bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting Outcomes in Trauma Patients With Cirrhosis Using Model for End-Stage Liver Disease Score: A Retrospective Study
Authors: Natkha Vitaliy P. , Southerland Parker , Almekdash Mhd Hasan , Keesair Rohali , Dhanasekara Chathurika S. , Dissanaike Sharmila
Published: May 2022

Background

Liver cirrhosis is associated with increased mortality in trauma victims. We stratified the impact of cirrhosis on trauma mortality by Model for End-stage Liver Disease (MELD) score.

Methods

Trauma center database was accessed for patients with established diagnosis of cirrhosis presenting 2014 - 2018, matched to control patients without cirrhosis in a 2:1 ratio by age, sex, and TRISS. Primary outcome was mortality, secondary outcomes were length of stay, intensive care unit days, and ventilator dependent days.

Results

Cirrhosis was present in 182 (1.5%) trauma patients. Mortality difference between 12 (7%) deaths in cirrhosis cohort versus 14 (4%) in control was not statistically significant (p = 0.38). No difference was found in secondary outcomes. Categorization of cirrhosis severity by MELD score range (MELD 6-7, 8-10, 11-14, 15-20, 21-30) showed a 1.9 fold increase in the odds of mortality for every increase in MELD score category (OR = 1.91, p = 0.03, 95% CI = 1.08 – 3.37).

Conclusion

Mortality effects of cirrhosis in trauma patients can be estimated using MELD score.
A Canadian story of Jewish divorce: listening to rabbis across denominations wrestle with egalitarianism and K’lal Yisrael
Authors: Butler Deidre , Appel Kuzmarov Betina
Published: May 2022

This ethnographic interview-based research (2016–2021) analyzes the narratives of a cohort of rabbis in Ottawa who share their experiences of Jewish divorce. Jewish religious divorce is gendered and asymmetrical where the husband gives the divorce to the passively receiving wife who may not herself initiate divorce. This project interrupts the ways in which Jewish divorce is primarily identified in terms of get abuse in the Orthodox world. The asymmetrical divorce process contributes to get abuse, which includes delaying, refusing, or extorting favourable terms in exchange for the husband providing the wife with her get (religious divorce). Women who cannot secure divorces are known as agunot (singular agunah, chained women), who cannot remarry and who commit adultery if they have sexual relations with another man. Women face the additional burden that if they bear children to anyone other than their husband, such children would have the status of mamzerim (singular mamzer, legally illegitimate, product of an illicit union) who may not marry other Jews except other mamzerim, who may not hold certain positions of communal leadership, and whose status is inherited from generation to generation. This gendered injustice becomes the focus of scholarship even as it arouses both communal activism and internal debates. While get abuse is most common in the Orthodox Jewish community, our interviews with Canadian rabbis reveals that Jewish divorce is a transdenominational phenomenon that plays out within and across denominational boundaries. Against a backdrop of increasing stringency in the Orthodox world transnationally, and intensifying concern for the consequences of inegalitarian Jewish divorce, rabbinic stories point to shifting denominational practice. This transdenominational context is key to understanding Jewish divorce in North America. Attending to Jewish divorce in Canada through a denominational lens does important work in disentangling systemic and local factors. We argue that rabbinic stories about how rabbis engage with divorce reveals how the twin challenges of egalitarianism and rabbinic concerns for the unity and continuity of the Jewish people ( K’lal Yisrael) shape the experience of Jewish divorce and divorce practice itself. Jewish divorce impacts women in particularly gendered ways but is largely interpreted and practiced by male rabbis. Through our original theoretical framework of “troubling orthopraxy”, we analyse how orthopraxy (correct divorce practice) is conflated with stringency, and how that dynamic pushes and pulls at divorce practice.
Experimental investigation of buckling behavior of E-glass/epoxy laminated composite materials with multi-walled carbon nanotube under uniaxial compression load
Authors: Mutu Halil Burak , Aslan Züleyha
Published: May 2022

This study experimentally investigated the effects of nanoparticle reinforcement on the buckling behavior of composite materials. Different sizes of carboxylic acid functionalized multi-walled carbon nanotubes were used as nanoparticles. E-glass fiber-reinforced composite materials with polymer matrix in the [0°/90°/0°/90°]s cross-ply array with and without carbon nanotube reinforcement were produced by hand lay-up and vacuum bagging. Three types of carbon nanotubes in different sizes and proportions of 0.1%, 0.2%, 0.3%, 0.4%, and 0.5% by weight were added to the epoxy resin. For the buckling test, the samples with two clamped and two free sides were attached to the universal testing machine to apply a uniaxial compressive load. As a result of the experiments, it was found that the addition of carbon nanotube in certain proportions increases the critical buckling load of composite materials. The highest increase in the critical buckling load (26.10% increase) was achieved with a carbon nanotube reinforcement of 0.2% by weight, having an outer diameter of 10–20 nm, internal diameter of 5–10 nm, and length of 0.5–2 mm. As the carbon nanotube sizes added to the epoxy resin decreased, the buckling strength increased.
Intensive Care Units Healthcare Professionals’ Experiences and Negotiations at the Beginning of the COVID-19 Pandemic in Germany: A Grounded Theory Study
Authors: Hörold Madlen , Drewitz Karl Philipp , Piel Julia , Hrudey Ilona , Rohr Magdalena , Brunnthaler Vreni , Hasenpusch Claudia , Ulrich Angela , Otto Niklas , Brandstetter Susanne , Apfelbacher Christian
Published: May 2022

