bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictability of 21-Gene Recurrence Score Assay by Using Pathological and Immunohistochemical Parameters in Breast Cancer
Authors: Alkushi Abdulmohsen , Omair Ahmad , Arabi Haitham , Masuadi Emad , Abualkhair Omalkhair
Published: December 2020

Background:

Oncotype Dx is used to predict the long-term recurrence risk in patients with estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative invasive breast cancer (BC). This study aimed at establishing a correlation between clinicopathological parameters and recurrence score (RS), subsequently improving predictability and ultimately justifying the use of the multigene assay.

Materials and methods:

A retrospective analysis of the pathology and clinical data of 114 female patients with BC who had Oncotype Dx testing between 2012 and 2019. The pathological parameters included are tumor cell type, tumor grade, pathological stage, and mitotic index (MI). The expression of ER, progesterone receptor (PR), HER2, and Ki67 was assessed by immunohistochemistry. A univariate and multivariate linear regression analysis was performed to assess the correlation between these parameters and the RS.

Results:

In univariate analysis, age (˂40 years), higher tumor grade, and low PR expression were significantly associated with higher RS ( P = .02; ˂.001; and ˂.001, respectively). Both MI and Ki67 were also strongly correlated with an increase in the RS with a P value of .01 (Spearman correlation 0.34 and 0.33). In multivariate linear regression analysis, age, MI, and Ki67 lost their significance, but both higher grade and PR remained significantly associated with a higher RS along with the tumor stage ( P ˂ .001; ˂.001; and .04, respectively).

Conclusions:

Tumor grade and PR immunohistochemical expression are the main predictors of RS in our study population. Other clinicopathological features were not significant predictors of change in RS in multivariate analysis.
Change in Compliance of Staff at 4 Vietnam Universities after the Enactment of Smoke-free Environment Decree
Authors: Nguyen Ngoc Bich , Capra Mike , Johnstone Kelly , Vu Hoang Lan , Tran Vu , Nguyen Minh Tham , Nguyen Kim Ngan , Cook Margaret
Published: December 2020

Background:

The Tobacco Control Law in Vietnam was adopted in 2012 and came into force from May 2013, followed by a number of guiding sub-law legal documents. Smoke-free campus policy in university is considered an important measure to protect people from secondhand smoking as well as staffs and students will be in favour of the policy. Furthermore, there has been evidence suggested that smoke-free policy had positive impact on active smoking as well as anti-smoking attitude.

Methods:

A cross-sectional self-administered study of staff at 4 universities were conducted in 2 phases, Phase 1 as early introduction of the Law (n = 900) and Phase 2 as 1-year post (n = 885). Demographics, tobacco consumption, compliance status and compliance with awareness towards the campus smoking regulations were assessed in both phases.

Results:

Daily smoking prevalence decreased significantly ( P < .05) 1 year after implementing the smoke-free policy, while a significant increase in occasional smoking ( P < .01). Compliance of staff to the regulation the campus should be indoor smoke-free was significantly increase at Phase 2 compared to Phase 1, however participants reported there would be places on campus that smokers frequently violated the smoke-free regulations.

Conclusions:

The study indicated a significant positive change in compliance of staff at the 4 universities after the implementation of the Tobacco Control Law, included the smoke-free policy. Although the prevalence of tobacco smoking in this study was low, the proportion of respondents who reported to reduce infringement the smoke-free policy suggests support for staff smokers would be beneficial. Raising awareness and enforcement is likely to enhance the long-term outcomes of the implementation of smoke-free environment.
Right-to-left Ventricular Diameter Ratio At Computed Tomographic Pulmonary Angiography in Patients with Acute Pulmonary Embolism and Obstructive Sleep Apnea
Authors: Berghaus Thomas M , Geissenberger Fabian , Konnerth Dinah , Probst Michael , Kröncke Thomas , Schwarz Florian
Published: December 2020

Purpose:

Right ventricular (RV) dysfunction in acute pulmonary embolism (PE) is a critical determinant of outcome. Obstructive sleep apnea (OSA) is a common comorbidity of PE and might also affect RV function. Therefore, we sought to investigate RV dysfunction in PE patients in proportion to the severity of OSA by evaluating the right-to-left ventricular (RV/LV) diameter ratio on computed tomographic pulmonary angiography (CTPA).

Materials and Methods:

197 PE patients were evaluated for sleep-disordered breathing by portable monitoring and nocturnal polysomnography. RV dilatation was defined as an RV/LV diameter ratio of ⩾ 1.0.

Results:

RV dilatation was significantly more frequent in OSA patients compared to study participants without OSA (66.4% vs 49.1%, P = .036). Elevated troponin I values, indicating myocardial injury due to acute, PE-related RV strain, were significantly more frequent in OSA patients with an apnea-hypopnea index (AHI) ⩾ 15/h compared to those with an AHI < 15/h (62.1% vs 45.8%, P = .035). However, RV dysfunction documented by the RV/LV diameter ratio on CTPA was not significantly associated with the severity of OSA in multivariable regression analysis.

