bluuebunny/crossref_metadata_2025 huggingface dataset:
Homoeopathic Management of Breast Fibroadenoma—An Open Label, Single Arm, Observational Trial
Authors: Shukla Purnima , Misra Purak , Misra Rajiv Kumar , Jain Rishabh Kumar , Shukla Rakesh , Manchanda R.K , Khurana Anil
Published: November 2021

Achtergrond Fibroadenoom van de borst is de meest voorkomende kwaal bij vrouwen met een aanzienlijk risico op overlijden. Uit de beschikbare literatuur blijkt dat borsttumoren verdwijnen door homeopathische behandeling. De huidige studie evalueerde de rol van homeopathische behandeling op borstfibroadenoma met behulp van ‘Triple assessment criteria’ (dubbel blind) en onderzoekt of homeopathische geneesmiddelen therapeutisch effect teweeg brengen door het veranderen van de oestrogeen en progesteron receptor (ER/PR) status op tumorweefsel.

Materialen en Methoden Een open-label, prospectieve, single-arm, observationele studie werd uitgevoerd bij 64 vrouwelijke patiënten met fibroadenoom van de borst. Er werden drievoudige beoordelingscriteria gebruikt om de doeltreffendheid van de homeopathische behandeling van borstfibroadenomen te onderzoeken. Geïndividualiseerde homeopathische geneesmiddelen werden voorgeschreven. De meetresultaten vertoonden veranderingen in het klinisch beeld en het aantal en de omvang van de knobbels door middel van ultrasoonmammografie. ER/PR studie werd uitgevoerd door immunohistochemie met gebruik van quick score analyse.

Resultaten Bij 23 gevallen (35,93%) van fibroadenomen was er na de behandeling geen knobbel meer meetbaar. Gedeeltelijke verbetering werd waargenomen in 22 gevallen (34,37%) met significante vermindering van de gemiddelde grootte (p < 0,001). Ook werd een significante vermindering van het aantal laesies gezien bij fibroadenomen (p < 0,05). Conium maculatum en Phytolacca decandra bleken de meest bruikbare remedies te zijn. De quick score waarde van ER na behandeling toonde significante vermindering (Z ¼ 4.910).

Conclusie De studie toont aan dat de therapeutische effecten van toediening van geïndividualiseerde homeopathische geneesmiddelen een belangrijke rol spelen bij de behandeling van fibroadenomen van de borst. De resultaten van ER/PR laten een significante vermindering van ER zien, wat suggereert dat homeopathische geneesmiddelen een remmend effect hebben op ER.
Spontaneous Pneumomediastinum: A Possible Severe Condition in SARS-CoV-2 Pneumonia
Authors: Jacqmin Geoffrey , Pirotte Manuel , Caravaggio Carlo , Devaux Philippe
Published: November 2021

Background Spontaneous pneumomediastinum (SP) is the presence of free air into extra-alveolar tissues within the mediastinum, without notion of trauma. This rare condition may occur as a complication of an underlying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Higher rates of mechanical ventilation are reported in coronavirus disease 2019 (COVID-19) patients with pneumomediastinum.

Case Description We report two cases of COVID-19 infected patients suffering from mild and severe SP and their outcome.

Discussion The objective of this report is to review the literature about this condition. We discuss about the pathological pathways underlying this complication and how it reflects the severity of COVID-19 pneumonia.

Conclusion Currently, it remains unclear if SP in SARS-CoV-2 pneumonia is a potential predictor of disease worsening, for it does not seem to be related with a higher rate of mortality.
15.1 Flow Chemistry in the Pharmaceutical Industry: Part 1
Authors: O’Brien A. G.
Published: November 2021

The use of flow chemistry in the single- and multistep synthesis of active pharmaceutical ingredients has been well demonstrated. The pharmaceutical industry is now taking the next steps towards integration of flow chemistry into large-scale commercialized processes, which can effectively supply patient populations. This chapter details advances in this area, and outlines the data and knowledge required to select, develop, scale, and commercialize an efficient flow process.
A square-integrable spinor solution to non-interacting Dirac equations
Authors: Fabbri Luca , Cianci Roberto , Vignolo Stefano
Published: November 2021

We consider the Dirac equation written in polar form, without any external potential but equipped with a non-zero tensorial connection, and we find a new type of solution that is localized around the origin with a decreasing exponential behavior in the radial coordinate.
Effects of different thermal sintering temperatures on pattern resistivity of printed silver ink with multiple particle sizes
Authors: Yu Zhiheng , Huang Fengli , Zhang Tiancheng , Tang Chengli , Cui Xihua , Yang Chao
Published: November 2021

