bluuebunny/crossref_metadata_2025 huggingface dataset:
Disability Content in the Journal of Counseling and Development and Social Work: A Comparative Analysis
Authors: Degeneffe Charles Edmund , Doty Heather , Martinez Rachel , Ncube Nothizile , Nguyen Nathan
Published: December 2021

The purpose of this study was to provide an understanding of how disability is addressed in the Journal of Counseling and Development (JCD), the flagship journal of the American Counseling Association. A review of disability content in JCD was compared with a review of disability in Social Work (SW), the flagship journal of the National Association of Social Workers. A series of between and within analyses for JCD and SW addressed the frequency, focus areas, and trends concerning how both journals addressed disability content over their histories. Overall, SW published a higher rate of disability content articles. Mental health was the most common disability domain addressed in both journals; however, JCD has published most of its disability content articles on mental health over the past two decades. The findings of the present study are discussed concerning prior research, historical events, and implications for accreditation.
Generating Healthy People: Stages in Reproduction Particularly Vulnerable to Xenobiotic Hazards and Nutritional Deficits
Authors: House Simon
Published: December 2021

Biochemical research has identified many failures in reproductive processes with specific nutrient deficits, xenobiotics and some infectious illnesses. This has led to some effective safeguards. During meiosis and fertilization, as genetic material divides and rearranges, it is exposed and open to mutation. A nutritionally unfavourable environment is a major risk factor. At stages of rapid cell division, differentiation and organisation, as in the embryo and later in the fetal brain, the child's survival, completeness and future health and ability are at stake.

From months before conception, reproduction needs preparing for, especially with today's environmental pollution, even entering the foodchain. Care from before conception can contribute not only to the child's healthy basis for life, full development of brain, eyesight and other complex attributes, but also to the health of at least the subsequent generation. Since the female baby's oocytes are being formed while she is still in the womb, the grandmother's nutritional status, around the time of conceiving a daughter, can permanently affect a grandchild. Recent insights into evolution, particularly of the brain, give us fresh indications of dietary needs to fulfil human potential for health and acuity.

Despite the hazards, nature is remarkably successful. This paper is not designed to alarm but to help attainment of full genetic potential. With healthy parents serious malformations are a low percentage. The numbers of babies with avoidable disorders, however, calls urgently for action, especially in our own inner cities and in developing countries where there is inadequate nutrition.

Action will more than justify itself, including financially. It will reward handsomely.
Microfoundations for Macromarketing: A Metatheoretical Lens for Bridging the Micro-Macro Divide
Authors: Akaka Melissa Archpru , Vargo Stephen L. , Nariswari Angeline , O'Brien Matthew
Published: December 2021

Macromarketing is often contrasted with micro-views of dyadic relationships, such as firm/customer interactions and transactional exchange. However, developing solutions for “wicked” social problems that are often viewed through a macro lens requires an approach that considers multiple perspectives at aggregated levels of interaction. We propose a framework for bridging the micro-macro divide by applying a metatheoretical lens, based on service-dominant logic and its service-ecosystems view. This approach highlights the importance of studying value cocreation practices as a microfoundation of macrostructures and highlights the need for studying institutions and institutional arrangements at varying levels of granularity. We argue for consideration of a meso-level, which is conceptually nested between micro-actions and macro-structures and allows researchers to investigate the emergence of markets as institutionalized, and potentially sustainable solutions. Exploring multiple levels of interaction can aid researchers and practitioners in understanding the complexity of wicked problems and cocreating solutions for major societal challenges faced in the world today.
Occupational disruptions during lockdown, by generation: A European descriptive cross-sectional survey
Authors: Engels Cynhia , Segaux Lauriane , Canouï-Poitrine Florence
Published: December 2021

Introduction

The periods of lockdown during 2020 led to changes in daily occupations. As participation relies on dynamic interactions between the person, his/her occupations and his/her environment, we wondered whether people from different generations shared the same perception of occupational disruptions during the lockdown.

Methods

We performed an online survey based on the Canadian Occupational Performance Measure (COPM) of adults in 27 European Union countries, the United Kingdom and Switzerland. Three groups were compared: young adults (YAs, aged 18–39), middle-aged adults (MAs, aged 40–59) and older adults (OAs, aged 60 and over).

Results

2865 participants (YAs: 47%; MAs: 33%; OAs: 20%) reported a total of 6549 disrupted occupations. The most frequently disrupted domain was leisure (83%), followed by productivity (16%) and self-care (2%); there were no significant intergroup differences ( p = 0.18). In a multivariate analysis, socializing disruptions were more likely to be associated with younger age (adjusted odds ratio (OR) [95% confidence interval (CI)] = 0.62 [0.50–0.76] for YAs versus MAs and 0.46 [0.30–0.71] for YAs versus OAs.