Conclusion:

Patients with moderate or severe OSA might compensate acute, PE-related RV strain better, as they are adapted to repetitive right heart pressure overloads during sleep.
Multi-objective optimization and significant analysis of bearing element adjustments on the static performance of an innovative adjustable bearing through design of experiment
Authors: A Ganesha , Pai Raghuvir , Rao Srikanth , Khader SM Abdul
Published: December 2020

Real-time position control of the journal in a hydrodynamic bearing demands continuous modification of the film thickness. Innovative adjustable bearings offer film thickness modifications in radial and circumferential directions through the flexible bearing elements. The position of the journal depends on the bearing element adjustments and the operating parameters. These adjustments also affect the static characteristic of the bearings. Hence, the position control requires an in-depth knowledge of the effects of bearing element adjustments on the bearing characteristics. In this paper, the main effect and the interaction effects of symmetric adjustment configuration of an innovative adjustable bearing at three levels are investigated through Taguchi method and ANOVA. Grey relational analysis is used to obtain the optimum bearing element adjustment. The results show that radial adjustment has the greatest influence on the attitude angle and tilt adjustment has a significant influence on the non-dimensional side leakage. The positive tilt, negative radial adjustment at 0.4 eccentricity ratio is the optimum bearing element adjustment for achieving a better static performance of innovative adjustable bearings.
Functional brain network organization measured with magnetoencephalography predicts cognitive decline in multiple sclerosis
Authors: Nauta Ilse M , Kulik Shanna D , Breedt Lucas C , Eijlers Anand JC , Strijbis Eva MM , Bertens Dirk , Tewarie Prejaas , Hillebrand Arjan , Stam Cornelis J , Uitdehaag Bernard MJ , Geurts Jeroen JG , Douw Linda , de Jong Brigit A , Schoonheim Menno M
Published: December 2020

Background:

Cognitive decline remains difficult to predict as structural brain damage cannot fully explain the extensive heterogeneity found between MS patients.

Objective:

To investigate whether functional brain network organization measured with magnetoencephalography (MEG) predicts cognitive decline in MS patients after 5 years and to explore its value beyond structural pathology.

Methods:

Resting-state MEG recordings, structural MRI, and neuropsychological assessments were analyzed of 146 MS patients, and 100 patients had a 5-year follow-up neuropsychological assessment. Network properties of the minimum spanning tree (i.e. backbone of the functional brain network) indicating network integration and overload were related to baseline and longitudinal cognition, correcting for structural damage.

Results:

A more integrated beta band network (i.e. smaller diameter) and a less integrated delta band network (i.e. lower leaf fraction) predicted cognitive decline after 5 years ([Formula: see text]), independent of structural damage. Cross-sectional analyses showed that a less integrated network (e.g. lower tree hierarchy) related to worse cognition, independent of frequency band.

Conclusions:

The level of functional brain network integration was an independent predictive marker of cognitive decline, in addition to the severity of structural damage. This work thereby indicates the promise of MEG-derived network measures in predicting disease progression in MS.
Multifaceted effects of globalisation on welfare attitudes: When winners and losers join forces
Authors: Lim Sijeong , Tanaka Seiki
Published: December 2020

How does economic globalisation influence individuals’ welfare state preferences? Moving beyond the unidimensional understanding of globalisation exposure, we intersect two dimensions of exposure perceptions (gain vs loss and individual vs societal impacts) and propose a novel typology: collective winner, lone winner, lone loser and collective loser. We then explain the preference gap among losers (collective losers vis-à-vis lone losers) and among winners (collective winners vis-à-vis lone winners) by considering three distinct motivations for welfare state support: compensation, risk-pooling and inequality reduction. We illustrate the usefulness of our typology using an original survey in South Korea. We find that lone winners are far more supportive of welfare spending than collective winners. At the same time, collective losers are found to be much more supportive of welfare spending than lone losers. We provide some first-cut evidence that the insurance-seeking motivation common to lone winners and collective losers drive their welfare state support.
Prevalence, mental health and substance use of anabolic steroid users: a population-based study on young individuals
Authors: Gestsdottir Sunna , Kristjansdottir Hafrun , Sigurdsson Hedinn , Sigfusdottir Inga Dora
Published: December 2020

Aims: The use of anabolic androgen steroids to enhance performance is not a modern phenomenon. However, the majority of today’s anabolic androgen steroid users are not competitive athletes, but individuals who want to look leaner and muscular. This study aimed to examine the prevalence of anabolic androgen steroid use among young individuals and assess whether their mental health, lifestyle and substance use differ from non-anabolic androgen steroid users. Methods: A population-based study conducted in secondary schools, mean age was 17.3 years. A total of 10,259 participants (50% young women, 1% reported gender as ‘other’, 49% young men) answered questions on mental health, anabolic androgen steroid use, substance use and sports participation. Statistical analysis included descriptive statistics, t-test, χ2 and logistic regression. Results: The prevalence of anabolic androgen steroid use was 1.6%, and 78% of users were young men. Anabolic androgen steroid users had more anger issues, anxiety, depression, and their self-esteem was lower than among non-anabolic androgen steroid users ( P<0.05). A larger proportion of anabolic androgen steroid users, 30%, had attempted suicide compared to 10% of non-users (χ2 (1, 9580) = 57.5, P<0.001). Proportionally, anabolic androgen steroid users were more likely to take medicine for mental health problems and misuse substances than non-users. Participation in non-organised sports, increased anger and body image were associated with increased odds of using anabolic androgen steroids. Conclusions: Anabolic androgen steroid use is a public health threat. It had an alarming effect on the life of individuals who report having used anabolic androgen steroids. Authorities, healthcare workers, parents and others working with young people need to be informed of the signs and risks of anabolic androgen steroid use to reduce future negative implications.
Influence of microstructural evolution and localized delta ferrite number on high-cycle fatigue crack opening and propagation rate
Authors: Ullah Mudaser , Qayyum Faisal , Elahi Hassan , Mukhtar Fariha , Ali Qasim , Abbas Ch Asad
Published: December 2020

