bluuebunny/crossref_metadata_2025 huggingface dataset:
Cancer-Associated Venous Thromboembolism Treatment With Anti-Xa Versus Weight-Based Enoxaparin: A Retrospective Evaluation of Safety and Efficacy
Authors: Hart Kayla , Andrick Benjamin , Grassi Stacey , Manikowski Jesse , Graham Jove
Published: January 2021

Background

Venous thromboembolism (VTE) is a complication of cancer, for which low-molecular-weight heparin (LMWH) remains the preferred anticoagulant. Enoxaparin is traditionally dosed using weight. In certain populations, monitoring anti-Xa levels for therapeutic effect provides pharmacokinetic guidance for dose adjustments. There is a paucity of data regarding anti-Xa–directed enoxaparin dosing for treatment of VTE in patients with cancer.

Objective

This study aims to evaluate efficacy (recurrent VTE) and safety (major bleed) between enoxaparin anti-Xa–guided dose adjustments and weight-based dosing in patients with cancer-associated VTE.

Methods

This single-center, retrospective cohort study examined patients treated with enoxaparin for cancer-associated VTE using data from electronic health records.

Results

There were 674 patients who met the inclusion criteria, with 283 receiving anti-Xa–directed dose adjustments. Recurrent VTE, major bleed, or all-cause death occurred in 102 of 283 patients (36%) in the anti-Xa cohort and 166 of 391 patients (42.5%) in the weight-based cohort (hazard ratio [HR] = 0.73; 95% CI = 0.57-0.93; P = 0.01). When death was removed from the composite end point, there was no significant difference between the cohorts in recurrent VTE or major bleed (HR = 1.18; P = 0.38). In the anti-Xa cohort, a total of 1584 anti-Xa peak levels were collected, with 1324 (83.6%) drawn correctly in relation to enoxaparin administration. Of those, 714 (53.9%) were within therapeutic range.

Conclusion and Relevance

Patients with cancer receiving anti-Xa–guided enoxaparin dose adjustments for initial VTE, compared with weight-based dosing, had no significant difference in the rate of recurrent VTE or major bleed.
Safety of Intravenous Olanzapine Administration at a Tertiary Academic Medical Center
Authors: Hunt Nicholas F. , McLaughlin Kevin C. , Kovacevic Mary P. , Lupi Kenneth E. , Dube Kevin M.
Published: January 2021

Background

Although approved by the Food and Drug Administration for intramuscular administration only, analyses have described the administration of intravenous push (IVP) olanzapine, particularly for acute agitation. The safety and efficacy of IVP olanzapine has mostly been limited to emergency department patients.

Objective

To evaluate the safety of IVP olanzapine administration in the inpatient setting.

Methods

This single-center, retrospective analysis was conducted between July 1, 2018, and December 31, 2019, at Brigham and Women’s Hospital in Boston, Massachusetts. Adult patients who received at least 1 dose of IVP olanzapine were included in the analysis. Safety endpoints analyzed included the following adverse drug events (ADEs): hypotension, bradycardia, cardiac arrhythmias, extrapyramidal adverse effects, and respiratory depressive events. Data on IV site reactions, including phlebitis and infiltration, were also collected.

Results

A total of 1,247 IVP administrations of olanzapine were identified across 252 patients. Two or more doses were received by 159 patients (63.1%). Most administrations (66%) took place in intensive care units, with 33% administered on general medicine wards. Overall, 104 administrations (8.3%) were associated with at least 1 ADE. Hypotension and bradycardia occurred in 62 (5.2%) and 16 (1.3%) administrations, respectively. Phlebitis occurred with 8 administrations (1.4%). All other adverse events were rare (<1%).

Conclusion and Relevance

Hypotension, the most commonly noted ADE, occurred more frequently than in previous studies. IVP olanzapine appears to be a safe route of administration in hospitalized patients, including those receiving multiple doses. Further studies are required to evaluate the effect of IV olanzapine on hemodynamics.
Penile Lymphoepithelioma-Like Carcinoma: A Rare Case With PD-L1 Expression
Authors: Machado-Neves Raquel , Teixeira Bernardo , Fonseca Elsa , Valente Pedro , Lindoro Joaquim , Vila Fernando , Polónia António
Published: January 2021

Most malignant tumors of the penis are squamous cell carcinomas (SCC), being divided in 2 groups, one human papillomavirus (HPV)-related and another non-HPV-related, with lymphoepithelioma-like carcinoma (LELC) being one of the rarest HPV-related SCC. In this article, we report a case of a 50-year-old man who presented testicular swelling and pain for the past 3 months. A penile mass was identified, and the patient was submitted to a total penectomy. The penectomy specimen showed an ulcerated lesion at the glans reaching the cavernous bodies. Microscopic examination showed undifferentiated epithelial cells with syncytial growth pattern mix with a dense lymphoplasmacytic infiltrate, consistent with LELC. The tumor cells expressed p16 and all 3 different clones of PDL1 (22C3, SP263, and SP142). The patient is alive and well with a follow-up of 3 months. To our knowledge, this is the third LELC of the penis reported in literature and the first case reported with PDL1 expression.
Atypical Cells in Peritoneal Cleft: A Pitfall in Diagnosis of Colorectal Adenocarcinoma
Authors: Lee Whayoung , Chandan Vishal Suresh , Johnson Cary , Li Xiaodong
Published: January 2021

