bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Chemical Compositions of the Pepper EOs From Different Cultivars and Their AChE Inhibitory Activity
Authors: Chen Shu-Xia , Yang Kong , Xiang Jia-Yao , Raymond Kwaku Osafo , Han Jia-Xin , Zhu Xian-Ai , Huang Ya-Ting , Liu Le-Jiang , Shen Shao-Bin , Li Hai-Zhou , Li Xing-Cong , Feng Yang , Xu Min
Published: November 2020

Pepper is one of the most popular spices over the world and is called the King of Spices. Its essential oils (EOs) could alleviate neuronal ailments due to the inhibitory effect against acetylcholinesterase (AChE). In this study, the chemical compositions of 26 EOs prepared from white and black pepper collecting from 6 different cultivars were analyzed by gas chromatography-mass spectrometry (GC-MS). A total of 133 compounds were identified in the white and black pepper EOs. Monoterpenes and sesquiterpenes were found to be riched in these EOs, of which α-pinene, β-pinene, sabinene, 3-carene, limonene, and ( E)- β-caryophyllene were the major constituents. Most of pepper EOs showed potential AChE inhibitory activity with half-maximal inhibitory concentration (IC50) values in the range of 0.5-182.5 µg/mL. Comparison of chemical constitutes of pepper EOs from different cultivars suggested that α-pinene, β-pinene, and 3-carene with an IC50 value of 3.2, 53.3, and 2.9 µg/mL, respectively, might be used as Quality-marker (Q-marker) of pepper oil in inhibiting AChE.
Bodyography as Activism in Qualitative Inquiry: The Bodies Collective at ECQI19
Authors: Collective The Bodies
Published: November 2020

If activism is an act of challenging marginalization and hierarchy, The Bodies Collective works to challenge the hierarchy between “mind” and “body” inherent in much academic discourse, and can be witnessed in the conference space. We do this, not through forming another hierarchical structure, but from within—through invitation and inviting those who may be labeled as “participant” to become a leader within each workshop presented. This is the act of activism that The 2019 European Congress of Qualitative Inquiry (ECQI19) invited. In this article, we discuss how The Bodies Collective’s contributions to ECQI can be seen as activism. We describe our contribution, a workshop, and provide examples of feedback from those involved. Finally, we show some of the challenges we have encountered and conclude with looking toward the future.
Empagliflozin improves chronic hypercortisolism-induced abnormal myocardial structure and cardiac function in mice
Authors: Zhang Qing-Qing , Li Guo-Qing , Zhong Yi , Wang Jie , Wang An-Ning , Zhou Xiao , Mao Xiao-Ming
Published: November 2020

Background:

Chronic exposure to excess glucocorticoids is frequently associated with a specific cardiomyopathy. Empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, has beneficial effects as it aids in the reduction of heart failure and cardiovascular mortality in hospitalized patients. The aim of this study was to investigate the effects of empagliflozin on chronic hypercortisolism-induced myocardial fibrosis and myocardial dysfunction in mice.

Methods:

Male C57BL/6J mice (6 weeks old) were randomized to control, corticosterone (CORT), and empagliflozin + CORT groups. After 4 weeks of administration, heart structure and function were evaluated by echocardiography, and peripheral blood and tissue samples were collected. Expressions of Ccl2, Itgax, Mrc1, and Adgre1 mRNA in heart tissue were evaluated by RT-PCR, and signal transducer and activator of transcription 3 (STAT3) and Toll-like receptor 4 (TLR4) protein expression were analyzed by Western blotting.

Results:

Empagliflozin effectively reduced body weight, liver triglyceride, visceral adipose volume, and uric acid in CORT-treated mice. Left ventricular hypertrophy and cardiac dysfunction were improved significantly, phosphorylated STAT3 and TLR4 were alleviated, and macrophage infiltration in the myocardium was inhibited after administration of empagliflozin in CORT-treated mice.

Conclusion:

Empagliflozin has beneficial effects on specific cardiomyopathy associated with CORT, and the results provide new evidence that empagliflozin might be a potential drug for the prevention of this disease.
Global trade in the Anthropocene: A review of trends and direction of environmental factor flows during the Great Acceleration
Authors: Brolin John , Kander Astrid
Published: November 2020

Global trade is a neglected topic in debates on the Anthropocene, but plays an implicit role in several suggested definitions of it. Trade’s role in shifting environmental burdens around the globe differed substantially between the Columbian Exchange (1492−1800), the Industrial Revolution (~1800−1950) and the Great Acceleration (post-1950). However, this systematic state-of-the-art review shows that the more than 350 global studies of trade-embedded environmental factors all centre on the Great Acceleration. An underlying concern here is whether environmental factor flows are to the economic and/or environmental benefit of all, a case of the rich exploiting the poor, or merely the inadvertent consequence of differences in environmental efficiency. We point out similarities in the trends and direction of flows between major world regions and between developed and developing countries. Factors such as land, virtual water, HANPP and eutrophying pollutants that are related to the organic economy (or direct biomass flows), primarily flow from regions where population density is low to where it is high, and are only secondarily affected by affluence. Indicators such as energy, airborne pollutant emissions and greenhouse gasses that are related to the mineral economy (fossil fuel, metal and mineral use) tend to flow from developing to developed countries, and are explained either by higher consumption rates or greater environmental efficiency in affluent countries, which has similar consequences for net flows. We weave the shifting trends and directions of flows during the Great Acceleration into a coherent story. Finally, returning to the period before the Great Acceleration, we argue the need for global studies of trade-embedded factor flows before 1950 to test ideas on the character and origins of the Anthropocene, and to accomplish this suggest either geographically extending quantitative long-term national and/or commodity studies, or environmentally extending recently compiled global monetary bilateral trade data for the pre-1950 period.
Editorial: The personalisation of insurance: Data, behaviour and innovation
Authors: McFall Liz , Meyers Gert , Hoyweghen Ine Van
Published: November 2020

