bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Application of Thromboelastography in Acute Ischemic Stroke
Authors: Chen Feng , Zhang Liren , Bai Xiaolin , Wang Xiuzhe , Geng Zhi
Published: October 2022

Acute ischemic stroke (AIS), characterized by high morbidity and mortality, has imposed a considerable burden on society. Despite rapid development in the treatment of AIS, there is still a high risk of recurrence. Furthermore, there is a time delay in waiting for the results of conventional coagulation tests in candidate patients for intravenous thrombolysis therapy. Heterogeneous responses to antiplatelet, intravascular thrombolysis, and endovascular therapies also worsen the situation. Thromboelastography (TEG), as a global and portable detection method for hemostasis, facilitates clinicians in disease monitoring, treatment evaluation, and prognosis prediction in AIS. In this narrative review, we provided a comprehensive summary of the clinical application of TEG in ischemic stroke and gave insights to further studies.
In-hospital Mortality Rates in SARS-CoV-2 Patients Treated with Enoxaparin and Heparin
Authors: Alroomi Moudhi , Alsaber Ahmad , Al-Bader Bader , Almutairi Farah , Malhas Haya , Pan Jiazhu , Zhanna Kobalava D. , Ramadhan Maryam , Saleh Mohammad Al , Abdullah Mohammed , Alotaibi Naser , AlNasrallah Noor , Rajan Rajesh , Hussein Soumoud , Aboelhassan Wael
Published: October 2022

Аbstrасt

Objectives

This study aimed to investigate in-hospital mortality rates in patients with coronavirus disease (COVID-19) according to enoxaparin and heparin use.

Methods

This retrospective cohort study included 962 patients admitted to two hospitals in Kuwait with a confirmed diagnosis of COVID-19. Cumulative all-cause mortality rate was the primary outcome.

Results

A total of 302 patients (males, 196 [64.9%]; mean age, 57.2 ± 14.6 years; mean body mass index, 29.8 ± 6.5 kg/m2) received anticoagulation therapy. Patients receiving anticoagulation treatment tended to have pneumonia (n = 275 [91.1%]) or acute respiratory distress syndrome (n = 106 [35.1%]), and high D-dimer levels (median [interquartile range]: 608 [523;707] ng/mL). The mortality rate in this group was high (n = 63 [20.9%]). Multivariable logistic regression, the Cox proportional hazards, and Kaplan-Meier models revealed that the use of therapeutic anticoagulation agents affected the risk of all-cause cumulative mortality.

Conclusion

Age, hypertension, pneumonia, therapeutic anticoagulation, and methylprednisolone use were found to be strong predictors of in-hospital mortality. In elderly hypertensive COVID-19 patients on therapeutic anticoagulation were found to have 2.3 times higher risk of in-hospital mortality. All cause in-hospital mortality rate in the therapeutic anticoagulation group was up to 21%.
Content That Engages Your Customers: The Role of Brand Congruity and Promotions in Social Media
Authors: Montaguti Elisa , Valentini Sara , Vecchioni Federica
Published: October 2022

Every day, social network users worldwide spend an average of 1 hour and 47 minutes on platforms such as Facebook, Instagram, Twitter, and YouTube, and they forward online content to friends. Nonetheless, 87% of posts to brand Facebook pages go unanswered. To reduce this negative outcome and attract fans’ attention, companies post content that is not necessarily congruent with their brand and that contains promotion-based themes. The question is whether this strategy is effective in boosting rebroadcasting. The authors propose a conceptual framework that explains how two key post themes—congruency and promotions—influence consumers’ propensity to share and why. They validate it through a multimethod approach. First, the authors document the existence of the effect between congruency, promotions, and rebroadcasting by analyzing one year of posts for four leading brands. Second, the authors run a field experiment with Samsung Mobile. They find that the degree of congruency between online content and the brand positively affects the amount of rebroadcasting. Posts that include promotional incentives generate fewer shares, but this negative effect reverses when the post is congruent with the brand. Third, the authors conduct two online lab experiments to explain why this happens and show that fans’ reactance and altruistic motives play a central role.
A Multi-Site Study of Firearms Displays by Police at Use of Force Incidents
Authors: Cubitt Timothy I. C. , Nix Justin
Published: October 2022

The power to use force is a defining characteristic of policing, one that is accompanied by a responsibility to exercise these powers in the circumstances deemed necessary. This study analyzes data from four policing agencies to predict the likelihood of an officer drawing and pointing their firearm at a use of force incident. Findings suggest that situational factors were important in influencing whether an officer may draw and point their firearm. However, a priming effect, in which officers were more likely to draw their firearms when dispatched to an incident, may also be present. The rate that officers drew and pointed their firearms varied between jurisdictions, as did the nature of the incidents. Caution should be exercised in generalizing the results of single-site studies on police use of force, or introducing research into policy beyond the jurisdiction in which it was performed.
Between past and future ruins: Post-Ottoman Niš in the album of Knez Milan Obrenović
Authors: Radovanović Jelena
Published: October 2022