Atypical cells in peritoneal clefts are usually either reactive mesothelial cells or pT4 colonic adenocarcinoma in colon specimen removed for primary colon cancer. However, rarely if ever are these atypical cells metastasis from other primary visceral malignancy due to “sac-like” anatomic structure of this area. We present a case where these atypical cells were determined to be metastasis of gynecological origin by judicious use of immunohistochemical stains. A final diagnosis of serous tubal intraepithelial carcinoma of right fallopian tube was diagnosed only after total abdominal hysterectomy bilateral salpingo-oophorectomy. To our knowledge, this is the first report of a serous tubal intraepithelial carcinoma presenting as stage 4 colonic adenocarcinoma. The importance of this interesting case is 2-fold. It highlights the peritoneal cleft as an anatomic region not often recognized or discussed as well as tumor presentation in this region. In addition, this example stresses the need for additional mesothelial markers in addition to WT-1 workup of atypical mesothelial proliferation.
Correlation of Patient-Reported Outcomes With Physical Function After Total Ankle Arthroplasty
Authors: Scott Daniel J. , Kane Justin , Ford Samuel , Daoud Yahya , Brodsky James W.
Published: January 2021

Background:

Total ankle arthroplasty (TAA) is successful by both subjective patient-reported outcome measures (PROMs) and objective functional improvements of gait. Each is reproducible and valid, but they are entirely distinct methods. This study investigated the correlation between subjective and objective outcomes of TAA.

Methods:

Seventy patients underwent gait analysis preoperatively and 1 year after TAA. The 36-Item Short-Form Health Survey (SF-36) and visual analog score (VAS) for pain and American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scores were recorded at each interval. A Student t test, a multivariate regression, and a Pearson correlation coefficient were used to measure the correlation between parameters of gait and PROMs.

Results:

Patients had statistically significant improvements in gait velocity, total range of motion (ROM), maximum plantarflexion, ankle power, and SF-36 Physical, VAS, and AOFAS scores. The SF-36 Physical score had a moderate positive correlation with preoperative walking speed, step length, and ankle power and postoperative walking speed and ankle power. No correlation between VAS score and function was detected. The AOFAS score had a moderate positive correlation with postoperative walking speed, step length, and ankle power, and improvement in walking speed, cadence, and ankle power.

Conclusion:

Statistically significant correlations were found between numerous preoperative and postoperative comparisons of PROMs and the AOFAS score with the objective biomechanical outcomes of gait. Walking speed and ankle push-off power correlated most with patient perceptions of function and improvement, while pain and ROM did not. Subjective PROMs and objective biomechanical outcomes were complementary in the assessment of surgical outcomes and, combined, helped to address the dilemma of the confounding effect of other lower extremity pathologies on PROMs.

Level of Evidence:

Level III, comparative series.
Clinical and Functional Outcomes of Peroneus Longus to Brevis Tendon Transfer
Authors: Burkhard Marco D. , Wirth Stephan H. , Andronic Octavian , Viehöfer Arnd F. , Imhoff Florian B. , Fröhlich Stefan
Published: January 2021

Background:

Peroneal tendon lesions can cause debilitating pain, but operative treatment remains controversial. Some studies recommend peroneal tenodesis or transfer if more than half of the tendon is affected. However, clinical outcomes and inversion/eversion motion after peroneal transfer have not been investigated yet.

Methods:

Patients who underwent distal peroneus longus to brevis transfer for major peroneus brevis tendon tears with a minimum follow-up of 2 years were included. Clinical outcome parameters included the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, the German Foot Function Index (FFI-D), and Karlsson-Peterson score. Functional outcome was tested with a standardized active range-of-motion (ROM) and isokinetic strength measurement protocol, including concentric and eccentric eversion and inversion tests.

Results:

Of total 23 eligible patients, 14 (61%) were available for follow-up. Clinical outcome scores were good with AOFAS 86 ± 16 points, FFI-D pain 26% and FFI-D disability 26%, and Karlsson-Peterson score 78 ± 23 points. There was no difference in strength in comparison to the contralateral foot (all P > .05). Isokinetic strength was 16.3 ± 4.9 Nm (108% of contralateral side) and 18.8 ± 4.5 Nm (101%) at concentric 30 deg/s and eccentric 30 deg/s eversion tests, as well as 15.7 ± 5.2 Nm (102%) and 18.7 ± 3.3 Nm (103%) at concentric 30 deg/s and eccentric 30 deg/s inversion tests, respectively. There was no difference in ROM compared to the contralateral side (eversion/inversion 14.5-0-18.7 vs 14.1-0-16.1 degrees).

Conclusion:

Peroneus longus to brevis transfer is a viable option for treating severe peroneus brevis tendon tears and does not compromise measurable strength or ROM in inversion or eversion in comparison to the contralateral ankle joint.

Level of Evidence:

Level IV, prospective case series.
Short- and Intermediate-Term Results of Extracorporeal Shockwave Therapy for Noninsertional Achilles Tendinopathy
Authors: Abdelkader Nasr Awad , Helmy Mohamed Nasser Kise , Fayaz Nadia Abdelazem , Saweeres Emad S. B.
Published: January 2021

Background:

Earlier randomized controlled trials (RCTs) reported only midterm (3-4 months) results of extracorporeal shockwave therapy (ESWT) as a treatment for noninsertional Achilles tendinopathy (NAT). This study compared the effectiveness of an eccentric loading program followed by stretching exercises combined with ESWT (study group) or sham ESWT (control group) for treating chronic NAT in both the short and long term.

