bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac Perforation Caused by Cement Embolism after Percutaneous Vertebroplasty: A Report of Two Cases
Authors: Zhang Yi , Liu Xinmei , Liu Hongsheng
Published: January 2022

Background

Percutaneous vertebroplasty (PVP) is a minimally invasive surgical technique in which polymethyl methacrylate (PMMA) is injected into the weakened vertebral body to strengthen it. However, this procedure is associated with various complications, the most common being cement leakage. Cardiac perforation caused by cement escape into the venous system is another complication, which is rare but potentially life‐threatening even if not treated promptly.

Case Presentation

Here, we report two elderly patients who developed cardiac perforation caused by cement escape into veins following PVP. Both patients had a history of severe osteoporosis. On admission, they presented with lower back pain and limited movement. MRI revealed vertebral bodies compression fracture in both patients. Considering the advanced age of the patients, PVP was performed to avoid the risk of potential complications associated with nonoperative therapy. Unfortunately, the rare and fatal postoperative complication, cardiac perforation caused by cement escape into veins, occurred in both patients. Emergency open‐heart surgery was performed to remove cement material and repair the heart, both patients recovered well and were discharged.

Conclusions

Although PVP is a safe and minimally invasive surgical technique, it is associated with various serious complications as seen in the present cases. We therefore recommend that surgeons should be aware of such complications. Appropriate timing of surgical operation, meticulous surgical procedures, early intraoperative and postoperative monitoring of cement leakage may improve outcomes of patients with such complications.
Impact of ultra‐conservative ICD programming in patients with LVADs: Avoiding potentially unnecessary tachy‐therapies
Authors: Robinson Alexander , Parikh Valay , Jazayeri Mohammad‐Ali , Pierpoline Michael , Reddy Y. Madhu , Emert Martin , Pimentel Rhea , Dendi Raghuveer , Berenbom Loren , Noheria Amit , Ramirez Rigoberto , Sauer Andrew J. , Shah Zubair , Abicht Travis , Haglund Nicholas , Sheldon Seth H.
Published: January 2022

Background

Patients with left ventricular assist devices (LVAD) often tolerate ventricular arrhythmias (VA). We aim to assess the frequency and outcomes of ICD therapies averted by ultraconservative ICD programming (UCP) in LVAD patients.

Methods

This single center, retrospective cohort study included patients with LVADs and ICDs implanted from 2015 to 2019 that had UCP. The aim for UCP was to maximally delay VA treatments and maximize anti‐tachycardia pacing (ATP) prior to ICD shocks. VA events were reviewed after UCP and evaluated under prior conservative programming to assess for potentially averted events (that would have resulted in either ATP or defibrillation with prior programming).

Results

Fifty patients were included in the study with follow‐up of median 16 ± 10.2 months after UCP. The median time from LVAD implantation to reprogramming was 7 days (IQR 5–9 days). Fourteen patients (28%) had potentially averted VA events that would have been treated with their prior ICD programming (82 total events, median two events per patient, IQR 1–10 events). Treated VA events occurred in 15 patients (30%). Eleven of the 14 patients with potentially averted VAs had treated events as well. Only one patient reported definitive symptoms of self‐limited “dizziness” during a potentially averted event that did not result in hospitalization. No patients died of complications from or needed emergent care/hospitalization due a potentially averted VA.

Conclusions

UCP in LVAD patients likely prevented unnecessary VA treatments in many patients with minimal reported symptoms during these potentially averted events. Prospective studies are necessary to confirm these findings.
Predicting upgrade timing for successive product generations: An exponential‐decay proportional hazard model
Authors: Qu Xinxue (Shawn) , Lotfi Aslan , Jain Dipak C. , Jiang Zhengrui
Published: January 2022

In the presence of successive product generations, most consumers are repeat buyers who may decide to purchase a future product generation even before its release. Therefore, after a new product generation enters the market, its sales often exhibit a declining pattern, which renders traditional diffusion models unsuitable for characterizing consumers’ decisions on upgrade timing. In this study, we propose an Exponential‐Decay proportional hazard model (Expo‐Decay model) to predict consumers’ time to product upgrade. The Expo‐Decay model is parsimonious, interpretable, and performs better than do existing models. We apply the Expo‐Decay model and three extensions to study consumers’ upgrade behavior for a sports video game series. Empirical results reveal that consumers’ previous adoption and usage patterns can help predict their timing to upgrades. In particular, we find that consumers who have adopted the immediate past generation and those who play games from previous generations more often tend to upgrade earlier, whereas those who specialize in a small subset of game modes tend to upgrade later. Further, we find that complex extensions to the Expo‐Decay model do not lead to better prediction performance than does the baseline Expo‐Decay model, whereas a time‐variant extension that updates the values of covariates over time outperforms the baseline model with static data.
The Making of Radical‐Right Voters: Persuasion and Contrast Effects in a Dynamic Political Context
Authors: Chan Ka Ming
Published: January 2022