Resistivity is considered a significant parameter for printing a conductive pattern and nano-ink. Nevertheless, the resistivity of a sintered printing pattern varies with the performance of the pattern and nano-ink. The cross section or non-uniformity of the printing pattern is not taken into consideration, and the changes in resistivity are not measured during the whole sintering process. In this work, the cross section uniformity of the pattern is improved, which is attributable to the standard sample template fabricated by laser engraving. First, the ink containing 50 wt. % silver nanoparticles (AgNPs) with sizes ranging from 30 to 100 nm was prepared. Second, the prepared ink and commercial ink containing 50 wt. % AgNPs with an average size of 5 nm were separately injected into two standard sample templates. Finally, a four-probe platform was employed to carry out the sintering process at different temperatures. We studied the effects of sintering temperature on pattern resistivity and the subsequent performance of the prepared ink. Furthermore, the thermal conductivities of inks were calculated through the optimized Wiedemann–Franz law for different temperatures. The results showed that electrical resistivity of two inks changed after sintering, presenting the same trend of an initial linear increase, then a linear decrease, followed by a period of stability, and finally a linear increase as the sintering temperature increased. In addition, when the ink was sintered completely, the porosity observed using an optical microscope with 1000× magnification and resistivity and thermal conductivity of the prepared ink were 80.13%, 69.48%, and 66% smaller than those of commercial ink, respectively. The methods proposed in this paper lay the foundation for further research on nano-ink.
FDA–MIMO radar transmitting subaperture design and anti-interference performance analysis
Authors: Zhou Changlin , Wang Chunyang , Gong Jian , Tan Ming , Zhao Yingjian , Liu Mingjie
Published: November 2021

The hybrid of the frequency diversity array (FDA) radar and multiple-input multiple-output (MIMO) radar, namely, FDA–MIMO radar, provides more degrees of freedom and improves the overall performance of the system. The essence of FDA–MIMO radar transmitting subaperture design is to divide the transmit array into multiple subapertures to improve the interference suppression capability of the radar. Among them, orthogonal waveforms are transmitted between each subaperture, and each element inside the subaperture transmits the same waveform. Aiming at the problem of how the subaperture design of the FDA–MIMO radar affects its interference suppression performance, we analyzed the two aspects of the normalized beampattern and (non-)adaptive beamforming. We conclude that when interference is dominant, setting the number of subapertures to half of the number of transmit array elements can effectively reduce the sidelobe level and increase the output signal-to-interference-plus-noise ratio. A large number of simulation results verify the effectiveness and superiority of this method.
Simulation of nanoscale domain growth for ferroelectric recording
Authors: Fukuzawa Kenji , Hiranaga Yoshiomi , Cho Yasuo
Published: November 2021

The growth process of nm-scale polarization domains is of great interest from a physical point of view and is also important in the design of ferroelectric recording, which is expected to be a high-density information recording method. To clarify the growth of nanoscale domains in probe-based ferroelectric recording, a simulation method based on the time-dependent Ginzburg–Landau equation has been developed. In this method, wall pinning is included in the phenomenological free energy by using a coercive field. The simulation results agreed with the experimental results for nanoscale domain writing using a probe. The developed method was used to determine the relationship between the smallest writable domain size and the material properties: smaller wall energy density and larger saturation polarization and coercive field enable writing smaller domains. The developed method is thus effective in designing ferroelectric recording systems for high-density information storage.
Induction of right open reading frame kinase 3 (RIOK3) during ovulation and luteinisation in rat ovary
Authors: Zhang Wei , Zhang Chujing , Huang Ruiqi , Qiu Mengsheng , Li Fei-xue
Published: November 2021

Atypical protein serine kinase RIOK3 is involved in cellular invasion and survival. The spatiotemporal expression pattern and regulatory mechanisms controlling expression of Riok3 were investigated in the rat ovary during the periovulatory period. Immature female rats (22–23 days old) were treated with pregnant mare’s serum gonadotropin (PMSG) to stimulate follicular development, followed 48 h later by injection with human chorionic gonadotrophin (hCG). Ovaries, granulosa cells, or theca-interstitial cells were collected at various times after hCG administration. Both real-time polymerase chain reaction (PCR) and in situ hybridisation analysis revealed that Riok3 was highly induced in both granulosa cells and theca-interstitial cells by hCG. Riok3 expression was induced in theca-interstitial cells at 4 h after hCG. However, the expression of Riok3 mRNA was stimulated in granulosa cells at 8 h. Both protein kinase C inhibitor (GF109203) and the protein kinase A inhibitor (H89) could block the stimulation of Riok3 mRNA by hCG. Furthermore, Riok3 induction is dependent on new protein synthesis. Inhibition of prostaglandin synthesis or progesterone action did not alter Riok3 mRNA expression, whereas inhibition of the epidermal growth factor (EGF) pathway downregulated Riok3 expression. In conclusion, our findings suggest that the induction of the RIOK3 may be important for ovulation and luteinisation.
Interdisciplinary research to advance animal welfare science: an introduction.
Authors: Camerlink Irene
Published: November 2021

