lateral zones of the liver. Herein, we report the first case of ischemic bowel obstruction caused by a hepatic bridge.

Case presentation

A 24-year-old man complaining of abdominal pain was referred to our hospital and admitted. Computed tomography showed formation of a closed loop of small bowel with a hernia orifice near the hilar region, and poor contrast of the prolapsed small bowel. We suspected ischemic bowel obstruction caused by an internal hernia with a fissure of the greater omentum as the hernia orifice, and performed emergency surgery. Laparoscopic observation revealed that the medial and lateral segments of the liver formed a bridge on the dorsal side at the liver portal, and that the small intestine was ischemic in the gap created between the bridge and the medial and lateral liver segments. A Meckel’s diverticulum was also invaginated in the gap. The bridge was dissected out and the hernia orifice was opened to release the bowel obstruction. The small bowel was preserved and the Meckel’s diverticulum was resected. The patient’s postoperative course was uneventful.

Conclusions

We experienced a case of ischemic bowel obstruction caused by hepatic bridge formation, which was successfully treated by laparoscopic surgery.
Risk factors of severe hepatotoxicity among HIV-1 infected individuals initiated on highly active antiretroviral therapy in the Northwest Region of Cameroon
Authors: Abongwa Lem Edith , Nyamache Anthony Kebira , Charles Fokunang , Torimiro Judith , Emmanuel Nshom , Domkam Irénée , Eyongetah Mbu , Jude Beriyuy , Mua Fung Holgar , Bella Sama , Tamboh Tankou Colman , Moungang Erna Charlene , Ngum Victorine , Okemo Paul
Published: June 2022

Background

Hepatotoxicity due to highly active antiretroviral therapy (HAART) has gained prominent attention since it can be affected by many factors. The aim of this study was to determine the prevalence of hepatotoxicity and related risk factors of severe hepatotoxicity following HAART initiation.

Methods

A total of 100 drug-naive patients aged between 18 and 61 years were recruited. They were put on Tenofovir/Lamivudine/Efavirenz [TDF/3TC/EFV] (64), Zidovudine/ Lamivudine/Efavirenz [AZT/3TC/EFV] (22), and Zidovudine/Lamivudine/Nevirapine AZT/3TC/NVP (14) and monitored for 6months and blood samples drawn.Alanine aminotransferases (ALT), aspartate aminotransferases (AST), and alkaline phosphatase (ALP) wereanalyzed by enzymatic methods and used to classify levels of hepatotoxicity.

Results

A total of 37(37%) and 49(49%) patients presented with hepatotoxicity while 15% and 28% had severe hepatotoxicity at 4 and 24 weeks respectively. Serum levels of all enzymes increased significantly (p = 0.001) with increased treatment duration. Univariate analysis revealed that the risk factor of developing severe hepatotoxicity was significantly greater in patients < 30years (p = 0.02), males(p = 0.04), low BMI (p = 0.02), low monthly income (p = 0.01) earners, and patients on AZT + 3TC + NVP regimen (p = 0.01). While multivariate analysis at p < 0.09 showed that age 30–40 years, low BMI, low monthly income, and the use of AZT + 3TC + NVP regimen were independent risk factors.

Conclusions

Low BMI, age group of 30–40years, low monthly income, and the use of AZT + 3TC + NVP regimen identified as risk factors for the development of severe hepatotoxicity should be considered as an important strategy by clinicians in preventing the hepatotoxicity.
Reasons for treatment changes in adults with attention-deficit/hyperactivity disorder: a chart review study
Authors: Schein Jeff , Childress Ann , Cloutier Martin , Desai Urvi , Chin Andi , Simes Mark , Guerin Annie , Adams Julie
Published: June 2022

Background

Adults with attention-deficit hyperactivity disorder (ADHD) often cycle through multiple treatments for reasons that are not well documented. This study analyzed the reasons underlying treatment changes among adults treated for ADHD in a real-world setting.

Methods

Data were collected via an online reporting form completed by eligible physicians between October and November 2020. Data for adult patients in the United States who were diagnosed with ADHD and initiated a treatment regimen within 1 to 5 years of chart abstraction were obtained. Reason for a treatment change was described for a randomly selected regimen episode, which spanned from treatment initiation until the earliest among treatment add-on/switch or discontinuation, death, or date of chart abstraction. The overall rate of ADHD/treatment-related complications were also described. Physician satisfaction with current treatment options for adult ADHD and opinions on areas for improvement were assessed.