Methods:

This double-blind RCT was conducted between 2018 and 2020. Adult patients with unilateral NAT who failed standard conservative treatment were randomly allocated to either group. Function and pain were assessed at baseline, 1 month, and 16 months using the Victorian Institute of Sport Assessment–Achilles questionnaire (VISA-A) and visual analog scale (VAS), respectively. Mixed-design analysis of variance and nonparametric statistics were performed. Twenty-two men and 28 women aged 18 to 40 years were allocated into 2 equally matched groups.

Results:

Function and pain scores in the study group were not significantly different from control group scores at baseline (VISA-A: 22.2 ± 6.5 vs 21.0 ± 5.2 and VAS: 8 ± 1 vs 8 ± 1, respectively). Both groups significantly improved posttreatment (VISA-A: 85 ± 6.2 vs 53.4 ± 7.7 and VAS: 1 ± 2 vs 7 ± 2, respectively). At the 16-month follow-up, outcome scores declined slightly but significantly in the study group (VISA-A: 80 ± 5.3; VAS: 3 ± 2) and improved in the control group (VISA-A: 67 ± 5.6; VAS: 5 ± 1). However, both groups were significantly better than baseline. At both time points, the study group had significantly superior scores (statistically and clinically) than the control group ( P = .0001).

Conclusion:

Combining calf eccentric loading with stretching exercises resulted in significant improvements in the pain and functional scores in patients with NAT. Adding ESWT to this combined protocol resulted in significantly greater improvements in both the short and long term.

Level of Evidence:

Level I, randomized controlled trial.
Assessment of Personality Functioning in Adolescence: Development of the Adolescent Personality Structure Questionnaire
Authors: Benzi Ilaria M. A. , Fontana Andrea , Di Pierro Rossella , Perugini Marco , Cipresso Pietro , Madeddu Fabio , Clarkin John F. , Preti Emanuele
Published: January 2021

Adolescence is a crucial period for the development of personality and its dysfunctions. In this regard, it is essential to evaluate the nature and degree of maladaptive personality functioning. However, measures currently available present some limitations, mainly being adaptations from adult’s tailored instruments and length. Moreover, no instrument considers the crucial dimensions related to body development and sexuality. This contribution presents data on the Adolescent Personality Structure Questionnaire (APS-Q) development, a self-report measure to capture core aspects of personality functioning in adolescence while being agile and reliable. On two large samples of adolescents (total N = 1,664), we investigated the psychometric properties of the APS-Q. We explored its factor structure and construct and incremental validity in the first sample, testing specific associations with existing measures of severity of personality pathology, maladaptive personality traits, and psychological distress. In the second sample, we confirmed its factor structure, assessing gender and age invariance. Overall, our findings support the APS-Q’s validity as a reliable and useful measure to assess personality functioning. Moreover, the APS-Q highlighted developmentally vital dimensions such as self-functioning (encompassing mental and bodily changes and considering the dimension of sexuality), interpersonal functioning (discriminating the dimensions of family and peers), and emotion regulation.
In Search of the Cognitively Complex Person: Is There a Meaningful Trait Component of Cognitive Complexity?
Authors: Woodard Shailee R. , Chan Linus , Conway Lucian Gideon
Published: January 2021

Researchers have long assumed that complex thinking is determined by both situational factors and stable, trait-based differences. However, although situational influences on complexity have been discussed at length in the literature, there is still no comprehensive integration of evidence regarding the theorized trait component of cognitive complexity. To fill this gap, we evaluate the degree that cognitive complexity is attributable to trait variance. Specifically, we review two domains of evidence pertaining to (a) the generalizability of individuals’ complex thinking across domains and the temporal stability of individuals’ complex thinking and (b) the relationship of complex thinking with conceptually related traits. Cumulatively, the literature suggests that persons’ cognitive complexity at any point in time results partially from a stable and generalizable trait component that accounts for a small-to-moderate amount of variance. It further suggests that cognitively complex persons are characterized by chronic trait-based differences in motivation and ability to think complexly.
Inverse Association Between Health Literacy and Obesity Among Children in Greece: A School-Based, Cross-Sectional Epidemiological Study
Authors: Kanellopoulou Aikaterini , Notara Venetia , Antonogeorgos George , Chrissini Maria , Rojas-Gil Andrea Paola , Kornilaki Ekaterina N. , Lagiou Areti , Panagiotakos Demosthenes B.
Published: January 2021

