bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding leader evaluations in European Parliament elections
Authors: Gattermann Katjana , de Vreese Claes H.
Published: October 2021

Leader evaluations are a crucial aspect in representative democracy. We analyse the patterns, antecedents and consequences of European Union leader evaluations against the backdrop of the 2019 European Parliament elections in ten countries. The article shows, firstly, that leader evaluations are unidimensional, both among voters with low and high knowledge as well as partisans and non-partisans. Secondly, among the antecedents of leader evaluations, European Union trust and performance evaluations are positively associated with leader evaluations, while European identity hardly plays a role compared to other factors. Lastly, the positive effect of leader evaluations on vote choice is conditional upon the individual leader and their party affiliation. Our results have important implications for expectations towards and evaluations of European Union leadership in the long term.
Development of health literacy in persons and caregivers living with dementia: A qualitative directed content analysis
Authors: Kimzey Michelle , Howe Carol J. , Martin Chelsea , McLarty Jim , Baucham Ramona
Published: October 2021

Background

Persons living with dementia and their caregivers need health information to understand and manage daily life. Previous studies focused on the associations of health literacy and cognitive impairment with less exploring if and how individuals develop health literacy during the course of the disease.

Purpose

This descriptive qualitative study aimed to explore the development of health literacy competencies among persons living with dementia and their caregivers.

Methods

Directed content analysis of six focus groups conducted in the community setting (15 persons living with dementia and 28 caregivers) was completed, using predetermined categories from the Integrated Model of Health Literacy: access, understand, appraise, and apply health information.

Findings

Participants described developing health literacy competencies over time, moving from a dependence on health care providers to becoming their own experts. Although health care providers were involved in the diagnosis and medication management, most participants admitted that they provided very little information on how to manage their daily life with dementia and often failed to inform them of community resources.

Conclusion

Participants seemed to find dementia resources on their own for both education and support, often stumbling upon them by accident. Health care providers should promote the health literacy competencies of their patients and caregivers by more intentionally providing dementia health and community resource information.
Athletics and Admissions: The Impact of the Penn State Football Scandal on Student Quality
Authors: Johnson Candon , McCannon Bryan C.
Published: October 2021

We ask whether a scandal in a university’s athletics department affects the quality of the incoming student body. To do so, we evaluate the child sex abuse scandal at Penn State University in 2011. The violations involved a former employee with the crimes occurring a decade prior. The plausibly-exogenous shock allows us to make a causal identification of the scandal's effect on the university. We use synthetic control methods establishing economically meaningful impacts. We find that the average high school GPA is 0.12 points less and the proportion of students with high SAT Math scores is down 4.8 percentage points.
Identification of Immune Subtypes for Predicting the Prognosis of Patients in Head and Neck Squamous Cell Carcinoma
Authors: Sun Jing , Fang Guiqing , Zuo Zhibin , Yu Xijiao , Xue Lande , Li Chong , Li Shu
Published: October 2021

Head and neck squamous cell carcinoma (HNSCC) is a common malignancy with poor prognosis and immune response, which plays an important role in tumor progression. Recently, immunotherapies have revolutionized the therapeutic means of malignancies including HNSCC. However, the relationship between immunophenotypes of HNSCC and its clinical response to immune-checkpoint inhibitors remains unclear. We aim to identify molecular subtyping related to distinct immunophenotypes in HNSCC. Consensus clustering algorithm was conducted for subtyping. Immunophenotypes between subtypes were compared according to infiltrating immunocytes, immune reactions, major histocompatibility complex (MHC) family, immunoinhibitory, immunostimulatory and immune scores. The relationship between immunophenotype and genotype was investigated from gene mutation and tumor mutation burden. The potential response of Immune-checkpoint blockade (ICB) therapy was estimated with TIDE and ImmuCellAI algorithms, and immune-checkpoint genes. The immune characteristics were also investigated. Biological functions were annotated by the gene-set enrichment analysis (GSEA) algorithm. Two distinct immune subtypes of HNSCC with different survival outcomes, biological characteristics, immunophenotype, and ICB response were identified. The subtype-1 was featured with better prognosis, more infiltrated immunocytes, stronger immune reaction, higher immune-related gene expression, higher immune-checkpoint gene expression (PD-1, PD-L1, and CTLA-4), and better ICB response. A higher immune response in subtype-1 was also revealed by GSEA. Subtype-1 possessed a higher immune response and more sensitivity to ICB therapy leading to a better prognosis. These findings may shed promising light on the immunotherapy strategy in HNSCC
Additional Radiotherapy With or Without Chemotherapy Following Endoscopic Resection for Stage I Esophageal Carcinoma: A Pilot Study
Authors: Yang Xu , Men Yu , Wang Jianyang , Kang Jingjing , Sun Xin , Zhao Maoyuan , Sun Shuang , Yuan Meng , Bao Yongxing , Ma Zeliang , Wang Guiqi , Hui Zhouguang
Published: October 2021