While historians of Southeast Europe have recently increasingly turned to photographs as primary sources, this article reads a late 19th century photographic album not as an (objective) representation of a city, but as a carefully constructed visual narrative with afterlives of its own. The album, created upon the annexation of the city of Niš from the Ottoman Empire, produces multiple temporalities: the “recurring” and “timeless” national authenticity of the village, shown through costumes and church ruins, is contrasted with the images of the city, which the album constitutes as “old” and photographs as “future ruins.” The latter serves to establish a temporal break between the Ottoman past and the pending Serbian modernization project. Today, the album embodies two distinct afterlives. First, the Ottoman city—and the Empire itself—which the album proclaims “dead,” continues to live only as an object of photography. Second, the album today represents an afterlife of the foundational ideologies and images of post-Ottoman nation-making in and beyond Serbia. The two afterlives are not without contradiction: even though it is used to proclaim the empire “dead,” the album represents an ambivalent material afterlife of the empire in the present (Walton, 2019), while the ambivalence of photography as a medium itself opens avenues for readings beyond the prescribed.
‘If I don’t do some couching I will burst’
Authors: Tulloch Carol
Published: October 2022

‘If I Don’t Do Some Couching I Will Burst’ was the explanation I gave to Dr. Amy Twigger-Holroyd to explain my need to make in order to feel more balanced due to work commitments generally, and during the Covid-19 pandemic in particular, and why I drew on couching as a stitch to achieve this. It was not until writing this essay about ‘The Piece’ I stitched in 2021 to stop me from ‘bursting’, that I realised the centrality of the work to expanded meanings of self-care.‘The Piece’ links my claims for psychological space, physical making space, camaraderie with like-minded makers and a quest for wholeness, all taking place within my home, in order to achieve the space that Louise Bourgeois refers to as being ‘‘a metaphor for the structure of our existence’ (Lorz 2015).
Physical activity environment inside and outside school and youth fitness: A spatial analysis at the level of elementary school attendance zone in Georgia
Authors: Yang Jue , Rajbhandari-Thapa Janani , Mu Lan , Zhang Donglan , Thapa Kiran
Published: October 2022

The present study investigates the spatial correlation between built and natural environments that promote physical activity (PA) and children’s fitness. Previous work has been conducted on various geographic scales such as from a county level. However, evaluations from a school attendance zone level, which are the policy and program administration units for schools, have yet to be investigated. Using a factor analysis, 24 PA-related environmental variables were reduced to six environmental factors and then run factors with geographically weighted regression (GWR) at the level of the elementary school attendance zones (ESAZ) in Georgia. The outside-school environmental factors (park, recreation, terrain, nature and camping) and inside school environmental factor (school PA time) were constructed by ESAZ. We found that of all the PA environment factors, the most highly associated with promoting PA and children’s fitness were inside-school PA environment. The outside factors of the park and terrain environment indicated strong local geographic variation in youth health. The result showed local variation in the association between PA environment and fitness among elementary school children in Georgia and highlighted the geographically customized efforts for different regions’ policy changes to improve child health.
Plastic deformation of AZ31B magnesium alloy in the preform and electropulsing treatment process
Authors: Zhang Meng , Wang Shunbo , Zhang Jianhai , Liu Changyi , Wang Zhaoxin , Zhao Hongwei
Published: October 2022

Magnesium alloys exhibit poor formability at room temperature owing to their hexagonal close-packed crystal structure. In this study, a multi-step preform and electropulsing treatment method was applied to the plastic deformation of AZ31B magnesium alloy to improve its cumulative ductility. The mechanical properties, microstructure, and dislocation evolution were investigated using various parameters. The cumulative elongation of all specimens increased significantly, with the maximum approximately twofold higher for the initial specimens. Although the yield strength decreased after the first step, it increased with the following steps. After electropulsing treatment, the specimens were recrystallized and the dislocations were annihilated. The deformed microstructure caused by preform recovered and the recovery degree was associated with the preform and electropulsing treatment parameters. Therefore, the preform and electropulsing treatment method is effective to enhance the ductility of AZ31B magnesium alloy at room temperature, and a set of appropriate pulse current parameters can achieve satisfactory strength and elongation results. Moreover, the effect of the pulse current on the dislocation mobility and climb mainly accounts for the beneficial restoration during the preform and electropulsing treatment process.
Experimental and numerical investigation on the resistance of steel fiber-reinforced heavyweight concrete slabs against rigid projectile impact
Authors: Hosseinipour Seyed Mohammad Amin , Vaseghi Amiri Javad , Naghipour Morteza , Khodarahmi Hossein
Published: October 2022