Faced with the pandemic of the novel coronavirus (SARS-CoV-2), healthcare professionals (HCPs) in intensive care units (ICU) adjusted their organizational, operational, and personal procedures to ensure care for COVID-19 patients. We used grounded theory approach to explore ICU HCPs' perspectives on professional action at the beginning of the COVID-19 pandemic in Germany from March to July 2020. The study aimed to examine implicit principles on negotiating social practice and interaction of ICU HCPs in an exceptional situation, which was characterized by a high level of changes. We conducted theme-guided qualitative telephone/virtual interviews with 39 ICU HCPs from ten German federal states. The data collection followed the principles of theoretical sampling. We adpoted grounded theory approach proposed by Charmaz and discussed using Lüscher’s theoretical concept of ambivalence. The analysis revealed five interconnected categories about the ICU HCPs’ negotiation of social practice and interaction at the beginning of the COVID-19 pandemic in Germany. In this context, a complex field of ambivalence (key category) emerged between habits and routines of a pre-pandemic normality. Pragmatic restructuring processes were initiated, which quickly resulted in a new normality of a “daily routine of preparation”. Dealing with ambivalence offers the potential for change.
Satinteti’s Offering Table: A Reused Block from Princess Watetkhethor Zeshzeshet’s Chapel in the Teti Pyramid Cemetery, Saqqara
Authors: Hamilton Julia C. F.
Published: May 2022

This article analyses the offering table from the chapel of Satinteti, a Memphite Priestess of Hathor, dating to the First Intermediate Period. The false-door and side-pieces are now held by the Museum of Fine Arts, Boston (24.593a–c). The offering table, however, is still in the Teti Pyramid Cemetery and was fashioned from a reused block from the chapel of Princess Watetkhethor Zeshzeshet, the eldest daughter of King Teti of the Sixth Dynasty. The former inscriptions on the offering table are transcribed and the block digitally resituated on the southern wall of room B5 in Watetkhethor’s chapel. The dating for the chapel is assessed from several perspectives, and the technique and motivations for the reuse of the offering table are discussed. It is proposed that Satinteti may have deliberately sought a block from the chapel of this earlier, eminent woman in the completion of her own monument.
Initial Construction and Validation of the Identity Shifting for Black Women Scale
Authors: Dickens Danielle D. , Hall Naomi M. , Watson-Singleton Natalie N. , Mitchell Cheyane , Thomas Zharia
Published: May 2022

In this study, we aimed to develop and validate the Identity Shifting for Black Women Scale (ISBWS), which assesses the process of altering one’s speech, perceptions, behaviors, and appearance to navigate experiences of discrimination and to enhance intraracial relationships. In Study 1, data from 356 Black women in the United States were used for exploratory factor analysis. Exploratory factor analysis results supported a 15-item, two-factor solution that captured the following domains: (a) Navigating Gendered Racial Oppressive Contexts and (b) Enhancing Intraracial Relationships. In Study 2, confirmatory factor analyses were performed with data from 289 United States Black women. Confirmatory factor analyses tested a unidimensional correlated traits model, a two-factor correlated traits model, and a bifactor model. The bifactor model provided optimal fit, and internal consistency estimates for scores on the ISBWS subscales were good. The ISBWS’ construct validity was supported given its association with related measures of shifting and gendered racial microaggressions. The ISBWS also accounted for additional variance in Black women’s anxiety symptoms over and above an existing shifting measure. Our findings support the added value of the ISBWS in understanding Black women’s multifaceted experiences and can be used to inform interventions aimed to maximize the benefits and reduce the costs of shifting among Black women.
The effect of renewable energy consumption on economic growth in KSA: A bootstrap causality test
Authors: Berradia Hakim , Abid Mehdi , Sakrafi Habib , Gheraia Zouheyr , Abdelli Hanane
Published: May 2022

The majority of studies analyzed show a positive and statistically significant impact of renewable energy consumption on economic growth. Nevertheless, some studies suggest a limited effect, while others find no statistically significant effect. Faced with this problem, we conducted a study aimed at analyzing the impact of renewable energy consumption on economic growth in the Kingdom of Saudi Arabia for the period 1990–2020. To determine the integration properties of the variables, we utilized the sharp and smooth structural breaks unit root test developed by Shahbaz, Omay and Roubaud (SOR). We also used the bootstrap approach of testing ARDL limits to examine the cointegration between variables. Using the VECM model, we studied the causal relationship between economic growth and its determinants. The results show, in the short and long run, the existence of a bidirectional causality between renewable energy consumption and economic growth (Feedback Hypothesis). Thus, there is a bidirectional relationship between GDP and capital and also between GDP and labor, in the long run. Therefore, an important policy implication resulting from this analysis is that renewable energy can be considered as an important factor for sustainable economic development in Saudi Arabia. The findings for Saudi Arabia may also be relevant for oil exporting countries to achieve efficiency and promote the renewable energy sector beyond oil.
Changing Contours of India’s Economic Diplomacy
Authors: Dabhade Manish
Published: May 2022