The adoption of Big Data analytics (BDA) in insurance has proved controversial but there has been little analysis specifying how insurance practices are changing. Is insurance passively subject to the forces of disruptive innovation, moving away from the pooling of risk towards its personalisation or individualisation, and what might that mean in practice? This special theme situates disruptive innovations, particularly the experimental practices of behaviour-based personalisation, in the context of the practice and regulation of contemporary insurance. Our contributors argue that behaviour-based personalisation in insurance has different and broader implications than have yet been appreciated. BDAs are changing how insurance governs risk; how it knows, classifies, manages, prices and sells it, in ways that are more opaque and more extensive than the black boxes of in-car telematics.
Management of Patients With Glomerulonephritis During the COVID-19 Pandemic: Recommendations From the Canadian Society of Nephrology COVID-19 Rapid Response Team
Authors: Moran Sarah M. , Barbour Sean , Dipchand Christine , Garland Jocelyn S. , Hladunewich Michelle , Jauhal Arenn , Kappel Joanne E. , Levin Adeera , Pandeya Sanjay , Reich Heather N. , Thanabalasingam Susan , Thomas Dorothy , Ma Jeffrey C. , White Christine ,   On Behalf of the CSN COVID-19 Rapid Response Team, Antonsen John , Banks Cheryl , Clark David , Clark Edward , Copland Michael , Davison Sara N. , Goldberg Aviva , Hemmett Juliya , Hiremath Swapnil , Kappel Joanne , MacRae Jennifer M. , Mac-Way Fabrice , Mathew Anna , McCormick Brendan , Moist Louise , Moran Sarah , Pandeya Sanjay , Qirjazi Elena , Ryz Krista , Singh Suneet , Soroka Steven , Suri Rita , Tennankore Karthik , Thanabalasingam Susan , Wald Ron , Weir Mathew , White Christine , Zimmerman Deborah , Levin Adeera , Mustafa Reem A. , Nesrallah Gihad , Soroka Steven , Zimmerman Deborah
Published: November 2020

Purpose of program:

This article will provide guidance on how to best manage patients with glomerulonephritis (GN) during the COVID-19 pandemic.

Sources of information:

We reviewed relevant published literature, program-specific documents, and guidance documents from international societies. An informal survey of Canadian nephrologists was conducted to identify practice patterns and expert opinions. We hosted a national webinar with invited input and feedback after webinar.

Methods:

The Canadian Society of Nephrology (CSN) Board of Directors invited physicians with expertise in GN to contribute. Specific COVID-19-related themes in GN were identified, and consensus-based recommendations were made by this group of nephrologists. The recommendations received further peer input and review by Canadian nephrologists via a CSN-sponsored webinar. This was attended by 150 kidney health care professionals. The final consensus recommendations also incorporated review by Editors of the Canadian Journal of Kidney Health and Disease.

Key findings:

We identified 9 areas of GN management that may be affected by the COVID-19 pandemic: (1) clinic visit scheduling, (2) clinic visit type, (3) provision of multidisciplinary care, (4) blood and urine testing, (5) home-based monitoring essentials, (6) immunosuppression, (7) other medications, (8) patient education and support, and (9) employment.

Limitations:

These recommendations are expert opinion, and are subject to the biases associated with this level of evidence. To expedite the publication of this work, a parallel review process was created that may not be as robust as standard arm’s length peer review processes.

Implications:

These recommendations are intended to provide optimal care during the COVID-19 pandemic. Our recommendations may change based on the evolving evidence.
The DIalysis Symptom COntrol-Restless Legs Syndrome (DISCO-RLS) Trial: A Protocol for a Randomized, Crossover, Placebo-Controlled Blinded Trial
Authors: Collister David , Pohl Kayla , Herrington Gwen , Lee Shun Fu , Rabbat Christian , Tennankore Karthik , Zimmermann Deborah , Tangri Navdeep , Wald Ron , Manns Braden , Suri Rita S. , Nadeau-Fredette Annie-Claire , Goupil Remi , Silver Samuel A. , Walsh Michael
Published: November 2020

Background:

Restless legs syndrome (RLS) affects approximately 30% of patients with end-stage kidney disease and is associated with impaired sleep and health-related quality of life. Medications used to treat RLS in patients receiving dialysis may have an increased risk of adverse events with dose titration, and residual RLS symptoms are common despite the use of effective treatments. Randomized controlled trials of monotherapy and combination pharmacologic therapy for RLS in hemodialysis are needed.

Objective:

To perform a randomized, crossover, placebo-controlled blinded trial of pharmacologic therapy for RLS in hemodialysis.

Design/setting:

The DIalysis Symptom COntrol-Restless Legs Syndrome (DISCO-RLS) trial is a randomized, crossover, placebo-controlled blinded trial of fixed low-dose pharmacologic therapy in patients receiving hemodialysis in 10 centers across Canada. It uses patient partners in its design, conduct, and reporting.