This study presents an inclusive experimental and numerical investigation of the resistance of steel fiber-reinforced heavyweight concrete under the impact of a high-velocity rigid projectile. Thus, concrete specimens were made using hooked-end steel fibers at 0%, 0.5%, 1%, 1.5%, 2%, and 2.5% volume fractions to assess the physicomechanical specifications of heavyweight concrete containing iron ore as fine and coarse aggregates. Also, the compressive and splitting tensile strengths, modulus of elasticity, stress–strain relationship, bulk density, and water absorption capacity of heavyweight concrete specimens were compared to those of the equivalent normal-weight concrete. The penetration tests were conducted on concrete slabs fabricated with normal weight and heavyweight concrete mixes to examine the specimens’ failure mode, penetration depth, and spalling volume. The results revealed that normal-weight concrete's compressive and splitting tensile strengths were more susceptible to adding steel fibers. It was also shown that increasing the density and fiber content significantly affected the impact resistance and residual velocity of fiber-reinforced concrete elements. Heavyweight concrete provided better life safety measures against the impact load than normal weight specimens, while the repair and reuse of heavyweight concrete components were feasible. Moreover, numerical modeling was performed using LS-DYNA finite element software, and the predictions were compared to the proposed experimental results and the analytical relations in the literature. There was good agreement between the results.
Hair Bias in the Workplace: A Critical Human Resource Development Perspective
Authors: Trusty Juanita , Ward David Akili , Good-Perry Ward Mijean , He Mengying
Published: October 2022

The Problem

Managers and other individuals in the workplace may have a bias, either conscious or unconscious, against Black women based on their appearance. Since slavery, Black people with lighter skin complexion and straighter hair have been given preferences and privileges not afforded Black people with darker skin or those with naturally kinky hair. This study brings this subtle form of discrimination to the attention of Human Resource Development professionals and sheds light on how such interactions may affect their learning, development, and performance.

The Solution

Using a critical Human Resource Development lens, we suggest that managers, organizational leaders, and decision-makers are educated to recognize and address hair bias. Leaders must ensure compliance with the CROWN Act and legislation that prohibits discrimination against natural and protective hairstyles.

The Stakeholders

Stakeholders include U. S. Human Resource Development professionals, hiring managers, recruiters, and leaders who are concerned with hiring and promoting diverse talent.
Variability in Ethics Review for Multicenter Protocols in Buenos Aires, Argentina. An Observational Study
Authors: Mariani Javier , Garau María Laura , Roitman Adriel Jonas , Vukotich Claudia , Perelis Leonardo , Ferrero Fernando , Domínguez Adriana Gladys , Campos Cecilia , Serrano Cecilia , Villa Monte Gabriel González
Published: October 2022

It has been reported that significant variability in the ethics review process affects multisite studies. We analyzed 1,305 applications for multicenter studies (409 unique protocols), from 1st January 2020 to 20th September 2021. We examined the variability in the times to approval and the first observation and the variation in the level of risk assigned. The median [IQR] variabilities were 42.19 [15.23–82.36] days and 8.00 [3.12–16.68] days, for the times to approval and to the first observation, respectively. There was disagreement in the level of risk assigned by the Research Ethics Committee (REC) in 24.0% of cases. Independent predictors of variability included the number of REC members. In our study, we found substantial variability in the ethics review process among health research protocols. Also, we describe methods to readily measure the delays and the variations in the ethics review process.
Early neurological deterioration as a predictor of outcomes after endovascular thrombectomy for stroke: A systematic review and meta-analysis
Authors: Kobeissi Hassan , Ghozy Sherief , Seymour Trey , Bilgin Cem , Kadirvel Ramanathan , Kallmes David F.
Published: October 2022

Background

Early neurological deterioration (END) is a potential predictor for 90-day outcomes following mechanical thrombectomy for acute ischemic stroke (AIS). We performed a systematic review and meta-analysis to better understand whether END can be used as a surrogate for long-term outcomes.

Methods

Following the PRISMA guidelines, a systematic literature review of the English language literature was conducted using PubMed, MEDLINE, and Embase. END definition was cataloged for each included study. Outcomes of interest included 90-day modified Rankin Scale (mRS) 0–2, symptomatic intracranial hemorrhage (sICH), mortality, and thrombolysis in cerebral infarction (TICI) 2b-3. We calculated pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CI) for all definitions of END.

Results

We included seven studies with 2992 patients in our analysis. There was a significant, inverse association with END and mRS 0–2 rates (OR = 0.15; 95% CI = 0.08–0.29; P-value< 0.001). Moreover, END was a significant predictor of increased odds for reported sICH rates (OR = 16.37; 95% CI = 7.66–34.99; P-value< 0.001). Furthermore, there was a significant association between END and increase in mortality rates (OR = 6.79; 95% CI = 2.62–17.62; P-value< 0.001). There was no significant association between END and rates of TICI 2b-3 (OR = 0.53; 95% CI = 0.27–1.05; p = 0.069).