In this research, percentages of nickel as austenizer and chromium as ferritizer, in the molten metal pool of SS304L weldments are varied to analyze the effect on the produced delta ferrites morphology and volume. The resulting localized precipitation of delta ferrite and its effect on the fatigue crack propagation rate of the material are examined in this work. The estimation of localized delta ferrite number for a particular weld zone is assessed through the development of a MATLAB code for image processing. It is observed that a reduction in the percentage of nickel in filler alloy yields randomly scattered granular ferrites in the fusion zone and equiaxed grain growing in the heat-affected zone with the development of blocky ferrites on the grain boundaries, whereas increased percentage of chromium in the filler causes the precipitation of dendritic clusters and vermicular ferrites in fusion zone and heat-affected zone of weldments, respectively. The effect of ferrite numbers and their morphology on the crack opening displacements and the corresponding fatigue crack propagation rate in different weld zones are analyzed. It is observed that the ferrite number ranging between 15 and 19 provides optimum fatigue strength for SS 304L. Paris curves are plotted from the test data, which shows that the weldment attained with filler alloy having Cr 26.60% and Ni 10.92% depicts the highest fatigue life compared to other studied weldments.
Numerical analysis of damping induced by impulse turbines for wave energy conversion
Authors: George Aravind , Thandayutham Karthikeyan , Samad Abdus
Published: December 2020

The oscillating water column (OWC) based wave energy devices require a turbine for the conversion of wave energy to electrical energy. Customarily, Wells and impulse turbines have been widely accepted for this energy conversion. However, the damping (i.e. the pressure drop developed based on volume flow rate) induced by the turbine significantly influences the performance of the OWC. The present study involves two different impulse turbines that is, reference and optimized. Initially, the reference turbine was numerically validated with two different turbulence models ( k- ε and SST). It was found that the SST predicted better than k- ε in terms of flow separation and efficiency. This numerical methodology was extended to the optimized turbine and detailed flow physics has been presented in this article. Furthermore, both the turbines were compared in terms of pressure drop, turbine pressure coefficient, and turbine damping coefficient. It was observed that the induced damping by the optimized turbine is less than the reference turbine. Finally, different diameters were arrived from the optimized turbine by the principle of dynamic similarity to match with an available optimum range of damping.
What are the effects of screen time on emotion regulation and academic achievements? A three-wave longitudinal study on children from 4 to 8 years of age
Authors: Cerniglia Luca , Cimino Silvia , Ammaniti Massimo
Published: December 2020

The use of digital devices among very young children is quickly spreading, although the effects of screen time on emotional and cognitive functioning are still debated. In a sample of N = 422 children and their mothers, this 4-year longitudinal study aimed to evaluate the hypothesis that the use of digital devices as smartphones and tablets at 4 years of age is related to later dysregulation symptoms and to lower academic achievements both at 6 and 8 years of age. Children’s mothers were asked whether or not their offspring had access to digital devices and what was their average screen time on a typical day. Mothers were also requested to specify whether they used to participate in their children’s activities during screen time and to report their offspring emotional/behavioral functioning. Children’s teachers were administered the Teachers Report Form including the competence part to evaluate academic achievements and possible dysregulation symptoms of their students. The Structural Equation Modeling showed that screen time at 4 years of age, the child was directly, positively and significantly associated with dysregulation and negatively associated with mathematics and literacy grades at 8 years of age of the child. These results could help orientate the guidelines for the use of digital devices by very young children.
States Should Remove Barriers to Advanced Practice Registered Nurse Prescriptive Authority to Increase Access to Treatment for Opioid Use Disorder
Authors: Germack Hayley D.
Published: December 2020