Results

Data on 320 patients were reported by 152 physicians specializing in psychiatry (40.1%), pediatrics (25.0%), family medicine (21.7%), and internal medicine (13.2%). Patients had a mean age of 29.3 years; most were diagnosed with ADHD as adults (57.5%) and within the previous 5 years (56.5%). Selected treatment regimens included stimulants (79.1%), nonstimulants (14.7%), and combination therapy (5.6%) for an average duration of 1.9 years. Among patients with treatment discontinuation (N = 59), the most common reasons for discontinuation were suboptimal symptom management (55.9%), occurrence of ADHD/treatment-related complications (25.4%), and patient attitude/dislike of medication (25.4%). The main reasons for other key treatment changes were inadequate/suboptimal management of symptoms and cost considerations. Over 40% of patients had ≥ 1 documented ADHD/treatment-related complication, irrespective of whether they led to a treatment change. One in 5 physicians (19.8%) were very dissatisfied, moderately dissatisfied, or neither satisfied nor dissatisfied with current treatment options for ADHD in adults; the top 3 suggested improvements were lower risk of abuse (71.7%), longer effect duration (65.1%), and fewer ADHD/treatment-related complications (61.2%).

Conclusions

The top reasons for treatment changes among adults with ADHD are lack of efficacy and ADHD/treatment-related complications, highlighting the importance of developing more effective and safer treatments to alleviate the burden of ADHD.
Effectiveness of registered nurses on patient outcomes in primary care: a systematic review
Authors: Lukewich Julia , Martin-Misener Ruth , Norful Allison A. , Poitras Marie-Eve , Bryant-Lukosius Denise , Asghari Shabnam , Marshall Emily Gard , Mathews Maria , Swab Michelle , Ryan Dana , Tranmer Joan
Published: June 2022

Background

Globally, registered nurses (RNs) are increasingly working in primary care interdisciplinary teams. Although existing literature provides some information about the contributions of RNs towards outcomes of care, further evidence on RN workforce contributions, specifically towards patient-level outcomes, is needed. This study synthesized evidence regarding the effectiveness of RNs on patient outcomes in primary care.

Methods

A systematic review was conducted in accordance with Joanna Briggs Institute methodology. A comprehensive search of databases (CINAHL, MEDLINE Complete, PsycINFO, Embase) was performed using applicable subject headings and keywords. Additional literature was identified through grey literature searches (ProQuest Dissertations and Theses, MedNar, Google Scholar, websites, reference lists of included articles). Quantitative studies measuring the effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN) that reported related outcomes were included. Articles were screened independently by two researchers and assessed for bias using the Integrated Quality Criteria for Review of Multiple Study Designs tool. A narrative synthesis was undertaken due to the heterogeneity in study designs, RN-led interventions, and outcome measures across included studies.

Results

Forty-six patient outcomes were identified across 23 studies. Outcomes were categorized in accordance with the PaRIS Conceptual Framework (patient-reported experience measures, patient-reported outcome measures, health behaviours) and an additional category added by the research team (biomarkers). Primary care RN-led interventions resulted in improvements within each outcome category, specifically with respect to weight loss, pelvic floor muscle strength and endurance, blood pressure and glycemic control, exercise self-efficacy, social activity, improved diet and physical activity levels, and reduced tobacco use. Patients reported high levels of satisfaction with RN-led care.

Conclusions

This review provides evidence regarding the effectiveness of RNs on patient outcomes in primary care, specifically with respect to satisfaction, enablement, quality of life, self-efficacy, and improvements in health behaviours. Ongoing evaluation that accounts for primary care RNs’ unique scope of practice and emphasizes the patient experience is necessary to optimize the delivery of patient-centered primary care.

Protocol registration ID

PROSPERO: International Prospective Register of Systematic Reviews. 2018. ID=CRD42 018090767.
Design-development of an at-home modular brain–computer interface (BCI) platform in a case study of cervical spinal cord injury
Authors: Davis Kevin C. , Meschede-Krasa Benyamin , Cajigas Iahn , Prins Noeline W. , Alver Charles , Gallo Sebastian , Bhatia Shovan , Abel John H. , Naeem Jasim A. , Fisher Letitia , Raza Fouzia , Rifai Wesley R. , Morrison Matthew , Ivan Michael E. , Brown Emery N. , Jagid Jonathan R. , Prasad Abhishek
Published: June 2022

Objective

The objective of this study was to develop a portable and modular brain–computer interface (BCI) software platform independent of input and output devices. We implemented this platform in a case study of a subject with cervical spinal cord injury (C5 ASIA A).

Background

BCIs can restore independence for individuals with paralysis by using brain signals to control prosthetics or trigger functional electrical stimulation. Though several studies have successfully implemented this technology in the laboratory and the home, portability, device configuration, and caregiver setup remain challenges that limit deployment to the home environment. Portability is essential for transitioning BCI from the laboratory to the home.