Conclusions

Broadly defined, END holds value as a potential predictor of rates of mRS 0–2 at 90 days and is associated with higher rates of mortality and sICH, but had no correlation with TICI 2b-3.
Dynamic ST-based PCA method for adaptive data detection
Authors: Lin Tsun-Kuo
Published: October 2022

This study developed a dynamic principal component analysis (PCA)-based algorithm for adaptive data detection. The algorithm employs suitable STs on the basis of various data to achieve high accuracy. The scree test (ST) has long been criticized for its subjectivity because no standard applies for retaining the correct number of components or factors when identifying various types of data. This article proposes a novel dynamic ST-based (STB) PCA method wherein a suitable ST is selected in using a support vector machine (SVM) for determining the correct number of components in data detection. The dynamic STB PCA can be employed as a solution to effectively detect various types of data. The proposed detection system can bridge the gap between input data and suitable STs for solving problems encountered when implementing data detection. The experimental results show that the STB PCA provides a ST-selection tool for automatically selecting the most suitable STs, and effectively detected various data using the STs. In the data detection, the proposed method outperforms existing PCA methods that do not consider suitable STs.
Multi-objective optimization of Nd:Yag laser machining’s conflicting responses while milling micro-channels
Authors: Abidi Mustufa Haider , Mohammed Muneer Khan , Aboudaif Mohamed K , Alkhalefah Hisham
Published: October 2022

Laser processing of materials finds application in micro-nano devices mainly because of its accuracy, flexibility, and ability to machine almost any material. Although it offers numerous advantages, it is a complex process involving a large number of factors. The quality of machining often depends on the appropriate selection of parameters. Moreover, the output responses in machining processes have conflicting nature; some are to be minimized, and others have to be maximized. This work uses grey relationship analysis coupled with principal component analysis for multi-response optimization of conflicting responses during laser machining of micro-channels. Micro-channels with a cross-sectional size of 200 × 100 µm were created using Nd:YAG laser beam micro-milling in steel alloy (AISI 1045). The scan speed, layer thickness, and scan strategy were found to have a significant effect on the dimensional accuracy of the microchannel. At the same time, the material removal rate was mostly influenced by layer thickness. Multi-response optimization results suggest low pulse frequency, high scan speed, low layer thickness, and S3 scan strategy for accurately fabricating micro-channels.
A qualitative study evaluating the discharge process for vascular surgery patients to identify significant themes for organizational improvement
Authors: Vogel Todd R , Kruse Robin L , Schlesselman Chase , Doss Elizabeth , Camazine Maraya , Popejoy Lori L
Published: October 2022

Objective

Transition from the hospital to an outpatient setting is a multifaceted process requiring coordination among a variety of services and providers to ensure a high-quality discharge. Vascular surgery patients comprise a complex population that experiences high unplanned readmission rates. We performed a qualitative study to identify themes for process improvement for vascular surgery patients. A validated discharge process, RED (Re-Engineered Discharge), was used to identify additional actionable themes to create a more efficient discharge process tailored specifically to the vascular surgery population.

Methods

A prospective, qualitative analysis at a tertiary center using a semi-structured focus group interview guide was performed to evaluate the current discharge process and identify opportunities for improvement. Focus groups were Zoom recorded, transcribed into electronic text files, and were loaded into Dedoose qualitative software for analysis using a directed content analysis approach. Two researchers independently thematically coded each transcript, starting with accepted discharge components to identify new thematic categories. Prior to analysis, all redundancy of codes was resolved, and all team members agreed on text categorization and coding.

Results

Eight focus groups with a total of 38 participants were conducted. Participants included physicians ( n = 13), nursing/ancillary staff ( n = 14), advanced nurse practitioners ( n = 2), social worker/dietitian/pharmacist ( n = 3), and patients ( n = 6). Transcript analyses revealed facilitators and barriers to the discharge process. In addition to traditional RED components, unique concepts pertinent to vascular surgery patients included patient complexity, social determinants of health, technology literacy, complexity of ancillary services, discharge appropriateness, and use of advanced nurse practitioners for continuity.

Conclusions

Specific themes were identified to target and enhance the future vRED (vascular Re-Engineered Discharge) bundle. Thematic targets for improvement include increased planning, organization, and communication prior to discharge to address vascular surgery patients’ multiple comorbidities, extensive medication lists, and need for complex ancillary services at the time of discharge. Other thematic barriers discovered to improve include provider awareness of patient health literacy, patient understanding of complex discharge instructions, patient technology barriers, and intrinsic social determinants of health in this population. To address these discovered barriers, organizational targets to improve include enhanced social support, the use of advanced nurse practitioners for education reinforcement, and increased coordination. These results provide a framework for future quality improvement targeting the vascular surgery discharge process.
Internally Triggered Experiences of Hedonic Valence in Nonhuman Animals: Cognitive and Welfare Considerations
Authors: Mahr Johannes B. , Fischer Bob
Published: October 2022

Do any nonhuman animals have hedonically valenced experiences not directly caused by stimuli in their current environment? Do they, like us humans, experience anticipated or previously experienced pains and pleasures as respectively painful and pleasurable? We review evidence from comparative neuroscience about hippocampus-dependent simulation in relation to this question. Hippocampal sharp-wave ripples and theta oscillations have been found to instantiate previous and anticipated experiences. These hippocampal activations coordinate with neural reward and fear centers as well as sensory and cortical areas in ways that are associated with conscious episodic mental imagery in humans. Moreover, such hippocampal “re- and preplay” has been found to contribute to instrumental decision making, the learning of value representations, and the delay of rewards in rats. The functional and structural features of hippocampal simulation are highly conserved across mammals. This evidence makes it reasonable to assume that internally triggered experiences of hedonic valence (IHVs) are pervasive across (at least) all mammals. This conclusion has important welfare implications. Most prominently, IHVs act as a kind of “welfare multiplier” through which the welfare impacts of any given experience of pain or pleasure are increased through each future retrieval. However, IHVs also have practical implications for welfare assessment and cause prioritization.
Complex Racial Trauma: Evidence, Theory, Assessment, and Treatment
Authors: Cénat Jude Mary
Published: October 2022