This chapter provides a brief introduction to animal welfare and animal welfare science, and to interdisciplinary research within this context.
Interdisciplinarity and the dilemmas of knowledge.
Authors: Frodeman Robert
Published: November 2021

This chapter explores the underlying issues that affect attempts to make one's research relevant to wider-than-disciplinary audiences. It does so via reflections on the nature of interdisciplinarity, the growing contradictions of the modern university and the future of knowledge production generally. Overall, the chapter offers an environmental critique of knowledge production within the contemporary university.
Improving animal welfare using genetic and genomic tools.
Authors: Rauw Wendy M. , Dekkers Jack C. M. , Gomez-Raya Luis
Published: November 2021

This chapter provides a useful overview of how the disciplines interrelate with animal welfare. An aspect of genetics which was given special attention in this chapter is on epigenetics.
Epigenetic tools to identify stress and exposure to detrimental conditions in production animals.
Authors: Guerrero-Bosagna Carlos
Published: November 2021

This chapter discusses how epigenetic serves as biomarkers of a history of stress with enormous potential to be converted to application in real situations within the production environment, particularly in hens and pigs.
Specialist α-tubulins for pluralist microtubules
Authors: Moore Jeffrey K. , Wethekam Linnea
Published: November 2021

α- and β-tubulins are encoded by multigene families, but the role of tubulin diversity for microtubule function has been a longstanding mystery. A new study (2021. J. Cell Biol.https://doi.org/10.1083/jcb.202010155) shows that the two budding yeast α-tubulins have distinct roles during mitotic spindle positioning.
Transient Phenomena from Gas Erupting Neutron Stars
Authors: Li Hui-Quan , Wang Jian-Cheng
Published: November 2021

Starquakes probably occur in rapidly spinning or ultra high field neutron stars. In this article, we argue that highly compressed gas containing electron–positron pairs could evaporate and erupt from inside the neutron star when a crack forms and then heals during a starquake. Under the influence of the existing oscillation modes of the star, the crack may have sufficiently large size and long lifetime. An appropriate amount of gas can erupt into the magnetosphere with relativistic and nearly uniform velocity, producing various transient and bursting phenomena.
Alpha/proton Instability in the Presence of Proton and Alpha Temperature Anisotropy and its Application to the Deceleration of Alpha Particles in the Solar Wind
Authors: Zhang Wen-Lu , Xiang Liang , Li Qiu-Huan , Lang Si-Yi , Yu Hong-Wei
Published: November 2021

Observations of solar wind plasma find that the drift velocity between alpha beams and protons, v

α
, is reduced with the heliocentric distance, but the ratio of v

α
to v

A
(the local Alfvén velocity) does not vary obviously and has a typical velocity ratio of v

α
/v

A
≤ 1. The alpha beam instability is believed to be responsible for the deceleration of alpha beams in the solar wind. However, the role of the temperature anisotropy of ions (protons and alpha particles) on the alpha beam instability has not been examined. Based on the kinetic theory of the PDRK solver, this study systemically investigates the alpha beam instability in the presence of proton and alpha temperature anisotropies and considers the effects of these temperature anisotropies on the instability at an arbitrary propagation angle relative to the ambient magnetic field. It is found that the real frequencies, growth rates and threshold conditions of the excited waves sensitively depend on the proton temperature anisotropy T

i⊥/T

i∥ and the alpha temperature anisotropy T

α⊥/T

α∥, as well as the parallel electron beta β

e∥. In particular, for both alpha beam and proton temperature anisotropy driven cases, the parallel magnetosonic/ whistler (PM/W), backward magnetosonic/ whistler (BM/W) and oblique Alfvén/ion cyclotron (OA/IC) waves arise when T

i⊥/T

i∥ < 1, and the PM/W, OA/IC, parallel Alfvén/ion cyclotron (PA/IC) and mirror waves occur when T

i⊥/T

i∥ > 1. The presence of anisotropic protons leads to a lower velocity threshold for the OA/IC and BM/W waves at T

i⊥/T

i∥ < 1 and for the OA/IC, PA/IC and mirror waves at T

i⊥/T

i∥ > 1. For both alpha beam and alpha temperature anisotropy driven cases, the PM/W and OA/IC waves are unstable when T

α⊥/T

α∥ < 1, and the PM/W, OA/IC, PA/IC, oblique magnetosonic/ whistler (OM/W) and mirror waves are likely to grow as T

α⊥/T

α∥ > 1. The presence of anisotropic alpha particles results in a lower threshold velocity for the PM/W wave at T