In October 2018, President Trump signed into law H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act. This piece of legislation addresses treatment, prevention, recovery, and enforcement with particular attention to access in rural areas. It contains numerous provisions to improve needed access to treat substance use disorders and especially opioid use disorder (OUD), including mandatory coverage of medications for OUD, partial elimination of Medicaid payment for inpatient mental health treatment, and state planning grants to increase provider capacity. Many of these provisions would be significantly enhanced by removing barriers to prescriptive authority for Advanced Practice Registered Nurses (APRNs), including Nurse Practitioners, Clinical Nurse Specialists, Certified Nurse Midwives, Certified Registered Nurse Anesthetists, and other state-specific titles for nurses whose scope allows the prescription of controlled substances. This policy brief includes a history of the role of APRNs in the delivery of medications for OUD, scope of practice restrictions related to prescriptive authority as a barrier in their ability to deliver care for this vulnerable population, and actionable strategies that APRNs can take to advocate for an increased role in providing care.
B7-H3 Promotes Prostate Cancer Progression in Mice by Antagonizing Myeloid-Derived Suppressor Cell Apoptosis
Authors: Zhou Yunfen , Zhang Guangbo , Zhang Weijie , Wei Xuedong , Hou Jianquan , Huang Yuhua
Published: December 2020

Background:

B7-H3 is an important immunomodulatory molecule, and clinical studies have confirmed that its expression level is closely correlated with prostate cancer prognosis. However, the mechanism of its biological action is unclear.

Methods:

An engineered cell line overexpressing B7-H3 was constructed. Cell apoptosis, growth and proliferation assays in vitro and an animal model in vivo were performed to analyze the role and possible mechanism of B7-H3 in promoting prostate cancer progression.

Results:

Compared with the control cell line (Mock-RM-1), the B7-H3-overexpressing prostate cancer cell line (B7-H3-RM-1) showed no significant growth differences in vitro, whereas the in vivo tumorigenesis rate of B7-H3-RM-1 was significantly higher than that of Mock-RM-1. These results suggest that B7-H3indirectly, rather than directly, promotes prostate cancer progression. Further analysis revealed that significantly higher levels of myeloid-derived suppressor cells (MDSCs) accumulated in vivo in B7-H3-RM-1 tumor-bearing mice than in Mock-RM-1 mice. In vitro and in vivo experiments showed that B7-H3-RM-1 cells significantly antagonized MDSC apoptosis. To further confirm the role of MDSCs in B7-H3-mediated prostate cancer progression, model mice were pretreated with cyclophosphamide before inoculation to clear immune cells and achieve myelo suppression. The results showed no significant differences in tumor growth between the B7-H3-RM-1 group and the Mock-RM-1 group.

Conclusions:

We found, for the first time, that B7-H3 can antagonize MDSC apoptosis, leading to MDSC accumulation in the tumor microenvironment and thereby promoting prostate cancer progression.
B4GalT1 Regulates Apoptosis and Autophagy of Glioblastoma In Vitro and In Vivo
Authors: Wang Pu , Li Xiaolong , Xie Yuan
Published: December 2020

Our study was designed to investigate the role of B4GalT1 in glioblastoma, in vitro and in vivo, to detect whether B4GalT1 knockdown could regulate the development of glioblastoma, and further observe the relationship between B4GalT1 knockdown and the apoptosis and autophagy of glioblastoma. To begin, we looked at TCGA and GEPIA systems to predict the potential function of B4GalT1. Western blot and RT-PCR were used to analyze the expression, or mRNA level, of B4GalT1 at different tissue or cell lines. Next, the occurrence and development of glioblastoma, in vitro and in vivo, was observed by using B4GalT1 knocked down by lentivirus. Finally, the apoptosis and autophagy of glioblastoma was observed in vitro and in vivo. Results show that B4GalT1 was a highly variable gene, and GEPIA and TCGA systems show B4GalT1 expression in GBM tumor tissue was higher than in normal tissue. Pair-wise gene correlation analysis revealed a probable relationship between B4GalT1 and autophagy related proteins. The B4GalT1 expression and mRNA level were increased in tumor cells, or U87 cells. B4GalT1 knocked down by lentivirus could inhibit glioblastoma development, in vitro and in vivo, by reducing tumor weight and volume, increasing survival, and weakening tumor cells proliferation, migration, invasion. B4GalT1 knockdown could increase apoptosis and autophagy of glioblastoma in vitro and in vivo. Our study demonstrates that B4GalT1 may be able to regulate apoptosis and autophagy of glioblastoma. Bax, Bcl-2, cleaved caspase-3, Beclin-1, and LC3 s may be the downstream target factors of B4GalT1 in apoptosis and autophagy, which may provide a new strategy to reduce glioblastoma development by regulating apoptosis and autophagy.
Racial Equity Policy That Moves Implicit Bias Beyond a Metaphor for Individual Prejudice to a Means of Exposing Structural Oppression
Authors: Johnson Detra D. , Bornstein Joshua
Published: December 2020

This case study follows a district racial equity initiative from policy formulation through implementation, and finally to the review of a high school discipline measure. The initiative had a consistent theme of addressing implicit bias. However, over time, district equity champions expanded the definition of implicit bias beyond its conventional meaning of subconscious prejudices and perceptions that may influence action. These champions came to identify policies, practices, and curriculum that presumed and privileged underlying White norms, and were thus implicitly biased. Hence, implicit bias became evident in powerful structural racism across the school system.
Lapping modeling of looped warp knitted jacquard fabrics based on web
Authors: Liu Haisang , Jiang Gaoming , Dong Zhijia
Published: December 2020