Racial trauma refers to experiences related to threats, prejudices, harm, shame, humiliation, and guilt associated with various types of racial discrimination, either for direct victims or witnesses. In North American, European, and colonial zeitgeist societies, Black, Indigenous, and people of color (BIPOC) experience racial microaggressions and interpersonal, institutional, and systemic racism on a repetitive, constant, inevitable, and cumulative basis. Although complex trauma differs from racial trauma in its origin, the consistency of racist victimization beyond childhood, and the internalized racism associated with it, strong similarities exist. Similar to complex trauma, racial trauma surrounds the victims’ life course and engenders consequences on their physical and mental health, behavior, cognition, relationships with others, self-concept, and social and economic life. There is no way to identify racial trauma other than through a life-course approach that captures the complex nature of individual, collective, historical, and intergenerational experiences of racism experienced by BIPOC communities in Western society. This article presents evidence for complex racial trauma (CoRT), a theoretical framework of CoRT, and guidelines for its assessment and treatment. Avenues for future research, intervention, and training are also presented.
Colposcopy and cervical cancer screening
Authors: Ramesh Pooja , Munjal Pooja
Published: October 2022

Cervical cancer is the fourth most common cancer for women, with 604 000 new cases and 342 000 deaths worldwide in 2020. In the United Kingdom, there were approximately 25 000 new cases a year between 2016 and 2018. The World Health Organization aims to eliminate cervical cancer as a public health problem by 2023. It has been estimated that the incidence of cervical cancer dropped by more than 50% from the 1970 s to the 2000 s, which is attributed to early intervention opportunities created by screening programmes. The majority (>99%) of cervical cancer is associated with human papilloma virus (HPV). Therefore, HPV vaccination along with cervical cancer screening and colposcopy play a significant role in prevention, early detection and management of cervical cancer.
Health promotion: Exercise
Authors: Keech Maximillian
Published: October 2022

Physical activity can have a transformational positive impact on both individual and public health outcomes. It can be used to positively and proactively manage many common chronic conditions, as well as reducing the risk of developing them. However, in the UK, over one-in-four adults is physically inactive, and one-in-three children do less than half the physical activity recommended for their age. This article looks at the benefits of physical activity, UK government recommendations for physical activity in different age groups, and how to support patients in primary care to become more active.
Clustering of UK universities based on the research productivity of psychology departments
Authors: Saxena Gaurav , Lai Katerina A , Allen Peter J
Published: October 2022

Higher education institutions in the UK have organised into mission groups for the advocacy of shared interests and ideologies. Although research productivity is claimed as a key point of difference between these groups, this claim has received relatively little empirical scrutiny. The current study examined the clustering of UK universities based on the research productivity of academic psychologists. It found evidence for the Russell Group’s (RG’s) claim that it represents leading, research-intensive universities, at least with respects to the discipline of psychology. Productivity metrics of a representative sample of 1339 academic psychologists were extracted from Scopus and Scimago database and were averaged to derive department level productivity indicators. Results from cluster analysis provided evidence in favour of RG’s research superiority claim. Cluster level averages of the cluster comprising RG universities were approximately 50–300% higher than those of the cluster comprising non-RG universities. As anticipated, the universities of Oxford and Cambridge surpassed all others to form separate clusters representing an ‘elite’ within the RG.
Digital inclusion, online participation and health promotion: promising practices from community-led participatory journalism
Authors: Mulligan Kate
Published: October 2022

A growing body of evidence demonstrates that digital inclusion mediates access to other social determinants of health – directly, through access to and literacy in technologies or services, and indirectly, by supporting people’s capacity to participate fully and equitably in civic and cultural life online. Novel approaches to community-led participatory journalism, in which people from equity-deserving communities are supported to tell their own stories, suggest promising practices for online civic engagement as an emerging approach to promoting health though digital inclusion.
Inflammatory Optic Neuropathy as a Presenting Feature of Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy
Authors: Moura João , Mendes Pinto Catarina , Pinto Pedro , Santos Ernestina
Published: October 2022

Background: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is commonly associated with early-onset stroke, migraine and vascular dementia. However, optic nerve involvement has been previously recognised.