This article explores India’s economic diplomacy since its early years of Independence, from the margins to a relative significance in the global economic hierarchy. It begins by identifying the constant, governing first principles and core objectives of India’s economic diplomacy that have remained constant over the years. The first three sections broadly embody the distinctive phases of India’s economic diplomacy, each laced with turning points, challenges and shifts entailed therein. The article ends with a concluding section that provides an analysis of India’s economic diplomacy in terms of broader trends, current challenges and the road ahead in the policy-relevant future.
Adolescent borderline personality disorder: Does early intervention ‘bend the curve’?
Authors: Allison Stephen , Bastiampillai Tarun , Looi Jeffrey CL , Mulder Roger
Published: May 2022

Objective

The Global Alliance for Prevention and Early Intervention for Borderline Personality Disorder (BPD) proposed a major change for youth mental health services. The Alliance recommended that early detection and specialised treatment for youth BPD becomes a major focus of their clinical activities. Since structured psychotherapies for BPD are complex and lengthy, this proposal has significant implications for youth policy, planning and resource allocation. Our commentary addresses whether BPD is diagnosable and treatable in youth, and whether early intervention results in longer-term benefits.

Conclusion

People diagnosed with BPD are highly heterogeneous and experience high levels of comorbidity. The low quality of the evidence for the treatment of BPD in adolescence limits our ability to develop evidence-based guidelines. Accordingly, there is no clear case for BPD early intervention as a major component of youth mental health services. The introduction of ICD-11 classification system may facilitate further empirical studies of personality disorders in adolescence and emerging adulthood.
Output feedback control for the driving cylinder of hydraulic support with error constraint
Authors: Wang Yunfei , Zhao Jiyun , Wang Hao , Ding Haigang
Published: May 2022

The position control of the driving cylinder of hydraulic support affects the straightness of the underground coal mining face, so this paper focuses on improving tracking performance of the driving cylinder system. Since only position signal of the system is measurable, a Levant differentiator is designed to estimate the velocity and acceleration of the driving cylinder system, which can reduce the effect of the measurement noise. Besides, the parameter changes, modelling errors and external disturbances are treated as a lumped disturbance, an extended disturbance observer is constructed to estimate the lumped disturbance and compensate for the proposed controller. Moreover, barrier Lyapunov function is introduced to limit the tracking error into a small set around zero, and then the stability of the close-loop system is proved. Both the performance of differentiator and disturbance observer is verified in simulation experiments in MATLAB/Simulink. Finally, an experiment rig for the driving cylinder system of hydraulic support is established and comparative experiments are carried out. The experiment results show that the proposed extended disturbance observer-based output feedback controller with error constraint has a satisfied effectiveness in improving tracking performance.
Space in Between
Authors: Asar Brown Serap
Published: May 2022

My poetic inquiry originated from reflecting on Ken Plummer’s (2019) book, Narrative Power, where Plummer insightfully discusses the intertwined nature of narratives with our lives. My poem is about the power of narratives to shape lives (i.e., toward suffering or liberation) and the role of human agency in giving life to narratives. My interest rests on the point of power in between narratives where there is a possibility for change, in which humans are the key players. This inquiry draws on narratives, memory, memory-making, imagination, and remembering.
Queer Asias: Genders and sexualities across borders and boundaries
Authors: Ho Michelle H. S. , Blackwood Evelyn
Published: May 2022

In this introduction, we highlight the developments and transformations that have been put forward and situate our examination of Queer Asias within that context. We then turn to the contributions in this special issue, which collectively examine the intricate and imbricated flows of capital, power, intimacy, citizenship, sexual politics, and categories of gender and sexual (self-)identification in and across Japan, Taiwan, Indonesia, Hong Kong, the Philippines, and the United States. The articles in this special issue take up the following questions through an exploration of local genealogies of sexual practices, intimacies, and meanings in people’s everyday lives: What forms of categories, politics, and activism have gender and sexually diverse peoples across East and Southeast Asia embraced, constructed, and challenged in the 2010s through the early 2020s? What new theories have scholars developed and to what end? Whose politics are now being advocated and how might their activism contest older strategies and discourses?
Correlation Between Bacteria Count Using a Rapid Bacterium Counting System and Changes in Wound Area on Diabetic Foot Ulcers in Indonesia: A Prospective Study
Authors: Haryanto Haryanto , Jais Suriadi , Supriadi Supriadi , Imran Imran , Ogai Kazuhiro , Oe Makoto , Okuwa Mayumi , Sugama Junko
Published: May 2022

This study aimed to clarify the correlation between changes in bacterial number and wound area in diabetic foot ulcers (DFUs). This study used a prospective longitudinal cohort design. A total of 30 participants met the inclusion criteria. Changes in bacterial number and wound area were evaluated weekly until week 4. The chi-square test indicated no significant correlation between biofilm formation and wound area (p = 0.32) but a significant correlation between bacterial count and wound area (p = 0.05). Logistic regression analysis showed a significant correlation between bacterial count and changes in wound area (odds ratio, 0.60; 95% confidence interval [CI], 0.372-0.997; p = 0.04). The receiver operating characteristic analysis showed an area under the curve of 0.660 (95% CI, 0.52-0.79; p = 0.03) with a sensitivity of 97% and specificity of 88%. The present prospective longitudinal cohort study demonstrated the correlation between bacterial count changes and wound area in DFUs. Our results suggest that changes in bacterial count could help wound healing evaluations.
Tumor cell anabolism and host tissue catabolism-energetic inefficiency during cancer cachexia
Authors: Hegde Mangala , Daimary Uzini Devi , Girisa Sosmitha , Kumar Aviral , Kunnumakkara Ajaikumar B
Published: May 2022