α⊥/T

α∥ < 1 and for the PA/IC, OM/W and mirror waves at T

α⊥/T

α∥ > 1. On account of the influences of the anisotropic proton and alpha, these alpha beam instabilities can effectively constrain the alpha-beam drift velocity to less than or equal to the local Alfvén velocity. These results may shed light on the evolution and deceleration mechanism of alpha particles in the solar wind.
Africa’s Revolutionary Nineteenth Century and the Idea of the “Scramble”
Authors: Reid Richard
Published: November 2021

This paper seeks to position the Scramble for Africa in the context of the continent’s transformative, global nineteenth century. While imperial historiography develops apace, Africa-facing analyses of the continent’s partition and the processes which led to it are increasingly rare. European expansion into Africa was characterized by an aggressive dynamism, and millions of Africans experienced profound crisis in the process of the establishment of colonial rule. Yet Africa’s revolutionary nineteenth century was both driven by, and culminated in, complex processes of co-option on the part of Africans and Europeans. The paper proposes that a more Africa-centered assessment of the Scramble is possible, one which aims to contextualize the partition of the continent as part of an ongoing, endogenously shaped but often exogenously connected, transformation in political, economic, and social organization and behavior. While no single overarching theory can apply to the entire continent, it is possible to identify dynamics and processes for change that recur across Africa, from political and military reform to economic innovation. These point toward possibilities for reframing Africa’s development in the late precolonial period, and enable us to challenge the hegemony long enjoyed by scholars of European empires.
Addressing noise in co-expression network construction
Authors: Burns Joshua J R , Shealy Benjamin T , Greer Mitchell S , Hadish John A , McGowan Matthew T , Biggs Tyler , Smith Melissa C , Feltus F Alex , Ficklin Stephen P
Published: November 2021

Gene co-expression networks (GCNs) provide multiple benefits to molecular research including hypothesis generation and biomarker discovery. Transcriptome profiles serve as input for GCN construction and are derived from increasingly larger studies with samples across multiple experimental conditions, treatments, time points, genotypes, etc. Such experiments with larger numbers of variables confound discovery of true network edges, exclude edges and inhibit discovery of context (or condition) specific network edges. To demonstrate this problem, a 475-sample dataset is used to show that up to 97% of GCN edges can be misleading because correlations are false or incorrect. False and incorrect correlations can occur when tests are applied without ensuring assumptions are met, and pairwise gene expression may not meet test assumptions if the expression of at least one gene in the pairwise comparison is a function of multiple confounding variables. The ‘one-size-fits-all’ approach to GCN construction is therefore problematic for large, multivariable datasets. Recently, the Knowledge Independent Network Construction toolkit has been used in multiple studies to provide a dynamic approach to GCN construction that ensures statistical tests meet assumptions and confounding variables are addressed. Additionally, it can associate experimental context for each edge of the network resulting in context-specific GCNs (csGCNs). To help researchers recognize such challenges in GCN construction, and the creation of csGCNs, we provide a review of the workflow.
Connecting Trauma-Sensitive Schooling and Social–Emotional Learning to Promote Educational Equity: One School’s Intentional Design
Authors: Ballin Amy Elizabeth
Published: November 2021

Equity in education begins with creating structures that support students inclusive of their social-emotional needs. Students exposed to trauma perform best in schools that adopt trauma-sensitive practices. Many of these trauma-sensitive practices naturally prepare students to learn social–emotional skills, as the trauma-informed staff also models social–emotional learning. Mastery of these skills leverages student success in school and adult life. This article focuses on one aspect of a larger qualitative case study of trauma-sensitive practices adopted by one elementary school to support all students, inclusive of students affected by trauma. The research presented in this article focuses on the intentional design of the school. The author uses the term intentional design to refer to specific structures and systems in place in the school to support a trauma-sensitive environment. This intentional design, which the author noted through observations and interviews, involved purposeful staffing, design of classrooms and other internal spaces, and schoolwide routines. These intentional design features, evolved from adopting trauma-sensitive practices, provide the framework and structure for students to build social–emotional competencies to help promote success in their schooling.
Optogenetics in bacteria – applications and opportunities
Authors: Lindner Florian , Diepold Andreas
Published: November 2021

Optogenetics holds the promise of controlling biological processes with superb temporal and spatial resolution at minimal perturbation. Although many of the light-reactive proteins used in optogenetic systems are derived from prokaryotes, applications were largely limited to eukaryotes for a long time. In recent years, however, an increasing number of microbiologists use optogenetics as a powerful new tool to study and control key aspects of bacterial biology in a fast and often reversible manner. After a brief discussion of optogenetic principles, this review provides an overview of the rapidly growing number of optogenetic applications in bacteria, with a particular focus on studies venturing beyond transcriptional control. To guide future experiments, we highlight helpful tools, provide considerations for successful application of optogenetics in bacterial systems, and identify particular opportunities and challenges that arise when applying these approaches in bacteria.
The Effect of Low-Dose Aspirin on Frailty Phenotype and Frailty Index in Community-Dwelling Older Adults in the ASPirin in Reducing Events in the Elderly Study
Authors: Espinoza Sara E , Woods Robyn L , Ekram A R M Saifuddin , Ernst Michael E , Polekhina Galina , Wolfe Rory , Shah Raj C , Ward Stephanie A , Storey Elsdon , Nelson Mark R , Reid Christopher M , Lockery Jessica E , Orchard Suzanne G , Trevaks Ruth , Fitzgerald Sharyn M , Stocks Nigel P , Chan Andy , McNeil John J , Murray Anne M , Newman Anne B , Ryan Joanne
Published: November 2021