Objective: To evaluate the safety and efficacy of additional radiotherapy after endoscopic resection (ER) for stage I esophageal carcinoma (EC) with high-risk factors. Materials and methods: Patients with stage cT1N0M0 EC who underwent ER and additional radiotherapy between January 2010 and August 2019 at our institution were retrospectively included. Overall survival (OS), disease-free survival (DFS), cancer-specific survival (CSS), local control rate, regional control rate, common acute toxicities, esophageal stricture, and dysphagia were analyzed. Results: Thirty-one consecutive patients were included in the study. The median age was 62 years (range, 49-78). Thirty patients (96.8%) had squamous cell carcinoma, and one patient (3.2%) had adenosquamous cell carcinoma. Twenty-six patients (83.9%) had submucosal invasion, 15 patients (48.4%) had lymphovascular invasion, and one patient (3.2%) had a venous invasion. The 1-, 3-, and 5-year OS rates were 100.0%, 86.9%, and 68.5%, respectively. The corresponding DFS rates were 100.0%, 85.2%, and 75.8%, respectively. The corresponding CSS rates were 100.0%, 89.8%, and 78.6%, respectively. The local and regional control rates were 100.0% and 93.5%, respectively. No grade 4-5 acute toxicities were observed. Fifteen patients (48.4%) were endoscopically diagnosed with esophageal strictures after ER. At the last follow-up, 28 patients (90.5%) were able to eat a regular diet, one patient (3.2%) could eat a soft diet, one needed a semifluid diet, and only one (3.2%) had to eat a fluid diet. Conclusions: For patients with stage I EC, additional radiotherapy following ER is safe and effective, with the swallowing function well-preserved. Nevertheless, prospective studies are needed to verify these results.
Evaluation of DIBH and VMAT in Hypofractionated Radiotherapy for Left-Sided Breast Cancers After Breast-Conserving Surgery: A Planning Study
Authors: Tang Liuwei , Ishikawa Yojiro , Ito Kengo , Yamamoto Takaya , Umezawa Rei , Jingu Keiichi
Published: October 2021

Background: Dosimetric parameters of the planning target volume (PTV) and organs at risk (OARs) were compared among 3 different radiotherapy (RT) modalities in left breast cancer patients after breast-conserving surgery (BCS). Methods: Eleven patients with left breast cancer after BCS were enrolled and underwent CT simulation in the free breathing (FB) and deep inspiration breath-hold (DIBH) position. Three-dimensional conformal RT (3DCRT) and volumetric modulated arc therapy (VMAT) plans were generated for each patient in the DIBH positions. A 3DCRT plan was also created in the FB position. A dose-volume histogram (DVH) was used to analyze each evaluation index of PTV and OARs. The principal outcomes were PTV dose, heart dose, right breast dose, left anterior descending coronary artery (LADCA) dose, and left lung dose. Results: For 3DCRT plans, significant dose reductions were demonstrated in all evaluation parameters of the heart, LADCA, and left lung doses in the DIBH position compared with those in the FB position ( P < 0.05). In the DIBH position, significant dose reductions were found in the heart and LADCA in VMAT plans compared to those in 3DCRT plans ( P < 0.05). For the right breast, VMAT reduced Dmean significantly (0.32 Gy vs 0.08  Gy, P < 0.01). There were no significant differences between 3DCRT and VMAT plans for the left lung dose in the DIBH position. The indicators of PTV had no significant difference between the 3 plans. Conclusion: DIBH and VMAT could reduce dosimetric parameters of the OARs in left breast cancer patients after BCS. RT plans for left breast cancer after BCS can be optimized by DIBH and VMAT techniques to minimize radiation-induced toxicity.
Influence of Autophagy Inhibition on Lung Adenocarcinoma Cell Migration and Invasion Ability, and Efficacy of Gefitinib
Authors: Liu Ying , Du Yun
Published: October 2021

An increasing number of studies have emphasized the role of autophagy in cancer cell metastasis and treatment of malignant tumors. Autophagy inhibitors have been widely used in combination therapies to treat advanced malignancies. Several lung adenocarcinoma cells harbor epidermal growth factor receptor (EGFR) gene mutations, and EGFR tyrosine kinase inhibitors (TKIs) are routinely used in the treatment of lung adenocarcinoma. However, a number of lung adenocarcinoma tumors do not respond or develop resistance to EGFR TKIs. The aim of the present study was to explore the effect of autophagy inhibition on the biological behavior of lung adenocarcinoma cells. In addition, whether autophagy inhibition increases the efficacy of gefitinib in lung adenocarcinoma was investigated. The activation of autophagy was inhibited via the reduction of the expression of ATG5 in A549, H1975 and HCC827 cells. ATG5 knockdown using ATG5 siRNA partially suppressed the LC3B-II expression, decreased the LC3B-I/II conversion rate and enhanced the P62 expression. Cell scratch test and Transwell assay showed that the inhibition of autophagy could impair the migration and invasion ability of cells. These studies suggested that autophagy may play a pro-survival role in lung adenocarcinoma.
Challenges in Advanced Lung Cancer Diagnosis During the COVID-19 Pandemic
Authors: Xu Chunhua , Li Li , Wang Wei
Published: October 2021

A pandemic of coronavirus diseases 2019 (COVID-19) outbreak is a major public health emergency that has spread in the fastest speed, and caused the most extensive infection world widely. Transbronchial biopsy (TBB) and computed tomography guided percutaneous needle biopsy (CTPNB) is the most common and significant method for the diagnosis of lung cancer. During the COVID-19 pandemic, the indications of TBB and CTPNB must be managed strictly. Therefore, it is extremely indispensable to perform meticulous and individualized management for lung cancer patients to protect the patients from COVID-19.
Hepatic Artery Infusion Pump Combined With Systemic Chemotherapy for Patients With Liver Metastases From Breast Carcinoma
Authors: Shi Hong-Bing , Qiang Wei-Guang , Zhu Wei-Liang , Yuan Ye , Wang Jun-Jun , Zhao Jie-Min , Hu Wen-Wei
Published: October 2021