Children’s health literacy is a crucial pillar of health. This study is aimed to examine the association between health literacy and weight status among Greek schoolchildren aged 10 to 12 years old. A population-based, cross-sectional observational study enrolling 1,728 students (795 boys), aged 10 to 12 years old, was conducted during school years 2014–2016. A health literacy index (range 0-100) was created through an item response theory hybrid model, by combining a variety of beliefs and perceptions of children about health. The mean health literacy score was 70.4 (±18.7). The majority of children (63.8%) had a “high” level (i.e., >67/100) of health literacy, 30.5% had a “medium” level (i.e., 34–66/100) of health literacy, while a small proportion of children (5.7%) had a “low” level (i.e., <33/100). Girls exhibited a higher level of health literacy than boys (71.7 ± 18.3 vs. 68.8 ± 19.1, p < .01). Regarding body weight status, 21.7% of children was overweight and 5.0% was obese. Linear regression models showed that the health literacy score was inversely associated with children’s body mass index (regression coefficient [95% CI]: −0.010 [−0.018, −0.001]), after adjusting for dietary habits, physical activity levels, and other potential confounders. Health literacy seems to be a dominant characteristic of children’s weight status; therefore, school planning, as well as public health policy actions should emphasize on the ability of children’s capacity to obtain, process, and understand basic health information.
Estimation of COVID-19 epidemic curves using genetic programming algorithm
Authors: Anđelić Nikola , Baressi Šegota Sandi , Lorencin Ivan , Mrzljak Vedran , Car Zlatan
Published: January 2021

This paper investigates the possibility of the implementation of Genetic Programming (GP) algorithm on a publicly available COVID-19 data set, in order to obtain mathematical models which could be used for estimation of confirmed, deceased, and recovered cases and the estimation of epidemiology curve for specific countries, with a high number of cases, such as China, Italy, Spain, and USA and as well as on the global scale. The conducted investigation shows that the best mathematical models produced for estimating confirmed and deceased cases achieved R2 scores of 0.999, while the models developed for estimation of recovered cases achieved the R2 score of 0.998. The equations generated for confirmed, deceased, and recovered cases were combined in order to estimate the epidemiology curve of specific countries and on the global scale. The estimated epidemiology curve for each country obtained from these equations is almost identical to the real data contained within the data set.
A Long-Term Study of What Best Predicts Graduating From University Versus Leaving Prior to Graduation
Authors: Willoughby Teena , Dykstra Victoria W. , Heffer Taylor , Braccio Joelle , Shahid Hamnah
Published: January 2021

Despite the importance of obtaining a university degree, retention rates remain a concern for many universities. This longitudinal study provides a multi-domain examination of first-year student characteristics and behaviors that best predict which students graduate. Graduation status was assessed seven years after students entered university. Participants (N = 1017; 71% female; mean age in Year 1 was 19 years) enrolled in a Canadian mid-sized university completed a survey, provided their enrollment status over the next 6 years (regardless of whether they left university), and consented to have their grades and status provided by the Registrar. Overall, 79% of students graduated by Year 7 (44% in 4 years). The strongest predictor of graduation was first-year grades. Social engagement in the university also predicted graduation. Surprisingly, mental health was not a significant predictor of graduation. Only a minority of students may experience mental health difficulties to such an extent that it affects their ability to succeed at university.
Assessing Health-Related Quality of Life Among Survivors of Testicular Cancer: A Systematic Review
Authors: Rovito Michael J. , Bruzzone Agata , Lee Eunkyung , López Castillo Humberto , Talton Walker , Taliaferro Lindsay , Falk Derek
Published: January 2021

This study aimed to determine if the current health-related quality of life (HRQoL) tools created for survivors of testicular cancer are collecting the highest quality of data via a two-step methodological critique of both the seminal studies that produced a survivor of testicular cancer HRQoL tool (Phase 1) and the actual tool itself (Phase 2). It is the goal of this current article to present and discuss Phase 1.

A systematic review aimed to assess the methodological quality of studies conducted to create instruments used to measure survivors of testicular cancer HRQoL. Five reviewers independently assessed each study with the 20-item Appraisal Tool for Cross-Sectional Studies (AXIS). Inter-rater agreement and Fleiss’ kappa was also assessed to ensure consistency in reported scores. Assessments for the EORTC QLQ-TC 26 and CAYA-T studies were low (AXIS 52.5%; IRA 95%; κ = 0.779) and fair (AXIS 65%; IRA 80%; κ = 0.599), respectively. Critical appraisal of the scales included issues within the three core AXIS domains. Primary concerns related to sampling methodology and the lack of a qualitative component of their core conceptual development phase.

Both reviewed seminal studies have significant methodological concerns that question the tools’ quality. Next steps include extensive appraisal of the psychometric properties of the EORTC QLQ TC-26 and the CAYA-T to complete the comprehensive review. Accurate and reliable data are necessary to understand survivor of testicular cancer HRQoL and assist in building the bridge of communication between health care professionals and survivors to help to improve patient outcomes.
Comprehensive Lifestyle Medicine Program Improves Fitness, Function, and Blood Pressure in Poststroke Veteran Cohort: A Pilot Study
Authors: Krauss Jeffrey , Frates Elizabeth , Parekh Mira , Chan John , Kiratli B. Jenny , Myers Jonathan
Published: January 2021