Conclusion

With the exception of socializing, the main disrupted occupations were similar from one generation to another. Our findings might enable the more accurate assessment of the risk of occupational disruption in a restrictive environment.
Weeds in action: Vegetal political ecology of unwanted plants
Authors: Argüelles Lucía , March Hug
Published: December 2021

This paper presents a vegetal political ecology of weeds. Weeds have barely been analysed in the burgeoning field of ‘more-than-human’ scholarship, this despite their ubiquity and considerable impact on human social life. We review how geographical scholarship has represented weeds’ material and political status: mostly as invasive plants, annoying species in private gardens and spontaneous vegetation in urbanized landscapes. Then, bringing together weed science, agronomic science and the critical geography of agriculture, we show how weeds ecology, weeds management and the environmental problems which weeds are entangled have critically shaped the industrial agriculture paradigm. Three main arguments emerging from our analysis open up new research avenues: weeds’ disruptive character might shape our understanding of human-plant relationships; human-weeds relation in agriculture have non-trivial socio-economic and political implications; and more-than-human approaches, such as vegetal political ecology, might challenge dominant modes of considering and practicing agriculture.
Inheritance, gifts and the accumulation of wealth for low-income households
Authors: Morelli Salvatore , Nolan Brian , Palomino Juan C , Van Kerm Philippe
Published: December 2021

Many low-income households in rich countries have very little wealth, but the role of intergenerational wealth transmission in underpinning this deficit is not known. This article seeks to fill that gap by investigating patterns of past wealth transfer receipt for low-income versus other households in seven rich countries and assessing the contribution that these transfers, or their absence, make to current wealth levels. We find that households on low incomes are relatively disadvantaged in terms of intergenerational transfers received in the past, both in terms of the likelihood of having received any and the amounts received by those who do benefit from such transfers. The role that this disadvantage plays in the linkage between current low-income and low wealth is assessed and evidence presented that it is significant. Simulation of a universal wealth transfer scheme or ‘capital endowment’ on reaching adulthood for two countries shows that such a policy could lead to a marked decline in the proportion of low-income adults with negative or no wealth. This and alternative or complementary policy responses to these wealth deficits merit the most serious attention.
Electroacupuncture and moxibustion-like stimulation activate the cutaneous and systemic hypothalamic–pituitary–adrenal axes in the rat
Authors: Zhang Xiao-Ning , He Wei , Wan Hong-Ye , Su Yang-Shuai , Yu Qing-Quan , Wang Yi , Jing Xiang-Hong , Zhu Bing
Published: December 2021

Objective:

To determine whether electroacupuncture (EA) or moxibustion-like stimulation (MLS) can affect the cutaneous and/or systemic hypothalamic–pituitary–adrenal (HPA) axes.

Methods:

Rats were divided into Control, EA, 37°C MLS and 43.5°C MLS groups. EA and MLS were performed at bilateral ST36 or LI4. The expression of corticotropin-releasing factor (CRF), adrenocorticotropic hormone (ACTH) and the glucocorticoid receptor (GR) was detected in local cutaneous tissues at the site of ST36 and LI4 by immunohistochemical staining. In addition, levels of CRF, ACTH and corticosterone (CORT) in cutaneous tissue and plasma were determined.

Results:

Cutaneous expression of CRF, ACTH and GR significantly increased after EA at ST36, while only GR increased after 43.5°C MLS at ST36. The results of EA and MLS at LI4 were in parallel with those at ST36. In plasma, compared with the control group, the level of CORT increased after EA at ST36, while both ACTH and CORT were markedly increased after 43.5°C MLS. For LI4, plasma CRF and CORT increased after EA, while the levels of all three hormones increased following 43.5°C MLS. Notably, compared with the effect of EA, 43.5°C MLS at ST36 produced a more substantial increase in plasma CORT, and 43.5°C MLS at LI4 induced a more dramatic increase in plasma CRF and CORT.

Conclusion:

Both EA and 43.5°C MLS can activate the cutaneous and systemic HPA axes of the rat. EA tended to activate the local cutaneous HPA, while 43.5°C MLS was more likely to activate the systemic HPA axis.
A randomized controlled clinical trial comparing different numbers of acupuncture sessions for migraine
Authors: Supasiri Thanan , Jariengprasert Chanchai , Phithaksilp Mayuri , Sangtongpanichakul Puritat , Anotayanonth Suchada , Buranatawonsom Tawat , Pongpirul Krit
Published: December 2021

Background:

Acupuncture has shown benefit in preventing migraine attacks, but there has been no clear recommendation about the number of treatment sessions that should be provided.

Objectives:

The aim of this study was to examine whether 5 sessions of acupuncture treatment is non-inferior to 10 sessions for migraine.

Methods:

We performed a multicenter, open-label, randomized, controlled clinical trial across five hospitals in Thailand. Migraine patients were randomly assigned into two groups: treatment with 5 sessions of acupuncture (group A) or 10 sessions of acupuncture (group B). Acupuncture was performed twice a week. We measured the number of migraine days, average pain severity according to a 0–10 numeric pain rating scale (NPRS) and quality of life using the EQ-5D-5L questionnaire, comparing 4 weeks after treatment versus baseline.