In this paper a mathematical model of looped warp knitted jacquard fabric is proposed. The technology parameters cover chain notation, threading, jacquard pattern grid and so on are defined based on the matrix. A basic pattern matrix is derived from chain notation and threading using the block matrix. Then combined with the displacement data of jacquard girds, the jacquard pattern matrix is calculated. Finally, the stitch type and stitch position are obtained analyzing the pattern information in the previous matrix. Special stress is laid on the difference between two different displacement data of jacquard girds, RT = 0 and RT = 1, which results in inconsistent lapping for the same jacquard bitmap. The pattern models are implemented and the jacquard lapping bitmap and three-dimensional simulation are generated by a calculating program via Visualstudio2015 using C# and JavaScript. The results show that this model can distinguish two types displacement jacquard information. The parameter input process is simplified and the run time for calculation is also shortened. In addition, with the help of CAD system via the web, priorities including resource sharing, design-time saving, and efficiency improving are achieved.
Land Back: A meta narrative to help indigenous people show up as movement leaders
Authors: Pieratos Nikki A , Manning Sarah S , Tilsen Nick
Published: December 2020

Present political climate and an increase in visibility and voice for Indigenous people are being leveraged to attract attention to dire social, environmental, and political issues. However, we need a more unified, organized, and coordinated policy platform, strategy, and public response. NDN Collective, an all Indigenous-led and staffed organization devoted to building Indigenous self-determination and power across Turtle Island, provides cohesion through a strong meta narrative of its Land Back campaign and an ecosystem of resources for Native Nations and peoples built around its three pillars: Defend, Develop, and Decolonize. This article shares a brief history of colonization and the lasting impacts of the American Indian Movement of the 1960s and what is needed from Indigenous leadership today. In recognizing that the collective liberation of Indigenous people is bound together with those of other Black and brown relatives, this article also explores our shared history with Black Americans and the success of the Black Lives Matter movement.
ASIC3 inhibition modulates inflammation-induced changes in the activity and sensitivity of Aδ and C fiber sensory neurons that innervate bone
Authors: Morgan Michael , Thai Jenny , Trinh Phu , Habib Mohamed , Effendi Kelly N , Ivanusic Jason J
Published: December 2020

The Acid Sensing Ion Channel 3 (ASIC3) is a non-selective cation channel that is activated by acidification, and is known to have a role in regulating inflammatory pain. It has pro-algesic roles in a range of conditions that present with bone pain, but the mechanism for this has not yet been demonstrated. We aimed to determine if ASIC3 is expressed in Aδ and/or C fiber bone afferent neurons, and to explore its role in the activation and sensitization of bone afferent neurons after acute inflammation. A combination of retrograde tracing and immunohistochemistry was used to determine expression of ASIC3 in the soma of bone afferent neurons. A novel, in vivo, electrophysiological bone-nerve preparation was used to make recordings of the activity and sensitivity of bone afferent neurons in the presence of carrageenan-induced inflammation, with and without the selective ASIC3 inhibitor APET×2. A substantial proportion of bone afferent neurons express ASIC3, including unmyelinated (neurofilament poor) and small diameter myelinated (neurofilament rich) neurons that are likely to be C and Aδ nerve fibers respectively. Electrophysiological recordings revealed that application of APET×2 to the marrow cavity inhibited carrageenan-induced spontaneous activity of C and Aδ fiber bone afferent neurons. APET×2 also inhibited carrageenan-induced sensitization of Aδ and C fiber bone afferent neurons to mechanical stimulation, but had no effect on the sensitivity of bone afferent neurons in the absence of inflammation. This evidence supports a role for ASIC3 in the pathogenesis of pain associated with inflammation of the bone.
Cerebral oximetry in adult cardiac surgery to reduce the incidence of neurological impairment and hospital length-of-stay: A prospective, randomized, controlled trial
Authors: Bennett Sean R , Smith Neil , Bennett Miriam R
Published: December 2020

Background

Cerebral oximetry using near-infrared spectroscopy (NIRS) has been shown to reduce neurological dysfunction and hospital length-of-stay after adult cardiac surgery in some but not all studies. We audited maintaining cerebral saturations at or above baseline and showed improved neurological and length-of-stay outcomes. Our hypothesis for this study was that our NIRS protocol would improve neurological and length-of-stay outcomes.

Methods

This prospective, single centre, double-blinded controlled study randomized 182 consecutive patients, scheduled for cardiac surgery using cardiopulmonary bypass. Participants were randomized by concealed envelope prior to anaesthesia. NIRS study group were managed perioperatively using our NIRS protocol of 8 interventions, increase cardiac output, normocapnia, increase mean arterial pressure, increase inspired oxygen, depth of anaesthesia, blood transfusion, correction of bypass cannula, change of surgical plan to restore levels equal to or above baseline. The control group had standard management without NIRS. Primary outcomes were neurological impairment (early and late) and hospital length-of-stay. Secondary outcomes were ventilation times, intensive care length-of-stay, major organ dysfunction and mortality.

Results

91 patients entered each group. There was a significant improvement in self-reported six-month general functionality in the NIRS group ( p = 0.016). Early neurological dysfunction and hospital length-of-stay was the same in both groups. Of the secondary outcomes only Intensive Care length-of-stay was statistically significant, being shorter in the NIRS group ( p = 0.026).