Comprehensive lifestyle medicine programs have begun to show efficacy in patients with cerebrovascular disease. The Veterans Affairs (VA) health care system has a large poststroke population and VA rehabilitation departments have significant expertise and resources for promoting healthy lifestyles. A 12-week clinical lifestyle medicine program was therefore implemented for poststroke patients, along with an optional observational study evaluating cardiovascular fitness, function, body composition, vitals, and quality of life before and after the program. Seventeen of 18 clinical patients elected to participate in the study, and 3 later withdrew. The 14 participants improved VO2 max by 1.94 mL O2/min/kg ( P = .001, 95% CI 0.96-2.90). Significant improvements were seen in estimated metabolic equivalents, exercise duration, 6-minute walk test, 30-second sit to stand, grip strength, and balance. Among patients who were hypertensive at baseline, mean decrease in supine systolic blood pressure (SBP) was −9.70 mm Hg (n = 10, P = .005, 95% CI −15.7 to −3.7) and standing SBP was −11.09 mm Hg (n = 11, P = .009, 95% CI −18.7 to −3.48). There were no significant improvements in laboratory measures or body composition. Participant satisfaction was high. These findings corroborate recent literature suggesting that lifestyle programs improve stroke recovery and reduce recurrence risk.
Repeatability, Completion Time, and Predictive Ability of Four Diabetes-Related Foot Ulcer Classification Systems
Authors: Alahakoon Chanika , Fernando Malindu , Galappaththy Charith , Lazzarini Peter , Moxon Joseph V. , Jones Rhondda , Golledge Jonathan
Published: January 2021

Introduction:

The inter and intra-observer reproducibility of measuring the Wound Ischemia foot Infection (WIfI) score is unknown. The aims of this study were to compare the reproducibility, completion times and ability to predict 30-day amputation of the WIfI, University of Texas Wound Classification System (UTWCS), Site, Ischemia, Neuropathy, Bacterial Infection and Depth (SINBAD) and Wagner classifications systems using photographs of diabetes-related foot ulcers.

Methods:

Three trained observers independently scored the diabetes-related foot ulcers of 45 participants on two separate occasions using photographs. The inter- and intra-observer reproducibility were calculated using Krippendorff’s α. The completion times were compared with Kruskal-Wallis and Dunn’s post-hoc tests. The ability of the scores to predict 30-day amputation rates were assessed using receiver operator characteristic curves and area under the curves.

Results:

There was excellent intra-observer agreement (α >0.900) and substantial agreement between observers (α=0.788) in WIfI scoring. There was moderate, substantial, or excellent agreement within the three observers (α>0.599 in all instances except one) and fair or moderate agreement between observers (α of UTWCS=0.306, α of SINBAD=0.516, α of Wagner=0.374) for the other three classification systems. The WIfI score took significantly longer ( P<.001) to complete compared to the other three scores (medians and inter quartile ranges of the WIfI, UTWCS, SINBAD, and Wagner being 1.00 [0.88-1.00], 0.75 [0.50-0.75], 0.50 [0.50-0.50], and 0.25 [0.25-0.50] minutes). None of the classifications were predictive of 30-day amputation ( P>.05 in all instances).

Conclusion:

The WIfI score can be completed with substantial agreement between trained observers but was not predictive of 30-day amputation.
Patients with Osteoarthritis and Kashin-Beck Disease Display Distinct CpG Methylation Profiles in the DIO2, GPX3, and TXRND1 Promoter Regions
Authors: Zhang Rongqiang , Guo Hao , Yang Xiaoli , Zhang Dandan , Zhang Di , Li Qiang , Wang Chen , Yang Xuena , Xiong Yongmin
Published: January 2021

Objective

We aimed to analyze deoxycytidine-deoxyguanosine dinucleotide (CpGs) methylation profiles in DIO2, GPX3, and TXNRD1 promoter regions in osteoarthritis (OA) and Kashin-Beck disease (KBD) patients.

Methods

Blood samples were collected from 16 primary OA patients and corresponding 16 healthy individuals and analyzed for methylations in the CpGs of DIO2, GPX3, and TXNRD1 promoter regions using MALDI-TOF-MS. The methylation profiles of these regions were then compared between OA and KBD patients.

Results

DIO2-1_CpG_2 and DIO2-1_CpG_3 methylations were significantly lower in OA than KBD patients ( P < 0.05). A similar trend was observed for GPX3-1_CpG_4, GPX3-1_CpG_7, GPX3-1_CpG_8.9.10, GPX3-1_CpG_13.14.15 and GPX3-1_CpG_16 ( P < 0.05) as well as TXNRD1-1_CpG_1 and TXNRD1-1_CpG_2 methylation between OA and KBD patients ( P < 0.05). However, there was no difference in methylation levels of other CpGs between the 2 groups ( P > 0.05).

Conclusion

OA and KBD patients display distinct methylation profiles in the CpG sites of DIO2, GPX3, and TXNRD1 promoter regions. These findings provide a strong background and new perspective for future studies on mechanisms underlying epigenetic regulation of selenoprotein genes associated with OA and KBD diseases.
Coronavirus Disease 2019 and Its Effect on Teaching and Learning Process in the Higher Educational Institutions
Authors: Kummitha Harshavardhan Reddy , Kolloju Naveen , Chittoor Prakash , Madepalli Venkatesh
Published: January 2021

In response to the coronavirus disease 2019 (COVID-19) pandemic, most of the higher education institutions (HEIs) across the globe have replaced conventional teaching with online teaching. However, the technological preparedness of countries of varied nature differs significantly. In this context, the purpose of the study is to answer the following research question: how are the HEIs mitigating the difficulties that have resulted from the COVID-19 pandemic to facilitate online teaching–learning process? The study is carried out based on a cross-sectional study from 281 academic professionals who are employed in HEIs in India and Ethiopia. The findings from this comparative study highlight that digital divide and lack of institutional preparedness are found to be major problems that constrained the effective implementation of online teaching/learning. Besides, this study also found that training programmes for the faculty members to utilize web resources and facilitate online teaching were found to be limited in both the countries. The article concludes by offering suggestions and policy advice to minimize the digital divide and for successful implementation of online teaching in HEIs.
Patient’s Satisfaction With Quality of Care at a National Health Insurance Clinic at a Tertiary Center, South-South Nigeria
Authors: Olamuyiwa Temitope Esther , Adeniji Foluke Olukemi
Published: January 2021

Introduction:

Patient satisfaction is a commonly used indicator for measuring the quality of health care. This study assessed patients’ satisfaction with the quality of care at the National Health Insurance Scheme (NHIS) clinic in a tertiary facility.