Background: When liver metastasis in patients with breast cancer is diagnosed, treatment is generally palliative and usually consists of systemic therapies only. This study aimed to evaluate the efficacy and safety of hepatic arterial infusion (HAI) combined with systemic chemotherapy in patients with breast carcinoma liver metastases (BCLM). Methods: From January 2012 to December 2019, HAI catheter systems were implanted under the guide of digital subtract angiography (DSA) in 19 patients with BCLM. All patients received systemic chemotherapy and HAI gemcitabine plus floxuridine (FUDR). Methods: The overall response rate (ORR) of intrahepatic lesions was 73.7%, including 2 patients (10.5%) with complete remission (CR) and 12 patients (63.2%) with partial remission (PR). Additionally, we found that young patients (age < 55 years) had a higher ORR than the older (100% vs 44.4%, P = .011). The median overall survival (mOS) was 13.1 months. Kaplan-Meier survival curves demonstrated that the mOS was not significantly different between patients with < 9 intrahepatic lesions and those with ≥ 9 lesions (13.7 months vs 10.9 months, P = .225). The mOS was 14.3 and 10.6 months for patients without extrahepatic metastases and with extrahepatic metastases, respectively ( P = .016). None of the patients had grade 4 toxicity. The grade 3 toxicities included leucopenia, neutropenia and diarrhea. Conclusions: HAI gemcitabine plus FUDR combined with systemic chemotherapy is effective in achieving a high local response and prolonging mOS for patients with BCLM and is associated with a relatively low rate of toxicity.
Perceived Barriers to Weight Loss among Hispanic Patients with Non-alcoholic Fatty Liver Disease
Authors: Heredia Natalia I. , Thrift Aaron P. , Balakrishnan Maya
Published: October 2021

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a growing problem in the United States and Hispanics experience the highest burden of this disease. Weight loss, physical activity (PA) and a healthy diet are the mainstay for NAFLD treatment, but patients experience barriers to behavior change. The purpose of this study was to identify barriers hindering Hispanic patients with NAFLD from making changes to PA and dietary habits. Methods: Participants referred to a multidisciplinary clinic completed self-administered questionnaires that measured barriers to greater PA engagement and eating healthier, with both close-ended and open-ended responses. One bilingual coder reviewed and categorized all open-ended responses. Results: The study population included 414 patients. The top five barriers for eating healthier were cost, perceptions that healthier food does not taste good, lack of time to cook, difficulty of cooking, and difficulty in going to the grocery store. Lack of time, feeling lazy, pain, a lack of place to exercise, and the perception that exercise is difficult were the top five barriers to PA engagement. Conclusions: Since Hispanic adults with NAFLD experience similar barriers to Hispanic adults more generally, existing behavioral lifestyle interventions may work well in this clinical population with some adaption for NAFLD-specific education.
Frontal Alpha Asymmetry in Posttraumatic Stress Disorder: Group Differences Among Individuals With and Without PTSD During an Inhibitory Control Task
Authors: López-Castro Teresa , Martin Laura , Nickley Sean , C. Saraiya Tanya , Melara Robert D.
Published: October 2021

The current study examined frontal alpha asymmetry (FAA) as a marker of approach- and avoidance-related prefrontal activity in participants with and without trauma exposure and posttraumatic stress disorder (PTSD). We investigated FAA in an inhibitory control paradigm (threatening vs nonthreatening cues) under 2 levels of cognitive demand (baseline: images constant within a block of trials; vs filtering: images varied randomly within a block) in 3 groups of participants: individuals with PTSD ( n = 16), exposed to trauma but without PTSD ( n = 14), and a control group without PTSD or trauma exposure ( n = 15). Under low demand (baseline), both PTSD and trauma-exposed participants exhibited significantly greater relative left than right frontal brain activity (approach) to threatening than to nonthreatening images. Under high demand (filtering), no FAA differences were found between threatening and nonthreatening images, but PTSD participants revealed more relative left than right FAA, whereas trauma-exposed participants showed reduced left relative right FAA. In all conditions, healthy controls exhibited reduced left relative to right FAA and no differences between threatening and nonthreatening images. Study findings suggest dysfunctional prefrontal mechanisms of emotion regulation in PTSD, but adaptive prefrontal regulation in trauma-exposed individuals without PTSD.
Effectiveness of the Complete Health Improvement Program in a Geriatric Population
Authors: Scriven Emily , Chavan Bhakti , Drozek David
Published: October 2021

The Complete Health Improvement Program (CHIP) is an intensive therapeutic lifestyle modification program (ITLMP) with well-documented success in decreasing risk factors for cardiovascular disease (CVD). Plant-based diets and physical activity are components of the program that contribute to these improvements. Yet, there are few studies on how ITLMPs affect risk factors specifically for the geriatric population. The goal of this study was to examine results of CHIP participants with a focus on the older (greater than 65 years) population in Athens, Ohio. Retrospective data from 2011 to 2017 were analyzed for 26 CHIP classes. Recorded variables included body mass index (BMI), blood pressure (BP), total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), blood glucose (BG), and exercise level. Among geriatric participants, significant changes were found in BMI, BP, TC, LDL, HDL, BG, and exercise level ( P < .001). As compared to the younger population, changes in variables were equivalent in the geriatric population in all variables ( P > .05). These improvements in CVD risk factors among the elderly support the hypothesis that CHIP should be considered for CVD prevention and treatment in the geriatric population.
Fuel economy improvement and emission reduction of 48 V mild hybrid electric vehicles with P0, P1, and P2 architectures with lithium battery cell experimental data
Authors: Liu Yiqun , Liao Y Gene , Lai Ming-Chia
Published: October 2021