Under what circumstances do first‐time radical‐right party (RRP) voters become more identified with the right‐wing label? Also, when do they perceive the center‐right party as more left wing and evaluate it more negatively? To answer these two intertwined questions, this article leverages the dynamic political context of Germany during the 2013–17 election cycle. In this election cycle, the political arena became abruptly polarized, as the refugee crisis took place and the Alternative for Germany (AfD) broke into 13 subnational parliaments. Using a unique longitudinal dataset, I find that first‐time AfD voters experienced a persuasion effect in such a polarized environment, as they became slightly more right wing. In addition, I find a contrast effect among these voters, as they came to perceive the Christian Democratic Union as more left wing and judged it more negatively. These findings have important implications for understanding the psychological processes of first‐time RRP voters in a multiparty system, as they show how a polarized environment can shape RRP voters' ideological identity and motivate them to see the mainstream center‐right party as an outgroup.
Food Hardship in the US During the Pandemic: What Can We Learn From Real‐Time Data?
Authors: Ayllón Sara , Lado Samuel
Published: January 2022

We study the potential effect of the declaration of the state of emergency, the beginning and end of the stay‐at‐home orders, and the one‐off Economic Impact Payments on food hardship in the US during the first wave of the coronavirus pandemic. We use daily data from Google Trends for the search term “foodbank” and document the development of a hunger crisis, as indicated by the number of individuals who need to locate a food pantry through the internet. The demand for charitable food handouts begins to decrease once families start receiving the stimulus payments, but the biggest fall comes when economic activity resumes after the lifting of the lockdown orders. Our estimates indicate that the increased need for emergency help among vulnerable families lasted for at least 10 weeks during the first wave of the pandemic, and we argue that real‐time data can be useful in predicting such urgency.
The Unequal Consequences of the Covid‐19 Pandemic: Evidence from a Large Representative German Population Survey
Authors: Immel Lea , Neumeier Florian , Peichl Andreas
Published: January 2022

We use panel data from three waves of a large representative population survey carried out between June and November 2020 to assess in what regards and to what extent different groups of the German population are affected by the COVID‐19 crisis. Using common factor analysis, we show that people’s lives are mainly affected in two ways: First, a notable fraction of the population is concerned that they or their family members and friends may get infected with the coronavirus. Second, many people suffer from socio‐economic consequences of the crisis, including a discontinuation of employment, a decrease in household income, and worries about financial troubles. Regressing these two factors on several socio‐demographic characteristics reveals that especially the socio‐economic consequences vary across population groups. Self‐employed persons, marginally employed workers, low‐income households, and families with children appear to be burdened overproportionally.
“Eurowhite Conceit,” “Dirty White” Ressentiment: “Race” in Europe by József Böröcz: A Comment
Authors: Lentin Alana
Published: January 2022

This essay is written in response to Böröcz’s (2021) essay on race in Europe.
Person‐centred care and short oral treatment for rifampicin‐resistant tuberculosis improve retention in care in Kandahar, Afghanistan
Authors: Mesic Anita , Ishaq Sadiqullah , Khan Waliullah H. , Mureed Atiqullah , Mar Htay Thet , Khaing Ei Ei , Bermudez‐Aza Elkin , Rose Letitia , Lynen Lutgarde , Seddiq Mohammad Khaled , Amirzada Hashim Khan , Keus Kees , Decroo Tom
Published: January 2022

Objectives

To describe the effect of adaptations to a person‐centred care with short oral regimens on retention in care for rifampicin‐resistant TB (RR‐TB) in Kandahar province, Afghanistan.

Methods

The study included people with RR‐TB registered in the programme between 01 October 2016 and 18 April 2021. From 19 November 2019, the programme implemented a trial investigating the safety and effectiveness of short oral RR‐TB regimens. During the trial, person‐centred care was adapted. We included the data from people living with RR‐TB treated in the period before and after the care model was adapted and applied Kaplan‐Meier statistics to compare rates of retention in care.

Results

Of 236 patients registered in the RR‐TB programme, 146 (61.9%) were registered before and 90 (38.1%) after the model of care was adapted. Before adaptations enhancing person‐centred care, pre‐treatment attrition was 23.3% (n = 34/146), whilst under the adapted care model it was 5.6% (n = 5/90). Attrition on treatment was 22.3% (n = 25/112) before adaptations, whilst during the study period none of the participants were lost‐to‐follow‐up on treatment and 3.3% died (n = 3/90).

Conclusions

As person‐centred care delivery and treatment regimens were adapted to better fit‐specific contextual challenges and the needs of the target population, retention in care improved amongst people with RR‐TB in Kandahar, Afghanistan.
Fetal cardiac rhabdomyomas as a sonographic sign of tuberous sclerosis complex – a diagnosis not to be missed. A pictorial essay
Authors: Boitor Borza Dan , Popa Stanila Roxana , Zaharie Gabriela , Hasmasanu Monica , Muresan Daniel
Published: January 2022

Fetal cardiac rhabdomyomas should trigger the awareness of a potential coexisting tuberous sclerosis complex that can lead to a poor neurological outcome. This condition is not only uncommon but can be easily unrecognized prenatally in the absence of a meticulous neurosonogram and MRI. We emphasize that careful consideration of all prenatal facilities is required to confirm the diagnosis of tuberous sclerosis complex as early as possible during pregnancy.
Scoping Review: Ultrasonographic evidence of intraabdominal manifestations of COVID-19 infection
Authors: Dehmani Sirine , Penkalla Nadine , Jung Ernst Michael , De Molo Chiara , Serra Carla , Hoffmann Beatrice , Fang Cheng , Dietrich Christoph F.
Published: January 2022

