bluuebunny/crossref_metadata_2025 huggingface dataset:
Unmet healthcare needs among middle-aged and older adults in China
Authors: Gao Qian , Prina Matthew , Wu Yu-Tzu , Mayston Rosie
Published: October 2021

Background

Unmet healthcare needs have increasingly been recognised as an indicator of equity of healthcare access and utilisation, having the potential to capture frailty of health and social protection systems.

Objectives

This study aimed to estimate the prevalence of unmet healthcare needs and its correlates among middle-aged and older adults in China.

Methods

This study is based on analyses of the China Health and Retirement Longitudinal Study carried out in 2011 among Chinese adults aged 45 years and above. Multivariable logistic regression models were conducted to examine associated factors, stratified by rural or urban residence. Reasons for having unmet needs for inpatient and outpatient services were also analysed.

Results

Among 14,774 participants, the prevalence of unmet healthcare needs was 13.0% (95% confidence interval 12.3–13.8%) and was higher in rural areas. The most prevalent reasons for unmet need for inpatient and outpatient care were ‘not enough money’ and ‘illness is not serious, don’t need treatment’, respectively. The respondents who were unmarried, employed, had poor self-reported health, needed help with activities of daily living, reported lower life satisfaction, multiple chronic conditions and depressive symptoms had increased odds of unmet healthcare needs.

Conclusion

This study suggests that unmet healthcare needs are more concentrated among people living with multiple health conditions and mental health problems in China. If universal health coverage goals and sustainable development goal 3 are to be met, it is essential that effective mechanisms for addressing unmet healthcare needs are identified.
Biogeographic breaks in the Atlantic Forest: evidence for Oligocene/Miocene diversification inBertolonia(Melastomataceae)
Authors: Bacci Lucas F , Reginato Marcelo , Bochorny Thuane , Michelangeli Fabián A , Amorim André M , Goldenberg Renato
Published: October 2021

The distribution of major clades in Bertolonia (Melastomataceae) is congruent with subareas of the Atlantic Forest, providing an opportunity to estimate ages of historical breaks in the Atlantic Forest, from its major north/south split to more restricted local radiations. The role of niche conservatism in driving diversification of Bertolonia is also analysed and discussed in the light of its historical distribution. We estimated the age of the diversification events, gathered the climatic envelopes of species and clades, generated bioregions for the Atlantic Forest and reconstructed the ancestral areas of speciation for the genus. Our analysis subdivided the Atlantic Forest in five subareas, three of them in the northern and two in the southern Atlantic Forest. We also recovered a deep north/south divergence of the Atlantic Forest in the Oligocene (c. 30 Mya) followed by subsequent local radiations in both regions and a south-eastern/southern division in the Miocene. Later diversification happened mostly from the Mid-Miocene to Pliocene/Pleistocene with several dispersal events, mostly between neighbouring areas. We corroborated this assumption demonstrating that closely related lineages tend to occur in habitats with similar climatic conditions, mainly related to temperature. Our analyses on Bertolonia effectively captured relatively old historical events in the Atlantic Forest, such as the north/south division in the Oligocene and south/south-eastern split in the Miocene, but also recent ones, such as climatic fluctuations and forest fragmentation in the Quaternary. We indicate here for the first time that, for some organisms, the well-known north/south split of the Atlantic Forest could be older than expected. Recent radiation events occurred mainly on a regional basis after this deep division of the domain and the subclades that were recovered showed a significant climatic niche conservatism.
A re-reading of Gandhi’s and Ambedkar’s emancipatory discourses for social action against untouchability
Authors: Biswas Sujay
Published: October 2021

Gandhi and Ambedkar offer a fascinating picture of community organizers fighting against caste oppression and caste discrimination. Both were committed to transforming the social, economic, political, and cultural conditions of ‘Dalits’†. They claimed that only through social action could societal transformation take place. As a result, they placed a strong emphasis on mobilizing the public against untouchability. They envisioned the removal of untouchability through popular struggles and popular participation. Not only did Gandhi and Ambedkar undertake popular campaigns, but they also saw them as necessary and beneficial. This paper explores the implications of integrating the constructs of the Gandhian and Ambedkarian models to tackle the problem of untouchability. It re-reads the Constitution of the Anti-Untouchability League (AUL) which was prepared by Gandhi himself in January 1935 in conjunction with a comprehensive letter penned by Ambedkar in November 1932, containing a plan of action for the AUL to carry out for the uplift of ‘Dalits’, to shed light on the lessons that are still important for the modern-day community organizers in India. The paper argues that synergizing Gandhi’s and Ambedkar’s emancipatory discourses can enrich the present-day activism for social action combatting untouchability.
Systems estimation of a structural model of distribution and demand in the US economy
Authors: Blecker Robert A , Cauvel Michael , Kim Y K
Published: October 2021

This paper investigates non-cyclical, short-run relationships between income distribution and the components of aggregate demand in the US from 1963–2016. Previous studies using this ‘structural’ methodology have typically found that demand is wage-led in most large, advanced economies. However, these studies have been criticised for treating total output and the wage share as exogenous, potentially leading to simultaneity bias. This paper corrects for such possible bias as well as common shocks to the equations by using systems GMM. Surprisingly, these estimates imply that private-sector aggregate demand is more, rather than less, wage-led (or in some cases, less profit-led) compared with OLS estimates of identically specified models. This paper is also the first to provide separate estimates of non-residential and residential investment functions and to distinguish the effects of shocks to different underlying determinants of the wage share (unit labour costs and firms’ monopoly power), finding that these differ qualitatively.
PBFL: Communication-Efficient Federated Learning via Parameter Predicting
Authors: Li Kaiju , Xiao Chunhua
Published: October 2021