This paper intends to provide design selections of hybrid powertrain architectures in 48 V mild hybrid electric vehicles. Based on the location of the electric machine in the driveline, the hybrid powertrain architectures can be categorized into five groups, P0, P1, P2, P3, and P4. This paper uses simulation software to investigate the fuel economy improvements and emission reduction of 48 V mild hybrid electric vehicles with P0, P1, and P2 architectures. A baseline conventional and a 12 V start/stop vehicle models based on the production vehicle are built for comparison. The 48 V battery pack model is based on experimental data including open-circuit voltage and internal resistance of a 20 Ah lithium polymer battery cell. Four standard driving cycles are used to assess the fuel economy and emissions of the vehicle models. With features of engine idle elimination, electric power assist, and regenerative braking, the 48 V P0 and P1 respectively gains average 13.5% and 15.5% simulated fuel economy compared to baseline vehicle. The 48 V P2 enables feature of electric launch/driving and improves the fuel economy by average 18.5% better than baseline vehicle. The 48 V mild hybrid system seems to be one of the promising techniques to meet future fuel economy standards and emission regulations.
The U.S. Food and Drug Administration’s Complex Innovative Trial Design Pilot Meeting Program: Progress to date
Authors: Price Dionne , Scott John
Published: October 2021

Background

The Center for Drug Evaluation and Research and the Center for Biologics Evaluation and Research of the U.S. Food and Drug Administration have been leaders in advancing science to protect and promote public health by ensuring that safe and effective drugs and biological products are available to those who need them. Recently, new therapeutic discoveries, increased understanding of disease mechanisms, the need for innovation to optimally use resources, and global public health crises have led to an evolving drug development landscape. As a result, the U.S. Food and Drug Administration and medical product developers are faced with unique challenges and opportunities. The U.S. Food and Drug Administration is proactively meeting the challenges of this evolving landscape through various efforts, including the Complex Innovative Trial Design Pilot Meeting Program. Our focus, here, will be on the pilot meeting program.

Methods

The U.S. Food and Drug Administration has defined a process to facilitate the implementation of the Complex Innovative Trial Design Pilot Meeting Program. The process is transparent and outlines the steps and timeline for submission, review, and meetings.

Results

Five submitted meeting requests have been selected for participation in the Complex Innovative Trial Design Pilot Meeting Program.

Conclusion

The pilot meeting program has been successful in further educating stakeholders on the potential uses of complex innovative designs in trials intended to provide substantial evidence of effectiveness. The selected submissions, thus far, have all utilized a Bayesian framework. The reasons for the use of Bayesian approaches may be due to the flexibility provided, the ability to incorporate multiple sources of evidence, and a desire to better understand the U.S. Food and Drug Administration perspective on such approaches. We are confident the pilot meeting program will have continued success and impact the collective goal of bringing safe and effective medical products to patients.
How do athletes cause ball flight path deviation in high-performance interceptive ball sports? A systematic review
Authors: Lindsay Cody , Clark Brad , Middleton Kane , Crowther Rian , Spratford Wayne
Published: October 2021

Athletes alter ball flight trajectory in interceptive ball sports to change task constraints that their opponents must overcome to successfully meet the ball in flight. This systematic review identified how athletes change their techniques to alter the ball flight trajectory in high-performance interceptive sports where the ball is projected by the hand towards an opponent. Studies that reported the kinematics or ball flight characteristics of these movements were searched for using SportsDiscus, Scopus, MEDLINE and CINAHL Plus databases up to 27 April 2021. Forty-eight articles met the inclusion criteria, including 19 baseball, 12 cricket, five handball, four softball, three volleyball and five water polo studies. Extracted data were presented as ranges and descriptively analysed to report athlete sporting actions. Trajectory deviation can be caused by imparting an altered seam orientation or spin rate and axis of rotation on the ball. Athletes impart sidespin or manipulate seam orientation to cause lateral deviation while topspin and backspin are used to create vertical changes in the flight path. Adjusting the shoulder, forearm, wrist, hand and fingers of the throwing or striking arm can be used to impart an altered seam orientation or spin rate and axis of rotation on the ball. The findings of this review could assist coaches and athletes across a variety of sports to improve the ability to deviate the ball during flight.
Costs and Outcomes Comparison of Diabetes Technology Usage Among People With Type 1 or 2 Diabetes Using Rapid-Acting Insulin
Authors: Vallarino Carlos R. , Wong-Jacobson Siew H. , Benneyworth Brian D. , Meadows Eric S.
Published: October 2021

Background:

Does initiation of a continuous glucose monitor (CGM) or insulin pump lower health care utilization and/or costs?

Methods:

Distinct cohorts of people with type 1 diabetes (T1D) or type 2 diabetes (T2D) using a blood glucose monitor (BGM), CGM, pump, or CGM with pump were identified from a large claims database. Patients ≥40 years old with 12 months of continuous enrollment before and after the device start date qualified for the study. Outcomes included one-year medical utilization and costs (minus device) for events such as hospitalizations and office visits. Generalized linear models were fitted, controlling for numerous baseline covariates. The Holm method corrected for the multiplicity of hypotheses tested.