Methods:

It was a descriptive cross-sectional study in which 379 systematically selected participants completed an interviewer-administered, semi-structured questionnaire. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 23. Bivariate analysis was performed using Pearson χ2 with a P value set at ≤ .05.

Results:

The study found out that about half (193, 50.9%) of the respondents were satisfied with the availability of structure. Patients were not satisfied with waiting time in the medical records, account, laboratory, and pharmacy sections. Overall, 286 (75.5%) of the respondents were satisfied with the outcome of health care provided at the NHIS clinic. A statistically significant association ( P = .00) was observed between treatment outcome and patient satisfaction.

Conclusion:

There is a need to address structural deficiencies and time management at the clinic.
Evaluation of a Multidisciplinary Cachexia and Nutrition Support Service— The Patient and Carers Perspective
Authors: Vaughan Vanessa C , Harrison Meg , Dowd Anna , Eastman Peter , Martin Peter
Published: January 2021

The Barwon Health Cachexia & Nutrition Support Service (CNSS) is an outpatient service focused on improving clinical outcomes and quality of life for patients with or at high risk of cancer cachexia. Patients see a multidisciplinary team, comprising a palliative medicine physician, physiotherapist, dietitian, and nurse practitioner. This study evaluated the service from patient and carer perspectives. In 2016/17, semistructured interviews were conducted with 12 patients and 9 carers attending the service, focusing on: (1) reflection on experience of the CNSS, and (2) describing how a cachexia-specific service can meet their needs and concerns. Analysis generated 4 superordinate themes: evolving perception of service value, empowerment through person-centered care, communication to patients and carers regarding health/disease information, and the importance of the multidisciplinary team-based approach. Generally, patients and carers reported overall positive experiences with the service, particularly with regard to improved communication and management of the patient. Findings confirmed the patient-centered and individualized approaches were particularly valued. These insights are a critical step in the development of recommendations for future clinical management of cancer cachexia.
Teaching With American Factory: Illustrating Management Concepts in a Multinational Enterprise With a Documentary Film
Authors: Liu Joseph T.
Published: January 2021

This article reviews the documentary film American Factory as a resource for undergraduate management courses, especially those with a global emphasis. The film illustrates several themes, including overcoming cross-cultural challenges with cultural intelligence; international labor relations; employee health, safety, and well-being; stereotypes; and power distance and collectivism. This article also details clips from the film that illustrate these themes and suggests instructors show them alongside class lectures (in person, online synchronous, and online asynchronous) as nonfictional demonstrations of the concepts covered in class. In addition, this article provides discussion questions and sample answers so that these clips can be used as springboards for further class analysis, application, and extension. In sum, American Factory is a tool that can increase engagement and multimodality teaching in the management curriculum.
Sonographic Detection of Placenta Percreta With Associated Placenta Previa and Succenturiate Lobe
Authors: Detweiler Melissa , Downs Emily
Published: January 2021

Placenta percreta is the most complicated degree of the placenta accreta spectrum (PAS). It involves placental invasion through the uterine myometrium and into, or beyond, the uterine serosa, which can ultimately lead to severe maternal hemorrhage. Placenta previa is often associated with PAS and can be a significant indicator, along with other clinical factors. Sonography has historically been a highly accurate and safe imaging modality to assess the PAS. This specific case examines a patient with a pathologically proven percreta with an associated previa and succenturiate placental lobe.
Prepared and highly committed despite the risk of COVID-19 infection: a cross-sectional survey of primary care physicians’ concerns and coping strategies in Singapore
Authors: Lau Jerrald , Tan David Hsien-Yung , Wong Gretel Jianlin , Lew Yii-Jen , Chua Ying-Xian , Low Lian-Leng , Ho Han-Kwee , Kwek Thiam-Soo , Toh Sue-Anne Ee-Shiow , Tan Ker-Kan
Published: January 2021

Background

Primary care physicians (PCPs) are first points-of-contact between suspected cases and the healthcare system in the current COVID-19 pandemic. This study examines PCPs’ concerns, impact on personal lives and work, and level of pandemic preparedness in the context of COVID-19 in Singapore. We also examine factors and coping strategies that PCPs have used to manage stress during the outbreak.

Methods

Two hundred and sixteen PCPs actively practicing in either a public or private clinic were cluster sampled via email invitation from three primary care organizations in Singapore from 6th to 29th March 2020. Participants completed a cross-sectional online questionnaire consisting of items on work- and non-work-related concerns, impact on personal and work life, perceived pandemic preparedness, stress-reduction factors, and personal coping strategies related to COVID-19.

