bluuebunny/crossref_metadata_2025 huggingface dataset:
Fractional integral inequalities involving Marichev–Saigo–Maeda fractional integral operator
Authors: Tassaddiq Asifa , Khan Aftab , Rahman Gauhar , Nisar Kottakkaran Sooppy , Abouzaid Moheb Saad , Khan Ilyas
Published: July 2020

The aim of this present investigation is establishing Minkowski fractional integral inequalities and certain other fractional integral inequalities by employing the Marichev–Saigo–Maeda (MSM) fractional integral operator. The inequalities presented in this paper are more general than the existing classical inequalities cited.
Solvability and stability of a fractional dynamical system of the growth of COVID-19 with approximate solution by fractional Chebyshev polynomials
Authors: Hadid Samir B. , Ibrahim Rabha W. , Altulea Dania , Momani Shaher
Published: July 2020

Lately, many studies were offered to introduce the population dynamics of COVID-19. In this investigation, we extend different physical conditions of the growth by employing fractional calculus. We study a system of coupled differential equations, which describes the dynamics of the infection spreading between infected and asymptomatic styles. The healthy population properties are measured due to the social meeting. The result is associated with a macroscopic law for the population. This dynamic system is appropriate to describe the performance of growth rate of the infection and to verify if its control is appropriately employed. A unique solution, under self-mapping possessions, is investigated. Approximate solutions are presented by utilizing fractional integral of Chebyshev polynomials. Our methodology is based on the Atangana–Baleanu calculus, which provides various activity results in the simulation. We tested the suggested system by using live data. We found positive action in the graphs.
A novel privacy-preserving speech recognition framework using bidirectional LSTM
Authors: Wang Qingren , Feng Chuankai , Xu Yan , Zhong Hong , Sheng Victor S.
Published: July 2020

Utilizing speech as the transmission medium in Internet of things (IoTs) is an effective way to reduce latency while improving the efficiency of human-machine interaction. In the field of speech recognition, Recurrent Neural Network (RNN) has significant advantages to achieve accuracy improvement on speech recognition. However, some of RNN-based intelligence speech recognition applications are insufficient in the privacy-preserving of speech data, and others with privacy-preserving are time-consuming, especially about model training and speech recognition. Therefore, in this paper we propose a novel Privacy-preserving Speech Recognition framework using Bidirectional Long short-term memory neural network, namely PSRBL. On the one hand, PSRBL designs new functions to construct security activation functions by combing with an additive secret sharing protocol, namely a secure piecewise-linear Sigmoid and a secure piecewise-linear Tanh respectively, to achieve privacy-preserving of speech data during speech recognition process running on edge servers. On the other hand, in order to reduce the time spent on both the training and the recognition of the speech model while keeping high accuracy during speech recognition process, PSRBL first utilizes secure activation functions to refit original activation functions in the bidirectional Long Short-Term Memory neural network (LSTM), and then makes full use of the left and the right context information of speech data by employing bidirectional LSTM. Experiments conducted on the speech dataset TIMIT show that our framework PSRBL performs well. Specifically compared with the state-of-the-art ones, PSRBL significantly reduces the time consumption on both the training and the recognition of the speech model under the premise that PSRBL and the comparisons are consistent in the privacy-preserving of speech data.
Using provider-focused education toolkits can aid enhanced recovery programs to further reduce patient exposure to opioids
Authors: Sarin Ankit , Lancaster Elizabeth , Chen Lee-lynn , Porten Sima , Chen Lee-may , Lager Jeanette , Wick Elizabeth
Published: July 2020

Background

Evidence-based perioperative analgesia is an important tactic for reducing patient exposure to opioids in the perioperative period and potentially preventing new persistent opioid use.

Study design

We assessed the impact of a multifaceted optimal analgesia program implemented in the setting of a mature surgical pathway program at an academic medical center. Using existing multidisciplinary workgroups established for continuous process improvement in three surgical pathway areas ((colorectal, gynecology, and urologic oncology (cystectomy)), we developed an educational toolkit focused on implementation strategies for multimodal analgesia and non-pharmacologic approaches for managing pain with the goal of reducing opioid exposure in hospitalized patients. We analyzed prospectively collected data from pathway patients before dissemination of the toolkit (July 2016–June 2017; n = 869) and after (July 2017–June 2018; n = 838). We evaluated the association between program implementation and use of oral morphine equivalents (OME), average pain scores, time to first ambulation after surgery, urinary catheter duration, time to solid food after surgery, length of stay, discharge opioid prescriptions, and readmission.

Results

Multivariate regression demonstrated that the program was associated with significant decreases in intraoperative OME (14.5 ± 2.4 mEQ (milliequivalents) reduction; p < 0.0001), day before discharge OME (18 ± 6.5 mEQ reduction; p < 0.005), day of discharge OME (9.6 ± 3.28 mEQ reduction; p < 0.003), and discharge prescription OME (156 ± 22 mEq reduction; p < 0.001). Reduction in OME was associated with earlier resumption of solid food (0.58 ± 0.15 days reduction; p < 0.0002).