Results: We report a case of a 21-year-old female presenting with right inferior temporal scotoma, dyschromatopsia, relative pupillary afferent defect and bilateral disk oedema in the fundoscopic examination. Visual evoked potential latencies were bilaterally increased, suggesting optic neuropathy. Cerebrospinal fluid (CSF) evaluation showed 11 leukocytes, .45 mg/dL proteins, elevated IgG (4.55 mg/dL) and 2 oligoclonal bands (OCB) restricted to the CSF. ESR was 17 mm/h and CRP 5 mg/dL. Anti-Aquaporin4 anti-MOG antibodies were negative. The MRI showed right optic nerve hyperintensity, enhancing after the administration of contrast product, and multiple FLAIR focal lesions present throughout the white matter, with a noticeable confluence in the anterior temporal horns. She improved after IV high-dose methylprednisolone. Because the lesions of the white matter were highly atypical for an inflammatory disease and highly suggestive of CADASIL genetic testing was requested. A heterozygous pathogenic variant c994C>T p (Arg332Cys) in the exon 6 of the NOTCH3 gene, compatible with the diagnosis of CADASIL was found.

Conclusions: This case highlights isolated optic nerve involvement as a presenting feature of CADASIL, possibly reflecting an inflammatory process associated with this hereditary vasculopathy.
Predicting non-initiation of care and dropout in a blended care CBT intervention: Impact of early digital engagement, sociodemographic, and clinical factors
Authors: Wu Monica S. , Chen Shih-Yin , Wickham Robert E. , Leykin Yan , Varra Alethea , Chen Connie , Lungu Anita
Published: October 2022

Objective

This study examines predictors of non-initiation of care and dropout in a blended care CBT intervention, with a focus on early digital engagement and sociodemographic and clinical factors.

Methods

This retrospective cohort analysis included 3566 US-based individuals who presented with clinical levels of anxiety and depression and enrolled in a blended-care CBT (BC-CBT) program. The treatment program consisted of face-to-face therapy sessions via videoconference and provider-assigned digital activities that were personalized to the client's presentation. Multinomial logistic regression and Cox proportional hazard survival analysis were used to identify predictors of an increased likelihood of non-initiation of therapy and dropout.

Results

Individuals were more likely to cancel and/or no-show to their first therapy session if they were female, did not disclose their ethnicity, reported poor financial status, did not have a college degree, endorsed more presenting issues during the onboarding triage assessment, reported taking antidepressants, and had a longer wait time to their first appointment. Of those who started care, clients were significantly more likely to drop out if they did not complete the digital activities assigned by their provider early in treatment, were female, reported more severe depressive symptoms at baseline, reported taking antidepressants, and did not disclose their ethnicity.

Conclusions

Various sociodemographic and clinical predictors emerged for both non-initiation of care and for dropout, suggesting that clients with these characteristics may benefit from additional attention and support (especially those with poor early digital engagement). Future research areas include targeted mitigation efforts to improve initiation rates and curb dropout.
Inverted Papilloma of the Middle Ear: Two New Cases and Systematic Review
Authors: Miller Peter L. , Walsh Erika , Cho Do-Yeon , Woodworth Bradford A. , Grayson Jessica W.
Published: October 2022

Introduction

Inverted papillomas of the middle ear are extremely rare tumors that carry an increased risk of recurrence and malignant transformation. There are currently 59 cases of middle ear inverted papillomas reported in the literature. The objective in this study was to systematically evaluate outcomes regarding middle ear inverted papillomas with respect to demographics, anatomical tumor sites, malignant transformation status, recurrence rate and HPV status.

Study Design

Retrospective case series and systematic review.

Methods

A systematic review was completed on June 25, 2020 with a search strategy including PubMed, Embase, Scopus and Google Scholar. This revealed 181 articles. Full-text review was completed, and 66 articles were included. 115 articles were eliminated due to duplication of articles from databases, article titles not applicable to the aims of the systematic review and articles describing inverted papilloma of body sites other than middle ear.

Discussion

Thirty-one cases of primary inverted papillomas of the middle ear were found in the literature with an additional 26 cases of secondary tumors. Four case reports did not specify primary versus secondary. The malignant transformation rate was 34.4% with a 53.6% recurrence rate. Treatment of middle ear inverted papillomas is primarily surgical with adjuvant radiation therapy considered for patients with recurrence or malignant transformation. Frequent clinical follow up of these patients is critical due to the increased rate of recurrence and malignant transformation.

Conclusion

Inverted papillomas of the middle ear are rare tumors that carry a high risk of recurrence and malignant transformation necessitating complete resection and frequent clinical follow up.
Eating Expectancy as a Moderator of Sociocultural Influence on Bulimic Symptoms among High-Risk Female College Students
Authors: Moon Hasom , Chang Hyein
Published: October 2022