Background

Frailty is associated with chronic inflammation, which may be modified by aspirin. The purpose of this study was to determine whether low-dose aspirin reduces incident frailty in healthy older adult participants of the ASPirin in Reducing Events in the Elderly (ASPREE) trial.

Methods

In the United States and Australia, 19 114 community-dwelling individuals aged ≥70 and older (U.S. minorities ≥65 years) and free of overt cardiovascular disease, persistent physical disability, and dementia were enrolled in ASPREE, a double-blind, placebo-controlled trial of 100-mg daily aspirin versus placebo. Frailty, a prespecified study end point, was defined according to a modified Fried frailty definition (Fried frailty) and the frailty index based on the deficit accumulation model (frailty index). Competing risk Cox proportional hazard models were used to compare time to incident frailty by aspirin versus placebo. Sensitivity analysis was conducted to include frailty data with and without imputation of missing data.

Results

Over a median 4.7 years, 2 252 participants developed incident Fried frailty, and 4 451 had incident frailty according to the frailty index. Compared with placebo, aspirin treatment did not alter the risk of incident frailty (Fried frailty hazard ratio [HR]: 1.04, 95% confidence interval [CI] 0.96−1.13; frailty index HR: 1.03, 95% CI 0.97−1.09). The proportion of individuals classified as frail, and the trajectory in continuous frailty scores over time, were not different between the aspirin and placebo treatment groups. The results were consistent across a series of subgroups.

Conclusions

Low-dose aspirin use in healthy older adults when initiated in older ages does not reduce risk of incident frailty or the trajectory of frailty.
Experiences with Childhood Cancer among Latinx Families: Identification of Informational and Support Needs
Authors: Lopez Kristina , Gutierrez Courtney , Martarella Patricia , Jimenez Gabriela
Published: November 2021

Latinx children with cancer generally have poorer health outcomes than their non-Latinx White counterparts. The purpose of this study was to examine the experience of Latinx mothers whose children have been diagnosed with cancer at the onset of symptoms, the barriers surrounding the diagnostic process, and the resources families identify are needed post-diagnosis. The researchers conducted two focus groups (one in Spanish, one in English) with Latina mothers of children who have or experienced pediatric cancer in the United States. Two researchers conducted constant comparative analysis of the transcribed focus group audio recordings to identify themes. Themes included a sense of community support at the onset of symptoms, feelings of disbelief, helplessness, overload of information, and a need for advocacy in medical settings. Needs included more palatable and simplified information, financial assistance and resources, increased parental social support, accessible Spanish-speaking providers, and culturally informed care. Latina mothers indicated a range of challenges pertaining to childhood cancer diagnosis and treatment that may impact child and family outcomes. Implications for social work practitioners to reduce disparities and develop intervention programs for Latinx families of children with cancer are discussed.
On the Hölder Regularity of Signed Solutions to a Doubly Nonlinear Equation. Part III
Authors: Liao Naian , Schätzler Leah
Published: November 2021

We establish the local Hölder continuity of possibly sign-changing solutions to a class of doubly nonlinear parabolic equations whose prototype is $$ \begin{align*} & \partial_t\big(|u|^{q-1}u\big)-\Delta_p u=0,\quad 1<p<2,\quad 0<p-1<q. \end{align*}$$The proof exploits the space expansion of positivity for the singular, parabolic $p$-Laplacian and employs the method of intrinsic scaling by carefully balancing the double singularity.
Direct observation of the moment of nucleation from a solution by TEM
Authors: Kimura Yuki
Published: November 2021

Recent discoveries of various nucleation processes make understanding the initial processes of crystallization, where atoms and molecules come together to form a crystal nucleus, difficult. Herein, transmission electron microscopy is used to directly visualize the moment of nucleation from a solution and to show that the singular phenomena of nanoparticles are critical to understanding nucleation. Our work revealed that nanoparticles undergo precipitation and dissolution even in undersaturated and equilibrium conditions, that crystal polymorphs formed at different frequencies compete, that molecules follow various nucleation pathways in the same solution, and that the hydration layer plays a critical role in crystallization. The observations visually support the common belief that dehydration is the greatest barrier to crystallization in an aqueous solution. These results are expected to contribute to the development of a unified nucleation model.
Combat Deployment Experiences and Soldier Mental Health: Examining the Factor Structure of a Combat Experiences Scale
Authors: Sherman Haley , Frye-Cox Nicky , Lucier-Greer Mallory
Published: November 2021