Conclusion

Our multifaceted optimal analgesia program to manage perioperative pain in the hospital was effective and further improved analgesia in the setting of a mature enhanced recovery program.
Evaluating the implementation of rapid diagnostic tests in a malaria elimination setting
Authors: Liang Di , Jin Jia-Jie , Wang Wei-Ming , Cao Yuan-Yuan , Zhu Guo-Ding , Zhou Hua-Yun , Cao Jun , Huang Jia-Yan
Published: July 2020

Background

It was recommended that malaria rapid diagnostic tests (RDTs) should be available in all epidemiological situations. But evidence was limited on the implementation of RDTs and its effectiveness in malaria elimination settings. This study examined the implementation of RDTs and how it affected the diagnosis of imported malaria patients in Jiangsu Province, China.

Methods

To scale up RDTs, this study developed an intervention package with four major elements covering the supply of RDT test, the training on RDTs, the monitoring and management of RDT use, and the advocacy of RDTs. By using a pretest-posttest control group design, we implemented the interventions in 4 cities in Jiangsu Province with the rest nine cities as controlled areas, from January 2017 to January 2018. Difference-in-Difference approach was used to evaluate the impact of the scale-up of RDTs on the identification of malaria cases. Three binary outcome measures were included to indicate delayed malaria diagnosis, malaria cases with confirmed malaria diagnosis at township-level institutions, and severe malaria cases, respectively. Linear probability regression was performed with time and group fixed effects and the interaction term between time and group.

Results

Intervention areas received sufficient RDT test supply, regular professional training programs, monthly tracking and management of RDT supply and use, and health education to targeted population. The implementation of interventions was associated with 10.8% (P = 0.021) fewer patients with delayed diagnosis. But intervention areas did not see a higher likelihood of having confirmed diagnosis from township-level institutions (coefficient = -0.038, P = 0.185) or reduced severe malaria cases (coef. = 0.040, P = 0.592).

Conclusions

The comprehensive package of RDT implementation in this study is promising in scaling up RDT use and improving access to care among malaria patients, especially in malaria elimination settings.
DNA methylation biomarkers of future health outcomes in children
Authors: Shanthikumar Shivanthan , Neeland Melanie R. , Maksimovic Jovana , Ranganathan Sarath C. , Saffery Richard
Published: July 2020

Biomarkers which predict future health outcomes are key to the goals of precision health. Such biomarkers do not have to be involved in the causal pathway of a disease, and their performance is best assessed using statistical tests of clinical performance and evaluation of net health impact. DNA methylation is the most commonly studied epigenetic process and represents a potential biomarker of future health outcomes. We review 25 studies in non-oncological paediatric conditions where DNA methylation biomarkers of future health outcomes are assessed. Whilst a number of positive findings have been described, the body of evidence is severely limited by issues with outcome measures, tissue-specific samples, accounting for sample cell type heterogeneity, lack of appropriate statistical testing, small effect sizes, limited validation, and no assessment of net health impact. Future studies should concentrate on careful study design to overcome these issues, and integration of DNA methylation data with other ‘omic’, clinical, and environmental data to generate the most clinically useful biomarkers of paediatric disease.
Clinical efficacy and safety in patients treated with teicoplanin with a target trough concentration of 20 μg/mL using a regimen of 12 mg/kg for five doses within the initial 3 days
Authors: Ueda Takashi , Takesue Yoshio , Nakajima Kazuhiko , Ichiki Kaoru , Ishikawa Kaori , Takai Yoshiko , Yamada Kumiko , Tsuchida Toshie , Otani Naruhito , Takahashi Yoshiko , Ishihara Mika , Takubo Shingo , Ikeuchi Hiroki , Uchino Motoi , Kimura Takeshi
Published: July 2020

Background

A trough concentration (Cmin) ≥20 μg/mL of teicoplanin is recommended for the treatment of serious methicillin-resistant Staphylococcus aureus (MRSA) infections. However, sufficient clinical evidence to support the efficacy of this target Cmin has not been obtained. Even though the recommended high Cmin of teicoplanin was associated with better clinical outcome, reaching the target concentration is challenging.

Methods

Pharmacokinetics and adverse events were evaluated in all eligible patients. For clinical efficacy, patients who had bacteremia/complicated MRSA infections were analyzed. The primary endpoint for clinical efficacy was an early clinical response at 72–96 h after the start of therapy. Five dosed of 12 mg/kg or 10 mg/kg was administered as an enhanced or conventional high loading dose regimen, respectively. The Cmin was obtained at 72 h after the first dose.

Results

Overall, 512 patients were eligible, and 76 patients were analyzed for treatment efficacy. The proportion of patients achieving the target Cmin range (20–40 μg/mL) by the enhanced regimen was significantly higher than for the conventional regimen (75.2% versus 41.0%, p < 0.001). In multivariate analysis, Cmin ≥ 20 μg/mL was an independent factor for an early clinical response (odds ratio 3.95, 95% confidence interval 1.25–12.53). There was no significant difference in the occurrence of adverse events between patients who did or did not achieve a Cmin ≥ 20 μg/mL.