Participants:

Adults receiving thrice-weekly hemodialysis for at least 3 months with RLS of at least mild symptoms defined International Restless Legs Syndrome Study Group Rating Scale (IRLS) of 10 or more will enter a double placebo run-in period to exclude nonadherent participants and those unable to tolerate double placebo. Seventy-two participants who completed the run-in period will be randomized to 1 of 8 treatment sequences based on modeling with 4 treatment periods.

Methods:

Each treatment period lasts 4 weeks and consists of ropinirole 0.5 mg daily and gabapentin 100 mg daily, both together or neither with a double dummy placebo control for each treatment. The primary outcome is the difference in change scores of the IRLS between study treatments. Secondary outcomes are the differences in change scores of the Restless Legs Syndrome-6 Scale, patient global impression, 5-level EQ-5D version, and safety outcomes.

Results:

This randomized, crossover, placebo-controlled blinded trial will evaluate the efficacy and safety of fixed low-dose combination of ropinirole and gabapentin in patients receiving hemodialysis with RLS.

Limitations:

Patients with chronic kidney disease not on dialysis, kidney transplant recipients and those receiving peritoneal dialysis or home hemodialysis are not included. The intervention’s long term safety and efficacy including the risk of augmentation is not captured.

Conclusion:

This randomized crossover placebo controlled blinded trial will evaluate the efficacy and safety of fixed low-dose combination ropinirole and gabapentin in patients receiving hemodialysis with RLS.

Trial Registration:

ClinicalTrials.gov (NCT03806530)
A Framework to Ensure Patient Partners Have Equal and Contributing Voices Throughout the Research Program Evaluation Process
Authors: Hillier David R. , Tang Mila , Clark William , MacDonald Cynthia , Connolly Carol , Large Chantel , King Malcolm , Singer Joel , Levin Adeera , Manns Braden , Konvalinka Ana , Scholey James , Rosenblum Norman D.
Published: November 2020

Purpose of program:

Traditionally, peer review was a closed process conducted only by individuals working in the research field. To establish a more integrated and patient-centered approach, one of Canada’s largest kidney research networks (Can-SOLVE CKD) has created a Research Operations Committee (ROC) that includes patients as key members. The ROC represents one way for achieving meaningful patient-oriented research (POR).

Source of information:

Can-SOLVE CKD, a network created as part of the Canadian Institutes of Health Research (CIHR) Strategy for Patient-Oriented Research (SPOR).

Methods:

The ROC consists of patients, physicians, scientists, Indigenous partners, experts in research methodology, and a member of Can-SOLVE CKD’s operational team. On an annual basis, Can-SOLVE CKD’s research teams provide the ROC with a review package, which incorporates information from patient engagement check-in calls and surveys, the project’s knowledge translation plan and products, and a progress report written by the project team. The ROC evaluates the review package and provides feedback and recommendations accordingly.

Key findings:

The transparent nature of the process, regular feedback and review, along with an overt accountability and scoring system, has been embraced by both patients and researchers. As a result of the ROC process, the number of patient leads for each project has grown over a 3-year period and more researchers have received POR and cultural sensitivity training.

Limitations:

While anecdotal evidence suggests this approach is beneficial for achieving POR, formal mechanisms of evaluation are currently lacking.

Implications:

This ROC framework ensures patients are active contributors throughout the research process and could be adopted by other organizations to achieve a more patient-centered approach to research.
Workplace Attachment as a Mediator of Organizational Tenure and Organizational Citizenship Behavior
Authors: Pradhan Anita , Mishra Sasmita
Published: November 2020

The impact of organizational tenure on organizational citizenship behavior (OCB) has been studied previously. However, the role of workplace attachment intervening the link between these two variables has not been researched. Looking at the growing research interest in OCB in academic context, this study aimed to test a mediation model of these three variables in a university context. A structured questionnaire comprising scales on place attachment and OCB was used to collect data from staff of the studied university. Correlation analysis and structural equation modeling of a total of 323 responses (after outlier elimination) was conducted using SPSS 24.0 and AMOS 23.0. It was found out that with the increase in tenure, employees’ attachment to place and their OCB enhanced. It was also found that workplace attachment was a significant mediator of tenure and OCB, implying that tenure enhanced workplace attachment and attachment further enhanced OCB. Based on the previous place attachment literature, it was suggested that there should be meaningful interactions between employees and the physical and group setting, which would foster employees’ emotional bonding with the organization. Theoretically, this study contributes by introducing workplace attachment as a new variable in OCB literature.
Effect of Endodontic Treatment on Serum Glutathione (GSH) Levels in Patients with Chronic Apical Periodontitis: A Clinical Pilot Study
Authors: Bains Rhythm , Tikku Aseem P. , Chandra Anil , Ali Wahid , Verma Promila
Published: November 2020

Aim:

To assess the before- and after-treatment levels of glutathione (GSH) in the serum of patients with chronic apical periodontitis.

Materials and Methods:

The study involved 20 systemically healthy patients with radiographic evidence of chronic apical periodontitis in at least one tooth, of which 11 were finally assessed. 10 mL of the patient’s venous blood was obtained before commencing the endodontic treatment to assess the pre-operative serum GSH levels (T0). The canals cleaned and shaped, and irrigated with 2.5% sodium hypochlorite, and filled with a calcium hydroxide based intracanal medicament. At the subsequent appointment after one week, teeth were obturated. The patients were recalled 30 days after the completion of endodontic therapy, and blood samples were assessed again at time frame T1 for serum GSH. The difference in pre- and post-treatment values for T0 and T1 was statistically analyzed.