Introduction

Researchers and practitioners are invested in understanding how deployment experiences impact the nearly 193,000 U.S. service members who deploy in a given year. Yet, there remains a need to adequately identify salient deployment experiences through survey measurement tools and understand how differential experiences are uniquely related to mental health outcomes. Therefore, this study examined the factor structure of an established combat experiences measure from the Army Study to Assess Risk and Resilience in Service members (Army STARRS) dataset to identify underlying survey constructs that reflect nuanced deployment experiences. Then, we examined the association between diverse combat experiences and current mental health symptoms (i.e., anxiety and depressive symptoms) and the mediating role of coping.

Materials and Methods

Data were drawn from the Army STARRS data (N = 14,860 soldiers), specifically the All Army Study component. A principal component analysis (PCA) was conducted to examine the dimensionality of the combat experiences scale, and then a path model was conducted to examine the relationships between combat experiences, coping with stress following a deployment, and mental health symptoms while controlling for relevant individual and interpersonal factors.

Results

Results from the principal component analysis suggested that the Army STARRS combat experiences scale encompasses two components, specifically: “Expected combat experiences” and “Responsible for non-enemy deaths.” Both “Expected combat experiences” and “Responsible for non-enemy deaths” were associated with higher levels of anxiety and depressive symptoms, respectively, and “Responsible for non-enemy deaths” was also indirectly linked to these mental health outcomes through coping with stress after deployment.

Conclusions

These findings provide insight into the dimensionality of combat experiences and offer practitioners a more nuanced understanding of how to process unique combat experiences that differentially relate to mental health symptoms.
Assessing the psychosocial impact of stammering on work
Authors: Parsons V , Ntani G , Muiry R , Madan I , Bricker-Katz G
Published: November 2021

Background

Stammering (stuttering) is a speech condition with high heterogeneity, affecting approximately 1% of adults. Research shows it can limit career progression, impact job performance and quality of life.

Aims

To assess the psychosocial impact of stammering among healthcare workers and to develop a new workplace support intervention.

Methods

A cross-sectional questionnaire of healthcare workers who stammer with qualitative work and a survey of occupational health (OH) usual care to assess the need for a workplace intervention.

Results

Data from 470 staff questionnaires and 32 OH clinicians were analysed. Eighty-four per cent rated their stammering severity as mild-to-moderate, with the majority reporting adverse impact on job performance and career progression. Most experienced a high degree of anxiety and embarrassment at work, with avoidance behaviours commonplace. Four per cent of respondents sought OH advice for work difficulties. Qualitative data highlighted practical challenges staff experience in the workplace. Sixty-five per cent supported the proposal for a new workplace intervention. We found workplace stress and anxiety were the most common reasons for OH referrals, and we found wide variation in the scope of OH assessments and work adjustments recommended. Most OH respondents reported insufficient clinical knowledge of speech disorders and their impact on work.

Conclusions

Stammering can have a negative impact of workers’ job performance and job satisfaction. This can precipitate feelings of stress and anxiety, and can affect self-identity at work. We found wide variation in the provision of OH usual care. The results informed the development of a new workplace intervention.
Eastern-breeding Lesser Yellowlegs are more likely than western-breeding birds to visit areas with high shorebird hunting during southward migration
Authors: McDuffie Laura A , Christie Katherine S , Harrison Autumn-Lynn , Taylor Audrey R , Andres Brad A , Laliberté Benoit , Johnson James A
Published: November 2021

Shorebirds have experienced a precipitous reduction in abundance over the past four decades. While some threats to shorebirds are widespread (e.g., habitat alteration), others are regional and may affect specific populations. Lesser Yellowlegs (Tringa flavipes) are long-distance migrants that breed across the North American boreal biome and have declined in abundance by 60–80% since the 1970s. The documented harvest of Lesser Yellowlegs in the Caribbean and northeastern South America during southward migration is a possible limiting factor for the species, but it is unknown to what extent birds from different breeding origins may be affected. To address the question of differential occurrence in harvest zones during southward migration, we used PinPoint GPS Argos transmitters to track the southward migrations of 85 adult Lesser Yellowlegs from across the species’ breeding range and 80° of longitude from Anchorage, Alaska, USA, to the Mingan Archipelago, Quebec, Canada. We classified migratory locations as inside or outside three zones with high levels of harvest (Caribbean, coastal Guianas, and coastal Brazil) and then fit generalized additive mixed models to estimate the probability of occurrence of Lesser Yellowlegs in harvest zones according to their breeding origin. Individuals from the Eastern Canada population had a higher probability of occurrence within one or more harvest zones and remained in those zones longer than individuals breeding in Alaska and western Canada. Linear regressions also suggested that longitude of the breeding origin is an important predictor of occurrence in harvest zones during southward migration. Lastly, our findings, combined with other sources of evidence, suggest that current estimated harvest rates may exceed sustainable limits for Lesser Yellowlegs, which warrants further investigation.
Party Quotas and Gender Differences in Candidate Experience in Australia: 1987–2016
Authors: Beauregard Katrine , Taflaga Marija
Published: November 2021