Federated learning (FL) is an emerging privacy-preserving technology for machine learning, which enables end devices to cooperatively train a global model without uploading their local sensitive data. Because of limited network bandwidth and considerable communication overhead, communication efficiency has become an essential bottleneck for FL. Existing solutions attempt to improve this situation by reducing communication rounds while usually come with more computation resource consumption or model accuracy deterioration. In this paper, we propose a parameter Prediction-Based DL (PBFL). In which an extended Kalman filter-based prediction algorithm, a practical prediction error threshold setting mechanism and an effective global model updating strategy are included. Instead of collecting all updates from participants, PBFL takes advantage of predicting values to aggregate the model, which substantially reduces required communication rounds while guaranteeing model accuracy. Inspired by the idea of prediction, each participant checks whether its prediction value is out of the tolerance threshold limits and only uploads local updates that have an inaccurate prediction value. In this way, no additional local computational resources are required. Experimental results on both multilayer perceptrons and convolutional neural networks show that PBFL outperforms the state-of-the-art methods and improves the communication efficiency by >66% with 1% higher model accuracy.
Intraspecific Variation in the Rates of Mutations Causing Structural Variation in Daphnia magna
Authors: Ho Eddie K H , Schaack Sarah
Published: October 2021

Mutations that cause structural variation are important sources of genetic variation upon which other evolutionary forces can act, however, they are difficult to observe and therefore few direct estimates of their rate and spectrum are available. Understanding mutation rate evolution, however, requires adding to the limited number of species for which direct estimates are available, quantifying levels of intraspecific variation in mutation rates, and assessing whether rate estimates co-vary across types of mutation. Here, we report structural variation-causing mutation rates (svcMRs) for six categories of mutations (short insertions and deletions, long deletions and duplications, and deletions and duplications at copy number variable sites) from nine genotypes of Daphnia magna collected from three populations in Finland, Germany, and Israel using a mutation accumulation approach. Based on whole-genome sequence data and validated using simulations, we find svcMRs are high (two orders of magnitude higher than base substitution mutation rates measured in the same lineages), highly variable among populations, and uncorrelated across categories of mutation. Furthermore, to assess the impact of scvMRs on the genome, we calculated rates while adjusting for the lengths of events and ran simulations to determine if the mutations occur in genic regions more or less frequently than expected by chance. Our results pose a challenge to most prevailing theories aimed at explaining the evolution of the mutation rate, underscoring the importance of obtaining additional mutation rate estimates in more genotypes, for more types of mutation, in more species, in order to improve our future understanding of mutation rates, their variation, and their evolution.
Concurrent Evolution of Antiaging Gene Duplications and Cellular Phenotypes in Long-Lived Turtles
Authors: Glaberman Scott , Bulls Stephanie E , Vazquez Juan Manuel , Chiari Ylenia , Lynch Vincent J
Published: October 2021

There are many costs associated with increased body size and longevity in animals, including the accumulation of genotoxic and cytotoxic damage that comes with having more cells and living longer. Yet, some species have overcome these barriers and have evolved remarkably large body sizes and long lifespans, sometimes within a narrow window of evolutionary time. Here, we demonstrate through phylogenetic comparative analysis that multiple turtle lineages, including Galapagos giant tortoises, concurrently evolved large bodies, long lifespans, and reduced cancer risk. We also show through comparative genomic analysis that Galapagos giant tortoises have gene duplications related to longevity and tumor suppression. To examine the molecular basis underlying increased body size and lifespan in turtles, we treated cell lines from multiple species, including Galapagos giant tortoises, with drugs that induce different types of cytotoxic stress. Our results indicate that turtle cells, in general, are resistant to oxidative stress related to aging, whereas Galapagos giant tortoise cells, specifically, are sensitive to endoplasmic reticulum stress, which may give this species an ability to mitigate the effects of cellular stress associated with increased body size and longevity.
Novel susceptibility loci for steroid-associated osteonecrosis of the femoral head in systemic lupus erythematosus
Authors: Suetsugu Hiroyuki , Kim Kwangwoo , Yamamoto Takuaki , Bang So-Young , Sakamoto Yuma , Shin Jung-Min , Sugano Nobuhiko , Kim Ji Soong , Mukai Masaya , Lee Yeon-Kyung , Ohmura Koichiro , Park Dae Jin , Takahashi Daisuke , Ahn Ga-Young , Karino Kohei , Kwon Young-Chang , Miyamura Tomoya , Kim Jihye , Nakamura Junichi , Motomura Goro , Kuroda Takeshi , Niiro Hiroaki , Miyamoto Takeshi , Takeuchi Tsutomu , Ikari Katsunori , Amano Koichi , Tada Yoshifumi , Yamaji Ken , Shimizu Masato , Atsumi Takashi , Seki Taisuke , Tanaka Yoshiya , Kubo Toshikazu , Hisada Ryo , Yoshioka Tomokazu , Yamazaki Mihoko , Kabata Tamon , Kajino Tomomichi , Ohta Yoichi , Okawa Takahiro , Naito Yohei , Kaneuji Ayumi , Yasunaga Yuji , Ohzono Kenji , Tomizuka Kohei , Koido Masaru , Matsuda Koichi , Okada Yukinori , Suzuki Akari , Kim Bong-Jo , Kochi Yuta , Lee Hye-Soon , Ikegawa Shiro , Bae Sang-Cheol , Terao Chikashi
Published: October 2021