Results:

The mean age of the subjects ( N = 11) was 21.09±3.24 years, with 19.50±0.71 years in female group and 21.44±3.50 years in the male group. The mean GSH at T0 was 11.73±8.30 units, which was increased to 14.04±13.96 units at T1. However, no significant change was observed in the GSH level from T0 to T1 (change = –2.30, t-value = –0.49, P = .635).

Conclusion:

The results of this study suggest that endodontic therapy may play a role in restoring the systemic oxidative balance, as seen by the increase in post-treatment serum GSH levels.
Survivin Expression in Metastatic and Nonmetastatic Oral Squamous Cell Carcinoma: A Comparative Study
Authors: Sekar B. , Indrapriyadharshini K. , Ambika M. , Saranyan R. , Nirmal Madhavan , Manzoor Sathick
Published: November 2020

Aim:

Survivin is a multifunctional protein chiefly involved in apoptosis and cell cycle regulation. Increased expression of survivin in tumors and fetal tissue determines its antiapoptotic activity. The aim of the study is to identify the immunoexpression of survivin in metastatic and nonmetastatic oral squamous cell carcinoma (OSCC) and also to evaluate and compare the expression of survivin in metastatic and nonmetastatic OSCC of buccal mucosa.

Materials and Methods:

In total, 40 histopathologically proven cases of OSCC, including 20 metastatic and 20 nonmetastatic cases, are selected. Among the 20 metastatic and nonmetastatic cases, 10 well-differentiated and 10 moderately differentiated squamous cell carcinoma cases were included and were subjected to immunohistochemical staining for survivin expression. The results were analyzed by SPSS version 11.5 using chi-square test.

Results:

The expression of survivin in metastatic and nonmetastatic tumors is 15%–70% and 15%–60%, respectively. When comparing the cases of moderately differentiated squamous cell carcinoma in metastatic and nonmetastatic tumors, 70% cases show moderate staining intensity.

Conclusion:

The survivin expression was comparatively high in metastatic OSCC. Also based on the aforementioned results, survivin expression was high in increasing grades of OSCC.
A 23-Year-Old Man With Multisystem Inflammatory Syndrome After Mild COVID-19
Authors: Razavi Alexander C. , Chang Jonathan L. , Sutherland Aimee , Niyogi Anjali , Ménard Geraldine E.
Published: November 2020

We present the case of a young obese patient with recent COVID-19 (coronavirus disease 2019) who developed multisystem inflammatory syndrome (MIS) 1 month after spontaneous resolution. A 23-year-old African American man was admitted with a 1-week history of worsening fatigue, myalgias, headache, and dyspnea. Nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was negative by polymerase chain reaction; however, the patient was febrile and had leukocytosis, elevated troponin I, transaminitis, and acute kidney injury. Bedside echocardiogram showed decreased left ventricular ejection fraction (40% to 45%) and global hypokinesis in the setting of a type II non-ST segment myocardial infarction. Despite being on broad spectrum antibiotic therapy, the patient’s clinical condition continued to worsen. The patient was then empirically treated for MIS with intravenous immunoglobulin and methylprednisolone, which led to a rapid resolution of fever and laboratory abnormalities. This case highlights that MIS associated with COVID-19 may present in patients above the age of 21 years and can occur with a delayed onset after mild illness in those with no previous oxygen requirement or hospitalization during SARS-CoV-2 infection.
Disseminated Coccidioidomycosis Presenting as Polyarticular Septic Arthritis: A Case Report
Authors: Nasrawi Faisal , Heidari Arash , Aljashamy Thulfiqar , Mangat Nishan , Bhaika Jasbir , Kaur Simmer , Kuran Rasha , Johnson Royce
Published: November 2020

Coccidioidomycosis a fungal infection endemic to southwestern United States. It is caused by inhalation of spores of Coccidioides immitis. Sixty percent of infections are asymptomatic; the remaining 40% are primarily pulmonary disease. In <1% of infections, dissemination can occur. Dissemination usually affects those with impaired cellular immunity and pregnant women, and can involve bones, joints, meninges, and skin. We present the case of a 29-year-old Hispanic male who presented to the emergency department (ED) complaining of pain and swelling of right wrist and ankle as well as left knee for 2 months. He was referred to rheumatology clinic but returned to the ED as he developed spontaneous purulent drainage from his wrist. In the ED, an arthrocentesis of 2 of the joints showed total nucleated cells of 520 000/cm2 and 90 000/cm2 with 61% and 93% neutrophils, respectively. Fungal culture eventually grew Coccidioides immitis from his wrist and knee. Coccidioidomycosis complement fixation titer came back >1:512. Bone scan showed uptake of adjacent bones in the affected joints. Superimposed bacterial infection of the wrist complicated the treatment course and delayed the start of liposomal amphotericin B. Eventually patient received 12 weeks of intravenous liposomal amphotericin-B with slow clinical improvement and then switched to oral isavuconazonium for maintenance therapy. This case shows that although disseminated polyarthritis coccidioidomycosis is very rare, clinicians should keep the diagnosis of disseminated synovial coccidioidomycosis in mind in patients with risk factors.
Endoscopic Decompression of Recurrent Sigmoid Volvulus in Pregnancy
Authors: Cortez Nathaly , Berzosa Manuel , Muddasani Kiranmayi , Ben-David Kfir
Published: November 2020