Results:

Of 156 patients, 83 and 73 patients were assigned to groups A and B, respectively. Comparing 4 weeks after treatment with baseline, the mean reduction in the number of headache days in groups A and B was 6.4 (95% confidence interval [CI] 4.8 to 7.9) days and 6.4 (95% CI 4.5 to 8.4) days, respectively (p = 0.97). The mean difference between the reduction in headache days of the two groups was −0.1 (95% CI −2.5 to 2.4) days, which included the pre-specified non-inferiority limit of −1. The mean reduction of NPRS scores in groups A and B was 4.5 (95% CI 3.8 to 5.1) and 3.8 (95% CI 3.1 to 4.5), respectively (p = 0.17). Both groups showed an improvement in quality of life.

Conclusion:

Both 5 and 10 sessions of acupuncture were associated with apparent benefits in terms of preventing migraine attacks, reducing the severity of the headache and improving quality of life, based on comparisons between baseline and follow-up in both study groups. Although we were unable to demonstrate non-inferiority of 5 sessions versus 10 sessions of acupuncture, the effects in the two groups were not significantly different and the temporal effects appeared to last for at least 1 month.

Trial registration number:

TCTR20170612002 (Thai Clinical Trials Registry).
Learn to Live Again
Authors: Kapoor Sumit , Thakkar Jyotsana
Published: December 2021

The COVID-19 pandemic has claimed more than 4.5 million lives so far throughout the world. These sudden, unnatural, and unexpected deaths have led to complicated grief reactions as families did not get time to prepare for death. I describe the experience of my family in India during the disastrous second wave of the pandemic. The experience of many such families of COVID-19 casualties is like a horror story that will continue to scare them each day of their life. These families have already suffered a serious and long-lasting harm and are at greater risk of suffering from prolonged grief disorder, post-traumatic stress disorder, depression, emotional distress, adult separation disorder, and generalized anxiety disorder for a long period of time. Creating support groups, empowering primary-care physicians to help and counsel their patients, providing them access to cognitive behavioral therapy, help with opening up and venting out some of their feelings, and training to develop resilience are some of the measures to help our grieving patients.
Assessment of the Risks and Needs of Middle School Students: Invariance Properties Related to Gender and Ethnicity
Authors: Strand Paul S. , French Brian F. , Austin Bruce W.
Published: December 2021

The middle school version of the Washington Assessment of Risks and Needs of Students (msWARNS) is a self-report instrument designed for use by school personnel to identify barriers to school attendance and school success for sixth- to eighth-grade students. It measures six domains relevant to improving school outcomes that include aggression-defiance, depression-anxiety, substance use, peer deviance, home environment, and school engagement. In the present study, a bifactor S − 1 model, for which the aggression-defiance domain was the reference factor for the general factor and the other domains constituted the subfactors, had good fit and better fit than several other alternative models. Results of multigroup confirmatory factor analysis revealed invariance across different groups defined by gender and race/ethnicity (Native American, African American, Hispanic, and White), with a sample of referred middle school students ( N = 2,356; ages 10–15 years). Reliability analyses support the use of the general factor to guide decision-making, the reliable use of the depression-anxiety factor for providing additional insights, and the remaining factors for guiding communication, as part of an assessment and intervention program for middle school students.
Convenient and worth the price? Identifying early users and predicting future use of book streaming services
Authors: Kristensen Linn-Birgit , Lüders Marika
Published: December 2021

The printed book has been resilient to change, and the adoption of e-books has been slow. In this context, few studies have addressed a potential turn to streaming services for books. This paper examines the adoption of book streaming in the Norwegian market, where the market-leaders Storytel and Fabel report rapid increases in number of subscribers. We examine who these early adopters are, and what may predict future use of streaming services among non-users. Theoretically, the study is situated within the fields of innovation diffusion and technology acceptance. The study is based on a cross-sectional online survey with a representative sample of the Norwegian population. Results show that users are younger and more educated, and that book streaming is more popular among women than men. The audiobook format allows for flexible ways of consuming books, complementing rather than replacing the printed book. For non-users, results show that convenience value and price value predict behavioural intention to use book streaming services. While emotional attachment to printed books has been found to act as a barrier for adoption of e-books, its negative effect on behavioural intention for book streaming services is only modest.
Multiple-frequency synchronization of the four exciters in a far super-resonant vibrating system with an isolation frame
Authors: Zhang Xueliang , Zhang Xu , Zhang Chen , Wang Zhihui , Wen Bang-Chun
Published: December 2021