Results:

Of the 8235 total patients, the BGM control group was the largest, had the lowest percentage of patients with T1D, and was significantly different from the device groups in most baseline categories. Formally, only two comparisons were statistically significant: Compared with BGM, the pump cohort had greater adjusted first-year total medical and office visit costs. Other secondary outcomes such as days hospitalized, emergency department visits and labs, favored pump. Most endpoints were favorable for CGM. Results for CGM with pump generally were intermediate between CGM and pump alone.

Conclusions:

During a one-year follow-up, unadjusted medical costs of both CGM and pump appear lower than BGM, but multivariable modeling yielded adjusted savings only for CGM use. Economic benefits might be observable sooner for CGMs than for pumps. Generalized linear models fitted to health care utilization event rates produced favorable results for both CGM and pump.
Inclusion of Condominium Units in Luxury Hotels as a Diversification Strategy: Property Performance Perspective
Authors: DeFranco Agnes , Koh Yoon , Prem Piyush , Love Benjamin
Published: October 2021

There is a new wave of mixed development where luxury hotels come with condominium units, though this type of diversification has gained scant attention. Prior hospitality literature on diversification strategies has mostly taken the firm-level approach and documented its impact on performance from various angles such as brand diversification, segment diversification, and geographic diversification, therefore leaving a void. In this work, we use the multilevel mixed effect model to examine 15,340 property-level data points from 2010 to 2019 for U.S. luxury hotels with and without condominium units. Our objective is to compare, at a property level, the performances of luxury hotels with condominium units with the performances of those not having condominium units and to determine whether the difference varies by hotel location. Our findings suggest that the Average Daily Rate (ADR), Revenue per Available Room (RevPAR), and Total Revenue per Available Rooms (TRevPAR) of luxury hotels with condominium units were significantly higher than those of hotels without condominium units. Significant moderating effect of location was found for Occupancy, ADR, Food and Beverage Revenue per Available Rooms (F&B RevPAR), and TRevPAR while no such effect was found for RevPAR and GOPPAR.
Regional Electromyography of the Infraspinatus and Supraspinatus Muscles During Standing Isometric External Rotation Exercises
Authors: Whittaker Rachel L. , Alenabi Talia , Kim Soo Y. , Dickerson Clark R.
Published: October 2021

Background:

Whole-muscle electromyography (EMG) data of the rotator cuff support external rotation (ER) strengthening exercises during shoulder rehabilitation. However, distinct neuroanatomic regions in the supraspinatus and infraspinatus exist. Differences in regional muscle activity occur during rehabilitation exercises, but little information is available for ER exertions.

Hypothesis:

Regional infraspinatus and supraspinatus muscle activity during standing ER exertions will differ with posture and intensity.

Study Design:

Descriptive laboratory study.

Level of Evidence:

Level 5.

Methods:

Twenty healthy individuals (12 men, 8 women) participated. Fine wire electrodes were inserted into 2 supraspinatus and 3 infraspinatus muscle regions. EMG data were recorded during standing isometric ER exertions at 2 intensities (maximal, submaximal) and in 7 postures defined by the angle (0°, 30°, 90°) and plane (abduction, scaption, flexion) of arm elevation. EMG data were normalized to maximum voluntary isometric contraction (% MVIC) to examine the influences of posture, intensity and their interaction on muscle activity.

Results:

Superior infraspinatus activity was higher in 0° of elevation (50.9% ± 5.7% MVIC) versus 30° of flexion (37.4% ± 3.9% MVIC) at maximal intensity. Inferior infraspinatus activity was higher in 90° of scaption (max = 59.8% ± 2.8% MVIC, submax = 29.4% ± 1.9% MVIC) versus 0° of elevation (max = 42.3% ± 4.5% MVIC, submax = 22.4% ± 2.8% MVIC) ( P = 0.02, P = 0.05, respectively). Anterior supraspinatus activity was highest in 90° of adbuction (max = 61.6% ± 3.1% MVIC; submax = 39.1% ± 3.8% MVIC) and lowest in 30° of flexion (max = 29.0% ± 3.4% MVIC, submax = 15.6% ± 1.7% MVIC) and 90° of flexion (max = 34.6% ± 2.4% MVIC, submax = 14.8% ± 1.9% MVIC). Posterior suprasptinatus activity was lowest in 0° of elevation (34.2% ± 3.0% MVIC), 30° of flexion (33.0% ± 3.6% MVIC) and highest in 90° of abduction (56.2% ± 4.1% MVIC) and 90° of scaption (46.7% ± 2.8% MVIC) (all Ps < 0.04).

Conclusion:

Regional infraspinatus and supraspinatus muscle activity differed with posture and intensity. Superior and middle infraspinatus muscle activities were similar across postures, but inferior infraspinatus activity was highest in 90° of arm elevation. Anterior and posterior supraspinatus activities were higher in the abduction and scaption planes, especially at 90° of elevation, as compared with the flexion plane.