Sigmoid volvulus is a rare condition seen during pregnancy with high maternal and fetal morbidity and mortality. We report a case of a young 26-year-old woman, primipara, in her third trimester who presented with recurrent sigmoid volvulus at both 30 and 32 weeks of gestation. She underwent successful repetitive endoscopic decompression on both admissions with uneventful recovery. Endoscopic evaluation is safe in pregnancy and uncomplicated volvulus. It allows for diagnostic confirmation and assessment of complications; and it has successful outcomes in the presence of a multidisciplinary team.
Percutaneous Endoscopic Jejunostomy Tube Placement for Treatment of Severe Hyperemesis Gravidarum in Pregnancy
Authors: Kruchko David , Shah Natasha , Broy Charles , Silas Dean
Published: November 2020

Hyperemesis gravidarum is a common disease. Most patients are effectively treated with conservative measures, but gastric feeding and, rarely, post-pyloric feeding can be necessary. A 27-year-old woman, G3P2002, with a history of refractory hyperemesis in previous pregnancies, required placement of a nasojejunal tube but was removed due to an oropharyngeal ulcer. Endoscopic placement of a percutaneous endoscopic transgastric-jejunostomy (PEG-J) tube caused resolution of her symptoms. Twelve days after placement, the distal tube became dislodged and was endoscopically replaced with hemoclip anchoring in the jejunum. PEG-J tube placement is a safe and effective option for nutritional support in refractory hyperemesis gravidarum.
Tattoo Granulomas With Uveitis
Authors: Carvajal Bedoya Guiset , Caplan Liron , Christopher Karen L. , Reddy Amit K. , Ifantides Cristos
Published: November 2020

Bilateral intraocular inflammation and simultaneous development of tattoo granulomas has been described in several case reports. The pathophysiology of this process is poorly understood, and it has been hypothesized that it could be a similar mechanism to systemic sarcoidosis versus a delayed hypersensitivity response. Granulomatous tattoo reaction with associated uveitis can manifest with or without evidence of systemic sarcoidosis, and it is usually responsive to immunosuppression and/or tattoo removal. We present a patient with no prior diagnosis of sarcoidosis who developed bilateral panuveitis and tattoo changes suggestive of tattoo granulomas with uveitis (TAGU). The patient was initially managed with intraocular steroids and systemic steroids with minimal improvement of symptoms. The patient later required steroid sparing therapy with a tumor factor inhibitor to achieve remission. There is a growing prevalence of tattooing among the general population and a low reported rate of tattooing complications. Granulomatous tattoo reaction with associated uveitis should be a consideration in patients with tattoos presenting with “idiopathic” uveitis.
COVID-19-Induced Acute Bilateral Optic Neuritis
Authors: Sawalha Khalid , Adeodokun Stephen , Kamoga Gilbert-Roy
Published: November 2020

A 44-year-old male patient with no past medical history presented 2 weeks after seropositive coronavirus disease 2019 (COVID-19) infection with vision problems suggestive of optic neuritis. Radiological testing showed findings suspicious for acute bilateral optic neuritis. The patient had also anti-MOG antibodies. Whether this was an optic neuritis due to COVID-19, MOG antibody disease, or an activation of MOG antibody disease by COVID-19 is discussed in this case.
Simultaneous Presentation of Crohn’s Disease and Takayasu Arteritis in a Teenage Patient
Authors: Polyakova Inna , Iannucci Glen , George Roshan , Gill Anne , Patel Dinesh Govind , Rouster-Stevens Kelly
Published: November 2020

A 14-year-old female with no significant medical history presented with hypertensive urgency, in the setting of 4 to 6 weeks of diarrhea, abdominal pain, headaches, anemia, weight loss, and high blood pressures. Her evaluation revealed signs of a systemic inflammatory process that was most suspicious for inflammatory bowel disease. However, when her hypertension was evaluated with a renal Doppler ultrasound, there were signs of narrowing, stenosis, and hypoplasia that led to a diagnostic angiogram of the abdominal aorta. Full body positron emission tomography scan revealed multiple areas of stenosis and aortic thickening with enhancement compatible with Takayasu arteritis. She received prednisone, methotrexate, and infliximab with marked improvement in her clinical symptoms and inflammatory markers.
Challenges of Patient Engagement in an HIV Clinical Research Program: A Qualitative Analysis of Stakeholder Accounts
Authors: Lessard David , Engler Kim , Vicente Serge , Bilodeau Martin , Lebouché Bertrand
Published: November 2020

Patient engagement (PE) promotes collaboration between stakeholders (researchers, patients, clinicians, etc). It often faces challenges due to tensions between its ethical/political and scientific underpinnings. This article explores how stakeholders applied the guiding principles of a PE project (“co-build,” “support and mutual respect,” and “inclusiveness”) for an HIV clinical research program initiated in January 2016. Three researchers/clinicians, a PE agent, and 2 patients held 3 meetings (June-October 2018) to discuss challenges faced and how these impacted their approach to PE. Regular stakeholder discussions about PE in clinical research could be documented and help guide PE to better meet stakeholder needs.
A Randomized, Crossover Pilot Study of a Novel Web-Based/Mobile Platform for Collaborative Small Group Practice in Therapeutic Reasoning
Authors: Gruenberg Katherine , Brock Tina , Garcia Joshua , MacDougall Conan
Published: November 2020

Background and Purpose:

Therapeutic reasoning—the mental process of making judgments and decisions about treatment—is developed through acquisition of knowledge and application in actual or simulated experiences. Health professions education frequently uses collaborative small group work to practice therapeutic reasoning. This pilot study compared the impact of a web-based/mobile tool for collaborative case work and discussion to usual practice on student perceptions and performance on questions designed to test therapeutic knowledge and reasoning.