Generally, the synchronization studies on two or multiple exciters are preconditioned by being a single frequency, while the multiple-frequency synchronization problems in a vibrating system, including double-frequency and triple-frequency, are less considered, which are also very significant in engineering. This paper attempts to solve this issue by considering a dynamical model with an isolation frame, driven by the four exciters. The synchronization for the four exciters and its stability under the double-frequency and triple-frequency conditions are studied in detail. Firstly, the mathematical modeling of the system is established, and the corresponding motion differential equations are derived. Using the asymptotic method and the average method, yields the theoretical condition of implementing multiple-frequency synchronization, and the theoretical condition for stability of the system complies with the Routh–Hurwitz criterion. The dynamic characteristics of the system, including stable phase differences, stability abilities, responses of the system, and relative motion relationship, are qualitatively discussed by numeric. Finally, simulations are performed by applying a Runge–Kutta program to validate the theoretical and numerical qualitative results. It is shown that, by reasonably matching the key parameters of the system, the stronger, stable, and valuable motion states of vibrating machines, including vibration amplitudes, frequencies, and motion trajectory, can be realized, which are exactly the desires in engineering.
Modeling and analysis on low energy consumption foot trajectory for hydraulic actuated quadruped robot
Authors: Sun Yaru , Hua Zisen , Li Yibin , Hui Chai , Li Xianhua , Su Bo
Published: December 2021

According to the energy consumption characteristics of hydraulic actuator, the valuable foot trajectory characterized by using segmented cubic spline interpolation curve in the swing phase is proposed firstly to reduce the energy consumption of quadruped robots, which is implemented by using controlling parameters tf to change the duration of leg raising and falling in one gait cycle, and then realized the directly control to the time ratio between the piston extension and retraction. Then, the total energy consumption of the hydraulic actuated quadruped robot SCalf-II is modeled. Meanwhile, the parameters of the foot trajectory that have a large impact on the energy consumption are determined. Finally, simulation analysis and verification experiments of the robot moving with constant speeds at the key parameters are performed. The results show that for the given foot trajectory, the optimization ranges of the gait cycle and duration of leg lifting from the lowest to highest are determined in which the energy required for the robot locomotion is at a relatively low level.
The relationship between Helicobacter pylori infection and reflux esophagitis and the long-term effects of eradication of Helicobacter pylori on reflux esophagitis
Authors: Hojo Mariko , Ueda Kumiko , Takeda Tsutomu , Akazawa Yoichi , Ueyama Hiroya , Shimada Yuji , Asaoka Daisuke , Nagahara Akihito
Published: December 2021

Introduction:

Whether the incidence of reflux esophagitis (RE) increases after the eradication of Helicobacter pylori ( H. pylori) is controversial. Few reports have evaluated the presence or absence of RE after a long period of time, taking into account the degree of atrophy and/or administration of acid secretion inhibitors. We investigated the relationship between H. pylori and RE taking into account these factors.

Methods:

This was a retrospective cohort study with approval by the Ethics Committee. Patients who succeeded in H. pylori eradication treatment, and in whom there were images of the gastroesophageal junction on endoscopic examinations within 1 year before eradication treatment and more than 3 years after eradication were included. The degrees of RE and atrophy were retrospectively determined from the endoscopic images. The prevalence of RE before and after eradication and the incidence of newly developed RE after eradication between patients with or without atrophy improvement were compared using Fisher’s exact test.

Results:

A total of 185 cases (male:female = 104:81; mean age, 63.5 years; mean observation period, 6.4 years) were examined. The prevalence of RE before and after eradication was 1.6% (3/185) and 7.0% (13/185), respectively ( P = 0.019). RE was present in 8 (7.5%) of 106 cases with closed-type atrophy and in 5 (6.3%) of 79 cases with open-type atrophy after eradication ( P = 0.75). Atrophy improved after eradication in 56 cases, of whom 4 (7.1%) had new onset of RE; the degree of atrophy did not improve in 126 cases, of whom 7 (5.4%) had new onset of RE ( P = 0.74). There was no difference between the percentage of cases who took acid secretion inhibitors before and after eradication ( P = 0.14).

Conclusion:

The prevalence of RE increased a long time after eradication, even in patients who were taking an acid secretion inhibitor. The prevalence of RE was not related to the degree of atrophy or change in atrophy.
Consensus evidence-based recommendations for treat-to-target management of immunoglobulin A vasculitis
Authors: Abu-Zaid Mohammed Hassan , Salah Samia , Lotfy Hala M. , El Gaafary Maha , Abdulhady Hala , Tabra Samar abd Alhamed , Salah Hala , Farag Yomna , Eissa Mervat , Maher Sheren Esam , Radwan Ahmed , El-Shanawany Amira Tarek , Medhat Basma M. , El Mikkawy Dalia , Mosad Mosa Doaa , El Deriny Ghada , Mortada Mohamed , Osman Naglaa S. , Fouad Nermeen Ahmed , Elkaraly Nourhan Elameen , Mohamed Sally S. , Hassan Waleed A. , Amer Youmna A. , Nasef Samah Ismail , El Miedany Yasser
Published: December 2021