Conclusion

A target Cmin ≥ 20 μg/mL might improve early clinical responses during the treatment of difficult MRSA infections using 12 mg/kg teicoplanin for five doses within the initial 3 days.
Studies of internal stress induced by solidification of menthol melt as temporary consolidant in archaeological excavations using resistance strain gauge method
Authors: Chen Xiuxiu , Xu Yang , Chen Ming , Huang Xiao , Luo Hongjie , Song Yicheng
Published: July 2020

Volatile organic solids, such as cyclododecane or menthol, have been employed as temporary reinforcement material during archaeological excavations. They are usually applied as melts and reinforcement is achieved once the melts solidify. Such solidification process can induce internal stress on the artifacts, which can be a big concern, especially to those very precious and fragile ones. However, information about such stress is still extremely limited at present. This paper proposes an experimental method based on resistance strain gauge technique to monitor the deformation induced by solidification of menthol melt. Bending tests are performed on very thin glass slides. The solidification process of menthol melt is well characterized by the development of mechanical strains. Then, menthol melts are applied to three kinds of simulated samples, i.e. glass, sandstone and rice paper, to investigate the mechanical response of preserved bodies upon solidification. It is found that menthol melt will generate certain amount expansion or contraction of the objects upon solidification. The stresses induced, evaluated according to obtained strains, are generally quite small, indicating that application of menthol as reinforcement material is safe in mechanics for cultural relics.
Growing a growth mindset: characterizing how and why undergraduate students’ mindsets change
Authors: Limeri Lisa B. , Carter Nathan T. , Choe Jun , Harper Hannah G. , Martin Hannah R. , Benton Annaleigh , Dolan Erin L.
Published: July 2020

Background

The extent to which students view their intelligence as improvable (i.e., their “mindset”) influences students’ thoughts, behaviors, and ultimately their academic success. Thus, understanding the development of students’ mindsets is of great interest to education scholars working to understand and promote student success. Recent evidence suggests that students’ mindsets continue to develop and change during their first year of college. We built on this work by characterizing how mindsets change and identifying the factors that may be influencing this change among upper-level STEM students. We surveyed 875 students in an organic chemistry course at four points throughout the semester and interviewed a subset of students about their mindsets and academic experiences.

Results

Latent growth modeling revealed that students tended to shift towards viewing intelligence as a stable trait (i.e., shifted towards a stronger fixed mindset and a weaker growth mindset). This trend was particularly strong for students who persistently struggled in the course. From qualitative analysis of students’ written survey responses and interview transcripts, we determined that students attribute their beliefs about intelligence to five factors: academic experiences, observing peers, deducing logically, taking societal cues, and formal learning.

Conclusions

Extensive prior research has focused on the influence of mindset on academic performance. Our results corroborate this relationship and further suggest that academic performance influences students’ mindsets. Thus, our results imply that mindset and academic performance constitute a positive feedback loop. Additionally, we identified factors that influence undergraduates’ mindset beliefs, which could be leveraged by researchers and practitioners to design more persuasive and effective mindset interventions to promote student success.
Assessing nest attentiveness of Common Terns via video cameras and temperature loggers
Authors: Sullivan Jeffery D. , Marbán Paul R. , Mullinax Jennifer M. , Brinker David F. , McGowan Peter C. , Callahan Carl R. , Prosser Diann J.
Published: July 2020

Background

While nest attentiveness plays a critical role in the reproductive success of avian species, nest attentiveness data with high temporal resolution is not available for many species. However, improvements in both video monitoring and temperature logging devices present an opportunity to increase our understanding of this aspect of avian behavior.

Methods

To investigate nest attentiveness behaviors and evaluate these technologies, we monitored 13 nests across two Common Tern (Sterna hirundo) breeding colonies with a paired video camera - temperature logger approach, while monitoring 63 additional nests with temperature loggers alone. Observations occurred from May to August of 2017 on Poplar (Chesapeake Bay, Maryland, USA) and Skimmer Islands (Isle of Wight Bay, Maryland, USA). We examined data respective to four times of day: Morning (civil dawn‒11:59), Peak (12:00‒16:00), Cooling (16:01‒civil dusk), and Night (civil dusk‒civil dawn).

Results

While successful nests had mostly short duration off-bouts and maintained consistent nest attentiveness throughout the day, failed nests had dramatic reductions in nest attentiveness during the Cooling and Night periods (p < 0.05) with one colony experiencing repeated nocturnal abandonment due to predation pressure from a Great Horned Owl (Bubo virginianus). Incubation appeared to ameliorate ambient temperatures during Night, as nests were significantly warmer during Night when birds were on versus off the nest (p < 0.05). Meanwhile, off-bouts during the Peak period occurred during higher ambient temperatures, perhaps due to adults leaving the nest during the hottest periods to perform belly soaking. Unfortunately, temperature logger data alone had limited ability to predict nest attentiveness status during shorter bouts, with results highly dependent on time of day and bout duration. While our methods did not affect hatching success (p > 0.05), video-monitored nests did have significantly lower clutch sizes (p < 0.05).

Conclusions

The paired use of iButtons and video cameras enabled a detailed description of the incubation behavior of COTE. However, while promising for future research, the logistical and potential biological complications involved in the use of these methods suggest that careful planning is needed before these devices are utilized to ensure data is collected in a safe and successful manner.
Surgical treatment of a giant right atrial myxoma
Authors: Numaguchi Ryosuke , Hashimoto Makoto , Koshima Ryuji , Mitsube Keijiro
Published: July 2020

Background

Right atrial myxoma is a rare anomaly. When present, it can rarely cause blood flow obstruction in the right cardiac chamber depending on its size and location. We herein report a rare case of a giant right atrial myxoma, which caused right heart failure due to tricuspid valve obstruction, along with our treatment experience.