Results

A total of 158 questionnaires were usable for analyses. PCPs perceived themselves to be at high risk of COVID-19 infection (89.9%), and a source of risk (74.7%) and concern (71.5%) to loved ones. PCPs reported acceptance of these risks (91.1%) and the need to care for COVID-19 patients (85.4%). Overall perceived pandemic preparedness was extremely high (75.9 to 89.9%). PCPs prioritized availability of personal protective equipment, strict infection prevention guidelines, accessible information about COVID-19, and well-being of their colleagues and family as the most effective stress management factors.

Conclusions

PCPs continue to serve willingly on the frontlines of this pandemic despite the high perception of risk to themselves and loved ones. Healthcare organizations should continue to support PCPs by managing both their psychosocial (e.g. stress management) and professional (e.g. pandemic preparedness) needs.
The role of lymphocyte-monocyte ratio on axial spondyloarthritis diagnosis and sacroiliitis staging
Authors: Wang Jing , Su Jinyu , Yuan Yuan , Jin Xiaxia , Shen Bo , Lu Guoguang
Published: January 2021

Background

Axial spondyloarthritis (axial SpA) is a chronic inflammatory disorder could lead to disability due to the failure of timely treatment. The role of lymphocyte-to-monocyte ratio (LMR) in axial SpA remains unclear. The aim of this study was to investigate the role of LMR in axial SpA diagnosis, disease activity classification and sacroiliitis staging.

Methods

Seventy-eight axial SpA patients [51males and 27 females; mean age 41.0 (29–52) years] and 78 healthy controls (HCs) [55males and 23 females; mean age 40 (30–53) years] were enrolled in this study. The diagnosis of axial SpA was performed according to the New York criteria or the Assessment of Spondyloarthritis international Society (ASAS) classification criteria, whereas the staging of sacroiliitis in axial SpA patients was determined by X-ray examination. Comparisons of LMR levels between groups were performed using t test. Pearson or Spearman correlation analysis were used to assess correlations between LMR and other indicators. Receiver operating characteristic (ROC) curves were used to determine the role of LMR in the diagnosis of axial SpA.

Results

Higher neutrophil-to-lymphocyte ratio(NLR), red blood cell distribution width(RDW), platelet-to-lymphocyte ratio(PLR), mean platelet volume(MPV), erythrocyte sedimentation rate (ESR), and C-reactive protein(CRP) levels and lower red blood cell (RBC), hemoglobin (Hb), Hematocrit (Hct), LMR, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and albumin/globulin (A/G) levels were noted in axial SpA patients compared to HCs. Positive correlations were observed between LMR and RBC, Hb, Hct and A/G, whereas negative correlations were found between LMR and NLR, PLR, AST, and TBIL (P < 0.05). ROC curves showed that the area under the curve (AUC) for LMR in the diagnosis of ankylosing spondylitis was 0.803 (95% CI = 0.734–0.872) with a sensitivity and specificity of 62.8 and 87.2%, respectively, and the AUC (95% CI) for the combination of ESR, CRP and LMR was 0.975 (0.948–1.000) with a sensitivity and specificity of 94.9 and 97.4%, respectively. LMR levels were lower (P < 0.05) and significant differences in LMR values were observed among different stages (P < 0.05).

Conclusions

Our study suggested that LMR might be an important inflammatory marker to identify axial SpA and assess disease activity and X-ray stage of sacroiliitis.
The baseline interferon signature predicts disease severity over the subsequent 5 years in systemic lupus erythematosus
Authors: Mai Lloyd , Asaduzzaman Arundip , Noamani Babak , Fortin Paul R. , Gladman Dafna D. , Touma Zahi , Urowitz Murray B. , Wither Joan
Published: January 2021

Objectives

Type I interferons (IFNs) play an important role in the pathophysiology of systemic lupus erythematosus (SLE). While cross-sectional data suggest an association between IFN-induced gene expression and SLE disease activity, interest in this as a biomarker of flare has been tempered by a lack of fluctuation with disease activity in the majority of patients. This led us to question whether IFN-induced gene expression might instead be a biomarker of overall disease severity, with patients with high levels spending more time in an active disease state.

Methods

Levels of five interferon-responsive genes were measured in the whole peripheral blood at baseline visit for 137 SLE patients subsequently followed for 5 years. Log transformed values were summed to yield a composite IFN5 score, and the correlation with various disease outcomes examined. Receiver operator characteristic analyses were performed for outcomes of interest. Kaplan-Meier curves were generated to compare the proportion of flare-free patients with high and low IFN5 scores over time.

Results

The baseline IFN5 score was positively correlated with the adjusted mean SLE disease activity index-2000, number of flares, adjusted mean prednisone dose, and number of new immunosuppressive medications over the subsequent 5 years. Optimal cut-offs for the IFN5 score were determined using Youden’s index and predicted more severe outcomes with 57–67% accuracy. A high baseline IFN5 level was associated with a significantly increased risk of subsequent flare.

Conclusions

Measurement of the type I IFN signature is a useful tool for predicting the subsequent disease activity course.
Recurrent and concurrent patterns of regional BOLD dynamics and functional connectivity dynamics in cognitive decline
Authors: Liang Lingyan , Yuan Yueming , Wei Yichen , Yu Bihan , Mai Wei , Duan Gaoxiong , Nong Xiucheng , Li Chong , Su Jiahui , Zhao Lihua , Zhang Zhiguo , Deng Demao
Published: January 2021

Background

The brain’s dynamic spontaneous neural activity and dynamic functional connectivity (dFC) are both important in supporting cognition, but how these two types of brain dynamics evolve and co-evolve in subjective cognitive decline (SCD) and mild cognitive impairment (MCI) remain unclear. The aim of the present study was to investigate recurrent and concurrent patterns of two types of dynamic brain states correlated with cognitive decline.