IgA vasculitis (IgAV), formerly known as Henoch-Schönlein purpura, is the most common cause of systemic vasculitis in childhood. Given its potential life-threatening systemic complications, early and accurate diagnosis as well as management of IgAV represent a major challenge for health care professionals. This study was carried out to attain an evidence-based expert consensus on a treat-to-target management approach for IgAV using Delphi technique. The preliminary scientific committee identified a total of 16 key clinical questions according to the patient, intervention, comparison, and outcomes (PICO) approach. An evidence-based, systematic, literature review was conducted to compile evidence for the IgAV management. The core leadership team identified researchers and clinicians with expertise in IgAV management in Egypt upon which experts were gathered from different governorates and health centers across Egypt. Delphi process was implemented (two rounds) to reach a consensus. An online questionnaire was sent to expert panel ( n = 26) who participated in the two rounds. After completing round 2, a total of 20 recommendation items, categorized into two sections were obtained. Agreement with the recommendations (rank 7–9) ranged from 91.7–100%. Consensus was reached (i.e. ⩾75% of respondents strongly agreed or agreed) on the wording of all the 20 clinical standards identified by the scientific committee. Algorithms for the diagnosis and management have been suggested. This was an expert, consensus recommendations for the diagnosis and treatment of IgAV and IgA vasculitic nephritis, based on best available evidence and expert opinion. The guideline presented a strategy of care with a pathway to achieve a state of remission as early as possible.

Plain Language Summary

Given its potential life-threatening systemic complications, early and accurate diagnosis of immunoglobulin A vasculitis represents a major challenge for health care professionals. This work provided cornerstone principles for the management of the condition. Adopting PICO approach and implementing Delphi process a consensus was reached on evidence-based treat-to-target treatment recommendations. This will endorse enhancement and consistency of care of this cohort of patients in standard practice.
Preparing for the Impact of COVID-19 on the Mental Health of Youth
Authors: O’Shea Eileen R. , Phillips Kathryn E. , O’Shea Kathleen N. , Roney Linda N.
Published: December 2021

The COVID-19 pandemic is continuing to have long-term and global effects that the vaccine may not ease. Children and adolescents endured unprecedented periods of loneliness, social isolation, financial stressors, in-home conflicts, changes in living circumstances, and variable access to healthcare, resulting in increased mental health sequelae. Timely recognition of students’ anxiety, depression, and disruptive behaviors will allow appropriate interventions to de-escalate these feelings and prevent suicidal ideations and attempts. As youth return to school, their mental health needs will not subside. School nurses and the multidisciplinary team have a vital role in impacting this population’s already surging increase of mental and behavioral health disorders.
Long COVID—The New “Invisible” Illness: How School Nurses Can Support the Nursing and Educational Teams for Student Success
Authors: Roesler Megan , Fato Patricia , Obst Barbara
Published: December 2021

School-age children are not immune to COVID-19 or the pronounced and persistent symptoms associated with a long-COVID diagnosis. Students may present with a variety of symptoms affecting their physical, cognitive, and mental health. The school community should be educated on the school-based interventions and recommendations for creating an individualized safe and successful return to school plan. As we await approval for vaccinations in school-age children younger than 12 years and continue to reposition ourselves to the waves of this pandemic and new variants of the virus, understanding the medical and educational long-term effects on our students may be a long-term need.
Examining the impact of both legal and nonlegal factors on following a vehicle too closely utilizing three deterrence-based theories
Authors: Ochenasek Michelle , Truelove Verity , Stefanidis Kayla B. , Watson-Brown Natalie
Published: December 2021

Following a vehicle too closely (otherwise known as tailgating) is a high-risk behavior and major contributor to motor-vehicle collisions and injuries. Both legal and nonlegal countermeasures are currently in place in an attempt to prevent this behavior, yet there has been limited research that has examined the effectiveness of both legal and nonlegal factors on engagement in the behavior. Therefore, this research utilized a combination of the three most salient deterrence-based theories used in road safety to understand the impact of both legal and nonlegal sanctions on following a vehicle too closely. A survey was completed by 887 Queensland drivers aged 17–84 years ( Mage  =  49 years; 55% males). Variables from Classical Deterrence Theory, the reconceptualized deterrence theory and the extended deterrence-based model (that includes perceived internal loss, physical loss, and social sanctions), as well as measures of following a vehicle too closely were used. The majority of the sample (98%) reported following a vehicle too closely at some point, with the average frequency ranging from rarely to sometimes. Significant predictors of more frequent unsafe following distances included: being male, younger in age, and avoiding punishment for the behavior. Meanwhile, significant predictors of less frequent unsafe following distances included knowing others who have been punished for the behavior, as well as fearing the physical and internal losses resulting from unsafe following distances. Notably, the severity of the punishment was also a significant deterrent, while the perceived certainty of being apprehended for the offence was low and did not impact engagement in behavior. These results have a number of important implications on how to maximize both legal and nonlegal countermeasures to further prevent following a vehicle too closely.
Gene therapy for sickle cell disease: where we are now?
Authors: Kanter Julie , Falcon Corey
Published: December 2021

The landscape of sickle cell disease (SCD) treatment continues to evolve rapidly, with new disease-modifying therapies in development and potentially curative options on the horizon. Until recently, allogeneic stem cell transplant has been the only proven cure for SCD. Gene therapy is rising to the forefront of the discussion as a potentially curative or highly disease- modifying option for abating the complications of the disease. Understanding the different types of gene therapy in use, the differences in their end points, and their potential risks and benefits will be key to optimizing the long-term use of this therapy.
Double-refractory Hodgkin lymphoma: tackling relapse after brentuximab vedotin and checkpoint inhibitors
Authors: Epperla Narendranath , Hamadani Mehdi
Published: December 2021