Cancer-associated cachexia (CC) is a pathological condition characterized by sarcopenia, adipose tissue depletion, and progressive weight loss. CC is driven by multiple factors such as anorexia, excessive catabolism, elevated energy expenditure by growing tumor mass, and inflammatory mediators released by cancer cells and surrounding tissues. In addition, endocrine system, systemic metabolism, and central nervous system (CNS) perturbations in combination with cachexia mediators elicit exponential elevation in catabolism and reduced anabolism in skeletal muscle, adipose tissue, and cardiac muscle. At the molecular level, mechanisms of CC include inflammation, reduced protein synthesis, and lipogenesis, elevated proteolysis and lipolysis along with aggravated toxicity and complications of chemotherapy. Furthermore, CC is remarkably associated with intolerance to anti-neoplastic therapy, poor prognosis, and increased mortality with no established standard therapy. In this context, we discuss the spatio-temporal changes occurring in the various stages of CC and highlight the imbalance of host metabolism. We provide how multiple factors such as proteasomal pathways, inflammatory mediators, lipid and protein catabolism, glucocorticoids, and in-depth mechanisms of interplay between inflammatory molecules and CNS can trigger and amplify the cachectic processes. Finally, we highlight current diagnostic approaches and promising therapeutic interventions for CC.
Arbitration Agreement and Arbitral Award: The Online Perspective
Authors: Singh Vandana , Bahmani Misha
Published: May 2022

Nowadays, the use of technology has lightened the workload in many sectors to some extent. International arbitration practice has become cost-efficient. Although the concern has been when some legal instruments are not legally accepted, they are subjective to fulfilment of precise requirements. This reflects that arbitration agreements, as well as arbitral awards, which are drawn online, test whether the old provisions are beneficial or not. This article elaborates on the challenges which prevail while providing legal acceptance to digital arbitration. The objective is to highlight the difficulties that municipal and international systems come across while following the procedural aspect. The use of technology and maintaining international standards in the commercial sector globally should encourage the practice of harmony and proper enforceability.
Between Heaven and Hell: Experiences of Preoperative Pain and Pain Management among Older Patients with Hip Fracture
Authors: Unneby Anna , Gustafson Yngve , Olofsson Birgitta , Lindgren Britt-Marie
Published: May 2022

Introduction

Among older adults, hip fracture is a common and serious consequence of a fall. Preoperative pain is common and often severe among patients with hip fracture. Opioids are usually used but have many side effects. One alternative is a femoral nerve block, which has been shown to reduce pain and lower the need for opioids. However, to our knowledge no study has explored qualitatively how patients with hip fracture experience treatment with femoral nerve block.

Objective

The aim of this study was to explore experiences of preoperative pain and pain management among older patients with hip fracture who had received a femoral nerve block.

Method

A qualitative design with semi-structured interviews (n = 23) conducted 2–6 days after surgery. Inclusion criteria were Swedish-speaking patients aged 70 years or older with hip fracture admitted to the orthopedic ward, treated with femoral nerve block before nursing actions. Data were analyzed with qualitative content analysis.

Results

Our result revealed one theme, hovering between heaven and hell, with five subthemes: how the pain was described – no pain, to worst pain and everything in between; they were dealing with pain in their own way; felt dependent on staff´s willingness to relieve pain; pain management could be lifesaving and a near-death experience; and how they experienced memory loss with respect to the pain and pain management.

Conclusion

The experience of pain and pain management was described as hovering between heaven and hell. We conclude that independent of which pain management given, staff should have an individualized pain mangement approach towards the patient in order to achieve well managed pain.
The ISHLT chronic lung allograft dysfunction consensus criteria are applicable to pulmonary chronic graft-versus-host disease
Authors: Pang Yifan , Charya Ananth V. , Keller Michael B. , Sirajuddin Arlene , Fu Yi-Ping , Holtzman Noa G. , Pavletic Steven Z. , Agbor-Enoh Sean
Published: May 2022