Clinical Relevance:

In shoulder rehabilitation of supraspinatus tendon injuries, ER exercises in the flexion plane challenge the whole infraspinatus muscle and require lower supraspinatus muscle activity.
Articular Cartilage Fragmentation Improves Chondrocyte Migration by Upregulating Membrane Type 1 Matrix Metalloprotease
Authors: Lei Yunliang , Peng Jiabin , Dai Zhu , Liao Ying , Liu Quanhui , Li Jian , Jiang Yonghui
Published: October 2021

Objective

This study was undertaken to elucidate the mechanism of improved chondrocyte migration after juvenile articular cartilage fragmentation.

Design

In vitro organ culture with rabbit cartilage fragments and cell culture with rabbit chondrocytes were performed. In part A, minced juvenile cartilage fragments (~0.5 × 0.5 × 0.5 mm) from rabbits, planted in gelatin sponge and fibrin glue, were cultured for 2, 4, or 6 weeks in vitro and compared with the cartilage chunks (~4 × 4 × 1 mm) and membrane type 1 matrix metalloprotease (MT1-MMP) inhibitor groups. Chondrocyte outgrowth was evaluated on histology and confocal laser scanning microscopy. MT1-MMP expression was compared between the cartilage fragment group and the cartilage chunks group. In part B, articular chondrocytes were harvested from juvenile rabbits, MT1-MMP was transfected into the cells, and cell migration was evaluated using the Transwell and wound healing tests.

Results

The histology and confocal microscopy results revealed that cell accumulation occurred at the edge of cartilage fragments, and outgrowth was better in the cartilage fragment group than those in the cartilage chunks group. Similar results were observed for MT1-MMP expression. After MT1-MMP inhibition, cells did not accumulate at the edge of the cartilage fragments, and chondrocyte outgrowth did not occur. Furthermore, overexpression of MT1-MMP enhanced the migration of articular chondrocytes.

Conclusions

Juvenile articular cartilage fragmentation improved chondrocyte migration by upregulating MT1-MMP.
CoMET: a randomised controlled trial of co-commencement of metformin versus placebo as an adjunctive treatment to attenuate weight gain in patients with schizophrenia newly commenced on clozapine
Authors: Siskind Dan , Russell Anthony W. , Suetani Shuichi , Flaws Dylan , Kisely Steve , Moudgil Vikas , Northwood Korinne , Robinson Gail , Scott James G. , Stedman Terry , Warren Nicola , Winckel Karl , Cosgrove Peter , Baker Andrea
Published: October 2021

Background:

There is limited evidence on interventions to minimise weight gain at clozapine commencement. We compared the effect of adjunctive metformin versus placebo at clozapine initiation.

Methods:

People with schizophrenia commencing on clozapine were randomised to either metformin or placebo for 24 weeks. The primary outcome was difference in the change of body weight. Secondary outcomes included comparative rates of weight gain of more than 5%, overall weight gain/loss, and differences in metabolic and psychosis outcomes.

Results:

The study was closed prematurely in March 2020 due to COVID-19 restrictions. Ten participants were randomised to each of the metformin and placebo groups. Eight metformin group and five placebo group participants completed the trial and were included in the analysis. The study was insufficiently powered to detect difference between the metformin and placebo groups for the primary outcome of change in weight (0.09 kg vs 2.88 kg, p = 0.231). In terms of secondary outcomes, people in the metformin group were significantly less likely to gain >5% of their body weight (12.5% vs 80%, p = 0.015) and were more likely to lose weight (37.5% vs 0% p = 0.024) compared to placebo. There was no difference between the groups in terms of adverse drug reactions (ADRs).

Conclusion:

While limited by the forced premature closure of the trial due to COVID19, the findings from this randomised controlled trial are promising. Clozapine and metformin co-commencement may be a promising treatment to prevent clozapine-associated weight gain, especially given the low rates of ADRs associated with metformin. This supports the consideration of use of metformin to prevent weight gain in people initiated on clozapine; however, further studies are needed to confirm this finding.

Trial registration:

ACTRN12617001547336
Cerebral spinal fluid positive pertussis encephalopathy in infants: Case reports
Authors: Anh Tuan Ta , Xoay Tran Dang , Thuy Phung Thi Bich , Ouellette Yves
Published: October 2021

Pertussis has re-emerged in both developed and developing countries and is an ongoing public health problem, even in countries with high rates of vaccination. Pertussis encephalopathy is a known complication of the disease, but the pathophysiology of this complication and the role of the pertussis bacteria have not been elucidated. We report three confirmed cases of pertussis infant younger than 3 months of age with neurological complications including lethargy, encephalopathy, and seizures. In each case, the cerebrospinal fluid was positive for Bordetella pertussis as determined by polymerase chain reaction. One patient did not survive and two were discharged with a normal neurological exam on follow-up. The cases emphasize the importance of analyzing cerebrospinal fluid in cases of pertussis-associated encephalopathy including polymerase chain reaction.
A secondary jejunal malignant melanoma from nasal mucosal melanoma: Case report
Authors: Xu Yingying , Duan Zongkui , Hu Wenqing , Zhu Kaixuan , Cui Peng , Du Zhuoran , Abe Masanomu , Zong Liang
Published: October 2021