The approval of brentuximab vedotin (BV) and checkpoint inhibitors (CPI) has revolutionized the management of relapsed/refractory classical Hodgkin lymphoma (cHL) patients. In recent years these agents have rapidly moved to earlier lines of therapy, including post-autologous hematopoietic cell transplant (auto-HCT) consolidation, pre-HCT salvage, and the frontline treatment setting. This shift in practice means that double-refractory (refractory to both BV and CPI) cHL is becoming an increasingly common clinical problem. In patients who are not eligible for clinical trials, conventional cytotoxic and targeted therapies (off label) may be a potential option. In patients who are transplant eligible, early referral to allogeneic HCT should be considered given the significant improvement in transplant outcomes in the contemporary era. Cellular therapy options including CD30.chimeric antigen receptor T cells, Epstein-Barr virus-directed cytotoxic T cells, and CD16A/30 bispecific natural killer cell engagers appear promising and are currently in clinical trials.
Increasing access to allotransplants in the United States: the impact of race, geography, and socioeconomics
Authors: Hong Sanghee , Majhail Navneet S.
Published: December 2021

Allogeneic hematopoietic cell transplantation (HCT) is particularly susceptible to racial, socioeconomic, and geographic disparities in access and outcomes given its specialized nature and its availability in select centers in the United States. Nearly all patients who need HCT have a potential donor in the current era, but racial minority populations are less likely to have an optimal donor and often rely on alternative donor sources. Furthermore, prevalent health care disparity factors are further accentuated and can be barriers to access and referral to a transplant center. Research has primarily focused on defining and quantifying a variety of social determinants of health and their association with access to allogeneic HCT, with a focus on race/ethnicity and socioeconomic status. However, research on interventions is lacking and is an urgent unmet need. We discuss the role of racial, socioeconomic, and geographic disparities in access to allogeneic HCT, along with policy changes to address and mitigate them and opportunities for future research.
Follicular lymphoma: is there an optimal way to define risk?
Authors: Casulo Carla
Published: December 2021

Follicular lymphoma (FL) has a long natural history and typically indolent behavior. In the present era, there are a plethora of prognostic factors combining clinical, biological, and genetic data to determine patient prognosis and help develop treatment strategies over the course of a patient's lifetime. The rapid pace of tumor-specific and clinical advances in FL has created a challenge in the prioritization and implementation of these factors into clinical practice. Developing a comprehensive understanding of existing prognostic markers in FL will help select optimal ways of utilization in the clinical setting and investigate opportunities to define and intervene upon risk at FL diagnosis and disease recurrence.
Fungal diagnostic testing and therapy: navigating the neutropenic period in children with high-risk leukemia
Authors: Fisher Brian T.
Published: December 2021

Children, adolescents, and young adults receiving intensive chemotherapy for acute myeloid leukemia or high-risk or relapsed acute lymphoblastic leukemia sustain prolonged periods of neutropenia that predispose them to invasive fungal disease (IFD). For many decades the standard of care for these patients was to initiate empirical antifungal therapy after a period of prolonged fever and neutropenia. Recent publications have yielded important evidence on the utility of different diagnostic and therapeutic approaches aimed at reducing the impact of IFD among these patients during these vulnerable periods. This case-based review highlights and interprets the published data to provide context for the IFD diagnostic and therapeutic recommendations proposed in multiple published guidelines. Personalized approaches are offered at points where evidence is lacking. Time points where specific knowledge gaps exist are identified along the clinical trajectory of the prolonged neutropenic period to illustrate areas for future investigation.
Optimizing management of sickle cell disease in patients undergoing surgery
Authors: Oyedeji Charity I. , Welsby Ian J.
Published: December 2021

Individuals with sickle cell disease (SCD) are likely to be referred for surgery at some point in their lifetime due to a high incidence of musculoskeletal and intrabdominal complications such as avascular necrosis and gallbladder disease. Preoperative optimization is a multidisciplinary process that involves a hematologist with SCD expertise, an anesthesiologist, and the surgical team. The type and risk classification of the surgery, disease severity, medications, baseline hemoglobin, transfusion history, and history of prior surgical complications are often documented. Clinicians should consider perioperative risk assessment that includes determining the patient's functional status and cardiovascular risk and screening for obstructive sleep apnea. Many patients will require preoperative transfusion to reduce the risk of postoperative complications such as acute chest syndrome and vaso-occlusive pain crises. The hematologist should consider the patient's preoperative transfusion requirements and ensure that the surgical team has an appropriate plan for postoperative observation and management. This often includes follow-up laboratory studies, a postoperative pain management plan, and venous thromboembolism prophylaxis. The transfusion plan should be patient-specific and take into account the SCD genotype, baseline hemoglobin, disease severity, risk classification of the surgery, and history of prior surgical complications. In the intraoperative and postoperative period, dehydration, hypothermia, hypotension, hypoxia, and acidosis should be avoided, and incentive spirometry should be utilized to minimize complications such as acute chest syndrome. In this review we discuss preoperative, intraoperative, and postoperative strategies to optimize patients with SCD undergoing surgery.
Treatment dilemmas: strategies for priapism, chronic leg ulcer disease, and pulmonary hypertension in sickle cell disease
Authors: Azbell Roberta C.G. , Desai Payal Chandarana
Published: December 2021