Conclusion

Maintaining cerebral saturations above baseline reduces time spent in Intensive Care and may improve long term functional recovery but not stroke, major organ dysfunction and mortality.
Lessons from a review of physiotherapy and psychological rehabilitation received during ICU stay and beyond to inform the development of an ICU follow clinic
Authors: Clarke Rachel , Schofield Holly , Tantam Kate
Published: December 2020

Background

Critical illness can have a long-term impact. A service evaluation was conducted in a hospital in the south west of Britain with an adult inter-connected general, surgical and neurological intensive care unit (ICU). The aim of the service evaluation was to generate knowledge on experiences of psychological and physical rehabilitation in intensive care, on other hospital wards and at home to inform the development of an Intensive Care follow up clinic.

Method

Data was collected from two sources. A week of ICU discharges was randomly selected, and a sample of 30 patients generated. All were sent information sheets and consent forms and offered telephone appointments. 12 participants took part in telephone interviews. The second source of participants was the ICU Expert by Experience group. Informed consent was gained with eight participants taking part. The data was analysed using thematic analysis, employing initial open coding to build a framework of emergent themes. A research group was formed to facilitate cross coding of extracts.

Results

The analysis identified three overarching themes: sense making difficulties; rehabilitation context; and sense of self. The theme of sense making difficulties had sub-themes of memory gaps, delirium, lack of information and anxiety. The theme of rehabilitation context had sub-themes of ICU environment, transitions, isolation and abandonment and valued support.

Conclusion

the process of sense making can be difficult, is filtered through contextual factors, and may influence sense of self. The results have been used to inform the development of an ICU follow up clinic.
The use of tranexamic acid in open elbow release surgery
Authors: Goyal Nitin , Wilson David J , Wysocki Robert W , Fernandez John J , Cohen Mark S
Published: December 2020

Background

Tranexamic acid (TXA) has been effective in reducing perioperative blood loss in hip, knee, and shoulder arthroplasty. Our purpose was to assess the effect of TXA on perioperative blood loss for open elbow release.

Methods

Consecutive open elbow releases performed between October 2016 and March 2020 were identified. Patients were included if both anterior and posterior joint releases with a single medial approach was performed. From November 2018 onward, intravenous TXA and topical TXA infused through a deep hemovac drain were administered as part of the perioperative protocol. Drain output, intraoperative blood loss, postoperative aspiration rate, and postoperative transfusion frequency were assessed.

Results

Fifty patients (25 TXA, 25 non-TXA) were included. Drain output was significantly lower in the TXA-treated group compared to the non-treated group (121 mL vs. 221 mL; p = 0.003). There was no significant difference in intraoperative blood loss and the incidence of postoperative aspiration between groups. None of the patients received a blood transfusion or had a documented thromboembolic event.

Discussion

The use of tranexamic acid with open elbow release surgeries resulted in decreased drain output, with no thromboembolic events. Perioperative tranexamic acid can be a safe and effective modality in reducing perioperative blood loss for open elbow release surgery.
Neoadjuvant treatment (FOLFOX4 plus hypofractionated tomotherapy) for patients with locally advanced rectal cancer: a multicenter phase II trial
Authors: Passardi Alessandro , Rapposelli Ilario Giovanni , Scarpi Emanuela , Neri Elisa , Parisi Elisabetta , Ghigi Giulia , Ercolani Giorgio , Avanzolini Andrea , Cavaliere Davide , Rudnas Britt , Valgiusti Martina , Barone Domenico , Ferroni Fabio , Frassineti Giovanni Luca , Romeo Antonino
Published: December 2020

Aims:

This study aims to evaluate the safety and efficacy of a new neoadjuvant regimen (FOLFOX4 plus hypofractionated tomotherapy) in patients with locally advanced rectal cancer.

Methods:

Patients with stage II–III rectal cancer were treated with the pre-operative chemoradiotherapy regimen comprising FOLFOX4 (two cycles), TomoTherapy (25 Gy in five consecutive fractions, one fraction per day in 5 days on the clinical target volume at the isodose of 95% of the total dose), FOLFOX4 (two cycles), followed by surgery with total mesorectal excision and adjuvant chemotherapy with FOLFOX4 (eight cycles). The primary endpoint was pathological complete response (pCR).

Results:

Fifty-two patients were enrolled and 50 patients were evaluable. A total of 46 (92%) patients completed chemoradiotherapy according to the study protocol and 49 patients underwent surgery. Overall, 12 patients achieved a pCR (24.5%, 95% CI 12.5–36.5). The most common grade 3 or more adverse events were neutropenia and alteration of the alvus. Adverse reactions due to radiotherapy, mainly grade 1–2 dermatitis, tenesmus, urinary dysfunction and pain, were tolerable and fully reversible. The most important surgical complications included infection, anastomotic leakage and fistula, all resolved with conservative treatment.

Conclusion:

FOLFOX and hypofractionated TomoTherapy is effective and safe in patients with locally advanced rectal cancer. Long-term efficacy needs to be further evaluated.