Melanomas most commonly localized in the skin can arise anywhere in the body, and approximately 5% of all melanomas appear in other sites of mucosal surfaces out of skin. Primary melanoma from nasal mucosa is quite rare. We present this case: a 46-year-old man had complained a pain in the left upper abdomen for 2 months when he was admitted to the Northern Jiangsu People’s Hospital. The pain was paroxysmal and enhanced when eating. There was no nausea, vomiting, or anorexia. There had been no change in weight in previous months. This patient had a past history of surgery for nasal mucosal malignant melanoma 2 years ago. Abdominal enhanced computed tomography (CT) indicated that a mass originated from small bowel and occupied the left upper abdomen. The patient underwent a laparotomy during which a black lesion measuring about 5 cm × 5 cm × 4 cm was found at the jejunum and resected totally together with partial jejunum. The patient was eventually diagnosed as secondary jejunal malignant melanoma from nasal mucosal melanoma. For patients with a history of melanoma, gastrointestinal metastasis should be considered when patients develop gastrointestinal symptoms. In addition, we recommend positive anti-tumor therapy after surgery.
The cocaine-e-cigarette – A theoretical concept of a harm reduction device for current users of smokable cocaine forms
Authors: Steinmetz Fabian P , Stöver Heino
Published: October 2021

Although there are great regional differences, smokable forms of cocaine (crack, free-base, paco, etc.) are a drug complex associated with often harmful and problematic drug use patterns. While strategies based on drug prohibition did not eradicate the consumption of smokable cocaine forms, prohibition itself led to many harmful effects, such as criminalisation, stigmatisation, unpredictable smokable cocaine forms quality and hardly any safer-use education. While there are many positive insights from heroin-assisted treatment programs with regard to heroin users, there are no comparable programs for problematic users of smokable cocaine forms. Smokable cocaine forms are challenging due to their different pharmacology and particularly their short duration leading to often many administrations per day. In this manuscript a device for a heroin-assisted treatment-like program for problematic users of smokable cocaine forms is suggested. This device is a cocaine-e-cigarette which could be prescribed to problematic users of smokable cocaine forms to reduce the risk of lung damage, exclude potentially harmful adulterants, limit intake (by formulation and/or technical settings) and also to bring users of smokable cocaine forms into the medical system to address comorbidities and risk factors, for example cardiovascular conditions, insomnia, depression, etc. This manuscript describes basic functionality and general specifications of a cocaine-e-cigarette as a medical device treating people with respective cocaine use disorder when cessation and substitution are not considered an option.
The Anthropocene and ecological awareness in Poland: The post-socialist view
Authors: Chodkowska-Miszczuk Justyna , Rogatka Krzysztof , Lewandowska Aleksandra
Published: October 2021

Dynamic and unrestrained socio-economic development is upsetting the balance of nature’s mechanisms, causing a climate stalemate, or even climate destabilisation. After the Second World War a new political system – real socialism – was enforced on Poland. It brought about changes of a social, cultural, economic and environmental nature. Its immanent feature was the application of top-down decisions that did not take into account environmental components. There was also little ecological awareness within Polish society at that time. The transformations of the 1990s resulted not only in the liberalisation of the Polish economy, but also in the permeation of new trends oriented towards pro-environmental activities. The aim of the article is to find an answer to the question: How is ecological awareness currently shaped in the context of Anthropocene in Poland during the transition from a socialist economy to a capitalist economic system?
Couples undergoing Assisted Reproductive Techniques: An Actor-Partner Interdependence Model of dyadic adjustment, attachment, and body-image avoidance
Authors: Salcuni Silvia , Mancinelli Elisa , Muneratti Anna , Grillo Antonella , Alessi Chiara , Guglielmino Antonino , Finos Livio
Published: October 2021

The aim is to assess the commonalities and interdependence referred to body-image avoidance among 118 couples newly introduced to first-level assisted reproductive techniques. Results showed non-clinical functioning levels, and partners showed a correlated, yet low, dyadic adjustment. The couple-effect was modeled through an Actor Partner Interdependence Model. For both partners, dyadic adjustment’s actor-effect associates with body-image avoidance. Moreover, psychological symptoms’ actor-effect associate to body-image avoidance, resulting significantly more influential than the partner-effect. Only for males, alexithymia’s actor-effect was significant. To conclude, partners’ functioning is quite specular yet not interdependent, as they do not show a couple-as-a-unit modality of functioning. Clinical implications are discussed.
Vulnerability and Primary Health Care: An Integrative Literature Review
Authors: Ferreira Janise Braga Barros , Santos Luciane Loures dos , Ribeiro Luciana Cisoto , Rodrigues Fracon Belkiss Rolim , Wong Sabrina
Published: October 2021

The objective was to analyze the evidence available in the scientific literature on the concept of vulnerability, in theoretical perspectives and its use, in Primary Health Care. An integrative literature review was carried out with the inclusion criteria: articles in English, full text, peerreviewed, related to vulnerability and primary health care, with the explicit concept of vulnerability, and published until July 31, 2020. The electronic databases accessed were by crossing the descriptors “vulnerability,” “vulnerabilities,” “primary health care,” “primary healthcare,” and “primary care.” The final sample consisted of 19 articles. The thematic analysis produced 2 themes: “Theoretical foundations of the concept of vulnerability” and “The use of the concept of vulnerability in PHC.” In the second theme, 2 sub-themes emerged: Evaluation of health policies, programs, and services and Classification of individuals, groups, and families. There was a plurality of theoretical foundations for the concept of vulnerability and a smaller scope of its use in Primary Health Care. It is expected that the study will subsidize public policymakers and health teams in the design of services and actions aimed at vulnerable populations and in situations of vulnerability.
Lyme Disease Training and Knowledge Translation Resources Available to Canadian Healthcare Professionals: A Gray Literature Review
Authors: Coderre-Ball Angela M. , Sahi Sania , Anthonio Vanessa , Roberston Madison , Egan Rylan
Published: October 2021

Introduction:

Lyme Disease (LD) is the most common tick-borne disease in North America. With the number of cases increasing yearly, Canadian healthcare professionals (HCP) rely on up-to-date and evidence-informed guidelines, instruction, and resources to effectively prevent, diagnose, and treat Lyme disease (LD). This review is the first of its kind to examine gray literature and analyze the diversity of recommendations provided to Canadian HCP about the prevention, diagnosis, and treatment of Lyme disease.