Sickle cell disease is a disorder characterized by chronic hemolytic anemia and multiorgan disease complications. Although vaso-occlusive episodes, acute chest syndrome, and neurovascular disease frequently result in complication and have well-documented guidelines for management, the management of chronic hemolytic and vascular-related complications, such as priapism, leg ulcers, and pulmonary hypertension, is not as well recognized despite their increasing reported prevalence and association with morbidity and mortality. This chapter therefore reviews the current updates on diagnosis and management of priapism, leg ulcers, and pulmonary hypertension.
Have we reached a molecular era in myelodysplastic syndromes?
Authors: Voso Maria Teresa , Gurnari Carmelo
Published: December 2021

Myelodysplastic syndromes (MDS) are characterized by heterogeneous biological and clinical characteristics, leading to variable outcomes. The availability of sophisticated platforms of genome sequencing allowed the discovery of recurrently mutated genes, which have led to a new era in MDS. This is reflected by the 2016 update of the World Health Organization classification, in which the criteria to define MDS with ringed sideroblasts include the presence of SF3B1 mutations. Further, the detection of somatic mutations in myeloid genes at high variant allele frequency guides the diagnostic algorithm in cases with cytopenias, unclear dysplastic changes, and normal karyotypes, supporting MDS over alternative diagnoses. SF3B1 mutations have been shown to play a positive prognostic role, while mutations in ASXL1, EZH2, RUNX1, and TP53 have been associated with a dismal prognosis. This is particularly relevant in lower- and intermediate-risk disease, in which a higher number of mutations and/or the presence of “unfavorable” somatic mutations may support the use of disease-modifying treatments. In the near future, the incorporation of mutation profiles in currently used prognostication systems, also taking into consideration the classical patient clinical variables (including age and comorbidities), will support a more precise disease stratification, eg, the assignment to targeted treatment approaches or to allogeneic stem cell transplantation in younger patients.
Oral hypomethylating agents: beyond convenience in MDS
Authors: Griffiths Elizabeth A.
Published: December 2021

Oral hypomethylating agents (HMAs) represent a substantial potential boon for patients with myelodysplastic syndrome (MDS) who have previously required between 5 and 7 visits per month to an infusion clinic to receive therapy. For patients who respond to treatment, ongoing monthly maintenance visits represent a considerable burden to quality of life, and for those who are early in therapy, these sequential visits may tax transportation and financial resources that would be optimally distributed over the treatment cycle to facilitate transfusion support. The availability of oral HMAs may support the optimal application of these agents by contributing to adherence and lessening the burden of therapy, potentially encouraging patients to stay on longer-term treatment. Distinct pharmacokinetic profiles for the recently approved oral HMAs (oral azacitidine and decitabine-cedazuridine) result in differential toxicity profiles and have prompted their clinical trial development in lower- and higher-risk MDS, respectively.
How to manage bleeding disorders in aging patients needing surgery
Authors: Abou-Ismail Mouhamed Yazan , Connell Nathan T.
Published: December 2021

With improvements in medical care, the life expectancy of patients with bleeding disorders is approaching that of the general population. A growing population of older adult patients with bleeding disorders is at risk of age-related comorbidities and in need of various elective and emergent age-related procedures. The increased risk of thrombosis and volume overload in older adults complicates perioperative hemostatic management. Furthermore, antithrombotic treatment such as antiplatelet or anticoagulant therapy, which is frequently required for various cardiovascular interventions, requires a meticulous individualized approach. Evidence-based guidelines for the management of aging patients with bleeding disorders are lacking, largely due to the underrepresentation of older adult patients in clinical trials as well as the rarity of many such bleeding disorders. We discuss the current guidelines and recommendations in the perioperative hemostatic management of older adult patients with hemophilia and von Willebrand disease as well as other rare bleeding disorders. The optimal management of these patients is often complex and requires a thorough multidisciplinary and individualized approach involving hematologists, surgeons, anesthesiologists, and the specialists treating the underlying disorder.
Passive immune therapies: another tool against COVID-19
Authors: Estcourt Lise J.
Published: December 2021