Osteonecrosis of the femoral head (ONFH) involves necrosis of bone and bone marrow of the femoral head caused by ischemia with unknown etiology. Previous genetic studies on ONFH failed to produce consistent results, presumably because ONFH has various causes with different genetic backgrounds and the underlying diseases confounded the associations. Steroid-associated ONFH (S-ONFH) accounts for one-half of all ONFH, and systemic lupus erythematosus (SLE) is a representative disease underlying S-ONFH. We performed a genome-wide association study (GWAS) to identify genetic risk factors for S-ONFH in patients with SLE. We conducted a two-staged GWAS on 636 SLE patients with S-ONFH and 95 588 non-SLE controls. Among the novel loci identified, we determined S-ONFH-specific loci by comparing allele frequencies between SLE patients without S-ONFH and non-SLE controls. We also used Korean datasets comprising 148 S-ONFH cases and 37 015 controls to assess overall significance. We evaluated the functional annotations of significant variants by in silico analyses. The Japanese GWAS identified 4 significant loci together with 12 known SLE susceptibility loci. The four significant variants showed comparable effect sizes on S-ONFH compared with SLE controls and non-SLE controls. Three of the four loci, MIR4293/MIR1265 [odds ratio (OR) = 1.99, P-value = 1.1 × 10−9)], TRIM49/NAALAD2 (OR = 1.65, P-value = 4.8 × 10−8) and MYO16 (OR = 3.91, P-value = 4.9 × 10−10), showed significant associations in the meta-analysis with Korean datasets. Bioinformatics analyses identified MIR4293, NAALAD2 and MYO16 as candidate causal genes. MIR4293 regulates a PPARG-related adipogenesis pathway relevant to S-ONFH. We identified three novel susceptibility loci for S-ONFH in SLE.
Inflammatory Process and Immune System in Major Depressive Disorder
Authors: Ruiz Norma Angélica Labra , Del Ángel Daniel Santamaría , Brizuela Norma Osnaya , Peraza Armando Valenzuela , Olguín Hugo Juárez , Soto Mónica Punzo , Guzmán David Calderón
Published: October 2021

Major depressive disorder (MDD) is one of the most common psychiatric illnesses in the general population. In mental disorders, the activation of inflammatory pathways in the brain is a major producer of excitotoxicity and an inducer of oxidative stress. The occurrence of these 2 events is partly responsible for the neuronal damage inherent in patients with mental disorders. In the case of MDD, the release of hormone and increase in pro-inflammatory cytokines in plasma and indicators of oxidative stress have been identified as consequences of this event. The most important affectations in patients with MDD are changes in their cognitive and executive functions due to brain inflammation. Hence, these biomarkers can serve as diagnostic and severity classification tools and treatment. In this work, we described the communication pathway between the immune and neuroendocrine systems in MDD and suggested possible therapeutic options for the disease.
Controversial collections
Authors: Tietze Anna
Published: October 2021

This study discusses the works of art presented by Randlord Max Michaelis and his wife, Lilian, to public institutions in South Africa, particularly in Cape Town. The study notes that benefactions of this kind were unusual for the Randlords– many of whom were, like Michaelis, of German-Jewish origin – and considers the gifts in the context of South African union and the drive to provide a ‘new’ nation with a humanist cultural heritage. But it observes that the works of art presented by the Michaelises – paintings as well as works on paper – prompted as much controversy as gratitude, since they were often judged to be of dubious authenticity. These various gifts, and their reception, are analysed to assess the extent to which this response was justified. Ultimately, it is argued, the honourable intentions of the couple, and some important benefactions, have been undervalued and might have been more positively acknowledged.
How a Legal Fight Against Monsanto Became an Indigenous Self-determination Claim in Mexico
Authors: Torres-Mazuera Gabriela , Ramírez-Espinosa Naayeli
Published: October 2021

This article examines the successful legal battle led by Mayan beekeepers participating within an activist network against the permission granted to Monsanto in 2012 by the Mexican government to commercialize genetically modified soybeans in the Yucatán Peninsula. Our approach emphasizes the relevant role of rights-advocacy lawyers and their organizations working together with local grassroots, Mayan beekeepers and scholars in a legal battle that puts forward the rights to a healthy environment and to indigenous self-determination. We consider the judiciary's response to such demands and, in doing so, we explain why some collective rights, such as the right to free, prior, and informed consultation, were more appealing to Mexican judges while others were blatantly ignored. Likewise, we explore why and how a legal fight against Monsanto GM soybean became a struggle for the recognition of Mayan communities’ self-determination expressed in the right to free consent and self-consultation. Our research sheds light on some positive and unexpected outcomes of legal mobilization against GMOs in the Yucatán Peninsula, while acknowledging that GM soybean, despite being banned, is still produced and marketed illegally in the country.
T-S A43.1+ and the Imitation of the Tiberian Reading Tradition
Authors: Phillips Kim
Published: October 2021

The c. tenth century CE Genizah manuscript T-S A43.1+ is one of the most substantial extant Bible manuscripts from the so-called Palestinian Masoretic tradition. Examining the partial vocalization of the MS reveals that it was produced to assist a reader from within this Palestinian tradition to emulate the prestigious Tiberian reading tradition. The article thereby contributes to the larger discussions surrounding the nature and development of the Palestinian reading tradition, and the relationship between the Palestinian and Tiberian Masoretic traditions.
H i 21 cm observation and mass models of the extremely thin galaxy FGC 1440
Authors: Aditya K , Kamphuis Peter , Banerjee Arunima , Borisov Sviatoslav , Mosenkov Aleksandr , Antipova Aleksandra , Makarov Dmitry
Published: October 2021