COVID-19 is an infectious disease caused by the novel SARS-CoV-2 coronavirus that in the majority of patients will only cause mild symptoms. The most common serious complication is COVID-19 pneumonia, however, gastrointestinal (GI) COV-ID-19 is also a frequent presentation and likely due to the high expression of the ACE2 receptor in the GI tract. As diagnostic ultrasound has been frequently used in the management of this patient cohort, we conducted a literature search with the aim to present and review the currently published evidence of using ultrasound examinations in the management of intraabdominal manifestations of COVID-19. Our analysis showed that sonographic abnormalities of the hepatobiliary system are the most commonly reported findings in adults, while gastrointestinal abnormalities are the most common findings in children. The most severe complications are related to thromboembolic complications in the intensive care unit.
REVIEWS OF ACOUSTICAL PATENTS
Authors: Fulop Sean A.
Published: January 2022

The purpose of these acoustical patent reviews is to provide enough information for a Journal reader to decide whether to seek more information from the patent itself. Any opinions expressed here are those of the reviewers as individuals and are not legal opinions. Patents are available via the internet at the USPTO website.
Stabilization but No Functional Influence of HIF-1α Expression in the Intestinal Epithelium during Salmonella Typhimurium Infection
Authors: Robrahn Laura , Dupont Aline , Jumpertz Sandra , Zhang Kaiyi , Holland Christian H. , Guillaume Joël , Rappold Sabrina , Roth Johanna , Cerovic Vuk , Saez-Rodriguez Julio , Hornef Mathias W. , Cramer Thorsten
Published: January 2022

Hypoxia-inducible transcription factor 1 (HIF-1) has been shown to enhance microbial killing and ameliorate the course of bacterial infections. While the impact of HIF-1 on inflammatory diseases of the gut has been studied intensively, its function in bacterial infections of the gastrointestinal tract remains largely elusive.
The Nutritional Environment Is Sufficient To Select Coexisting Biofilm and Quorum Sensing Mutants of Pseudomonas aeruginosa
Authors: Scribner Michelle R. , Stephens Amelia C. , Huong Justin L. , Richardson Anthony R. , Cooper Vaughn S.
Published: January 2022

Pseudomonas aeruginosa
produces dangerous chronic infections that are known for their rapid diversification and recalcitrance to treatment. We performed evolution experiments to identify adaptations selected by two specific aspects of the CF respiratory environment: nutrient levels and surface attachment.
Diagnostic and management considerations in pseudohypoaldosteronism type 1b
Authors: Kelchtermans Jelte , Pinney Sara E , Leonard Jacqueline M M , Mcgrath-Morrow Sharon
Published: January 2022

Pseudohypoaldosteronism type 1B is a rare autosomal recessive disorder caused by dysfunction of amiloride-sensitive epithelial sodium channels (ENaCs). We present the case of a neonate with cardiogenic shock after cardiac arrest due to profound hyperkalaemia. Genetic testing revealed a novel homozygous variant inSCNNIA. We review diagnostic considerations including the molecular mechanisms of disease, discuss treatment approaches and highlight the possible significance of the diversity of pulmonary ENaCs.
Development and validation of the self-management Barriers and Supports Evaluation for working-aged adults with type 1 diabetes mellitus
Authors: Planalp Elizabeth M , Kliems Harald , Chewning Betty A , Palta Mari , LeCaire Tamara J , Young Laura A , Cox Elizabeth D
Published: January 2022

Introduction

To optimize type 1 diabetes mellitus self-management, experts recommend a person-centered approach, in which care is tailored to meet people’s needs and preferences. Existing tools for tailoring type 1 diabetes mellitus education and support are limited by narrow focus, lack of strong association with meaningful outcomes like A1c, or having been developed before widespread use of modern diabetes technology. To facilitate comprehensive, effective tailoring for today’s working-aged adults with type 1 diabetes mellitus, we developed and validated the Barriers and Supports Evaluation (BASES).

Research design and methods

Participants 25–64 years of age with type 1 diabetes mellitus were recruited from clinics and a population-based registry. Content analysis of semistructured interviews (n=33) yielded a pool of 136 items, further refined to 70 candidate items on a 5-point Likert scale through cognitive interviewing and piloting. To develop and validate the tool, factor analyses were applied to responses to candidate items (n=392). Additional survey data included demographics and the Diabetes-Specific Quality of Life (QOL) Scale-Revised. To evaluate concurrent validity, hemoglobin A1c (HbA1c) values and QOL scores were regressed on domain scores.

Results

Factor analyses yielded 5 domains encompassing 30 items: Learning Opportunities, Costs and Insurance, Family and Friends, Coping and Behavioral Skills, and Diabetes Provider Interactions. Models exhibited good to adequate fit (Comparative Fit Index >0.88 and Root Mean Squared Error of Approximation <0.06). All domains demonstrated significant associations with HbA1c and QOL in the expected direction, except Family and Friends. Coping and Behavioral Skills had the strongest associations with both HbA1c and QOL.