Pulmonary chronic graft-versus-host disease (PcGVHD) is a devastating complication of allogeneic hematopoietic stem cell transplant (HCT). The 2014 National Institutes of Health cGVHD consensus criteria (NIH criteria) only captures bronchiolitis obliterans syndrome (BOS). In this study, we adapted the 2019 International Society for Heart and Lung Transplantation (ISHLT) criteria of chronic lung allograft dysfunction (CLAD) to define novel phenotypes of PcGVHD and compared the performance of this criteria with the NIH criteria to identify patients with high-risk PcGVHD. We reviewed consecutive patients in a cGVHD natural history protocol (#NCT00092235) and adapted the 2019 CLAD criteria (the adapted criteria) to define PcGVHD as post-HCT forced expiratory volume at 1 second < 80% predicted value, with 4 phenotypes: obstructive, restrictive, mixed obstructive/restrictive, and undefined. An independent adjudication committee evaluated subjects for diagnosis and phenotyping. We identified 166 (47.4%) patients who met the adapted criteria, including obstruction (n = 12, 3.4%), restriction (n = 67, 19.1%), mixed obstruction/restriction (n = 47, 13.4%), and undefined (n = 40, 11.4%). In these patients, less than half (n = 78) met the NIH criteria for BOS (NIH+); the rest (n = 88) did not (NIH−). The NIH− subjects showed increased risk of death compared with those without PcGVHD (hazard ratio = 1.88, 95% confidence interval = 1.20-2.95; P = .006) that was similar to NIH+ subjects (P = .678). Our study demonstrated the potential of the adapted criteria in identifying patients with high-risk PcGVHD that have been missed by the NIH criteria. The adapted criteria could become a valuable tool to better phenotype and study lung disease in cGVHD.
Enhanced VWF clearance in low VWF pathogenesis: limitations of the VWFpp/VWF:Ag ratio and clinical significance
Authors: Doherty Dearbhla , Lavin Michelle , Byrne Mary , Nolan Margaret , O’Sullivan Jamie M. , Ryan Kevin , O’Connell Niamh M. , Haberichter Sandra L. , Christopherson Pamela A. , Di Paola Jorge , James Paula D. , O’Donnell James S.
Published: May 2022

Increased von Willebrand factor (VWF) clearance plays a key role in the pathogenesis of type 1 and type 2 von Willebrand disease (VWD). However, the pathological mechanisms involved in patients with mild to moderate reductions in plasma VWF:Ag (range, 30-50 IU/dL; low VWF) remain poorly understood. In this study, we investigated the hypothesis that enhanced VWF clearance may contribute to the pathobiology of low VWF. Patients with low VWF were recruited to the LoVIC study after ethics approval and receipt of informed consent. Desmopressin was administered IV in 75 patients, and blood samples were drawn at baseline and at the 1-hour and 4-hour time points. As defined by recent ASH/ISTH/NHF/WFH guidelines, 20% of our low-VWF cohort demonstrated significantly enhanced VWF clearance. Importantly, from a clinical perspective, this enhanced VWF clearance was seen after desmopressin infusion, but did not affect the steady-state VWF propeptide (VWFpp)-to-VWF antigen (VWF:Ag) ratio (VWFpp/VWF:Ag) in most cases. The discrepancy between the VWFpp/VWF:Ag ratio and desmopressin fall-off rates in patients with mild quantitative VWD may have reflected alteration in VWFpp clearance kinetics. Finally, bleeding scores were significantly lower in patients with low VWF with enhanced VWF clearance, compared with those in whom reduced VWF biosynthesis represented the principle pathogenic mechanism. This trial was registered at http://www.clinicaltrials.gov as #NCT03167320.
Modulation of the Drosophila transcriptome by developmental exposure to alcohol
Authors: Morozova Tatiana V. , Shankar Vijay , MacPherson Rebecca A. , Mackay Trudy F. C. , Anholt Robert R. H.
Published: May 2022

Background

Prenatal exposure to ethanol can cause fetal alcohol spectrum disorder (FASD), a prevalent, preventable pediatric disorder. Identifying genetic risk alleles for FASD is challenging since time, dose, and frequency of exposure are often unknown, and manifestations of FASD are diverse and evident long after exposure.Drosophila melanogasteris an excellent model to study the genetic basis of the effects of developmental alcohol exposure since many individuals of the same genotype can be reared under controlled environmental conditions.

Results

We used 96 sequenced, wild-derived inbred lines from theDrosophila melanogasterGenetic Reference Panel (DGRP) to profile genome-wide transcript abundances in young adult flies that developed on ethanol-supplemented medium or standard culture medium. We found substantial genetic variation in gene expression in response to ethanol with extensive sexual dimorphism. We constructed sex-specific genetic networks associated with alcohol-dependent modulation of gene expression that include protein-coding genes, Novel Transcribed Regions (NTRs, postulated to encode long non-coding RNAs) and female-specific coordinated regulation of snoRNAs that regulate pseudouridylation of ribosomal RNA. We reared DGRP lines which showed extreme upregulation or downregulation of snoRNA expression during developmental alcohol exposure on standard or ethanol supplemented medium and demonstrated that developmental exposure to ethanol has genotype-specific effects on adult locomotor activity and sleep.

Conclusions

There is significant and sex-specific natural genetic variation in the transcriptional response to developmental exposure to ethanol in Drosophila that comprises networks of genes affecting nervous system development and ethanol metabolism as well as networks of regulatory non-coding RNAs.
Correction to: Multimorbidity patterns, polypharmacy and their association with liver and kidney abnormalities in people over 65 years of age: a longitudinal study
Authors: Villén Noemí , Guisado-Clavero Marina , Fernández-Bertolín Sergio , Troncoso-Mariño Amelia , Foguet-Boreu Quintí , Amado Ester , Pons-Vigués Mariona , Roso-Llorach Albert , Violán Concepción
Published: May 2022

An amendment to this paper has been published and can be accessed via the original article.
Healthcare utilisation for elderly people at the onset of the COVID-19 pandemic in South Korea
Authors: Park K. , Byeon J. , Yang Y. , Cho H.
Published: May 2022

Background

At the onset of the coronavirus disease 2019 (COVID-19) pandemic, health care systems were severely disrupted in many countries and in particular, elderly people vulnerable to COVID-19 may have been reluctant to receive their medical treatment.