Methods:

In a therapeutics course that includes case-based workshops, student teams of 3 to 4 were randomly assigned to usual workshop preparation (group SOAP sheet) or preparation using the Practice Improvement using Virtual Online Training (PIVOT) platform. PIVOT was also used in the workshop to review the case and student responses. The next week, groups crossed over to the other condition. Students rated favorability with the preparatory and in-workshop experiences and provided comments about the PIVOT platform via a survey. Student performance on examination items related to the 2 workshop topics was compared.

Results:

One hundred and eleven students (94%) completed post-workshop surveys after both workshops. The majority of students (57%) preferred using the PIVOT platform for workshop collaboration. Favorability ratings for the in-workshop experience did not change significantly from first to second study week, regardless of sequence of exposure. There was no relationship between examination item scores and the workshop platform the students were exposed to for that content ( P = .29). Student responses highlighted the efficiency of working independently before collaborating as a group and the ability to see other students’ thought processes as valuable aspects of PIVOT. Students expressed frustration with the PIVOT user interface and the lack of anonymity when discussing their answers in the workshop.

Conclusion:

A web-based/mobile platform for student team collaboration on therapeutic reasoning cases discussed in small group settings yielded favorable ratings, examination performance comparable to standard approaches, and was preferred by a majority of students. During the rapid shift to substantial online learning for the COVID-19 pandemic, virtual collaboration tools like PIVOT may help health professions teachers to better support groups working virtually on scaffolded therapeutic reasoning tasks.
Science, Technology, Enterprise and Society
Authors: Smit Christian
Published: November 2020

One of the greatest challenges for civil societies, politicians and organisations around the globe in the twenty-first century is the digitisation and automatisation of work processes. Through means of machine learning, new mechanical product developments, and a further development of digital work organisation, fundamental aspects of the working reality are changing. The arguments of this essay show that some scholars predict a massive replacement of manufacturing jobs by machines. Others show that people fear to arrive at a feeling of overextension through constant availability or new developments in how firms are organised. All of these aspects can have drastic implications on a macroeconomic level and for the mental health and general well-being of workers. Henceforth, it is utterly important to analyse the implications of digitisation thoroughly and not prematurely arrive at an overly positive perception of such changes in the work environment.
Assessing Entrepreneurship Education Outcomes in an Innovative Way: Situational Judgment Tests
Authors: Cualheta Luciana Padovez , Abbad Gardenia da Silva
Published: November 2020

Entrepreneurship education outcomes have been poorly evaluated. Previous research focused mostly on subjective measures like entrepreneurial intention that does not necessarily turn into behavior, and have mostly used self-perception questionnaires. Learning and competence results have been under researched. Therefore, the use of situational judgment tests to assess entrepreneurship education learning outcomes is proposed. This is an exploratory study that presents the development and validation process of situational judgment tests, following twelve steps, including the analysis of course’s materials, focus groups with professors and former students, expert validation, semantic validation, empirical validation, the definition of correction sheets and equivalence tests. The course is presented in details and its goals are defined using a learning taxonomy. Results present the three situational judgment tests that were developed and the correction sheets that can be used to guarantee correction in an objective manner. The situational tests developed in this study can be used to evaluate courses with similar goals and the development and validation process can be adopted to evaluate other courses.
Endothelial eNAMPT amplifies pre-clinical acute lung injury: efficacy of an eNAMPT-neutralising monoclonal antibody
Authors: Quijada Hector , Bermudez Tadeo , Kempf Carrie L. , Valera Daniel G. , Garcia Alexander N. , Camp Sara M. , Song Jin H. , Franco Evelyn , Burt Jessica K. , Sun Belinda , Mascarenhas Joseph B. , Burns Kimberlie , Gaber Amir , Oita Radu C. , Reyes Hernon Vivian , Barber Christy , Moreno-Vinasco Liliana , Sun Xiaoguang , Cress Anne E. , Martin Diego , Liu Zhonglin , Desai Ankit A. , Natarajan Viswanathan , Jacobson Jeffrey R. , Dudek Steven M. , Bime Christian , Sammani Saad , Garcia Joe G.N.
Published: November 2020

Rationale

The severe acute respiratory syndrome coronavirus 2/coronavirus disease 2019 pandemic has highlighted the serious unmet need for effective therapies that reduce acute respiratory distress syndrome (ARDS) mortality. We explored whether extracellular nicotinamide phosphoribosyltransferase (eNAMPT), a ligand for Toll-like receptor (TLR)4 and a master regulator of innate immunity and inflammation, is a potential ARDS therapeutic target.

Methods

Wild-type C57BL/6J or endothelial cell (EC)-cNAMPT−/−knockout mice (targeted ECNAMPTdeletion) were exposed to either a lipopolysaccharide (LPS)-induced (“one-hit”) or a combined LPS/ventilator (“two-hit”)-induced acute inflammatory lung injury model. A NAMPT-specific monoclonal antibody (mAb) imaging probe (99mTc-ProNamptor) was used to detect NAMPT expression in lung tissues. Either an eNAMPT-neutralising goat polyclonal antibody (pAb) or a humanised monoclonal antibody (ALT-100 mAb) were usedin vitroandin vivo.