Conclusions

The BASES is a valid, comprehensive, person-centered tool that can tailor diabetes support and education to individuals’ needs in a modern practice environment, improving effectiveness and uptake of services. Clinicians could use the tool to uncover patient-specific barriers that limit success in achieving HbA1c goals and optimal QOL.
Impact of the COVID-19 pandemic on the utilisation of health services at public hospitals in Yemen: a retrospective comparative study
Authors: Kotiso Mikyias , Qirbi Naseeb , Al-Shabi Kahtan , Vuolo Elena , Al-Waleedi Ali , Naiene Jeremias , Senga Mikiko , Khalil Mohammed , Basaleem Huda , Alhidary Ahmed
Published: January 2022

Background

The COVID-19 pandemic has led to a global crisis, creating an unprecedented situation, which has taken the world by storm, overshadowing on all life’ aspects and having a significant impact on the health systems of most countries. In this study, the delivery of health services is investigated both before and during the outbreak of the COVID-19 pandemic at public hospitals in Yemen to assess the impact of COVID-19 on the utilisation of health services.

Method

Data collected from 127 hospitals in Yemen were reviewed using the DHIS2 system. The data represented 3 months before the outbreak of COVID-19 between January and March 2020 and during the outbreak of COVID-19 outbreak between April and June 2020. The results were then compared with the same period in 2019. The utilisation pattern of healthcare services during the period of investigation was compiled and analysed by applying a generalised estimating equation (GEE) to examine the effects of the COVID-19 outbreak in Yemen. The data collected from the targeted hospitals included information related to consultations, surgeries, deliveries, C-sections and penta-3rd dose immunisation.

Results

The trendline of health services used during the pandemic showed a gradual decline beginning from April 2020 for consultations, surgeries and penta-3rd dose utilisation. The GEE model revealed a significant effect (p<0.05) during the outbreak compared with preoutbreak in the consultation services (B=−1,343.9; 95% CI −1,767.2 to −920.6; χ2=38.718), surgeries (B=−54.98; 95% CI −79.13 to −30.83, χ2=19.911) and penta-3rd dose (B=−24.47; 95% CI −30.56 to −18.38 and χ2=62.010). As for deliveries and C-sections, the results were shown to be statistically non-significant.

Conclusion

The impact of COVID-19 on continuity of health services delivery in Yemen has been distinct and profound, where the study revealed that the number of the consultations, surgeries and number of vaccinated children have been declined during the COVID-19 pandemic, likely due to the partially lockdown measures taken and fear of being infected. However, the deliveries and C-section services remained nearly in the same level and did not affect by the COVID-19 pandemic.
Artificial intelligence (AI) to enhance breast cancer screening: protocol for population-based cohort study of cancer detection
Authors: Marinovich M Luke , Wylie Elizabeth , Lotter William , Pearce Alison , Carter Stacy M , Lund Helen , Waddell Andrew , Kim Jiye G , Pereira Gavin F , Lee Christoph I , Zackrisson Sophia , Brennan Meagan , Houssami Nehmat
Published: January 2022

Introduction

Artiﬁcial intelligence (AI) algorithms for interpreting mammograms have the potential to improve the effectiveness of population breast cancer screening programmes if they can detect cancers, including interval cancers, without contributing substantially to overdiagnosis. Studies suggesting that AI has comparable or greater accuracy than radiologists commonly employ ‘enriched’ datasets in which cancer prevalence is higher than in population screening. Routine screening outcome metrics (cancer detection and recall rates) cannot be estimated from these datasets, and accuracy estimates may be subject to spectrum bias which limits generalisabilty to real-world screening. We aim to address these limitations by comparing the accuracy of AI and radiologists in a cohort of consecutive of women attending a real-world population breast cancer screening programme.

Methods and analysis

A retrospective, consecutive cohort of digital mammography screens from 109 000 distinct women was assembled from BreastScreen WA (BSWA), Western Australia’s biennial population screening programme, from November 2016 to December 2017. The cohort includes 761 screen-detected and 235 interval cancers. Descriptive characteristics and results of radiologist double-reading will be extracted from BSWA outcomes data collection. Mammograms will be reinterpreted by a commercial AI algorithm (DeepHealth). AI accuracy will be compared with that of radiologist single-reading based on the diﬀerence in the area under the receiver operating characteristic curve. Cancer detection and recall rates for combined AI–radiologist reading will be estimated by pairing the first radiologist read per screen with the AI algorithm, and compared with estimates for radiologist double-reading.

Ethics and dissemination

This study has ethical approval from the Women and Newborn Health Service Ethics Committee (EC00350) and the Curtin University Human Research Ethics Committee (HRE2020-0316). Findings will be published in peer-reviewed journals and presented at national and international conferences. Results will also be disseminated to stakeholders in Australian breast cancer screening programmes and policy makers in population screening.
Prevalence and individual and work-related factors associated with suicidal thoughts and behaviours among veterinarians in Norway: a cross-sectional, nationwide survey-based study (the NORVET study)
Authors: Dalum Helene Seljenes , Tyssen Reidar , Hem Erlend
Published: January 2022

Objectives

Several studies have shown increased suicide rates among veterinarians. We investigated the self-reported prevalence of suicidal thoughts and behaviours and contributing and independent factors associated with suicidal thoughts and behaviours among veterinarians in Norway.

Design

Cross-sectional, nationwide survey.

Participants

2596 veterinarians in Norway (response rate: 75%).

Main outcome measure

Paykel’s five-item questionnaire.