Methods

We conducted interrupted time series analyses (ITSA) using nationwide medical claim data between January 2020 and July 2020, with focus on different disease categories for the patients of 65 to 84-year-olds, i.e., acute upper respiratory infections (AURIs) vs. chronic diseases.

Results

AURIs and chronic diseases showed a sharp contrast with respect to the change in healthcare service utilisation. First, the utilisation rate for chronic diseases changed little whereas for AURIs it dropped by 20.4% year-over-year (yoy) at the onset of the pandemic (week 6, 2020). Second, as social distancing relaxed (week 17, 2020), the AURIs patients trended up and even reached to 7.8% above yoy whereas no significant change found for chronic diseases.

Conclusions

The uninterrupted treatment for chronic diseases in contrast to the AURIs implies that the governmental and public responses to the pandemic outbreak worked for efficient healthcare provision to patients in needs of regular check-ups and treatment in the middle of an infectious disease crisis.
Renal artery thrombosis in SARS-CoV-2 infection: a case report
Authors: Huang Huayan , Lin Chunguang , Chen Yongdong , Wu Xiuting , Lin Miaomiao , Chen Siqi , Li Kai
Published: May 2022

Background

Coronavirus disease 2019 (COVID-19) is identified as the pneumonia and acute respiratory distress syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). The intravascular thrombotic phenomena related to the COVID-19 are emerging as an important complication that contribute to significant mortality.

Case presentation

We present a 62-year-old man with severe COVID-19 and type 2 diabetes. After symptomatic and supportive treatment, the respiratory function was gradually improved. However, the patient suddenly developed abdominal pain, and the enhanced CT scan revealed renal artery thrombosis. Given the risk of surgery and the duration of the disease, clopidogrel and heparin sodium were included in the subsequent treatment. The patient recovered and remained stable upon follow-up.

Conclusions

Thrombosis is at a high risk in patients with severe COVID-19 pneumonia because of hypercoagulable state, blood stasis and endothelial injury. Thrombotic events caused by hypercoagulation status secondary to vascular endothelial injury deserves our attention. Because timely anticoagulation can reduce the risk of early complications, as illustrated in this case report.
A real-world retrospective study of the use of Ki-67 testing and treatment patterns in patients with HR+, HER2− early breast cancer in the United States
Authors: Brown Jacqueline , Scardo Savannah , Method Michael , Schlauch Dan , Misch Amanda , Picard Shaita , Hamilton Erika , Jones Suzanne , Burris Howard , Spigel David
Published: May 2022

Background

The National Comprehensive Cancer Network recommends that patients with hormone receptor-positive early breast cancer be considered for adjuvant endocrine therapy (ET) after primary treatment like surgical excision. Adjuvant chemotherapy (CT) use primarily depends on risk of recurrence. Biomarkers such as Ki-67 potentially have most value in patients with intermediate risk factors, such as involvement of 1–3 positive nodes. This study evaluated the use of Ki-67 testing and treatment patterns in patients with HR+, human epidermal growth factor receptor 2-negative early breast cancer.

Methods

This was an observational retrospective cohort study of patients with electronic medical records from January 2010 to August 2018 treated for HR+, HER2− early breast cancer at Sarah Cannon sites in the United States (US). Overall, 567 patients were randomly selected after using the eligibility criteria: female or male ≥18 years, without distant metastases, and with available physician and pathology reports. Multivariable logistic regression was used to investigate factors predicting Ki-67 testing and test results. Descriptive analyses were applied to treatment patterns.

Results

Multivariable logistic regression analyses found no clinical or pathological factors that predicted whether Ki-67 testing had been ordered by physicians. Of all tested patients (N = 130), having Grade-2 tumors (OR, 7.95 [95% CI: 2.05, 30.9]; p = 0.0027) or Grade-3 tumors (OR, 95.3 [95% CI, 11.9, 760.7]; p < 0.001) at initial diagnosis was a predictor of high Ki-67 expression (≥20%). Ki-67 expression was tested in 23.6% (61/258) of patients with 1–3 positive nodes; 54.1% of them (33/61) had high Ki-67 expression (≥20%). While having a higher grade tumor predicted high Ki-67 (≥20%), 28.6% of patients with Grade-1 tumors also had high Ki-67 expression. Neo-adjuvant therapy was received by 16.0% of patients (91/567), most of whom (66/91; 72.5%) received CT alone. Adjuvant therapy, either endocrine and/or chemotherapy, was received by 92.6% (525/567) of patients and by 67.0% (61/91) of those who received neo-adjuvant therapy. Most (428/525, 81.5%) received ET in the adjuvant treatment setting.

Conclusions

High grade tumors predicted high Ki-67 (≥20%) expression, but Ki-67 testing was not widely used in these US patients. Most HR+, HER2− early breast cancers were treated with adjuvant ET, with or without CT.
Long-term outcome and relapse patterns in Ewing sarcoma patients with extensive lung/pleural metastases after a complete response to systemic therapy
Authors: Xu Jie , Zhi Xin , Xie Lu , Sun Xin , Liu Xingyu , Liu Kuisheng , Guo Wei
Published: May 2022

Background

Ewing sarcoma (ES) is sensitive to systemic therapy, including chemotherapy and anti-angiogenesis Tyrosine Kinase Inhibitors(aaTKIs). However, the prognosis of patients with metastatic disease remains poor. Recurrence or distant metastasis after a complete response (CR) or near-CR due to systemic therapy is not rare.