This study examined the interactive effects of sociocultural influence from different sources (parent, peer, and media) and eating expectancy on bulimic symptoms among 116 female college students experiencing relatively high levels of bulimia nervosa. Participants ( Mage = 19.32, SD = 1.26) completed self-report inventories assessing bulimic symptoms, sociocultural influence, and eating expectancy at baseline (T1) and one-year follow-up (T2). The results indicated that eating expectancy moderated the relation between peer influence and future bulimic symptoms. Specifically, peer influence was positively related to bulimic symptoms in higher levels of eating expectancy, whereas peer influence was negatively related to bulimic symptoms in lower levels of eating expectancy. However, media influence independently predicted bulimic symptoms regardless of eating expectancy and parent influence did not predict bulimic symptoms. The findings are discussed with respect to considering sociocultural influence and individual cognition as potential targets for the prevention and intervention of bulimic symptoms.
The COVID-19 vaccination experience of non-English speaking immigrant and refugee communities of color: A community co-created study
Authors: Salib Yesmina , Amodei Joseph , Sanchez Claudia , Castillo Smyntek Ximena Alejandra , Lien Marian , Liu Sabrina , Acharya Geeta , Kihumbu Benoit , Mishra Pralad , Chaves-Gnecco Diego , Timsina Khara , Diaz Jenny , Henry Constanza , Mickievicz Erin , Mwaliya Aweys , Ho Ken , Sidani Jaime , Ragavan Maya I
Published: October 2022

In this community-partnered study we conducted focus groups with non-English speaking immigrant and refugee communities of color in 4 languages to understand their perspectives on COVID-19 vaccines, barriers to accessing vaccines, and recommendations for healthcare providers. We used a mixed deductive-inductive thematic analysis approach and human centered design to guide data analysis. 66 individuals participated; 85% were vaccinated. The vaccination experience was often positive; however, participants described language inaccessibility, often relying on family members for interpretation. Community-based organizations played a role in connecting participants to vaccines. Unvaccinated participants expressed fear of side effects and belief in natural immunity. Participants shared recommendations to providers around increasing vaccine access, improving language accessibility, and building trust. Results from our study show numerous barriers immigrant and refugee communities of color faced getting their COVID-19 vaccine, but also highlights opportunities to engage with community partners. Future implications for research, policy, and practice are described.
HDAC1 regulates the chromatin landscape to control transcriptional dependencies in chronic lymphocytic leukemia
Authors: Lai Tzung-Huei , Ozer Hatice Gulcin , Gasparini Pierluigi , Nigita Giovanni , Distefano Rosario , Yu Lianbo , Ravikrishnan Janani , Yilmaz Selen , Gallegos Juan , Shukla Sachet , Puduvalli Vinay , Woyach Jennifer , Lapalombella Rosa , Blachly James , Byrd John C. , Sampath Deepa
Published: October 2022

Chronic lymphocytic leukemia (CLL) is a quiescent B-cell malignancy that depends on transcriptional dysregulation for survival. The histone deacetylases are transcriptional regulators whose role within the regulatory chromatin and consequence on the CLL transcriptome is poorly characterized. Here, we profiled and integrated the genome-wide occupancy of HDAC1, BRD4, H3K27Ac, and H3K9Ac signals with chromatin accessibility, Pol2 occupancy, and target expression signatures in CLL cells. We identified that when HDAC1 was recruited within super-enhancers (SEs) marked by acetylated H3K27 and BRD4, it functioned as a transcriptional activator that drove the de novo expression of select genes to facilitate survival and progression in CLL. Targeting HDACs reduced BRD4 and Pol2 engagement to downregulate the transcript and proteins levels of specific oncogenic driver genes in CLL such as BLK, a key mediator of the B-cell receptor pathway, core transcription factors such as PAX5 and IKZF3, and the antiapoptotic gene, BCL2. Concurrently, HDAC1, when recruited in the absence of SEs, repressed target gene expression. HDAC inhibition reversed silencing of a defined set of protein-coding and noncoding RNA genes. We focused on a specific set of microRNA genes and showed that their upregulation was inversely correlated with the expression of CLL-specific survival, transcription factor, and signaling genes. Our findings identify that the transcriptional activator and repressor functions of HDACs cooperate within the same tumor to establish the transcriptional dependencies essential for survival in CLL.
Health following recovery from immune thrombotic thrombocytopenic purpura: the patient’s perspective
Authors: Kelley Rachel A. , Cheney Marshall K. , Martin Clare M. , Cataland Spero , Quick Lauren B. , Keller San , Vesely Sara K. , Llaneza Amanda J. , Khawandanah Mohamad O. , Journeycake Janna M. , Panepinto Julie A. , Terrell Deirdra R.
Published: October 2022