Results

In total, 27% (n=682/2567) of veterinarians in Norway felt that life was not worth living during the last year, 5% (n=139/2562) had serious suicidal thoughts, and 0.2% (n=6/2537) had attempted suicide. Female veterinarians reported significantly higher prevalence of suicidal feelings and thoughts than males. For serious suicidal thoughts, women had nearly twice the prevalence as their male colleagues (6.2% (n=108/1754) vs 3.6% (n=28/766), χ2: 6.5, p=0.011). Independent factors associated with serious suicidal thoughts were being single (OR 1.76, 95% CI 1.13 to 2.72, p<0.05), negative life events (OR=1.43, 95% CI 1.22 to 1.68, p<0.001) and the presence of mental distress (OR 2.75, 95% CI 2.14 to 3.52, p<0.001). The veterinarians related their serious suicidal thoughts to work and personal problems, and a lesser degree to family, social and other problems. Nearly twice as many women (53%, n=57/108) as men (28%, n=7/25) reported work problems as the most important contributing factor to their serious suicidal thoughts (χ2: 4.99, p=0.03). 4% (n=6/139) reported work problems as the only factor of importance.

Conclusions

Veterinarians in Norway have relatively high prevalence of suicidal feelings and thoughts, including serious suicidal thoughts. In multivariable analyses, the individual factors were more important than work-related ones, while work problems were the most reported contributing factor to serious suicidal thoughts by the veterinarians themselves. The role of gender and specific work-related factors should be further investigated to better understand the complexity of suicidal behaviour among veterinarians.
Attitudes towards vaccines and intention to vaccinate against COVID-19: a cross-sectional analysis—implications for public health communications in Australia
Authors: Enticott Joanne , Gill Jaskirath Singh , Bacon Simon L. , Lavoie Kim L. , Epstein Daniel S. , Dawadi Shrinkhala , Teede Helena J , Boyle Jacqueline
Published: January 2022

Objective

To examine SARS-CoV-2 vaccine confidence, attitudes and intentions in Australian adults as part of the iCARE Study.

Design and setting

Cross-sectional online survey conducted when free COVID-19 vaccinations first became available in Australia in February 2021.

Participants

Total of 1166 Australians from general population aged 18–90 years (mean 52, SD of 19).

Main outcome measures

Primary outcome: responses to question ‘If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?’.

Secondary outcome: analyses of putative drivers of uptake, including vaccine confidence, socioeconomic status and sources of trust, derived from multiple survey questions.

Results

Seventy-eight per cent reported being likely to receive a SARS-CoV-2 vaccine. Higher SARS-CoV-2 vaccine intentions were associated with: increasing age (OR: 2.01 (95% CI 1.77 to 2.77)), being male (1.37 (95% CI 1.08 to 1.72)), residing in least disadvantaged area quintile (2.27 (95% CI 1.53 to 3.37)) and a self-perceived high risk of getting COVID-19 (1.52 (95% CI 1.08 to 2.14)). However, 72% did not believe they were at a high risk of getting COVID-19. Findings regarding vaccines in general were similar except there were no sex differences. For both the SARS-CoV-2 vaccine and vaccines in general, there were no differences in intentions to vaccinate as a function of education level, perceived income level and rurality. Knowing that the vaccine is safe and effective and that getting vaccinated will protect others, trusting the company that made it and vaccination recommended by a doctor were reported to influence a large proportion of the study cohort to uptake the SARS-CoV-2 vaccine. Seventy-eight per cent reported the intent to continue engaging in virus-protecting behaviours (mask wearing, social distancing, etc) postvaccine.

Conclusions

Most Australians are likely to receive a SARS-CoV-2 vaccine. Key influencing factors identified (eg, knowing vaccine is safe and effective, and doctor’s recommendation to get vaccinated) can inform public health messaging to enhance vaccination rates.
Antibiotic prescribing rate after optimal near-patient C-reactive protein testing in acutely ill children presenting to ambulatory care (ARON project): protocol for a cluster-randomized pragmatic trial
Authors: Verbakel Jan Yvan Jos , De Burghgraeve Tine , Van den Bruel Ann , Coenen Samuel , Anthierens Sibyl , Joly Louise , Laenen Annouschka , Luyten Jeroen , De Sutter An
Published: January 2022

Introduction

Children become ill quite often, mainly because of infections, most of which can be managed in the community. Many children are prescribed antibiotics which contributes to antimicrobial resistance and reinforces health-seeking behaviour. Point-of-care C reactive protein (POC CRP) testing, prescription guidance and safety-netting advice can help safely reduce antibiotic prescribing to acutely ill children in ambulatory care as well as save costs at a systems level.

Methods and analysis

The ARON (Antibiotic prescribing Rate after Optimal Near-patient testing in acutely ill children in ambulatory care) trial is a pragmatic cluster randomized controlled superiority trial with a nested process evaluation and will assess the clinical and cost effectiveness of a diagnostic algorithm, which includes a standardised clinical assessment, a POC CRP test, and safety-netting advice, in acutely ill children aged 6 months to 12 years presenting to ambulatory care. The primary outcome is antibiotic prescribing at the index consultation; secondary outcomes include clinical recovery, reconsultation, referral/admission to hospital, additional testing, mortality and patient satisfaction. We aim to recruit a total sample size of 6111 patients. All outcomes will be analysed according to the intent-to-treat approach. We will use a mixed-effect logistic regression analysis to account for the clustering at practice level.