We present observations and models of the kinematics and distribution of neutral hydrogen (H i) in the superthin galaxy FGC 1440 with an optical axial ratio a/b = 20.4. Using the Giant Meterwave Radio telescope (GMRT), we imaged the galaxy with a spectral resolution of 1.7 km s−1 and a spatial resolution of 15${_{.}^{\prime\prime}}$9 × 13${_{.}^{\prime\prime}}$5. We find that FGC 1440 has an asymptotic rotational velocity of 141.8 km s−1. The structure of the H i disc in FGC 1440 is that of a typical thin disc warped along the line of sight, but we cannot rule out the presence of a central thick H i disc. We find that the dark matter halo in FGC 1440 could be modelled by a pseudo-isothermal (PIS) profile with $\\ R_{\rm c}/ R_{\rm d} \lt 2$, where Rc is the core radius of the PIS halo and Rd the exponential stellar disc scale length. We note that in spite of the unusually large axial ratio of FGC 1440, the ratio of the rotational velocity to stellar vertical velocity dispersion, $\frac{V_{\rm Rot}}{\sigma _{z}} \sim 5 - 8$, which is comparable to other superthins. Interestingly, unlike previously studied superthin galaxies which are outliers in the log10(j*) − log10(M*) relation for ordinary bulgeless disc galaxies, FGC 1440 is found to comply with the same. The values of j for the stars, gas, and the baryons in FGC 1440 are consistent with those of normal spiral galaxies with similar mass.
Spectral States of OJ 287 blazar from Multiwavelength Observations with AstroSat
Authors: Singh K P , Kushwaha P , Sinha A , Pal Main , Agarwal A , Dewangan G C
Published: October 2021

We present AstroSat soft X-ray, near-UV (NUV), and far-UV (FUV) observations of a blazar, OJ 287, carried out in 2017, 2018, and 2020. The simultaneous observations with NuSTAR in 2017 provide a broad-band look encompassing NUV, FUV, soft, and hard X-rays. Captured in three different broad-band spectral states in three observations, the X-ray spectrum is found to be the hardest during 2018, while the high-energy-end of the simultaneous optical-FUV spectrum shows a steepening that is modelled with a broken power-law spectrum. The spectral energy distribution (SED) in 2017 shows a relatively flatter optical-FUV and soft X-ray spectra, implying an additional emission component. The 2020 optical-FUV spectrum is harder than in 2017 and 2018, with an extremely soft X-ray spectrum and a hardening above ∼1 GeV, similar to the SEDs of High-energy-peaked BL Lac objects (HBL), thereby establishing that this additional emission component has HBL-like properties. The AstroSat multiwavelength observations trace the spectral evolution from the end-phase of the HBL component in 2017 to its disappearance in 2018 followed by its revival in 2020. A single zone leptonic model reproduces the 2018 broad-band spectrum, while the 2017 and 2020 SEDs require an additional HBL-like emitting zone. The spectral evolution of the high-energy-end of optical-UV spectrum, revealed by the FUV observations in 2017 and 2018, strongly suggests that X-ray spectral changes in the normal broad-band spectral state of OJ 287 are primarily due to the evolution of the optical-UV synchrotron spectrum.
Unusual nucleosome formation and transcriptome influence by the histone H3mm18 variant
Authors: Hirai Seiya , Tomimatsu Kosuke , Miyawaki-Kuwakado Atsuko , Takizawa Yoshimasa , Komatsu Tetsuro , Tachibana Taro , Fukushima Yutaro , Takeda Yasuko , Negishi Lumi , Kujirai Tomoya , Koyama Masako , Ohkawa Yasuyuki , Kurumizaka Hitoshi
Published: October 2021

Histone H3mm18 is a non-allelic H3 variant expressed in skeletal muscle and brain in mice. However, its function has remained enigmatic. We found that H3mm18 is incorporated into chromatin in cells with low efficiency, as compared to H3.3. We determined the structures of the nucleosome core particle (NCP) containing H3mm18 by cryo-electron microscopy, which revealed that the entry/exit DNA regions are drastically disordered in the H3mm18 NCP. Consistently, the H3mm18 NCP is substantially unstable in vitro. The forced expression of H3mm18 in mouse myoblast C2C12 cells markedly suppressed muscle differentiation. A transcriptome analysis revealed that the forced expression of H3mm18 affected the expression of multiple genes, and suppressed a group of genes involved in muscle development. These results suggest a novel gene expression regulation system in which the chromatin landscape is altered by the formation of unusual nucleosomes with a histone variant, H3mm18, and provide important insight into understanding transcription regulation by chromatin.
Efficacy and safety of secukinumab in patients with spondyloarthritis and enthesitis at the Achilles tendon: results from a phase 3b trial
Authors: Behrens Frank , Sewerin Philipp , de Miguel Eugenio , Patel Yusuf , Batalov Anastas , Dokoupilova Eva , Kleinmond Christine , Pournara Effie , Shekhawat Ankita , Jentzsch Claudia , Wiedon Annette , Baraliakos Xenofon ,   the ACHILLES study group
Published: October 2021

Objective

ACHILLES aimed to demonstrate efficacy of secukinumab on Achilles’ tendon enthesitis in spondyloarthritis (SpA) patients.