Case presentation

A 59-year-old woman was admitted to our hospital for palpitations and edema of the lower extremity. Computed tomography image and transthoracic echocardiography showed a 57 mm × 63 mm giant tumor obstructing the tricuspid valve inflow. The tumor was excised surgically and the residual septal defect was repaired with a Dacron patch. Tricuspid valve annuloplasty was performed additionally. The postoperative course was uneventful and the patient was discharged on postoperative day 5.

Conclusion

Giant right atrial myxoma is a rare cause of tricuspid valve stenosis and right heart failure. Surgical resection is the most appropriate treatment option and should be performed as soon as possible after diagnosis.
Medical and surgical management of a pulmonary hypertensive adult patient with unrepaired complex congenital heart disease: a case report
Authors: Akagi Satoshi , Kasahara Shingo , Akagi Teiji , Nakamura Kazufumi , Ito Hiroshi
Published: July 2020

Background

Some patients with congenital heart defects are considered inoperable because of severe pulmonary arterial hypertension (PAH) at birth, and some of these patients are followed for a long period. Recently, PAH-specific drugs have been developed to treat PAH. These drugs might make it possible to operate in adult patients with congenital heart defects who were previously considered inoperable. However, it is unclear which cases are appropriate for treatment and how they should be managed.

Case presentation

We describe a 32-year-old woman who was diagnosed with a ventricular septal defect, patent ductus arteriosus, and coarctation of the aorta, as well as severe PAH at birth. The attending physician at the time decided not to perform total repair. We re-evaluated the patient’s haemodynamics at 32 years of age. Her mean pulmonary artery pressure was 105 mmHg, pulmonary vascular resistance was 14.5 Wood units and pulmonary blood flow-to-systemic blood flow ratio (Qp/Qs) was 2.8. However, she had good vasoreactivity to oxygen. Vasoreactivity testing with 100% oxygen showed decreases in the following measures: the mean pulmonary artery pressure was 88 mmHg, pulmonary vascular resistance was 3.8 Wood units, and Qp/Qs was 10.8. We repaired the cases of coarctation of the aorta, patent ductus arteriosus and ventricular septal defect without the occurrence of a pulmonary hypertension crisis after surgery by using PAH-specific drugs. Furthermore, the continuous use of PAH-specific drugs improved the patient’s symptoms and the 6-min walk distance and decreased the mean pulmonary artery pressure and pulmonary vascular resistance. Her mean pulmonary artery pressure was 22 mmHg, and her pulmonary vascular resistance was 4.7 Wood units at the one-year follow-up.

Conclusions

With perioperative use of PAH-specific drugs, CHDs can be repaired without the occurrence of a pulmonary hypertension crisis after surgery in patients with a good vasoreactivity response to oxygen, even if the PVR is high. Medical treatment and surgery can therefore treat PAH and improve patients’ exercise capacity over time.
Rhabdomyolysis-induced acute kidney injury requiring hemodialysis after a prolonged immobilization at home in 2 morbidly obese women: case reports with literature review
Authors: Sakai Kazuhiro , Omizo Hiroki , Togashi Ryo , Hayama Yuto , Ueno Masaki , Tomomitsu Yoshihiro , Nemoto Yoshikazu , Asakawa Shinichiro , Nagura Michito , Arai Shigeyuki , Yamazaki Osamu , Tamura Yoshifuru , Uchida Shunya , Shibata Shigeru , Fujigaki Yoshihide
Published: July 2020

Background

Rhabdomyolysis may develop into acute kidney injury (AKI), a life-threatening complication. Obese people are at risk for rhabdomyolysis due to prolonged immobilization. However, there are only a few reports of rhabdomyolysis-induced AKI due to prolonged immobilization after falls in morbidly obese people. Myoglobin is a causative compound for rhabdomyolysis-induced AKI, but the lack of treatments targeting its mechanism is a problem.

Case presentation

Two morbidly obese women (body mass index > 40.0 kg/m2) who fell on the floor at home and remained in the same posture for more than 12 h developed rhabdomyolysis-induced AKI. Both patients received aggressive fluid resuscitation but required hemodialysis because of persistent oliguria. They underwent 11 and 2 intermittent hemodialysis (HD) sessions with a conventional polymethylmethacrylate (PMMA) high-flux dialyzer, respectively, and their renal functions returned to baseline after withdrawal of HD.

Conclusions

We should be aware that morbidly obese people are at risk for rhabdomyolysis-induced AKI due to prolonged immobilization, such as after falls. At present, prophylactic renal replacement therapy (RRT) is not recommended for rhabdomyolysis. We need to reevaluate whether RRT using the appropriate membranes to effectively remove myoglobin including the PMMA membrane can improve the renal outcome in patients with rhabdomyolysis-induced AKI.
Religiosity differences in the transition to first intercourse before age 18 among Polish students
Authors: Wróblewska Wiktoria
Published: July 2020

Poland is a Catholic country and is one of a few countries in Europe where the percentage of people declaring themselves as non-believing remains rather low. Thus, most young Poles are brought up in Catholic families and receive religious instruction at school.