Ethics and dissemination

The study will be conducted in compliance with the principles of the Declaration of Helsinki (current version), the principles of Good Clinical Practice and in accordance with all applicable regulatory requirements. Ethics approval for this study was obtained on 10 November 2020 from the Ethics Committee Research of University Hospitals Leuven under reference S62005. We will ensure that the findings of the study will be disseminated to relevant stakeholders other than the scientific world including the public, healthcare providers and policy-makers. The process evaluation that is part of this trial may provide a basis for an implementation strategy. If our intervention proves to be clinically and cost-effective, it will be essential to educate physicians about introducing the diagnostic algorithm including POC CRP testing and safety-netting advice in their daily practice.

Trial registration number

ClinicalTrials.gov Identifier: NCT04470518. Protocol V.2.0 date 2 October 2020. (Pre-results)
Implementation of a sedation protocol: a quality improvement project to enhance sedation management in the paediatric intensive care unit
Authors: Hazwani Tarek , Al Ahmady Arwa , Kazzaz Yasser , Al Smari Abeer , Al Enizy Seham , Alali Hamza
Published: January 2022

Background

Proper sedation is integral to ensuring the safety and comfort of children on mechanical ventilation (MV). Sedation protocols help to achieve this goal and reduce the duration of MV. We have observed varied sedation approaches, sedation score targets and sedative use by our physicians, which were manifested as oversedation and undersedation with associated accidental extubation. Hence, we aimed to implement a standardised sedation protocol and assess its impact on mechanically ventilated paediatric patients.

Methods

A multidisciplinary quality improvement team was formed to develop and implement a standardised sedation protocol for mechanically ventilated paediatric patients. COMFORT-Behaviour (COMFORT-B) Scale score was used to assess the sedation targets and define undersedation, oversedation or adequate sedation. Our goal was to achieve adequate sedation during 90% of the sedation period. Based on the model for improvement methodology, we used plan–do–study–act cycles to develop, test and implement the new sedation protocol.

Results

There was an immediate percentage increase in COMFORT-B Scale scores within the target sedation level, which was associated with a gradual decrease in the need for intermittent sedation doses over sedation infusion in the preimplementation, improvement and control phases (6.3, 4.9 and 3.1 sedation doses/12 hours/patient, respectively) to achieve adequate sedation target.

Conclusions

The standardisation of sedation protocols was safe and efficient, and improved the sedation quality in mechanically ventilated paediatric patients.
Macrophage polarisation in caesarean scar diverticulum
Authors: Huang Jinfa , Liu Xiaochun , Hou Yi , Liu Yixuan , Liao Kedan , Xie Ning , Deng Kaixian
Published: January 2022

Aims

To determine immunohistochemical features and correlations between M1/M2 polarisation status with disease severity of post-caesarean scar diverticulum (CSD).

Methods

Histological and immunohistological stainings were performed and inflammatory (CD16, CD163 and tumour necrosis factor-α (TNF-α)), fibrosis (α-smooth muscle actin (α-SMA)) and angiogenic (CD31) markers were examined in uterine tissues collected from patients with uterine scar diverticula (CSD) (n=37) and caesarean section (CS) (n=3).

Results

CSD tissues have higher expression of α-SMA, TNF-α, CD16 and CD31 and lower expression of CD163 than CS tissue (p<0.05). Compared with adjacent tissues, thick-walled blood vessels, glands and fibrotic sites have higher expression of α-SMA, TNF-α and CD16. Statistical correlation was observed between the expression of CD16 and TNF-α (R=0.693, p<0.001), α-SMA (R=0.404, p<0.05) and CD31 (R=0.253, p<0.05) in CSD tissues, especially with the ratio of CD16/CD163 (R=0.590, p<0.01). A more significant difference was observed between the expression of CD16/CD163 and α-SMA (R=0.556, p<0.001), TNF-α (R=0.633, p<0.0001) and CD31 (R=0.336, p<0.05).

Conclusions

In this study, TNF-α, α-SMA, CD16 and CD31 proteins were overexpressed in all CSD cases, and CD16/CD163 was positively correlated with tissue inflammation, fibrosis and neovascularisation. Abnormal mononuclear macrophage infiltration may be involved in the origin and progression of CSD.
Fertility preservation for transgender children and young people in paediatric healthcare: a systematic review of ethical considerations
Authors: Warton Chanelle , McDougall Rosalind J
Published: January 2022

Background

While fertility preservation is recommended practice for paediatric oncology patients, it is increasingly being considered for transgender children and young people in paediatric care. This raises ethical issues for clinicians, particularly around consent and shared decision-making in this new area of healthcare.

Methods

A systematic review of normative literature was conducted across four databases in June 2020 to capture ethical considerations related to fertility counselling and preservation in paediatric transgender healthcare. The text of included publications was analysed inductively, guided by the Qualitative Analysis Guide of Leuven.

Results

Twenty-four publications were identified for inclusion. Four key ethical considerations emerged from this literature: access to fertility preservation, conscientious objection, decision-making capacity of children and young people, and shared decision-making.

Conclusion

In the identified literature, there is consensus that transgender children and young people should not be refused access to fertility preservation services solely due to their gender identity, and that clinicians with conscientious objections to fertility preservation for this group have an obligation to refer on to willing providers. Factors that create ethical complexity in this area of paediatric care include the child’s age, mental health, and parents’ views.
Information batteries
Authors: Switzer Jennifer , Raghavan Barath
Published: January 2022

Coping with the intermittency of renewable power is a fundamental challenge, with load shifting and grid-scale storage as key responses. We propose Information Batteries (IB), in which energy is stored in the form of information---specifically, the results of completed computational tasks. Information Batteries thus provide storage through speculative load shifting, anticipating computation that will be performed in the future.