Methods

Patients ≥18 years (n = 204) with active PsA or axial SpA and heel enthesitis were randomized 1:1 to secukinumab 150/300 mg or placebo up to week 24, and thereafter placebo patients were switched to secukinumab.

Results

At week 24, a higher, yet statistically non-significant (P = 0.136), proportion of patients in secukinumab vs placebo reported resolution of Achilles tendon enthesitis in affected foot (42.2% vs 31.4%; odds ratio [OR] = 1.63; 95% CI: 0.87, 3.08). Proportion of patients reporting resolution of enthesitis based on Leeds Enthesitis Index was higher with secukinumab vs placebo (33.3% vs 23.5%; OR = 1.65; 95% CI: 0.85, 3.25) at week 24. Mean change from baseline in heel pain at week 24 was higher in secukinumab patients vs placebo (−2.8 [3.0] vs −1.9 [2.7]). Greater improvements with secukinumab were observed in heel enthesopathy activity and global assessment of disease activity. Imaging evaluation by local reading confirmed heel enthesitis on MRI at screening for all patients. Based on central reading, 56% presented with bone marrow oedema and/or tendinitis; according to Heel Enthesitis MRI Scoring System (HEMRIS) post hoc analysis, 76% had signs of entheseal inflammation while 86% had entheseal inflammation and/or structural changes.

Conclusion

A substantial proportion of patients showed no signs of inflammation on the centrally read MRIs despite a clinical diagnosis of heel enthesitis, thus highlighting that the discrepancy between the clinical and imaging assessments of enthesitis requires further investigation. Although ACHILLES did not meet the primary end point, the study reported clinically meaningful improvements in patient-related outcomes.

Trial registration

clinicaltrials.gov, NCT02771210
Plasma Pyruvate Kinase M2 as a marker of vascular inflammation in giant cell arteritis
Authors: Esen Idil , Jiemy William F , van Sleen Yannick , Bijzet Johan , de Jong Daniel M , Nienhuis Pieter H , Slart Riemer H J A , Heeringa Peter , Boots Annemieke M H , Brouwer Elisabeth
Published: October 2021

Objectives

GCA is a large vessel vasculitis in which metabolically active immune cells play an important role. GCA diagnosis is based on CRP/ESR and temporal artery biopsies (TABs), in combination with 18F-fluorodeoxyglucose ([18F]FDG)-PET/CT relying on enhanced glucose uptake by glycolytic macrophages. Here, we studied circulating Pyruvate Kinase M2 (PKM2), a glycolytic enzyme, as a possible systemic marker of vessel wall inflammation in GCA.

Methods

Immunohistochemical detection of PKM2 was performed on inflamed (n = 12) and non-inflamed (n = 4) TABs from GCA patients and non-GCA (n = 9) patients. Dimeric PKM2 levels were assessed in plasma of GCA patients (n = 44), age-matched healthy controls (n = 41), metastatic melanoma patients (n = 7) and infection controls (n = 11). CRP, ESR and macrophage markers calprotectin and YKL-40 were correlated with plasma PKM2 levels. To detect the cellular source of plasma PKM2 in tissue, double IF staining was performed on inflamed GCA TABs. [18F]FDG-PET scans of 23 GCA patients were analysed and maximum standard uptake values and target to background ratios were calculated.

Results

PKM2 is abundantly expressed in TABs of GCA patients. Dimeric PKM2 plasma levels were elevated in GCA and correlated with CRP, ESR, calprotectin and YKL-40 levels. Elevated plasma PKM2 levels were downmodulated by glucocorticoid treatment. PKM2 was detected in both macrophages and T cells at the site of vascular inflammation. Circulating PKM2 levels correlated with average target to background ratios PET scores.

Conclusion

Elevated plasma PKM2 levels reflect active vessel inflammation in GCA and may assist in disease diagnosis and in disease monitoring.
Trends in Hospitalizations for Serious Infections Among People With Opioid Use Disorder in Ontario, Canada
Authors: Gomes Tara , Kitchen Sophie A. , Tailor Lauren , Men Siyu , Murray Regan , Bayoumi Ahmed M. , Campbell Tonya , Young Samantha , Kolla Gillian
Published: October 2021

Objectives

Opioid use among people who inject drugs can lead to serious complications, including infections. We sought to study trends in rates of these complications among people with an opioid use disorder (OUD) and the sequelae of those hospitalizations.

Methods

We analyzed all inpatient hospitalizations for serious infections (infective endocarditis [IE], spinal infections, nonvertebral bone infections, and skin or soft tissue infections) among people with OUD in Ontario between 2013 and 2019. We reported the population adjusted rate of hospitalizations for serious infections annually, stratified by type of infection and prevalence of prior opioid agonist therapy and hydromorphone prescribing. We reported characteristics of hospitalizations and 30–day mortality in the most recent 2 years.

Results

Among people with OUD there was a 167% increase in rates of IE (7.7-20.6 per million residents; P < 0.01), a 394% increase in rates of spinal infections (3.4–16.8 per million residents; P < 0.01), a 191% increase in rates of nonvertebral bone infections (8.9 to 25.9 per million residents; P < 0.01), and a 147% increase in infections of the skin or soft tissue (32.1–79.4 per million residents; P < 0.01) over 7 years in Ontario. Death in-hospital and within 30 days of discharge was highest among those with IE (11.5% and 15.9%, respectively), and lower among those with other infections (<5%).