The purpose of this study is to estimate the effects of religiosity and gender on the risk of first intercourse before age 18 among university students in Poland. We analysed data from two comparative studies of affective life, sexual behaviour, and attitudes conducted among university students in 2001 and 2013. We used survival analysis techniques to test for relative differences in the effects of religiosity on the timing of first sexual intercourse. While the results confirm that religiosity was a significant differentiating factor in the sexual behaviours of students in Poland, they also show that religiosity was a significant predictor of sexual abstinence only if a young person regarded religion as very important. The unadjusted median age at first sex for the participants who attached no or little importance to religion was more than 2 years lower than the median age among those who considered religion very important and attended church services regularly. The findings also indicate that there were significant gender differences, with young males transitioning to sex earlier than young females, albeit only among the 2001 cohort. The multivariate analyses confirm the absence of significant gender differences in FSI before age 18 within religious groups (controlling for other factors) in the cohort of students born after 1990. The results for control variables are consistent with the literature indicating that growing up in a two-parent household has a protective effect, and that teenage lifestyles are significant. Our observation of a distinct polarity of students with respect to religiosity and the timing of sexual debut may be a starting point for further analyses of FSI determinants.
Relationship between Religion and Unintended Childbearing in Nigeria: A Cross-Regional Perspective
Authors: Oyediran Kola’ A. , Ishola Gbenga , Bankole Akinrinola
Published: July 2020

Context

Childbearing remains a global public health issue, posing an enormous challenge to families, communities, governments, program managers, and researchers, especially in developing countries.

Objective

The study examines the influence of religion on women’s experience of unintended childbearing in Nigeria.

Method

Using the 2018 Demographic and Health Survey, the analysis focused on 13,109 women of reproductive age who had a birth within 2 years preceding the date of the interview. Multivariate logistic regression was used to examine the association between religion and unintended childbearing.

Results

Nearly 13% of births in Nigeria over the last 2 years were unintended. The results showed that Muslims are less likely to experience unintended childbearing compared to Christians (Catholics as well as other Christians). In addition to religion having independent effects on unintended childbearing, the association between religion and unintended childbearing also depends on the region of residence. Muslims in the northern regions are less likely to have unintended births relative to Muslims in the southern regions.

Conclusion

Policy and program interventions to address unintended childbearing should take into consideration the country’s religious diversity as well as regional sociocultural influences on reproductive preferences and behavior.
A prospective study to validate the functional assessment of cancer therapy (FACT) for epidermal growth factor receptor inhibitor (EGFRI)-induced dermatologic toxicities FACT-EGFRI 18 questionnaire: SWOG S1013
Authors: Wong Siu-Fun , Unger Joseph M. , Wade James L. , Wagner Lynne I. , Lacouture Mario E. , Humphries Keisha C. , Moseley Anna , Arnold Kathryn , Velasco Mario R. , Floyd Justin D. , Esparaz Benjamin T. , Barzi Afsaneh , Lenz Heinz-Josef , Koczywas Marianna , Dakhil Shaker , Burton Gary V. , Fisch Michael J. , Henry N. Lynn , Hershman Dawn L. , Moinpour Carol M.
Published: July 2020

Background

Papulopustular rash is a common class effect of epidermal growth factor receptor inhibitors (EGFRI) that can affect patients’ health-related quality of life and cause disruptions to treatment. SWOG S1013 (NCT01416688) is a multi-center study designed to validate the Functional Assessment of Cancer Therapy EGFRI 18 (FACT-EGFRI 18) using 7-items from the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 to assess EGFRI-induced skin-related toxicities and their impact on functional status.

Methods

Patients with a diagnosis of colorectal or lung cancer to receive EGFRI therapies for at least 6 weeks were enrolled. Patient self-assessments using the FACT-EGFRI 18 were completed prior to undergoing CTCAE assessment by trained clinicians at baseline, weekly × 6, and then monthly × 3. The psychometric properties of the FACT-EGFRI 14 (skin toxicity items only) and 18 (plus 2 nail and 2 hair items) were established based on criterion validity, known groups validity, internal consistency reliability, and responsiveness to change.

Results

Of the 146 registered patients, 124 were evaluable. High Cronbach’s alpha (> 0.70) for both FACT-EGFRI 14 and FACT-EGFRI 18 scores across assessment times were observed. Although agreement (i.e. criterion validity) between individual and summary scales of the FACT-EGFRI 18 for assessing skin toxicity was good, agreement with the clinician-reported CTCAE was only fair. The minimal important difference was determined to be 3 points. The results also demonstrated responsiveness to symptom change.

Discussion

Based on the results of this multi-center validation study, the FACT-EGFRI 18 patient-reported outcome instrument provided data from the patient’s perspective yielding unique information as well as complementing clinician-rated CTCAE grades, especially for the symptoms of pain, pruritus, and paronychia.

Conclusions

Good to excellent psychometric properties for the FACT-EGFRI 18 were demonstrated, supporting further use of this patient-reported outcomes measure. Additional validation with a more diverse group of patients should be conducted.
Comparing the efficacy and safety of duloxetine and amitriptyline in the treatment of fibromyalgia: overview of systematic reviews
Authors: de Farias Áurea Dias , Eberle Luciana , Amador Tânia Alves , da Silva Dal Pizzol Tatiane
Published: July 2020

Background

Duloxetine and amitriptyline are antidepressants used in the treatment of fibromyalgia. In published systematic reviews, there is no agreement about which drug is more effective and safer. This study aimed to compare evidence of the efficacy and safety of duloxetine compared with amitriptyline in the treatment of adult patients with fibromyalgia. This work contributes to guiding clinicians on the use of duloxetine or amitriptyline for the treatment of fibromyalgia and provides information for public health decision-makers.