Methods

The BCI platform implementation consisted of an Activa PC + S generator with two subdural four-contact electrodes implanted over the dominant left hand-arm region of the sensorimotor cortex, a minicomputer fixed to the back of the subject’s wheelchair, a custom mobile phone application, and a mechanical glove as the end effector. To quantify the performance for this at-home implementation of the BCI, we quantified system setup time at home, chronic (14-month) decoding accuracy, hardware and software profiling, and Bluetooth communication latency between the App and the minicomputer. We created a dataset of motor-imagery labeled signals to train a binary motor imagery classifier on a remote computer for online, at-home use.

Results

Average bluetooth data transmission delay between the minicomputer and mobile App was 23 ± 0.014 ms. The average setup time for the subject’s caregiver was 5.6 ± 0.83 min. The average times to acquire and decode neural signals and to send those decoded signals to the end-effector were respectively 404.1 ms and 1.02 ms. The 14-month median accuracy of the trained motor imagery classifier was 87.5 ± 4.71% without retraining.

Conclusions

The study presents the feasibility of an at-home BCI system that subjects can seamlessly operate using a friendly mobile user interface, which does not require daily calibration nor the presence of a technical person for at-home setup. The study also describes the portability of the BCI system and the ability to plug-and-play multiple end effectors, providing the end-user the flexibility to choose the end effector to accomplish specific motor tasks for daily needs.

Trial registrationClinicalTrials.gov: NCT02564419. First posted on 9/30/2015
Machine learning methods for functional recovery prediction and prognosis in post-stroke rehabilitation: a systematic review
Authors: Campagnini Silvia , Arienti Chiara , Patrini Michele , Liuzzi Piergiuseppe , Mannini Andrea , Carrozza Maria Chiara
Published: June 2022

Background

Rehabilitation medicine is facing a new development phase thanks to a recent wave of rigorous clinical trials aimed at improving the scientific evidence of protocols. This phenomenon, combined with new trends in personalised medical therapies, is expected to change clinical practice dramatically. The emerging field of Rehabilomics is only possible if methodologies are based on biomedical data collection and analysis. In this framework, the objective of this work is to develop a systematic review of machine learning algorithms as solutions to predict motor functional recovery of post-stroke patients after treatment.

Methods

We conducted a comprehensive search of five electronic databases using the Patient, Intervention, Comparison and Outcome (PICO) format. We extracted health conditions, population characteristics, outcome assessed, the method for feature extraction and selection, the algorithm used, and the validation approach. The methodological quality of included studies was assessed using the prediction model risk of bias assessment tool (PROBAST). A qualitative description of the characteristics of the included studies as well as a narrative data synthesis was performed.

Results

A total of 19 primary studies were included. The predictors most frequently used belonged to the areas of demographic characteristics and stroke assessment through clinical examination. Regarding the methods, linear and logistic regressions were the most frequently used and cross-validation was the preferred validation approach.

Conclusions

We identified several methodological limitations: small sample sizes, a limited number of external validation approaches, and high heterogeneity among input and output variables. Although these elements prevented a quantitative comparison across models, we defined the most frequently used models given a specific outcome, providing useful indications for the application of more complex machine learning algorithms in rehabilitation medicine.
Inkoo and Sindbis viruses in blood sucking insects, and a serological study for Inkoo virus in semi-domesticated Eurasian tundra reindeer in Norway
Authors: Shakya Ruchika , Tryland Morten , Vikse Rose , Romano Javier Sánchez , Åsbakk Kjetil , Nymo Ingebjørg H. , Mehl Reidar , Evander Magnus , Ahlm Clas , Vapalahti Olli , Lwande Olivia Wesula , Putkuri Niina , Johansen Wenche , Soleng Arnulf , Edgar Kristin S. , Andreassen Åshild K.
Published: June 2022

Background

Mosquito-borne viruses pose a serious threat to humans worldwide. There has been an upsurge in the number of mosquito-borne viruses in Europe, mostly belonging to the families Togaviridae, genus Alphavirus (Sindbis, Chikungunya), Flaviviridae (West Nile, Usutu, Dengue), and Peribunyaviridae, genus Orthobunyavirus, California serogroup (Inkoo, Batai, Tahyna). The principal focus of this study was Inkoo (INKV) and Sindbis (SINV) virus circulating in Norway, Sweden, Finland, and some parts of Russia. These viruses are associated with morbidity in humans. However, there is a knowledge gap regarding reservoirs and transmission. Therefore, we aimed to determine the prevalence of INKV and SINV in blood sucking insects and seroprevalence for INKV in semi-domesticated Eurasian tundra reindeer (Rangifer tarandus tarandus) in Norway.

Materials and methods

In total, 213 pools containing about 25 blood sucking insects (BSI) each and 480 reindeer sera were collected in eight Norwegian reindeer summer pasture districts during 2013–2015. The pools were analysed by RT-PCR to detect INKV and by RT-real-time PCR for SINV. Reindeer sera were analysed for INKV-specific IgG by an Indirect Immunofluorescence Assay (n = 480, IIFA) and a Plaque Reduction Neutralization Test (n = 60, PRNT).