Conclusions

Rates of serious infections among people with OUD are rising, placing a significant burden on patients. These findings suggest that early intervention and treatment of infections in this population are needed to prevent downstream harm.
The Association Between Hearing Loss and Surgical Complications in Older Adults
Authors: Huang Ryan J. , Riska Kristal M. , Gordee Alexander , Peskoe Sarah B. , Francis Howard W. , Witsell David L. , Smith Sherri L.
Published: October 2021

Objectives:

In this study, we sought to evaluate whether older patients with hearing loss who underwent surgery were at greater risk of postsurgical complications, increased inpatient length-of-stay (LOS), and hospital readmission.

Design:

This was a retrospective cohort study of patients receiving surgery at a tertiary medical center. Utilizing electronic health record data from two merged datasets, we identified patients 65 years and older, undergoing major surgery between January 1, 2014 and January 31, 2017, and who had audiometric evaluation before surgery. Patients were classified as having either normal hearing or hearing loss based on pure-tone average in the better ear. A Generalized Estimating Equations approach was used to fit multivariable regression models for outcome variables of interest.

Results:

Of patients ≥65 years undergoing major surgery in our time frame, a total of 742 surgical procedures were performed on 621 patients with available audiometric data. After adjusting for age, sex, race, and comorbidities, hearing loss was associated with an increase in the odds of developing postoperative complications. Every 10 dB increase in hearing loss was associated with a 14% increase in the odds of developing a postoperative complication (odds ratio = 1.14, 95% confidence interval = 1.01–1.29, p = 0.031). Hearing loss was not significantly associated with increased hospital LOS, 30-day readmission, or 90-day readmission.

Conclusions:

Hearing loss was significantly associated with developing postoperative complications in older adults undergoing major surgery. Screening for hearing impairment may be a useful addition to the preoperative assessment and perioperative management of older patients undergoing surgery.
A treat-to-target approach is needed for Behçet's syndrome
Authors: Hatemi Gülen
Published: October 2021

Purpose of review

Treat-to-target (T2T) approach has improved outcomes in chronic diseases. The aim of this review is to discuss the long-term goals and review the evidence for possible targets that would predict the achievement of these goals for developing a T2T strategy for Behçet's syndrome.

Recent findings

There are no trials comparing a tight control strategy to standard care in Behçet's syndrome but recent studies suggest better outcomes with earlier use of biologic agents compared with sustained conventional treatment. Fluorescein angiography may be a reliable tool for assessing remission in uveitis as fluorescein angiography findings were shown to predict relapses and long-term visual outcome. Good recanalization on Doppler ultrasonography can be a target for venous involvement as this was the only predictor of relapse. Fecal calprotectin levels were associated with small intestinal and colonic ulcers and may be used as a surrogate for remission of gastrointestinal involvement.

There are several new treatment modalities that are tried for Behçet's syndrome and ongoing work on outcome measures for reliable disease assessment. In order to ensure the wise and efficient use of treatment modalities, development and implementation of T2T strategies are needed through multidisciplinary and multinational efforts that include patient research partners.
The Role of a Statewide Critical Care Coordination Center in the Coronavirus Disease 2019 Pandemic—and Beyond
Authors: Galvagno Samuel M. , Naumann Andrew , Delbridge Theodore R. , Kelly Melissa A. , Scalea Thomas M.
Published: October 2021

OBJECTIVE:

Public health emergencies, like the coronavirus disease 2019 pandemic, can cause unprecedented demand for critical care services. We describe statewide implementation of a critical care coordination center designed to optimize ICU utilization. To describe a centralized critical care coordination center designed to ensure appropriate intensive care resource allocation.

DESIGN:

A descriptive case series of consecutive critically ill adult patients.

SETTING:

ICUs, emergency departments, freestanding medical facilities in the state of Maryland and adjacent states, serving a population of over 6,045,000 across a land area of 9,776 sq mi (25,314 km2).

PATIENTS:

Adults requiring intensive care.

INTERVENTIONS:

Consultation with a critical care physician and emergency medical services clinician.

MEASUREMENTS AND MAIN RESULTS:

Number of consults, number of patient movements to higher levels of critical care, and number of extracorporeal membrane oxygenation referrals for both patients with and without coronavirus disease 2019. Over a 6-month period, critical care coordination center provided 1,006 critical care consultations and directed 578 patient transfers for 58 hospitals in the state of Maryland and adjoining region. Extracorporeal membrane oxygenation referrals were requested for 58 patients. Four-hundred twenty-eight patients (42.5%) were managed with consultation only and did not require transfer.

CONCLUSIONS:

Critical care coordination center, staffed 24/7 by a critical care physician and emergency medical service clinician, may improve critical care resource use and patient flow. This serves as a model for a tiered regionalized system to ensure that the demand for critical care services may be met during a pandemic and beyond.
Sacubitril/Valsartan in the Treatment of Right Ventricular Dysfunction in Patients With Heart Failure With Reduced Ejection Fraction: A Real-world Study
Authors: Yang Ying , Shen Chao , Lu Jiangting , Fu Guosheng , Xiong Cui
Published: October 2021

Objective:

There is increasing evidence supporting the efficacy of sacubitril/valsartan for treating left heart failure, but few studies have investigated its effects on right ventricular (RV) dysfunction. This study aimed to explore the effects of sacubitril/valsartan on RV dysfunction among patients with heart failure with reduced ejection fraction (HFrEF).