Methods

Overview of systematic reviews of clinical trials comparing duloxetine and amitriptyline in the treatment of fibromyalgia. The reviews were screened in Cochrane, PubMed, EMBASE, and SRDR with no restrictions on language and year of publication, considering that the research was conducted in July 2018 and updated until May 2020. The selection was based on the following criteria: adult patients with a diagnosis of fibromyalgia treated with duloxetine or amitriptyline, comparing the efficacy and safety in pain, fatigue, sleep, and mood disorder symptoms and quality of life, in addition to the acceptability of these antidepressants. The methodological quality and strength of evidence were assessed using the AMSTAR and GRADE instruments.

Results

Eight systematic reviews were selected. Amitriptyline had low evidence for pain, moderate evidence for sleep and fatigue, and high evidence for quality of life. Duloxetine had high quality of evidence in patients with mood disorders. With low evidence, duloxetine has higher acceptability, but is safer in older patients, while amitriptyline is safer for non-elderly individuals.

Conclusion

Both antidepressants are effective in the treatment of fibromyalgia, differing according to the patient’s symptoms and profile.

Registration

PROSPERO: CRD42019116101.
Adolescents’ social needs living with juvenile idiopathic arthritis and their views about digital resources
Authors: Beneitez Imma , Nieto Rubén , Hernández Eulàlia , Boixadós Mercè
Published: July 2020

Background

Juvenile Idiopathic Arthritis (JIA) and its related symptoms (e.g. pain) have been associated with interference in the daily life of adolescents with JIA including their friendships. There is little research in that sense and in consequence, interventions designed to improve this area. The objectives of this study are 1) to gain knowledge about the needs of adolescents with JIA, particularly focused on their friendships; 2) to explore the potential of the Internet to help them, and 3) to determine what kind of online resource would be the best and what elements it should include.

Methods

To achieve the proposed objectives we designed a qualitative study including two phases: the first one exploratory (semi-structured interviews) and the following, confirmatory (online focus group).

Results

14 adolescents were interviewed and 7 participated in the focus group. They reported some social challenges related to their illness: feeling different, criticized by peers, or not believed. Additionally, they specified some of the coping strategies they used, such as disclosing to others that they have JIA, using communication skills, maintaining activities with friends, trying to minimize pain, and ignoring negative comments. Adolescents considered an online resource useful and mentioned that they would like to find general information and to have the possibility to interact with others. They considered Instagram and WhatsApp as good platforms to implement the online resource.

Conclusions

According to their perceptions, adolescents with JIA can benefit from an online resource which delivers information, strategies and facilitates interaction with others.
Guillain-Barré syndrome and SARS-CoV-2
Authors: Lampe Anne , Winschel Alexander , Lang Cornelie , Steiner Thorsten
Published: July 2020

Since January 2020, after Chinese health authorities identified a new type of coronavirus (SARS-CoV-2), the virus has spread throughout China and consecutively throughout the whole world. The most common symptoms include fever and respiratory tract symptoms. Nevertheless, some patients show less common symptoms such as gastrointestinal or neurological manifestations. This article presents the case of a 65-years old man who was presumptively infected with SARS-CoV-2 during his ski vacation in Austria in March 2020 and acutely presented with typical symptoms of Guillain-Barré syndrome.
Transcatheter closure of Patent ductus arteriosus in a child with IVC interruption through standard femoral access: a case report
Authors: Naganur Sanjeev H. , Pruthvi C. R. , Bootla Dinakar , Prasad Krishna , Krishna Santosh V. , Barwad Parag
Published: July 2020

Background

Portsmann and co. performed the first PDA device closure in 1967. The technique and the devices used have evolved since then and are the first choice in managing anatomically feasible patent ductus arteriosus (PDA) for the last 20 years. Though catheter-based closure of PDA is generally a simple procedure, there are instances when the interventionist faces challenges, especially in smaller children, with syndromic features and venous anomalies even when defects are small and pulmonary artery pressures are normal. Although the femoral vein is the relatively risk-free standard access, internal jugular vein, femoral artery, and transhepatic IVC can be used to close the PDA in different anomalies.

The rare venous anomaly of infrahepatic interruption of the IVC with azygous continuation poses technical challenges when percutaneous closure of PDA was attempted through the standard femoral access.

Case presentation

We report a rare case of PDA device closure in a syndromic child with a short neck having interrupted IVC via femoral-azygous venous approach.

Conclusion

Knowledge of the IVC course and its anomalies should be known to the operator before the percutaneous closure of PDA. Although other approaches are available, femoral vein approach can be used in case of interrupted IVC for percutaneous closure of PDA.
A clinical study of suicide in patients admitted in psychiatry unit in Assiut University
Authors: Hassan Wageeh A. N. , Noaman Mostafa M. , Khalifa Hossam , Abdelrahman Ahmed A. , Omar Sally M.
Published: July 2020

Background

This study was performed for clinical study of suicide including risk factors in psychiatric patients admitted in psychiatric unit of Assiut University Hospital (AUH).