Methods:

A gray literature review consisting of 4 search strategies was conducted to retrieve materials targeted to Canadian HCP. Searches within targeted websites, targeted Google searches, and gray literature databases, and consultation with content experts were done to look for continuing medical education (CME) events, clinical flow charts, webinars, videos, and reference documents that discussed the prevention, diagnosis, and treatment of Lyme disease.

Results:

A total of 115 resources were included in this study. Recommendations surrounding prevention strategies were less varied between materials, whereas diagnosis and treatment recommendations were more varied. Our findings suggest that Canadian HCP are met with varying and sometimes contradictory recommendations for diagnosing and treating LD.

Conclusions:

Due to the increasing incidence of LD in Canada, there is a greater need for resource consistency. Providing this consistency may help mitigate LD burden, standardize approaches to prevention, diagnosis and treatment, and improve patient outcomes.
Evaluation of Shoulder Muscle Improvement in Patients Following Free Latissimus Dorsi Muscle Pedicle Flap Transfer
Authors: Ak Erman , Ayik Ömer , Berköz Ömer , Kozanoğlu Erol , Akalin Bora Edim , Bayram Serkan , Şahinkaya Türker , Emekli Ufuk
Published: October 2021

Aim: This study aimed to evaluate the clinical outcomes, shoulder muscle strength, and donor site morbidity following the free latissimus dorsi (LD) muscle pedicle flap transfer. Materials: Patients with free LD muscle pedicle flap reconstructions and with asymptomatic shoulders (affected and contralateral side) were included. The follow-up duration was 12 months. The combined shoulder range of motion (ROM), Constant–Murley shoulder (CMS), and quick disabilities of the arm, shoulder, and hand (QuickDASH) scores were measured preoperatively and at 1 year postoperatively. The ratio of the isokinetic muscle strength and total work was measured with an isokinetic dynamometer (Cybex 350®) both preoperatively and at sixth month postoperatively. Results: Twenty patients with a mean age of 37.06 ± 9.74 years and a mean body mass index of 23.49 ± 8.6 kg/m2 were included. The difference in shoulder ROM and CMS and increase in QuickDASH were not significant at the first postoperative year. The peak torque and total work performed decreased by 13%–16% for the adductor and extensor functions at the six month postoperatively, and these differences were significant. Although the adductor peak torque was significantly lower in the postoperative test of the operated side, no significant difference was found between the operated and unaffected shoulder peak torque values. Moreover, no significant difference was noted between the operated and unaffected shoulders in all isokinetic tests pre- and postoperatively. Conclusion: The free LD muscle pedicle flap harvest did not decrease function and ROM at the first postoperative year. The muscle strength and total work of shoulders after the LD muscle transfer returned to the preoperative condition at the sixth month, except adductor and extensor muscle strengths. However, adductor and extensor muscle strengths of the operated shoulders were not significantly different postoperatively.
Efficacy and Safety of Robotic Dor Fundoplication on Severe Gastroesophageal Reflux Disease in Patients With Scleroderma
Authors: Loganathan Priyadarshini , Gajendran Mahesh , Davis Brian , McCallum Richard
Published: October 2021

Systemic sclerosis (SSc) is a disease that affects the gastrointestinal tract resulting in its atrophy and fibrosis of smooth muscles. Approximately 80% of SSc patients develop both gastroesophageal reflux disease (GERD) and dysphagia. The nocturnal GERD can cause regurgitation and aspiration, which can further aggravate the pulmonary fibrosis from SSc. Also, their dysphagia is further worsened by performing standard Nissen fundoplication. Therefore, we aimed to investigate whether Dor fundoplication (a 180° anterior wrap) can reduce nocturnal heartburn and regurgitation without worsening dysphagia in patients with SSc and severe GERD. Five SSc patients with drug-refractory severe GERD underwent a Dor fundoplication procedure with a median follow-up of 2 years (range: 1-5 years). In all 5 patients, the preoperative high-resolution manometry showed significant impairment of esophageal motility. Patients were interviewed postoperatively to assess for nocturnal and diurnal GERD symptoms, treatment response, the status of dysphagia, and adverse effects of surgery. The average age of 5 patients was 50 years and all were females. Four of the 5 patients (80%) reported 90% improvement in both diurnal and nocturnal GERD symptoms since surgery, with no nocturnal reflux, heartburn, or regurgitation, and reports to sleep at night without requiring any more pillows or wedges. About 50% of patients reported a decrease in their proton pump inhibitor dosage after surgery compared to before surgery. No surgical complication was reported and specifically, no worsening of dysphagia. The Dor fundoplication performed for refractory GERD in SSc patients substantially decreases heartburn and regurgitation, primarily nocturnal, without affecting dysphagia, thus improving the quality of life.