Trial registration

ClinicalTrials.gov identifier: NCT02000050 (registration date: 26 November 2013) https://clinicaltrials.gov/ct2/show/NCT02000050
The mediating role of international student satisfaction in the influence of higher education service quality on institutional reputation in Taiwan
Authors: Moslehpour Massoud , Chau Ka Yin , Zheng JingJing , Hanjani Asalia Noor , Hoang Minh
Published: December 2020

The number of international students applying to universities in Taiwan is increasing annually. Moreover, universities’ choice for international students is also increasing with support from the Ministry of Education of Taiwan. Therefore, it is crucial to understand the factors that influence student choice. This study investigates the effects of Taiwan’s higher education service quality on international student satisfaction and institutional reputation. We collected data from 197 international students studying at 33 national and private universities in Taiwan to test the study’s proposed model. This study uses a quantitative approach to examine the proposed hypotheses, and causal research design is used to elucidate the cause-and-effect relationship between constructs. The non-academic aspect of service quality is the most influential variable in student satisfaction, and student satisfaction strongly affects institutional reputation. Student satisfaction mediates the relationship between the academic and non-academic aspects of service quality and institutional reputation. This study’s findings could help higher education institutions in Taiwan assess and improve their service quality, which would help them attract international students.
Taming the Thoughts in the Writings of Maximos the Confessor
Authors: Prassas Despina D.
Published: December 2020

St. Maximos the Confessor, a 7th-century monk, wrote several ascetical treatises that addressed the monastic life. This article explores the role of unwanted intrusive thoughts, the logismoi, outlined in two of his earlier works, the Centuries on Love and the Questions and Doubts. The author encourages the reader to pay particular attention to one’s thoughts, take the time to familiarize oneself with the thoughts that enter one’s mind, and offers advice on how to eliminate the causes of unwanted intrusive thoughts. He concludes that the mind or nous is considered neutral ground and one is able to control, but not completely eradicate, the unwanted thoughts by utilizing specific spiritual techniques.
When Friends are Separated by Miles: Using Technology as a Bridge Over Troubled Times
Authors: Purnell David , Pia Zonni Spinazola Lisa
Published: December 2020

This is a performative collaboration between two friends: Dave and Lisa. When Dave moved from Florida to Washington state, it made the lively in-person conversations and shared lamentations about common family dynamics between us difficult to continue. When Trump was voted into office, we needed each other. Reaching out across the miles that seem insurmountable, a new connection was made. We needed to try to make sense of the election of 2016. It was perfect timing for both of us as we became a sounding board for each other to just explode upon each other. The day after the election, we were both in Philadelphia for the National Communication Association (NCA) conference and we were able to have our in-person conversation about our reactions to Trump. We continued our lamentation of events, but needed to get out of the hotel space and find a place of quietness. We needed to breathe and regroup. This in-person connection made our future digital communications more embodied with the face-to-face spirit in which we began this exchange. What follows is how our long distant conversation and support for each other played out.
A Nomogram Combing Peripheral Parameters for Estimation of CRSwNP Recurrence
Authors: Du Kun , Zheng Ming , Zhao Yan , Jiao Chunyuan , Xu Wenbin , Hao Yun , Wang Yue , Zhao Jinming , Wang Xiangdong , Zhang Luo
Published: December 2020

Background

The preoperative prediction of the recurrence of chronic rhinosinusitis with nasal polyps (CRSwNP) remains difficult in clinical practice.

Objective

We aimed to develop a nomogram that combined peripheral risk factors to clinically predict the recurrence of CRSwNP.

Methods

Data from 158 CRSwNP patients who underwent endoscopic sinus surgery (ESS) from January 2012 to December 2016 were collected, and the patients were followed up for 3 years. Of these, 96 patients who underwent ESS in an earlier period formed the training cohort for nomogram development, and 62 patients who underwent ESS thereafter formed the validation cohort to confirm the model’s performance. Risk factors for recurrence identified by univariate and multivariate logistic regression were used to create a nomogram.

Results

The recurrence rate was 29.2% (28/96) for the training cohort and 35.5% (22/62) for the validation cohort. Univariate analysis identified blood eosinophils (Eos), serum IgE level, asthma comorbidity, and the number of previous ESSs as risk factors for recurrence. Among those four parameters, serum IgE level and a previous ESS surgery were identified as two independent risk factors. A nomogram consisting of blood Eos, total serum IgE level, asthma comorbidity, and the number of previous ESSs was constructed, demonstrating a C index of 0.81 (95% CI, 0.79-0.83) and 0.80 (95% CI, 0.77-0.83) for predicting recurrence in the training and validation cohorts, respectively. The nomogram had well-fitted calibration curves.