Results

We found that frequency of suicidal attempts is more in MDD (major depressive disorder), bipolar disorders followed by schizophrenia. And frequency of suicidal attempts in patients with multiple previous attempts before this one was higher in patients with mood disorders (53.8%) than psychotic and substance-induced disorders (32.3%, 13.8% respectively), with statistically significant difference in patients with MDD as well as there was significant treatment outcome on suicidal behavior.

Conclusion

The frequency of suicidal attempts is more in MDD (major depressive disorder), bipolar disorders followed by schizophrenia. There was significant severity of suicidal behavior in patients with psychotic disorders in comparison to patients with substance-induced disorder or mood disorders.
The correlation between pre-operative ultrasonographic median nerve evaluation and the operative procedure in CTS
Authors: Allam Ahmad Fouad Abdelbaki , Sadek Ahmed Fathy , AbuSamra Manal Fayez , Ismail Ahmed Hamed , Allam Mohammad Fouad Abdel Baki
Published: July 2020

Background

Ultrasonography is a convenient non-invasive diagnostic tool with wide availability and cost effectiveness. Musculoskeletal ultrasonography is a growing field used for diagnosis of many musculoskeletal disorders; carpal tunnel syndrome (CTS) could be one of these disorders. The purpose of this study was to assess the impact of median nerve ultrasonography in carpal tunnel syndrome on surgical management, and its added value in operative techniques selection, and in tailoring the surgical steps. Thirty patients with CTS and thirty normal subjects underwent superficial ultrasonography. The cross-sectional area at different levels and flattening ratios were measured on both groups. The patients who had failed conservative treatment had surgical carpal tunnel release.

Results

There was significant positive correlation between the need for external neurolysis with increased flattening ratio with cutoff values > 4, and between the need for approach extension with increased cross-sectional area difference between pisiform level and pronator quadratus level with cutoff values of cross-sectional area difference > 7.

Conclusions

Ultrasonographic measurements of median nerve in CTS could be helpful in selection and modification of operative procedure including the surgical approach and need for neurolysis.
A longitudinal implementation evaluation of a physical activity program for cancer survivors: LIVESTRONG® at the YMCA
Authors: Faro Jamie M. , Arem Hannah , Heston Ann-Hilary , Hohman Katherine H. , Hodge Heather , Wang Bo , Lemon Stephenie C. , Houston Thomas K. , Sadasivam Rajani S.
Published: July 2020

Purpose

Increased physical activity (PA) levels in cancer survivors are associated with decreased risk of recurrence and mortality as well as additional positive health outcomes. PA interventions have shown to be efficacious, though many lack translation to and sustainability in community settings. We used dimensions of the RE-AIM framework to evaluate LIVESTRONG® at the YMCA, a nation-wide community-based PA program for cancer survivors delivered at Ys.

Methods

This was a longitudinal study design using national LIVESTRONG at the YMCA data compiled between 2010 and 2018. Data is from all YMCAs who deliver LIVESTRONG at the YMCA, submitted by Program Directors to the YMCA-USA. We assessed reach (number of participants), adoption (associations offering the program), implementation (conducting 3 fidelity checks), and organizational level maintenance (associations recently offering program). We also examined relationships between organizational characteristics (years of program existence and association area household income) and program implementation factors with member conversion rates.

Results

As of 2018, LIVESTRONG at the YMCA has reached 62,044 survivors and 245 of the 840 (29.2%) of Y associations have adopted the program. Among the adopters, 91% were aware of fidelity checks; implementation of observational (62.3%), goal setting (49.9%), and functional (64.6%) checklists varied. Most (95.1%) adopters reported offering ≥ 1 LIVESTRONG session per year (organizational-level maintenance) and a facility-level mean membership conversion percentage of 46.9 ± 31.2%. Fewer years implementing the program and higher association area household income were significantly associated with a greater membership conversion rate vs their comparison. In a multiple regression model controlling for organizational characteristics, conducting the fidelity checks independently (observational, β = 8.41; goal-setting, β = 9.70; and functional, β = 9.61) and collectively (β = 10.82; 95% CI 5.90–16.80) was positively associated with higher membership conversion rates.

Conclusions

LIVESTRONG at the YMCA, in its early years, has shown promise for high reach, while adoption at more associations could be facilitated. Implementing fidelity checks along with organizational characteristics were associated with membership conversion rate. Identification of association-level strategies to increase reach, adoption, implementation, and maintenance may increase the impact of this community-based PA program.
Telemedicine During the COVID-19 Pandemic: Impact on Care for Rare Cancers
Authors: Smrke Alannah , Younger Eugenie , Wilson Roger , Husson Olga , Farag Sheima , Merry Eve , Macklin-Doherty Aislinn , Cojocaru Elena , Arthur Amani , Benson Charlotte , Miah Aisha B. , Zaidi Shane , Gennatas Spyridon , Jones Robin L.
Published: July 2020

PURPOSE

Many patients with cancer, often those with rare cancers such as sarcomas, travel long distances to access expert care. The COVID-19 pandemic necessitated widespread changes in delivery of cancer care, including rapid adoption of telemedicine-based care. We aimed to evaluate the impact of telemedicine on patients, clinicians, and care delivery at the Royal Marsden Hospital (RMH) Sarcoma Unit during the pandemic.

METHODS

Data were extracted from patient records for all planned outpatient appointments at the RMH Sarcoma Unit from March 23 to April 24, 2020. Patients and clinicians completed separate questionnaires to understand their experiences.