We take a distributed systems perspective, and evaluate the extent to which an IB storage system can be made practical through augmentation of compiler toolchains, key-value stores, and other important elements in modern hyper-scale compute. In particular, we implement one specific IB prototype by augmenting the Rust compiler to enable transparent function-level precomputation and caching. We evaluate the overheads this imposes, along with macro-level job prediction and power prediction. We also evaluate the space of operation for an IB system, to identify the best case efficiency of any IB system for a given power and compute regime.
Empiricism and collaboration on grid data analytics
Authors: Von Meier Alexandra , Dunn Laurel N.
Published: January 2022

This paper discusses the need for data-driven tools to manage modern electric grids, where planning and operational decisions increasingly require empirical data on various time scales. The advancement of such tools will hinge on deploying instrumentation to collect faster and more localized measurements, capitalizing on state-of-the-art software solutions to facilitate big-data workflows, and enabling open exchange of data and information with research collaborators.
Surf or sleep?
Authors: Guo Teng , Li Linhong , Zhang Dongyu , Xia Feng
Published: January 2022

Poor sleep habits may cause serious problems of mind and body, and it is a commonly observed issue for college students due to study workload as well as peer and social influence. Understanding its impact and identifying students with poor sleep habits matters a lot in educational management. Most of the current researches is either based on self-reports and questionnaires, suffering from small sample size and social desirability bias, or the methods used are not suitable for the education system. In this paper, we develop a general data-driven method for identifying students' sleep patterns according to their Internet access pattern stored in the education management system and explore its influence from various aspects. First, we design a Possion-based probabilistic mixture model to cluster students according to the distribution of bedtime and identify students who are used to stay up late. Second, we profile students from five aspects (including eight dimensions) based on campusbehavior data and build Bayesian networks to explore the relationship between behavioral characteristics and sleeping habits. Finally, we test the predictability of sleeping habits. This paper not only contributes to the understanding of student sleep from a cognitive and behavioral perspective but also presents a new approach that provides an effective framework for various educational institutions to detect the sleeping patterns of students.
A Perspective on "CCS Expressions, Finite State Processes, and Three Problems of Equivalence"
Authors: Bartocci Ezio , Bender Michael A.
Published: January 2022

With the publication of the Kannellakis-Smolka 1983 PODC paper, Kanellakis and Smolka pioneered the development of efficient algorithms for deciding behavioral equivalence of concurrent and distributed processes, especially bisimulation equivalence. Bisimulation is the cornerstone of the process-algebraic approach to modeling and verifying concurrent and distributed systems. They also presented complexity results that showed certain behavioral equivalences are computationally intractable. Collectively, their results founded the subdiscipline of algorithmic process theory, and established the associated bridges between the European research community, whose focus at the time was on process theory, and that of the US, with a rich tradition in algorithm design and computational complexity, but to whom process theory was largely unknown.
Kanellakis-Smolka 1983
Authors: Smolka Scott A.
Published: January 2022

Dan Alistarh, Editor of the "Distributed Computing" SIGACT column, asked me if I might be interested in publishing a written version of the perspective I gave at DISC 2021 upon receiving the 2021 Dijkstra Prize for the PODC 1983 paper I wrote with Paris Kanellakis on "CCS Expressions, Finite State Processes, and Three Problems of Equivalence". Paris and I also published a journal version with the same title in Information & Computation (1990). I took Dan up on his kind invitation because it would give me a proper forum to thank all of the people who helped make this award happen. Also, it allows me to fill in some other gaps in my earlier remarks. So thank you, Dan, for this opportunity!
Bäcklund Transformation and Exact Solutions to a Generalized (3 + 1)‐Dimensional Nonlinear Evolution Equation
Authors: Shen Yali , Yang Ying
Published: January 2022

In this article, a generalized (3 + 1)‐dimensional nonlinear evolution equation (NLEE), which can be obtained by a multivariate polynomial, is investigated. Based on the Hirota bilinear method, the N‐soliton solution and bilinear Bäcklund transformation (BBT) with explicit formulas are successfully constructed. By using BBT, two traveling wave solutions and a mixed solution of the generalized (3 + 1)‐dimensional NLEE are obtained. Furthermore, the lump and the interaction solutions for the equation are constructed. Finally, the dynamic properties of the lump and the interaction solutions are described graphically.
Undrained Deformation Characteristics of Soft Marine Clay Subjected to One-Way Cyclic Loading with Variable Confining Pressure
Authors: Sun Lei
Published: January 2022

To gain a better understanding of the undrained deformation characteristic of saturated marine clay soil subjected to vehicle cyclic traffic load, a sophisticated dynamic triaxial was used to conduct a variety of undrained one-way compression cyclic experiments with variable confining pressure (VCP) as well as constant confining pressure (CCP). The results indicate that, compared to CCP test results, VCP is helpful to raise the axial resilient modulus (Mr) and restrain the permanent plastic strain (

ε
a
p

) development of the specimens. By normalization analysis of the measured data of Mr and

ε
a
p

, the virtually unique correlation between normalized average resilient modulus, normalized permanent axial strain after 1,000 loading cycles, and normalized mean normal stress is established, respectively, regardless of the values of CSR. Additionally, the VCP influence on