Methods

The present study analyzed resting-state functional magnetic resonance imaging data from 62 SCD patients, 75 MCI patients, and 70 healthy controls (HCs). We used the sliding-window and clustering method to identify two types of recurrent brain states from both dFC and dynamic regional spontaneous activity, as measured by dynamic fractional amplitude of low-frequency fluctuations (dfALFF). Then, the occurrence frequency of a dFC or dfALFF state and the co-occurrence frequency of a pair of dFC and dfALFF states among all time points are extracted for each participant to describe their dynamics brain patterns.

Results

We identified a few recurrent states of dfALFF and dFC and further ascertained the co-occurrent patterns of these two types of dynamic brain states (i.e., dfALFF and dFC states). Importantly, the occurrence frequency of a default-mode network (DMN)-dominated dFC state was significantly different between HCs and SCD patients, and the co-occurrence frequencies of a DMN-dominated dFC state and a DMN-dominated dfALFF state were also significantly different between SCD and MCI patients. These two dynamic features were both significantly positively correlated with Mini-Mental State Examination scores.

Conclusion

Our findings revealed novel fMRI-based neural signatures of cognitive decline from recurrent and concurrent patterns of dfALFF and dFC, providing strong evidence supporting SCD as the transition phase between normal aging and MCI. This finding holds potential to differentiate SCD patients from HCs via both dFC and dfALFF as objective neuroimaging biomarkers, which may aid in the early diagnosis and intervention of Alzheimer’s disease.
Can adaptive clinical trials help to solve the productivity crisis of the pharmaceutical industry? - a scenario analysis
Authors: Mahlich Jörg , Bartol Arne , Dheban Srirangan
Published: January 2021

Aim

The productivity of pharmaceutical research and development (R&D) investments is declining due to high failure rates in clinical research. Recently, the US Food and Drug Administration (FDA) acknowledged that adaptive designs can make drug development more efficient and less costly. Our objective is to simulate cost-saving effects and estimate the impact on global R&D expenditures as well as possible outcomes measured in life-years gained.

Methods

Based on published drug-development cost data we calculate potential cost savings derived from variations in clinical success rates that result from employing adaptive trial designs. In a subsequent step we estimate how those cost changes affect global R&D expenditures and outcomes.

Results

Our calculations indicate that an adaptive trial design with the potential to increase success rates of clinical trials by 4 percentage points could lower development costs for a new drug from 2.6 to 2.2bn USD. On a global scale, this cost reduction would free up an additional 4.2bn USD for investment into pharmaceutical R&D to bring about drug innovations that in turn would be capable of generating up to 3.5 million life-years.

Conclusion

New clinical trial designs are crucial to improving productivity within the pharmaceutical industry and to fostering a sustainable health-care system.
Early detection of sepsis using artificial intelligence: a scoping review protocol
Authors: Pepic Ivana , Feldt Robert , Ljungström Lars , Torkar Richard , Dalevi Daniel , Maurin Söderholm Hanna , Andersson Lars-Magnus , Axelson-Fisk Marina , Bohm Katarina , Sjöqvist Bengt Arne , Candefjord Stefan
Published: January 2021

Background

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. To decrease the high case fatality rates and morbidity for sepsis and septic shock, there is a need to increase the accuracy of early detection of suspected sepsis in prehospital and emergency department settings. This may be achieved by developing risk prediction decision support systems based on artificial intelligence.

Methods

The overall aim of this scoping review is to summarize the literature on existing methods for early detection of sepsis using artificial intelligence. The review will be performed using the framework formulated by Arksey and O’Malley and further developed by Levac and colleagues. To identify primary studies and reviews that are suitable to answer our research questions, a comprehensive literature collection will be compiled by searching several sources. Constrictions regarding time and language will have to be implemented. Therefore, only studies published between 1 January 1990 and 31 December 2020 will be taken into consideration, and foreign language publications will not be considered, i.e., only papers with full text in English will be included. Databases/web search engines that will be used are PubMed, Web of Science Platform, Scopus, IEEE Xplore, Google Scholar, Cochrane Library, and ACM Digital Library. Furthermore, clinical studies that have completed patient recruitment and reported results found in the database ClinicalTrials.gov will be considered. The term artificial intelligence is viewed broadly, and a wide range of machine learning and mathematical models suitable as base for decision support will be evaluated. Two members of the team will test the framework on a sample of included studies to ensure that the coding framework is suitable and can be consistently applied. Analysis of collected data will provide a descriptive summary and thematic analysis. The reported results will convey knowledge about the state of current research and innovation for using artificial intelligence to detect sepsis in early phases of the medical care chain.

Ethics and dissemination

The methodology used here is based on the use of publicly available information and does not need ethical approval. It aims at aiding further research towards digital solutions for disease detection and health innovation. Results will be extracted into a review report for submission to a peer-reviewed scientific journal. Results will be shared with relevant local and national authorities and disseminated in additional appropriate formats such as conferences, lectures, and press releases.