Methods

We reviewed data from 187 ES patients between 2014–2019 treated at a single institute in China. Patients with extensive lung/pleural metastases (L/Pmeta) who had a CR or near-CR after first- or second-line chemotherapy with or without aaTKIs were retrospectively enrolled. Event-free survival (EFS) and overall survival (OS) were determined using the Kaplan–Meier method. For patients who had L/P recurrence, images were reviewed to define the exact location of each recurrent lesion, compared with the primary L/P lesion before chemotherapy and summarized as the relapse pattern.

Results

Seventeen patients and 21 cases of CR/nCR (5 by VDC/IE, 3 by VIT, and 13 by AVI) were finally analyzed. Median follow-up for surviving patients was 39.6 (range, 14.5–60.9) months. Median EFS and OS were 9.3 (95% confidence interval [CI], 2.0–16.6) months and 37.5 (95% CI, 21.8–53.1) months, respectively. The 2-year EFS was 19% and the 2-year OS was 70.6%, respectively. Most patients (82.4%) received whole lung irradiation (WLI). Lung/pleural relapse occurred in 71.4% (15/21) of CR/nCR cases. Most notably, all recurrent lesions exactly coincided with the original metastatic lesions before chemotherapy (exactly in situ) in 9 of the 15 recurrent cases, which was thus the major relapse pattern, whereas 42.9% had distant metastases other than L/Pmeta.

Conclusions

Survival of ES patients with extensive L/Pmeta remains poor, even if they have a CR after systemic therapy. Recurrence exactly in situ is the major relapse pattern. WLI is not sufficient to prevent local recurrence in lung or pleura. More aggressive local treatment for metastatic lesions is warranted.
Hemodynamic parameters after Delayed Cord Clamping (DCC) in term neonates: a prospective observational study
Authors: Gupta Bhvya , Yengkhom Rameshwor , Banait Nishant , Chetan Chinmay , Pareek Prince , Suryawanshi Pradeep
Published: May 2022

Background

Delayed cord clamping (DCC) is practiced worldwide, as standard care in both term and preterm babies. Our aim was to determine the hemodynamic effects of DCC on transitional circulation.

Material and methods

This prospective observational study was carried out in a tertiary care hospital, at Pune, India, from May 2018 to October 2019.Term neonates born during the study period were included. The primary outcome variables of the study were right ventricular output (RVO), left ventricular output (LVO), superior vena cava (SVC) flow (ml/kg/min) and heart rate(HR) at 12 ± 6 and 48 ± 6 h of life measured by point of care functional echocardiography. Inter-observer and intra-observer variability was calculated for these parameters.

Results

Out of a total of 2744 deliveries during the study period, 620 babies were included. Mean gestational age of the enrolled babies was 38.96 ± 1.08 weeks and mean birth weight was 2.9 ± 0.39 kg. Mean heart rate of babies recorded at 12 ± 6 h of life was 127 beats per minute (bpm) whereas it was 128 bpm at 48 ± 6 h of life. RVO {mean (SD)} was 209.55(44.89) and 205.85(46.35) ml/kg/min, LVO {mean (SD)} was 133.68(31.15) and 134.78(29.84) ml/kg/min whereas SVC flow {mean (SD)} was 106.85(26.21) and 109.29(25.11) ml/kg/min at 12 ± 6 and 48 ± 6 h of life respectively. There was good intra-observer agreement in all the variables.

SGA babies had a significantly higher heart rate at 12 ± 6 h of life as compared to AGA babies, although this difference in heart rate could not be appreciated at 48 ± 6 h of life. However SGA babies had a higher LVO, RVO and SVC flow than AGA babies at both the time points of observation.

Conclusion

After DCC there is less fluctuation in the hemodynamic parameters (heart rate, cardiac output) at the two time points of observation.. As compared to AGA babies, SGA babies had a significantly higher baseline heart rate, LVO, RVO and SVC flow. LVO of SGA babies after delayed cord clamping is found to be significantly lower than LVO seen in other studies, favoring the cardio-stabilizing effect of DCC.

Brief rationale

This is the first study with a large sample size evaluating the hemodynamic effects of DCC in term neonates by functional echocardiography. The normative data of heart rate and cardiac output of term, stable babies with small for gestational age(SGA) as a special subgroup undergoing DCC requires further evaluation.
Determinants of the evolutions of behaviours, school adjustment and quality of life in autistic children in an adapted school setting: an exploratory study with the International Classification of Functioning, disability and health (ICF)
Authors: Schneider Stéphanie , Clément Céline , Goltzene Marc-André , Meyer Nicolas , Gras-Vincendon Agnès , Schröder Carmen M. , Coutelle Romain
Published: May 2022

Background

Previous studies about Quality of Life (QoL) in autistic children (ASD) have put forward the negative impact of factors such as Autism Spectrum Disorder (ASD) severity, psychiatric comorbidities and adaptive behaviour impairment. However, little is known about the relation of these factors to school adjustment, measured with the International Classification of Functions disability and health (ICF) framework (World Health Organization, 2001), and QoL evolutions. Thus, this study aimed at investigating the determinants of behaviours, school adjustment and QoL changes in 32 children in an ASD inclusion program over one academic year.