ε
a
p

is quantified and fitted by a power law function, which can be used for subsoil deformation prediction and provides new insights into the mechanics of strain accumulation under undrained cyclic loading conditions.
Circular RNA CCDC66 Regulates Osteoarthritis Progression by Targeting miR-3622b-5p
Authors: Zhang Chengyuan , Lu Ye , Yuan Feng , Jiang Shilin
Published: January 2022

Objective: CircCCDC66 is involved in cancer progression, but its role in osteoarthritis (OA) remains unknown. This study was carried out to explore the biological role of circCCDC66 in OA and its underlying mechanism. Methods: The expression levels of miR-3622b-5p and circCCDC66 in OA cartilage tissues were detected by qRT-PCR. Cell Counting Kit-8 (CCK8) and flow cytometry were used to detect the chondrocyte viability and apoptosis. The expression of chondrocyte inflammatory factors (IL-6 and TNF-α) was measured by ELISA. The target genes of circCCDC66 and miR-3622b-5p were analyzed by bioinformatics analysis and luciferase reporter gene assay. The relationship between circCCDC66 and miR-3622b-5p was analyzed by bioinformatics analysis and luciferase reporter gene assay. Results: It was found that circCCDC66 expression in OA cartilage tissues was upregulated. CircCCDC66 overexpression inhibited proliferation and promoted apoptosis of chondrocytes and increased IL-6 and TNF-α levels in chondrocytes. miR-3622b-5p was predicted to be a downstream target gene of circCCDC66, and circCCDC66 overexpression inhibited miR-3622b-5p expression in chondrocytes. Moreover, miR-3622b-5p expression was downregulated in OA cartilage tissues. miR-3622b-5p overexpression increased chondrocyte proliferation, inhibited chondrocyte apoptosis, and enhanced the expression of IL-6 and TNF-α in chondrocytes. In addition, circCCDC66 overexpression enhanced SIRT3 expression in chondrocytes, while miR-3622b-5p overexpression inhibited SIRT3 expression in chondrocytes. Conclusion: CircCCDC66 promoted OA chondrocyte apoptosis by regulating the miR-3622b-5p/SIRT3 axis. CircCCDC66 may be a new therapeutic target of OA.
Real-World Effects of Antibiotic Treatment on Acute COPD Exacerbations in Outpatients: A Cohort Study under the PharmLines Initiative
Authors: Wang Yuanyuan , Pera Victor , Boezen H. Marike , Alffenaar Jan-Willem C. , Wilffert Bob , Groenwold Rolf H.H. , Hak Eelko
Published: January 2022

Background: Although antibiotic treatment is recommended for acute exacerbations of chronic obstructive pulmonary disease (AECOPD), its value in real-world settings is still controversial. Objectives: This study aimed to evaluate the short- and long-term effects of antibiotic treatment on AECOPD outpatients. Methods: A cohort study was conducted under the PharmLines Initiative. We included participants with a first recorded diagnosis of COPD who received systemic glucocorticoid treatment for an AECOPD episode. The exposed and reference groups were defined based on any antibiotic prescription during the AECOPD treatment. The short-term outcome was AECOPD treatment failure within 14–30 days after the index date. The long-term outcome was time to the next exacerbation. Adjustment for confounding was made using propensity scores. Results: Of the 1,105 AECOPD patients, antibiotics were prescribed to 518 patients (46.9%) while 587 patients (53.1%) received no antibiotics. The overall antibiotic use was associated with a relative risk reduction of AECOPD treatment failure by 37% compared with the reference group (adjusted odds ratio [aOR] 0.63 [95% CI: 0.40–0.99]). Protective effects were similar for doxycycline, macrolides, and co-amoxiclav, although only the effect of doxycycline was statistically significant (aOR 0.53 [95% CI: 0.28–0.99]). No protective effect was seen for amoxicillin (aOR 1.49 [95% CI: 0.78–2.84]). The risk of and time to the next exacerbation was similar for both groups. Conclusion: Overall, antibiotic treatment, notably with doxycycline, supplementing systemic glucocorticoids reduces short-term AECOPD treatment failure in real-world outpatient settings. No long-term beneficial effects of antibiotic treatment on AECOPD were found for the prevention of subsequent exacerbations.
Bladder Neck Contracture with Hem-o-Lok Clips Migration after Robotic-Assisted Radical Prostatectomy: A Case Report and Literature Review
Authors: Chen Bo-Han , Tseng Jen-Shu , Chiu Allen W.
Published: January 2022

Hem-o-lok clips are widely used in robotic-assisted radical prostatectomy (RARP). However, clips-related complications have been reported, including intravesical migration. Here, we share a 60-year-old male case with newly diagnosed prostatic adenocarcinoma. With an unfavorable intermediate risk, he was admitted for RARP. He was discharged from hospital without any immediate complications. However, he reported progressive dysuria and slow urine stream 6 months after surgery. Cystoscopy showed severe bladder neck contracture (BNC), and 2 Hem-o-lok clips were found intravesically and removed during bladder neck incision. Subsequently, fiberocystoscopy revealed another 2 clips near the bladder neck with mild BNC after another 6 months. These 2 clips were also removed during bladder neck dilatation. His urination status then improved without further obstruction. Clip migration after RARP is uncommon; however, clinicians must keep this in mind when patients present with new complaints such as lower urinary tract symptoms, hematuria, and recurrent urinary tract infections.