RESULTS

Of 379 planned face-to-face appointments, 283 (75%) were converted to telemedicine. Face-to-face appointments remained for patients who needed urgent start of therapy or performance status assessment. Patients lived on average > 1.5 hours from RMH. Patient satisfaction (n = 108) with telemedicine was high (mean, 9/10), and only 48% (n = 52/108) would not want to hear bad news using telemedicine. Clinicians found telemedicine efficient, with no associated increased workload, compared with face-to-face appointments. Clinicians indicated lack of physical examination did not often affect care provision when using telemedicine. Most clinicians (n = 17; 94%) believed telemedicine use was practice changing; congruently, 80% (n = 86/108) of patients desired some telemedicine as part of their future care, citing reduced cost and travel time.

CONCLUSION

Telemedicine can revolutionize delivery of cancer care, particularly for patients with rare cancers who often live far away from expert centers. Our study demonstrates important patient and clinician benefits; assessment of longer-term impact on patient outcomes and health care systems is needed.
Primary Care Provider Involvement in Thyroid Cancer Survivorship Care
Authors: Radhakrishnan Archana , Reyes-Gastelum David , Gay Brittany , Hawley Sarah T , Hamilton Ann S , Ward Kevin C , Wallner Lauren P , Haymart Megan R
Published: July 2020

Context

While prior research has examined how primary care providers (PCPs) can care for breast and colon cancer survivors, little is known about their role in thyroid cancer survivorship.

Objective

To understand PCP involvement and confidence in thyroid cancer survivorship care.

Design/Setting/Participants

We surveyed PCPs identified by thyroid cancer patients from the Georgia and LA SEER registries (n = 162, response rate 56%). PCPs reported their involvement in long-term surveillance and confidence in handling survivorship care (role of random thyroglobulin levels and neck ultrasound, and when to end long-term surveillance and refer back to the specialist). We examined: 1) PCP-reported factors associated with involvement using multivariable analyses; and 2) bivariate associations between involvement and confidence in handling survivorship care.

Main Outcome Measures

PCP involvement (involved vs not involved) and confidence (high vs low).

Results

Many PCPs (76%) reported being involved in long-term surveillance. Involvement was greater among PCPs who noted clinical guidelines as the most influential source in guiding treatment (OR 4.29; 95% CI, 1.56-11.82). PCPs reporting high confidence in handling survivorship varied by aspects of care: refer patient to specialist (39%), role of neck ultrasound (36%) and random thyroglobulin levels (27%), and end long-term surveillance (14%). PCPs reporting involvement were more likely to report high confidence in discussing the role of random thyroglobulin levels (33.3% vs 7.9% not involved; P < 0.01).

Conclusions

While PCPs reported being involved in long-term surveillance, gaps remain in their confidence in handling survivorship care. Thyroid cancer survivorship guidelines that delineate PCP roles present one opportunity to increase confidence about their participation.
Risk Factors for Intraoperative Hypoglycemia in Children: A Multicenter Retrospective Cohort Study
Authors: Riegger Lori Q. , Leis Aleda M. , Golmirzaie Kristine H. , Malviya Shobha
Published: July 2020

BACKGROUND:

Intraoperative hypoglycemia can result in devastating neurologic injury if not promptly diagnosed and treated. Few studies have defined risk factors for intraoperative hypoglycemia. The authors sought to characterize children with intraoperative hypoglycemia and determine independent risk factors in a multicenter cohort.

METHODS:

This retrospective multicenter study included all patients <18 years undergoing an anesthetic from January 1, 2012, to December 31, 2016, at 12 institutions participating in the Multicenter Perioperative Outcomes Group (MPOG). The primary outcome was blood glucose <60 mg/dL (3.3 mmol/L). Data collected included patient characteristics, comorbidities, and intraoperative factors. A multivariable logistic regression model was used to identify independent predictors of intraoperative hypoglycemia.

RESULTS:

Blood glucose was measured in 26,142 of 394,231 (6.6%) cases. Of these, 1017 (3.9%) had a glucose <60 mg/dL (3.3 mmol/L). Independent predictors for intraoperative hypoglycemia identified were age <30 days (estimated adjusted odds ratio [AOR] vs ≥5 years 4.2; 95% confidence interval [CI], 3.4–5.3), age 30 days to <5 years (estimated AOR vs ≥5 years 2.7; 95% CI, 2.3–3.2), weight for age <5th percentile (estimated AOR, 1.6; 95% CI, 1.4–1.9), American Society of Anesthesiologists (ASA) status ≥III (estimated AOR, 1.3; 95% CI, 1.1–1.6), presence of a gastric or jejunal tube (estimated AOR, 1.3; 95% CI, 1.1–1.6), poor feeding (estimated AOR, 1.5; 95% CI, 1.2–1.7), and abdominal surgery (estimated AOR, 1.4; 95% CI, 1.1–1.7). Eighty percent of hypoglycemia occurred in children <5 years of age and in children <20 kg.

CONCLUSIONS:

Young age, weight for age <5th percentile, ASA status ≥III, having a gastric or jejunal tube, poor feeding, and abdominal surgery were risk factors for intraoperative hypoglycemia in children. Monitoring of blood glucose is recommended in these subsets of children.