Passive immune therapy consists of several different therapies, convalescent plasma, hyperimmune globulin, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neutralizing monoclonal antibodies. Although these treatments were not part of any pandemic planning prior to coronavirus disease 2019 (COVID-19), due to the absence of high-quality evidence demonstrating benefit in other severe respiratory infections, a large amount of research has now been performed to demonstrate their benefit or lack of benefit in different patient groups. This review summarizes the evidence up to July 2021 on their use and also when they should not be used or when additional data are required. Vaccination against SARS-CoV-2 is the most important method of preventing severe and fatal COVID-19 in people who have an intact immune system. Passive immune therapy should only be considered for patients at high risk of severe or fatal COVID-19. The only therapy that has received full regulatory approval is the casirivimab/imdevimab monoclonal cocktail; all other treatments are being used under emergency use authorizations. In Japan, it has been licensed to treat patients with mild to moderate COVID-19, and in the United Kingdom, it has also been licensed to prevent infection.
β-Thalassemia: evolving treatment options beyond transfusion and iron chelation
Authors: Langer Arielle L. , Esrick Erica B.
Published: December 2021

After years of reliance on transfusion alone to address anemia and suppress ineffective erythropoiesis in β-thalassemia, many new therapies are now in development. Luspatercept, a transforming growth factor–β inhibitor, has demonstrated efficacy in reducing ineffective erythropoiesis, improving anemia, and possibly reducing iron loading. However, many patients do not respond to luspatercept, so additional therapeutics are needed. Several medications in development aim to induce hemoglobin F (HbF): sirolimus, benserazide, and IMR-687 (a phosphodiesterase 9 inhibitor). Another group of agents seeks to ameliorate ineffective erythropoiesis and improve anemia by targeting abnormal iron metabolism in thalassemia: apotransferrin, VIT-2763 (a ferroportin inhibitor), PTG-300 (a hepcidin mimetic), and an erythroferrone antibody in early development. Mitapivat, a pyruvate kinase activator, represents a unique mechanism to mitigate ineffective erythropoiesis. Genetically modified autologous hematopoietic stem cell transplantation offers the potential for lifelong transfusion independence. Through a gene addition approach, lentiviral vectors have been used to introduce a β-globin gene into autologous hematopoietic stem cells. One such product, betibeglogene autotemcel (beti-cel), has reached phase 3 trials with promising results. In addition, 2 gene editing techniques (CRISPR-Cas9 and zinc-finger nucleases) are under investigation as a means to silence BCL11A to induce HbF with agents designated CTX001 and ST-400, respectively. Results from the many clinical trials for these agents will yield results in the next few years, which may end the era of relying on transfusion alone as the mainstay of thalassemia therapy.
Morphological analysis of posterior malleolar fractures with intra-articular impacted fragment in computed tomography scans
Authors: Xie Wenyong , Lu Hao , Xu Hailin , Quan Yuan , Liu Yijun , Fu Zhongguo , Zhang Dianying , Jiang Baoguo
Published: December 2021

Background

Intraarticular impacted fragment (IAIF) of posterior malleolar fractures has been reported by a few studies. However its location, morphology, and the correlation of posterior malleolar fractures have not been described in detail. The aim of this study was to describe the morphology of IAIF in posterior malleolar fractures, to analyze the related factors between IAIF and posterior malleolar fragments, and explore the treatment of IAIF.

Materials and methods

Between January 2013 and December 2018, 108 consecutive patients with unilateral posterior malleolar fractures were managed in our hospital. Basic demographic and computed tomography (CT) data were collected and classified by Lauge–Hansen, OTA/AO, Haraguchi, and Mason classification. Additional radiographic data, including the length and area of posterior malleolar fragment, IAIF, and stable tibial plafond were measured. The location of IAIF was described, and involvement of the fibular notch and medial malleolus was also observed. Statistics were analyzed based on univariate analysis (Chi-square test, t-test, Mann–Whitney U test, Fisher’s test) and Spearman’s correlation test.

Results

Among the 108 cases of posterior malleolar fractures, 75 (69.4%) were with IAIF and 33 (30.6%) cases were without. There were 74 (68.5%) females and 34 (31.5%) males, and the average age of the patients was 49 years (18–89 years). The average LIFN/(LIFN + LSFN) [length of involving fibular notch/(length of involving fibular + length of stable notch fibular notch)] was 32.9% (11.6–64.9%). The APMF/(APMF + ASTP + AIAIF) [area of posterior malleolar fragment/(area of posterior malleolar fragment + area of IAIF + area of stable tibial plafond)] and AIAIF/APMF (area of IAIF/area of posterior malleolar fragment) were 13.1% (0.8–39.7%) and 52.6% (1.2–235.4%), respectively. Involvement of medial malleolus (fracture line extended to medial malleolus, P = 0.022), involvement of fibular notch (P = 0.021), LIFN/(LIFN + LSFN) (P = 0.037), LMPMF (P = 0.004), and APMF were significantly related to the occurrence of IAIF.

Conclusion

Our research indicates a high incidence of IAIF in posterior malleolar fractures. All IAIFs were found in posterior malleolar, and the most common location was within the lateral area A. Posterior malleolar fracture lines that extend to medial malleolus or fibular notch herald the incidence of IAIF. LIFN/(LIFN + LSFN), LMPMF and APMF are also associated with the incidence of IAIF. CT scans are useful for posterior malleolar fractures to determine the occurrence of IAIF and make operational plans. Operation approach selection should be based on the morphology of posterior malleolar fragments and the location of IAIF.

Level of evidence

Level III, retrospective case analysis.