Methods

Using Bayesian methods, we studied the impact of ASD severity, psychiatric comorbidities, adaptive behaviour level and a diagnosis of Pathological Demand Avoidance (PDA) on evolutions of behaviour, school adjustment (measured with the ICF) and QoL.

Results

As predicted, adequate adaptive behaviour levels were associated with better progress of behaviours and school adjustment whereas psychiatric comorbidities were related to worse outcome of school adjustment. Contrary to our hypotheses, severe ASD was associated to better evolution of adjustment at school. PDA was not discriminant. We did not find any association between the studied factors and the evolution of QoL over the academic year.

Conclusion

Our results show that the assessment of adaptive behaviour levels, psychiatric comorbidities and ASD severity level may be useful predictors to discriminate of school adjustment evolution (assessed by teachers within the ICF model) over a one-year period in autistic children. The assessment of this time course of school adjustment was sensitive to change and adapted to differentiate evolutions in an inclusive education framework. The investigation of quality of school life of autistic children as well as its determinants may therefore be relevant to improving academic adaptation. However, further research in larger groups, over longer periods and in different personalized school settings for autistic children is needed.
Correlates of influenza vaccination among underserved Latinx middle-aged and older adults: a cross-sectional survey
Authors: Bazargan Mohsen , Martinez-Hollingsworth Adrienne , Cobb Sharon , Kibe Lucy W.
Published: May 2022

Background

Vaccination is a powerful tool in the fight against seasonal influenza, among underserved, middle-age and older, Latinx adults. Yet, vaccine hesitancy and inconsistent uptake in this population continues to represent a substantial challenge to public health. A better understanding of factors impacting influenza vaccination behaviors in this group could result in more effective messaging and initiatives promoting universal vaccination among Latinx.

Methods

In this cross-sectional survey, we explore correlates of influenza vaccination uptake among underserved, Latinx, older adults. Our focus was on the role of socio-demographics, living arrangements, financial strain, access and satisfaction with medical care, and the presence of major chronic conditions in terms of vaccine uptake. Middle-aged and older Latinx residents diagnosed with diabetes and/or hypertension (n=165), were recruited from the South Los Angeles Service Plan Area (SPA), a historically under-resourced community. Bi-variate and multi-variate logistical regression were performed on survey data to explore independent correlates of influenza vaccination.

Results

Almost half of underserved Latinx older adults in our study (45%) reported influenza vaccination within the 12 months prior to the study. The majority (~85%) reported receiving this recommendation from their primary care provider. However, thirty percent (30%) of those receiving this advice did not get the vaccine. A decreased likelihood of vaccination was significantly associated with living alone (p-value=0.026), lacking Medicare coverage (0.028), or higher levels of financial strain (0.020). Difficulty accessing medical care (p-value=0.008) or dissatisfaction with these experiences (p-value=0.001) were also strongly associated with decreased likelihood of vaccination. Participants diagnosed with COPD had 9.5 (CI: 1.76 – 51.3) higher odds of being vaccinated compared to those without; no correlation was detected for other chronic conditions.

Conclusion

The high number of unvaccinated Latinx participants receiving a vaccine recommendation from a provider is consistent with studies among other ethnic/racial minority older adults and highlights the pivotal role of the provider in influenza vaccine adoption. Additional findings reflect negative impact of Social Determinates of Health on preventive care efforts in this group. Further efforts to quantify these associations are needed to explore structural and human factors impacting influenza vaccine uptake.
The absence of IL-9 reduces allergic airway inflammation by reducing ILC2, Th2 and mast cells in murine model of asthma
Authors: Li Yan , Lan Feng , Yang Yiran , Xu Yingjie , Chen Yalin , Qin Xiaofeng , Lv Zhe , Wang Wei , Ying Sun , Zhang Luo
Published: May 2022

Allergic asthma is an allergic inflammatory disease of the airways, in which numerous cell types and cytokines have been shown to contribute to pathogenesis of the disease. Although increased expression of IL-9 has been shown to influence the activity of structural as well as eosinophils and mast cells in asthma, the influence of IL-9 on function of ILC2 and Th2 cells remains unclear. This study therefore aimed to elucidate the role of IL-9 on ILC2 and Th2 cells using a murine model of asthma. A murine model of asthma was established using wild type (WT) and IL-9-deficient (Il9−/−) transgenic mice sensitized to house dust mite (HDM). Bronchoalveolar lavage fluid (BALF) and lung tissues were collected, and analysed for inflammatory cells (eosinophils, mast cells, Th2 cells and ILC2 cells), histopathological changes, and several cytokines. HDM challenge significantly increased accumulation of ILC2 cells, Th2 cells and mast cells, as well as goblet cell hyperplasia, and the expression of cytokines IL-4, IL-5 and IL-13, but not IFN-γ, in WT mice compared to saline-challenged control group. In contrast, all pathological changes, including infiltration of ILC2 cells, Th2 cells and mast cells, were significantly attenuated in HDM-challenged Il9−/− mice. Furthermore, the number of Ki67+ILC2 cells, Ki67+Th2 cells and Ki67+mast cells were significantly reduced in the absence of IL-9 signalling. These data suggest that IL-9 promotes the proliferation and type 2 cytokine production of type 2 cells in the murine models of asthma, and therefore might be a potential therapeutic target for asthma treatment.