The impact of residual symptoms following recovery from immune-mediated thrombotic thrombocytopenic purpura (iTTP) on activities of daily living during remission is not routinely discussed or evaluated by hematologists. This study used qualitative methodology to understand 3 issues from the patient’s perspective: the most important symptoms during remission, the impact of these symptoms on their daily activities, and the effectiveness of communication with hematologists. Oklahoma and Ohio patients participated in either focus groups or individual interviews. Eligibility included age ≥18 years, ADAMTS13 deficiency (<10% activity) at diagnosis or relapse, and in clinical remission (≥1 year from episode). A nonprobabilistic purposive sampling approach was used. The most important symptoms were defined as symptoms mentioned across all 7 focus groups. The interviews supplemented focus group data. The analysis focused on describing the impact of symptoms and barriers to communicating with hematologists. A total of 44 patients participated (focus groups, N = 25; interviews, N = 19). The most important symptoms affecting the patients’ daily activities were cognitive issues, anxiety, depression, and fatigue. These symptoms affected patients’ ability to return to their previous level of functioning and created difficulties in relationships. A key communication barrier with their hematologists was forgetting to mention these symptoms. Although hematologists pronounce patients as recovered, iTTP remains a life-changing event. Patients often did not return to their previous functioning; relationships and careers were affected. However, patients may forget to discuss these concerns with their hematologist. To improve remission care, hematologists should incorporate patient-reported outcome measures evaluating these symptoms in remission visits.
Pirtobrutinib targets BTK C481S in ibrutinib-resistant CLL but second-site BTK mutations lead to resistance
Authors: Naeem Aishath , Utro Filippo , Wang Qing , Cha Justin , Vihinen Mauno , Martindale Stephen , Zhou Yinglu , Ren Yue , Tyekucheva Svitlana , Kim Annette S. , Fernandes Stacey M. , Saksena Gordon , Rhrissorrakrai Kahn , Levovitz Chaya , Danysh Brian P. , Slowik Kara , Jacobs Raquel A. , Davids Matthew S. , Lederer James A. , Zain Rula , Smith C. I. Edvard , Leshchiner Ignaty , Parida Laxmi , Getz Gad , Brown Jennifer R.
Published: October 2022

Covalent inhibitors of Bruton tyrosine kinase (BTK) have transformed the therapy of chronic lymphocytic leukemia (CLL), but continuous therapy has been complicated by the development of resistance. The most common resistance mechanism in patients whose disease progresses on covalent BTK inhibitors (BTKis) is a mutation in the BTK 481 cysteine residue to which the inhibitors bind covalently. Pirtobrutinib is a highly selective, noncovalent BTKi with substantial clinical activity in patients whose disease has progressed on covalent BTKi, regardless of BTK mutation status. Using in vitro ibrutinib-resistant models and cells from patients with CLL, we show that pirtobrutinib potently inhibits BTK-mediated functions including B-cell receptor (BCR) signaling, cell viability, and CCL3/CCL4 chemokine production in both BTK wild-type and C481S mutant CLL cells. We demonstrate that primary CLL cells from responding patients on the pirtobrutinib trial show reduced BCR signaling, cell survival, and CCL3/CCL4 chemokine secretion. At time of progression, these primary CLL cells show increasing resistance to pirtobrutinib in signaling inhibition, cell viability, and cytokine production. We employed longitudinal whole-exome sequencing on 2 patients whose disease progressed on pirtobrutinib and identified selection of alternative-site BTK mutations, providing clinical evidence that secondary BTK mutations lead to resistance to noncovalent BTKis.
A phase 2 study of nivolumab combined with ibrutinib in patients with diffuse large B-cell Richter transformation of CLL
Authors: Jain Nitin , Senapati Jayastu , Thakral Beenu , Ferrajoli Alessandra , Thompson Philip , Burger Jan , Basu Sreyashi , Kadia Tapan , Daver Naval , Borthakur Gautam , Konopleva Marina , Pemmaraju Naveen , Parry Erin , Wu Catherine J. , Khoury Joseph , Bueso-Ramos Carlos , Garg Naveen , Wang Xuemei , Lopez Wanda , Ayala Ana , O’Brien Susan , Kantarjian Hagop , Keating Michael , Allison James , Sharma Padmanee , Wierda William
Published: October 2022

Richter transformation (RT) is a rare complication of chronic lymphocytic leukemia (CLL) that has dismal outcomes. Upregulation of PD-1/PD-L1 drives immunological evasion in patients with RT. We hypothesized that combining nivolumab, a PD-1 blocking antibody, with the BTK inhibitor (BTKi) ibrutinib could potentiate tumor-cell killing. We conducted an investigator-initiated phase 2 clinical trial to assess the efficacy of combined nivolumab and ibrutinib in patients with diffuse large B-cell lymphoma (DLBCL) RT and CLL. Patients included were ≥18 years of age with adequate hepatic and renal function. Patients received nivolumab every 2 weeks of a 4-week cycle for a maximum of 24 cycles. A standard dose ibrutinib was initiated from cycle 2 onward and continued daily until progression. For patients who were already on ibrutinib at the time of study entry, the same was continued while nivolumab was initiated. A total of 24 patients with RT with a median age of 64.5 years (range, 47-88) were enrolled. Ten patients (42%) had received prior treatment for RT and 13 patients (54%) had received a prior BTKi. A total of 10 patients (42%) responded with a median duration of response of 15 months. The median overall survival was 13 months. Four of 24 (17%) patients had checkpoint inhibition–related immunological toxicities. In the CLL cohort, 10 patients were enrolled, of whom 3 patients converted from partial to complete remission; 1 patient had a grade 2 immunological toxicity. Combined nivolumab and ibrutinib is an active regimen for patients with DLBCL RT with an overall response rate of 42%. Given the limited treatment options for patients with RT, checkpoint inhibition provides a potential therapeutic option. This trial is registered at www.clinicaltrials.gov as #NCT02420912.