Results

Immunohistochemical, biochemical and imaging studies validated time-dependent increases in NAMPT lung tissue expression in both pre-clinical ARDS models. Intravenous delivery of either eNAMPT-neutralising pAb or mAb significantly attenuated inflammatory lung injury (haematoxylin and eosin staining, bronchoalveolar lavage (BAL) protein, BAL polymorphonuclear cells, plasma interleukin-6) in both pre-clinical models.In vitrohuman lung EC studies demonstrated eNAMPT-neutralising antibodies (pAb, mAb) to strongly abrogate eNAMPT-induced TLR4 pathway activation and EC barrier disruption.In vivostudies in wild-type and EC-cNAMPT−/−mice confirmed a highly significant contribution of EC-derived NAMPT to the severity of inflammatory lung injury in both pre-clinical ARDS models.

Conclusions

These findings highlight both the role of EC-derived eNAMPT and the potential for biologic targeting of the eNAMPT/TLR4 inflammatory pathway. In combination with predictive eNAMPT biomarker andNAMPTgenotyping assays, this offers the opportunity to identify high-risk ARDS subjects for delivery of personalised medicine.
Development and validation of a deep learning algorithm detecting 10 common abnormalities on chest radiographs
Authors: Nam Ju Gang , Kim Minchul , Park Jongchan , Hwang Eui Jin , Lee Jong Hyuk , Hong Jung Hee , Goo Jin Mo , Park Chang Min
Published: November 2020

We aimed to develop a deep learning algorithm detecting 10 common abnormalities (DLAD-10) on chest radiographs, and to evaluate its impact in diagnostic accuracy, timeliness of reporting and workflow efficacy.

DLAD-10 was trained with 146 717 radiographs from 108 053 patients using a ResNet34-based neural network with lesion-specific channels for 10 common radiological abnormalities (pneumothorax, mediastinal widening, pneumoperitoneum, nodule/mass, consolidation, pleural effusion, linear atelectasis, fibrosis, calcification and cardiomegaly). For external validation, the performance of DLAD-10 on a same-day computed tomography (CT)-confirmed dataset (normal:abnormal 53:147) and an open-source dataset (PadChest; normal:abnormal 339:334) was compared with that of three radiologists. Separate simulated reading tests were conducted on another dataset adjusted to real-world disease prevalence in the emergency department, consisting of four critical, 52 urgent and 146 nonurgent cases. Six radiologists participated in the simulated reading sessions with and without DLAD-10.

DLAD-10 exhibited area under the receiver operating characteristic curve values of 0.895–1.00 in the CT-confirmed dataset and 0.913–0.997 in the PadChest dataset. DLAD-10 correctly classified significantly more critical abnormalities (95.0% (57/60)) than pooled radiologists (84.4% (152/180); p=0.01). In simulated reading tests for emergency department patients, pooled readers detected significantly more critical (70.8% (17/24)versus29.2% (7/24); p=0.006) and urgent (82.7% (258/312)versus78.2% (244/312); p=0.04) abnormalities when aided by DLAD-10. DLAD-10 assistance shortened the mean±sdtime-to-report critical and urgent radiographs (640.5±466.3versus3371.0±1352.5 s and 1840.3±1141.1versus2127.1±1468.2 s, respectively; all p<0.01) and reduced the mean±sdinterpretation time (20.5±22.8versus23.5±23.7 s; p<0.001).

DLAD-10 showed excellent performance, improving radiologists' performance and shortening the reporting time for critical and urgent cases.
Outcomes with a shorter multidrug-resistant tuberculosis regimen from Karakalpakstan, Uzbekistan
Authors: du Cros Philipp , Khamraev Atadjan , Tigay Zinaida , Abdrasuliev Tleubergen , Greig Jane , Cooke Graham , Herboczek Krzysztof , Pylypenko Tanya , Berry Catherine , Ronnachit Amrita , Lister David , Dietrich Sebastian , Ariti Cono , Safaev Khasan , Nyang'wa Bern-Thomas , Parpieva Nargiza , Tillashaikhov Mirzagalib , Achar Jay
Published: November 2020

Background

In 2016, World Health Organization guidelines conditionally recommended standardised shorter 9–12-month regimens for multidrug-resistant (MDR) tuberculosis (TB) treatment. We conducted a prospective study of a shorter standardised MDR-TB regimen in Karakalpakstan, Uzbekistan.

Methods

Consecutive adults and children with confirmed rifampicin-resistant pulmonary TB were enrolled between September 1, 2013 and March 31, 2015; exclusions included prior treatment with second-line anti-TB drugs, and documented resistance to ofloxacin or to two second-line injectable agents. The primary outcome was recurrence-free cure at 1 year following treatment completion.

Results

Of 146 enrolled patients, 128 were included: 67 female (52.3%), median age 30.1 (interquartile range 23.8–44.4) years. At the end of treatment, 71.9% (92 out of 128) of patients achieved treatment success, with 68% (87 out of 128) achieving recurrence-free cure at 1 year following completion. Unsuccessful outcomes during treatment included 22 (17.2%) treatment failures with fluoroquinolone-resistance amplification in 8 patients (8 out of 22, 36.4%); 12 (9.4%) lost to follow-up; and 2 (1.5%) deaths. Recurrence occurred in one patient. Fourteen patients (10.9%) experienced serious adverse events. Baseline resistance to both pyrazinamide and ethambutol (adjusted OR 6.13, 95% CI 2.01; 18.63) and adherence <95% (adjusted OR 5.33, 95% CI 1.73; 16.36) were associated with unsuccessful outcome in multivariable logistic regression.