While previous investigations have demonstrated that legislative gender quotas can disrupt traditional recruitment networks to level women’s and men’s political experience, little is known about the impact of party quotas. Using the Australian Candidate Survey, we find that gender party quotas can help close the experience gap between male and female candidates, but also between women. Before the adoption of party quotas, Coalition female candidates had more experience than Labor female candidates. This party gap disappears along with gender gaps amongst Labor candidates after the Labor Party adopted gender quotas. We find that party quotas made little impact on the experience levels of male Labor candidates or Coalition candidates’ of both sexes. We identify the professionalisation of politics and women-centric networks as factors shaping how quotas impact candidate selection processes.
La prise en charge des nourrissons, des enfants et des adolescents vulnérables à l’infection par le virus de l’hépatite C
Authors: Bitnun Ari
Published: November 2021

L’infection par le virus de l’hépatite C touche de 0,5 % à 1,0 % de la population canadienne. La plupart des infections pédiatriques découlent d’une transmission verticale ou, chez les adolescents et les jeunes adultes, de comportements à haut risque comme l’utilisation de drogues injectables et les activités sexuelles non protégées. Il est désormais recommandé que tous les nourrissons, les enfants et les adolescents qui présentent au moins un facteur de risque soient soumis au dépistage de l’infection par le virus de l’hépatite C. Il est démontré que le traitement de la forme chronique de cette infection au moyen d’antiviraux à action directe provoque une suppression virologique soutenue chez 97 % à 100 % des enfants dès l’âge de trois ans. Les pédiatres et les médecins de famille ont un rôle important à jouer pour informer les adolescents des risques et des modes de prévention de l’infection par le virus de l’hépatite C, ainsi que pour revendiquer, auprès du gouvernement et des autorités sanitaires, l’adoption de stratégies d’intervention globales de réduction des méfaits ciblant les jeunes à risque, des traitements accessibles et le dépistage prénatal systématique de ce virus.
P016 Updated Clinical Practice Guidelines for JIA management adopting Treat to Target approach: the Egyptian College of Paediatric Rheumatology initiative
Authors: El Miedany Y , Hassan M , Salah S , Lotfy H , Abdulhady H , Salah H , El Gaafary M , Abd El-Latif E , Farag Y , Eissa M , Esam Maher S , Radwan A , El-Shanawany Amira T , Medhat B M , El Mikkawy D , Mosa D M , El Deriny G , Mortada M , Osman N S , Fouad N A , Elkaraly N E , SMohamed S , Tabra S , Hassan W A , Amer Y , Nasef S I
Published: November 2021

Background

There is an unmet need from paediatric rheumatologists and rheumatologists, managing children with JIA, for a well formulated guidelines aiming at achieving better outcomes of their patients. To establish adequate and easily adopted guidelines in management of different variants of JIA in a relatively low resources country.

Method

This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for Juvenile Idiopathic Arthritis using Delphi technique. The preliminary scientific committee identified a total of 17 key clinical questions according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. An evidence-based, systematic, literature review was conducted to compile evidence for the benefits and harms associated with JIA treatments. The core leadership team identified researchers and clinicians with expertise in JIA management in Egypt upon which Experts were gathered from different governorates and health centres across Egypt. Delphi process was implemented (2-rounds) to reacha consensus on the management recommendations of Egyptian JIA patients. Results: An online questionnaire were sent to expert panel (n = 27), of whom 26 participated in the two rounds. At the end of round 2, a total of eighteen (18) recommendation items, categorized into 4 sections to address the main 4 JIA categories, were obtained. Agreement with the recommendations (rank 7–9) ranged from 83.2–100% (average 86.8%). Consensus was reached (i.e. ≥75% of respondents strongly agreed or agreed) on the wording of all the 18 clinical standards identified by the scientific committee. Algorithms for the management of JIA polyarthritis, oligoarthritis and systemic JIA have been suggested.

Conclusion

A wide and representative panel of experts established a consensus regarding the management of JIA in Egypt. The developed guidelines provide a comprehensive approach to the management of JIA for ll Egyptian healthcare professionals who are involved in its management for follow up and frequent evaluation of these guidelines.
P020 The male gender predicts the hip involvement among JIA patients
Authors: Yasmine Makhlouf , Ferjani Hanene , Triki Wafa , Maatallah Kaouther , Ben Nessib Dorra , Kaffel Dhia , Hamdi Wafa
Published: November 2021

Background

Juvenile idiopathic arthritis (JIA) represents a heterogeneous group of chronic arthritides that affect children aged 16 years and under. Regardless of the clinical presentation, hip involvement ranges between 20% to50% of cases [1]. The aim of the present study was to examine the role of gender and disease onset in coxitis involvement.