Results

Aedes spp. were the most dominant species among the collected BSI. Two of the pools were positive for INKV-RNA by RT-PCR and were confirmed by pyrosequencing. The overall estimated pool prevalence (EPP) of INKV in Norway was 0.04%. None of the analysed pools were positive for SINV. Overall IgG seroprevalence in reindeer was 62% positive for INKV by IIFA. Of the 60 reindeer sera- analysed by PRNT for INKV, 80% were confirmed positive, and there was no cross-reactivity with the closely related Tahyna virus (TAHV) and Snowshoe hare virus (SSHV).

Conclusion

The occurrence and prevalence of INKV in BSI and the high seroprevalence against the virus among semi-domesticated reindeer in Norway indicate that further studies are required for monitoring this virus. SINV was not detected in the BSI in this study, however, human cases of SINV infection are yearly reported from other regions such as Rjukan in south-central Norway. It is therefore essential to monitor both viruses in the human population. Our findings are important to raise awareness regarding the geographical distribution of these mosquito-borne viruses in Northern Europe.
Experimental data manipulations to assess performance of hyperspectral classification models of crop seeds and other objects
Authors: Nansen Christian , Imtiaz Mohammad S. , Mesgaran Mohsen B. , Lee Hyoseok
Published: June 2022

Background

Optical sensing solutions are being developed and adopted to classify a wide range of biological objects, including crop seeds. Performance assessment of optical classification models remains both a priority and a challenge.

Methods

As training data, we acquired hyperspectral imaging data from 3646 individual tomato seeds (germination yes/no) from two tomato varieties. We performed three experimental data manipulations: (1) Object assignment error: effect of individual object in the training data being assigned to the wrong class. (2) Spectral repeatability: effect of introducing known ranges (0–10%) of stochastic noise to individual reflectance values. (3) Size of training data set: effect of reducing numbers of observations in training data. Effects of each of these experimental data manipulations were characterized and quantified based on classifications with two functions [linear discriminant analysis (LDA) and support vector machine (SVM)].

Results

For both classification functions, accuracy decreased linearly in response to introduction of object assignment error and to experimental reduction of spectral repeatability. We also demonstrated that experimental reduction of training data by 20% had negligible effect on classification accuracy. LDA and SVM classification algorithms were applied to independent validation seed samples. LDA-based classifications predicted seed germination with RMSE = 10.56 (variety 1) and 26.15 (variety 2), and SVM-based classifications predicted seed germination with RMSE = 10.44 (variety 1) and 12.58 (variety 2).

Conclusion

We believe this study represents the first, in which optical seed classification included both a thorough performance evaluation of two separate classification functions based on experimental data manipulations, and application of classification models to validation seed samples not included in training data. Proposed experimental data manipulations are discussed in broader contexts and general relevance, and they are suggested as methods for in-depth performance assessments of optical classification models.
Prognostic factors for the successful conservative management of nonocclusive mesenteric ischemia
Authors: Toda Yoko , Komatsu Shunichiro , Fukami Yasuyuki , Saito Takuya , Matsumura Tatsuki , Osawa Takaaki , Kurahashi Shintaro , Uchino Tairin , Kato Shoko , Yasui Kohei , Hanazawa Takaaki , Kaneko Kenitiro , Sano Tsuyoshi
Published: June 2022

Background

The criteria for deciding upon non-operative management for nonocclusive mesenteric ischemia (NOMI) are poorly defined. The aim of this study is to determine the prognostic factors for survival in conservative treatment of NOMI.

Methods

Patients with bowel ischemia were identified by searching for “ICD-10 code K550” in the Diagnosis Procedure Combination database between June 2015 and May 2020. A total of 457 patients were extracted and their medical records, including the clinical factors, imaging findings and outcomes, were analyzed retrospectively. Diagnosis of NOMI was confirmed by the presence of specific findings in contrast-enhanced multidetector-row CT. Twenty-six patients with conservative therapy for NOMI, including four cases of explorative laparotomy or laparoscopy, were enrolled.

Results

Among the 26 cases without surgical intervention, eight patients (31%) survived to discharge. The level of albumin was significantly higher, and the levels of lactate dehydrogenase, total bilirubin, C-reactive protein, and lactate were significantly lower in the survivors than the non-survivors. Sepsis-related Organ Failure Assessment (SOFA) score was significantly lower in the survivors than the non-survivors. The most reliable predictor of survival for NOMI was SOFA score (cutoff value ≤ 3 points), which had the highest AUC value (0.899) with odds ratio of 0.075 (CI: 0.0096–0.58).

Conclusions

The SOFA score and several biological markers are promising predictors to determine a treatment plan for NOMI and to avoid unnecessary laparotomy.