Conclusion

The nomogram might be able to preoperatively predict the recurrence of CRSwNP by using currently available and objective parameters. Further studies are required to validate its reliability and effectiveness.
Pyriform sinus rupture caused by blunt trauma
Authors: Barkovich Emil Jernstedt , Taheri M Reza
Published: December 2020

Hypopharyngeal perforation (HP) is a potentially life-threatening condition most associated with iatrogenic injury and foreign body impaction. Additionally, a number of cases of posterior HP have been reported following blunt cervical trauma. We present a case of a construction accident causing lateral hypopharyngeal rupture. Visceral perforation was initially diagnosed on computed tomography (CT) imaging and managed conservatively. We speculate this region may be particularly vulnerable to injury due to an anatomic transition in adjacent fascial support. A review of 29 prior cases suggests that this may be the first reported case of blunt trauma causing rupture of the pyriform sinus. However, significant heterogeneity exists in diagnostic approach. Radiography and CT are rapid, sensitive modalities for suggesting pharyngeal perforation, while fluoroscopy and endoscopy can better assess injury size and location and monitor resolution. Early radiologic recognition of hypopharyngeal injury is essential to initiate appropriate treatment. In certain cases, including our own, both the presence and specific location of perforation may be identified on initial CT images.
First reported cases of linezolid-resistant vancomycin-resistant enterococci in South-East Asia: A report of three cases and literature review
Authors: Chua Wei Chuan , Zaidah Abdul Rahman
Published: December 2020

Infections with vancomycin-resistant enterococci (VRE) have limited treatment options, with linezolid the mainstay of therapy. The emergence of linezolid-resistant vancomycin-resistant enterococci (LRVRE) further restricts the therapeutic options. LRVRE isolated from clinical specimen have not previously been reported in South-East Asia. Here, we report three clinical cases of LRVRE from a teaching hospital in Malaysia. Three isolates of Enterococcus faecium were isolated from three different patients. These isolates were determined to be resistant to both vancomycin and linezolid by Etest gradient diffusion test and Vitek2 automated antibiotic susceptibility testing, respectively. Retrospective analysis of the microbiological and clinical data of the three patients was undertaken. LRVRE were isolated from from tissue and peritoneal fluid of two patients who underwent complicated abdominal surgery. Another patient with underlying acute lymphoblastic leukaemia developed neutropenia following chemotherapy. LRVRE were isolated from the blood culture. All three patients were not treated with linezolid. The possible risk factors for LRVRE acquisition are administration of multiple broad-spectrum antimicrobials and disruption of the gastrointestinal mucosa. The appearance of LRVRE in increasingly widespread geographic locations may lead to a global health threat. Judicious use of broad-spectrum antimicrobials and infection-control practices are crucial to curb its spread.
Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of tuberculous pleural effusion
Authors: Huan Nai-Chien , Khor Inn Shih , Ramarmuty Hema Yamini , Lim Ming Yao , Ng Kai Choon , Syaripuddin Alfieyanto , Lee Qin Zhi , Teo Wee Jing , Sivaraman Kannan Kunji Kannan
Published: December 2020

Introduction:

Pleural fluid adenosine deaminase (pfADA) is a simple, rapid and inexpensive surrogate marker for tuberculous pleural effusion (TPE). A nationwide cut-off of 40 U/L is currently used based on overseas data. There is a need to optimise the diagnostic utility of pfADA by establishing a local cut-off value. In this study, we aimed to describe the demographics and clinical characteristics of patients with TPE and non-TPE; determine the sensitivity and specificity of current pfADA of 40 U/L; and establish a new local pfADA cut-off for TPE.

Methods:

We conducted a single-centre, observational, prospective study of patients with exudative pleural effusion and pfADA measured from 1 October 2019 to 30 April 2020 at Queen Elizabeth Hospital, Malaysia.

Results:

The diagnosis of analysed patients ( n = 93) included TPE ( n = 41), malignancy ( n = 28), parapneumonic effusion ( n = 12) and other causes ( n = 12). The mean pfADA was 51.15 U/L (standard deviation (SD) = 13.77) among TPE group and 18.86 U/L (SD = 12.33) among non-TPE. When analysis was restricted to TPE patients, the local pfADA cut-off is 29.6 U/L, with a sensitivity of 97.6% and specificity of 90.4%. The current pfADA of 40 U/L has a sensitivity of 87.8% and specificity of 92.3%.

Conclusion:

We established a local pfADA cut-off of 29.6 U/L for TPE. Optimising the utility of pfADA helps to enhance clinicians’ treatment confidence of TPE when initial work-up is inconclusive.
Specialty: Arresting an elusive ‘right’ in European extradition law
Authors: Tinsley Alex
Published: December 2020

Specialty (a near-universal rule of extradition law whereby a person extradited cannot be prosecuted or punished for matters other than those for which they were extradited) is viewed traditionally as a tool to protect the sovereignty of the extraditing state, rather than as an individual right. A review of international material shows a dispute as to the existence of a rule or principle of specialty in customary international law and emphasises themes such as enforceability and standing of individuals to plead violations. Against that backdrop, the European situation is characterised by the presence of broad specialty rules which are not always implemented in legislation by requesting states, leading to refusal of extradition in some cases. Arguably, combinations of the EU law duty of conforming interpretation and European human rights law principles may offer tools to overcome such situations, approaching protection of specialty ‘rights’ whatever the original doctrinal rationale. If they do not, and international cooperation is further undermined by ineffective specialty protection, EU legislation or the development of soft law standards may be a useful way forward.