Methods:

A total of 93 patients with HFrEF with RV dysfunction who were hospitalized from January 2018 through June 2019 were included in this retrospective observational study. All patients received their first sacubitril/valsartan treatment as in patients during the study period. We excluded 11 patients who were lost to follow-up or had incomplete heart echocardiography data. After 6 months of follow-up, we re-evaluated New York Heart Association Functional Classification and performed echocardiography to identify changes in relevant variables after treatment.

Results:

At baseline, 24% of the patients had an initial sacubitril/valsartan regimen of 12/13 mg twice daily and 76% of the patients had an initial dose of 24/26 mg twice daily. During follow-up, 27% of patients increased their dosage to 49/50 mg twice daily, 68% of patients were taking 24/26 mg twice daily, and 5% of the patients were still taking 12/13 mg twice daily. We found that sacubitril/valsartan treatment was associated with significant improvements in the following RV function indicators: tricuspid annular plane systolic excursion, tricuspid annular s′ peak velocity (S′), RV fractional area change, and pulmonary artery systolic pressure (PASP). Crude linear regression analysis revealed that a tricuspid annular plane systolic excursion improvement was positively correlated with a change in left ventricular ejection fraction (LVEF) and negatively correlated with a change in left ventricular end-systolic volume (LVESV). However, these correlations were nonexistent after adjusting for multiple echocardiographic variables.

Conclusions:

In patients with RV dysfunction and HFrEF, sacubitril/valsartan may improve RV remodeling. This influence may be independent of left cardiac remodeling.
Hemodynamic Effects of Levosimendan in Outpatients With Advanced Heart Failure: An Echocardiographic Pilot Study
Authors: Masarone Daniele , Melillo Enrico , Errigo Vittoria , Martucci Maria Luigia , Pacileo Roberta , Pollesello Piero , Petraio Andrea , Pacileo Giuseppe
Published: October 2021

Infusions of levosimendan delivered in ambulatory/outpatient settings have been shown to improve quality of life and reduce hospitalizations in patients with advanced heart failure (HF). The aim of this pilot study was to evaluate the effects of ambulatory infusion of levosimendan on echocardiographic markers of perfusion, congestion, and cardiovascular efficiency. Thirty patients with diagnosed advanced HF underwent ambulatorial infusion of levosimendan at a total dose of 6.25 mg as a part of a repetitive biweekly treatment strategy with the inotrope. Standardized transthoracic echocardiography and Doppler examinations, were performed 1 hour before and 48 hours after completion of ambulatory infusion. At 48 hours after ambulatory infusion of levosimendan, a significant increase in the stroke volume (37.47 ± 12.38 mL/beat vs. 45.47 ± 14.48 mL/beat; P < 0.05) and cardiac output (2.64 ± 0.66 L/min vs. 3.26 ± 0.57 L/min; P < 0.05) occurred. Significant postreductions versus prereductions were also recorded in left atrial pressure (27.37 ± 6.62 mm Hg vs. 22.82 ± 4.17 mm Hg; P < 0.01), mean pulmonary artery pressure (27.69 ± 4.64 mm Hg vs. 23.24 ± 5.32; P < 0.01), and inferior vena cava diameter (23.81 ± 7.63 mm vs. 18.53 ± 4.82 mm; P < 0.01). Significant improvements were noted in the resting cardiac power output (0.46 ± 0.15 watt vs. 0.53 ± 0.22 watt; P < 0.01) and the resting cardiac power index (0.24 ± 0.08 watt/m2 vs. 0.28 ± 0.11 watt/m2; P < 0.01). In outpatients with advanced HF, infusion of levosimendan was associated with hemodynamic responses that may contribute to the clinical benefit previously reported in such patients.
Chronic Ventricular Assist Device Support in Adult Congenital Heart Disease Patients: A Children’s Hospital Perspective
Authors: Perry Tanya , Lorts Angela , Morales David L. S. , Fields Katrina , Fahnhorst Sarah E. , Brandewie Katie , Lubert Adam , Villa Chet R.
Published: October 2021

With improvement in early surgical outcomes in patients with complex congenital heart disease, most patients are now expected to survive to adulthood. As adult congenital heart disease (ACHD) patients age, they are at risk of heart failure, which has become the leading cause of mortality in ACHD. Some who develop advanced heart failure may not be candidates for transplant, and chronic ventricular assist device (VAD) therapy may be the only means of survival. There is limited experience with chronic VAD therapy in ACHD patients, and the outcomes are not well delineated. We describe our center’s experience with chronic VAD therapy in ACHD patients receiving care exclusively within our children’s hospital.
Clinicopathological analysis of 67 cases of esophageal neuroendocrine carcinoma and the effect of postoperative adjuvant therapy on prognosis
Authors: Liu Shenxiang , Ge Xiaolin , Gao Zhenzhen , Zhou Qing , Shi Yu , Jiang Wangrong , Yang Min , Sun Xinchen
Published: October 2021

The clinicopathological properties of esophageal neuroendocrine carcinoma (ENEC) and its optimal therapy have not been widely studied, as the disease is not common. Consequently, we conducted a retrospective study to analyze the clinical features as well as the prognosis of patients with surgically resected ENEC.

The clinicopathological data of patients with ENEC who underwent esophagostomy with regional lymphadenectomy at Jiangsu Province People's Hospital and Jiangsu Provincial Tumor Hospital starting January 2008 until December 2014 were collected.