Conclusions

Overall success with a standardised shorter MDR-TB regimen was moderate with considerable treatment failure and amplification of fluoroquinolone resistance. When introducing standardised shorter regimens, baseline drug susceptibility testing and minimising missed doses are critical. High rates globally of pyrazinamide, ethambutol and ethionamide resistance raise questions of continued inclusion of these drugs in shorter regimens in the absence of drug susceptibility testing-confirmed susceptibility.
Direct oral anticoagulant therapy in patients with morbid obesity after intermediate- or high-risk pulmonary emboli
Authors: Lachant Daniel J. , Bach Christina , Fe Alexander , White R. James , Lachant Neil A.
Published: November 2020

There is little reported on the efficacy and safety of direct oral anticoagulants (DOACs) in morbid obesity after venous thromboembolism (VTE).

In this observational study, patients were followed up after intermediate- or high-risk pulmonary embolism (PE) at the University of Rochester Pulmonary Hypertension Clinic 2–4 months after the initial event. All patients had echocardiography and V/Q imaging regardless of symptoms. Outcomes of interest were the rates of recurrent VTE, thrombus resolution and development of chronic thromboembolic pulmonary hypertension (CTEPH) in patients with morbid obesity treated with a DOAC compared to treatment with vitamin K antagonists and to non-morbidly obese patients after PE. Using the electronic medical record, recurrent events were assessed up to 12 months after the event.

107 patients (body mass index (BMI)>40 kg·m−2, n=32; BMI 30–39.9 kg·m−2, n=39; BMI<30 kg·m−2, n=36) attended follow-up appointments after treatment for PE. A DOAC was used in 70 patients (BMI>40 kg·m−2, n=19; BMI 30–39.9 kg·m−2, n=27; BMI<30 kg·m−2, n=24). There were no recurrent events within the first 12 months of initial diagnosis based on symptoms and imaging in any patient. There was no difference in rate of residual unmatched perfusion defect with DOACs or conventional anticoagulation (49%versus49%). This finding remained in the subset of morbidly obese patients (47%versus50%). For the overall cohort, there was no difference in the rate of CTEPH development based on anticoagulation with a DOAC (5%versus8% with warfarin). There were no major bleeding complications with a DOAC.

DOAC therapy appears to be effective and safe in morbid obesity even after intermediate- or high-risk PE. ​
Severe outcomes of COVID-19 among patients with COPD and asthma
Authors: Hansen Erik Soeren Halvard , Moeller Amalie Lykkemark , Backer Vibeke , Andersen Mikkel Porsborg , Kober Lars , Kragholm Kristian , Torp-Pedersen Christian
Published: November 2020

Introduction

Patients with obstructive lung diseases are possibly at risk of developing severe outcomes of coronavirus disease 2019 (COVID-19). Therefore, the aim of this study was to determine the risk of severe outcomes of COVID-19 among patients with asthma and COPD.

Methods

We performed a nationwide cohort study of patients with COVID-19 from 1 February to 10 July 2020. All patients with COVID-19 registered in the Danish registers were included. Using International Classification of Diseases (ICD) codes and medication history, patients were divided into asthma, COPD or no asthma or COPD. Primary outcome was a combined outcome of severe COVID-19, intensive care or death.

Results

Out of 5104 patients with COVID-19 (median age 54.8 years (25–75th percentile 40.5 to 72.3); women, 53.0%), 354 had asthma and 432 COPD. The standardised absolute risk of the combined end-point was 21.2% (95% CI 18.8–23.6) in patients with COPD, 18.5% (95% CI 14.3–22.7) in patients with asthma and 17.2% (95% CI 16.1–18.3) in patients with no asthma or COPD. Patients with COPD had a slightly increased risk of the combined end-point compared with patients without asthma or COPD (risk difference 4.0%; 95% CI 1.3–6.6; p=0.003). In age standardised analyses, there were no differences between the disease groups. Low blood eosinophil counts (<0.3×109 cells·L−1) were associated with increased risk of severe outcomes among patients with COPD.

Conclusion

Patients with COPD have a slightly increased risk of developing severe outcomes of COVID-19 compared with patients without obstructive lung diseases. However, in age-standardised analysis, the risk difference disappears.
New Hybrid AD Methodology for Minimizing the Total Amount of Information Content: A Case Study of Rehabilitation Robot Design
Authors: Yang Tao , Gao Xueshan , Dai Fuquan
Published: November 2020

Converting customer needs into specific forms and providing consumers with services are crucial in product design. Currently, conversion is no longer difficult due to the development of modern technology, and various measures can be applied for product realization, thus increasing the complexity of analysis and evaluation in the design process. The focus of the design process has thus shifted from problem solving to minimizing the total amount of information content. This paper presents a New Hybrid Axiomatic Design (AD) Methodology based on iteratively matching and merging design parameters that meet the independence axiom and attribute constraints by applying trimming technology, the ideal final results, and technology evolution theory. The proposed method minimizes the total amount of information content and improves the design quality. Finally, a case study of a rehabilitation robot design for hemiplegic patients is presented. The results indicate that the iterative matching and merging of related attributes can minimize the total amount of information content, reduce the cost, and improve design efficiency. Additionally, evolutionary technology prediction can ensure product novelty and improve market competitiveness. The methodology provides an excellent way to design a new (or improved) product.