Ninety-two cases of ENEC were part of this study. However, only 67 patients were analyzed and followed up. A univariate model for the Cox proportional hazards revealed that prognosis was associated with postoperative adjuvant therapy, age, and lymph node metastasis (P < .05); a multivariate Cox proportional hazards model showed that postoperative adjuvant therapy was a significant independent prognostic factor. Postoperative adjuvant therapy directly affected overall survival, with a significant disparity noted between the groups (P = .022). In this study, patients who received adjuvant therapy had an average time of survival of 39 months (interquartile range: 27.068–50.932 months), while those who did not receive adjuvant therapy had an average survival time of 13 months (interquartile range: 10.129–15.871 months). The survival time was longer in the treated group than in the untreated group (hazard ratio = 0.47; 95% confidence interval: 0.23–0.94; P = .034).

ENEC is a heterogeneous tumor with a very poor prognosis. Combining surgery with adjuvant and/or chemotherapy significantly prolongs the survival of patients, and the optimal treatment for ENEC should be determined with future prospective studies.
Overcoming Obstacles in Professional Development During COVID-19
Authors: Davis Lois , Chappell Hazel
Published: October 2021

The unexpected challenges of COVID-19 forced our nation to “rework” normal practices and routines. Kathy Chappell states that nurse professional development practitioners must be problem focused and solution oriented. Led by a nurse professional development specialist, planners employed innovation and creativity to address the problems found in one professional development program. This article assures readers that remote day-long conferences are well accepted and useful in today’s fast-paced learning environment.
Psychometric Testing of a Nurse Residency Program Stakeholder Evaluation Survey
Authors: Failla Kim Reina , Ecoff Laurie , Stichler Jaynelle F. , Kendal Courtney
Published: October 2021

This article describes the development and psychometric testing of a 43-item nurse residency program stakeholder evaluation. The valid and reliable survey provides nursing professional development practitioners with insight into opportunities to improve nurse residency program design and educational content. Survey results may also substantiate human and capital resources required for effective programs.
Speech Outcomes of Treatment for Velopharyngeal Insufficiency
Authors: Nam Seung Min , Kim Yong Bae , Park Kyong Chan , Park Eun Soo , Choi Chang Yong , Cha Han Gyu , Jung Se A.
Published: October 2021

Background

Velopharyngeal insufficiency involving a large velopharyngeal gap and poor lateral wall movement is referred to as a “black hole” and remains a challenging problem for cleft surgeons. The effect of the pharyngeal flap on this form of velopharyngeal insufficiency is still debatable because a wide pharyngeal flap is associated with a high incidence of airway obstruction. The present study aimed to evaluate the speech outcomes of combined overlapping intravelar veloplasty and dynamic sphincter pharyngoplasty for the treatment of velopharyngeal insufficiency.

Methods

Between March 2016 and June 2019, 15 patients with velopharyngeal insufficiency were treated with a combination of overlapping intravelar veloplasty and dynamic sphincter pharyngoplasty. Preoperative speech evaluation was performed on the basis of perceptual speech evaluation, nasometry, and nasoendoscopy. Postoperative speech evaluation using the same approach as that used preoperatively was performed after completion of speech therapy.

Results

All 15 patients achieved satisfactory velopharyngeal port closure and speech phonation after completion of speech therapy. No additional procedures were performed to improve velopharyngeal port closure and speech production. The preoperative and postoperative results of perceptual speech evaluation, nasometry, and nasoendoscopy evaluation were significantly different (P < 0.01).

Conclusion

Combined treatment with overlapping intravelar veloplasty and dynamic sphincter pharyngoplasty can correct the velopharyngeal insufficiency “black hole” with highly reliable results and minimal risk of airway obstruction.
Use of the O-Z Flap to Repair Scalp Defects After Cancer Tumor Resection
Authors: Lin Jian , Wei Peng , Xu Yi , Wang Guoyao , Wu Kerong , Lin Bingjiang , Wang Yangjian
Published: October 2021

Background:

Large benign and malignant tumors in the scalp cannot be sutured directly after resection. Instead, skin grafting or skin flap repair is the most commonly used techniques. Local tissue depression and lack of hair growth are some of the drawbacks associated with these techniques. The use of a modified local flap (the O-Z flap) may effectively overcome these issues.

Objective:

To explore the application of O-Z flap in wound repair after excision of benign and malignant tumors of the scalp.

Methods:

Between April 2016 and November 2017, the authors treated 6 patients with scalp tumors. They underwent round or oval radical tumor resection with negative margins. Tumor specimens were diagnosed by cryosection during operation. According to the wound defect size and location, surrounding scalp looseness, and hair distribution, 2 rotating flaps in opposite directions were formed on the left and right sides or front and back of the wound. Subsequently, the skin flaps were rotated in opposite directions to repair the wound.

Results:

The scalp tumors comprised 2 cases of basal cell carcinoma, 2 cases of squamous cell carcinoma, 1 case of hair sheath carcinoma, and 1 case of epidermoid cyst. After complete tumor resection, the wound defect area was between 3.0 cm × 3.5 cm and 5.0 cm × 6.0 cm. After operation, approximately 6% of the tip of the skin flap was necrotized. The wounds healed after 4 weeks of dressing treatment. All skin flaps survived in stage I and no complications occurred. All patients were followed up for 3 to 12 months; the scalps were in good condition and no tumor recurrence was found.

Conclusions:

The use of the O-Z flap to repair scalp wounds offers flexible design, good blood circulation, uniform tension, and good hair growth after operation; thus, this technique is suitable for wound repair following scalp tumor resection.