Methods

We conducted a cross-sectional study including children with JIA according to the International League of Associations for Rheumatology (ILAR)). Transcribed data included age, sex and the characteristics of the disease (subtype of JIA, disease duration). Regarding coxitis, we collected radiographs, ultrasound (US) and magnetic resonance imaging (MRI) of the hip when performed. Coxitis was defined by clinical (limited range of motion) and/or radiographic findings (destruction, synovitis, bone marrow oedema).

We divided patients into two groups: G1: presence of coxitis and G2: absence of coxitis.

Results

The study included 62 patients with a male perdominance: sex ratio was 2.3. The mean age of onset of the disease was 11.4 years [3–16]. The frequency of each JIA subset was as follows: polyarticular with rheumatoid factor (n = 2), polyarticular without rheumatoid factor (n = 4), systemic (n = 1), enthesitis-related arthritis (n = 44), oligoarthritis (n = 8), psoriatic arthritis (n = 3). A Hip involvement was reported in 71% of cases and was bilateral in 81% of patients. Coxitis was not correlated with the disease duration (P = 0.7). A positive correlation was found between the age of onset of the disease and the presence of coxitis (12.2 vs 9.6, P = 0.005). However, hip involvement was higher among males without significant difference (76.7% vs 58%, P = 0.132).

Conclusion

Unlike the literature data, our study showed a high frequency of hip involvement in Tunisian children with JIA. We found an association between the male gender and coxitis involvement without significant difference. However, coxitis was more frequent in later onset of the disease.
P025 Risk assessment of covid 19 in patients with Juvenile Idiopathic Arthritis
Authors: Ines Cherif , Ben Nessib Dorra , Maatallah Kaouther , Ferjani Hanene , Triki Wafa , Kaffel Dhia , Hamdi Wafa
Published: November 2021

Background

On March 11th, 2020 the World Health Organization declared the coronavirus outbreak a global pandemic. Since then, the world has faced multiple flares. In March 2021, the third wave hit Tunisia, resulting in a total of 331 674 confirmed cases and 12 089 Covid-19 related deaths (on May 19th, 2021). Among these reported cases, >6000 were children under the age of 18.

Patients with inflammatory rheumatic diseases undergoing immunosuppressive treatment are considered immunocompromised. Therefore, it is only fair to question whether children suffering from juvenile idiopathic arthritis (JIA) are specially at risk during this pandemic. Our objective was to assess the impact of the Covid -19 pandemic on patients with JIA.

Methods

We conducted a cross-sectional study including patients with JIA, all fulfilling the International League of Associations for Rheumatology (ILAR) criteria. We prepared a questionnaire evaluating the clinical data of our patients during the outbreak. We asked whether the child had been infected with the virus or whether he had contact histories with confirmed cases, and if so, had the child developed any symptoms (such as fever, respiratory, digestive or osteoarticular symptoms, myalgia, asthenia) or required any specific care.

For all patients, we collected the following data: age, age of onset, the duration of the disease, JIA subtype, and the current treatment.

Results

We included 25 JIA patients, mean age at disease onset was 7.6 +/- 3.8 years [1–11]. Among them, 17 were female. The mean duration of the disease was 4.9 +/- 3 years [0–15]. Three patients were on biological disease-modifying anti-rheumatic drugs (bDMARDs) and six on conventional synthetic DMARDs (csDMARDs). Sixteen patients had no background treatment.

None of the children had a positive PCR test nor symptoms suggestive of Covid-19.

There were only 2 children with contact histories with confirmed cases: one with his cousin and one with his grandfather. Both patients were on NSAIDS with no DMARDS, and both followed social distancing rules. Neither one of them developed any symptoms.

There have been no reports of absenteeism from school or medical checkups or disruption of treatment due to this pandemic, outside of the government-imposed lockdown period.

Conclusion

None of our patients contracted the corona virus or developed any symptoms, during the deadliest wave in Tunisia to date. These results align with different research and the hypothesis that children with JIA under treatment do not have an increased susceptibility to COVID-19 compared with healthy children. Our study, however, had its limitations due to the small number of patients. Further research with larger sample size are, therefore, required.
P031 Adherence with Methotrexate in Tunisian Juvenile Idiopathic Arthritis Patients
Authors: Bettaieb Hiba , Triki Wafa , Maatallah Kaouther , Ferjani Hanene , Ben Nessib Dorra , Kaffel Dhia , Hamdi Wafa
Published: November 2021

Background

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in the pediatric population. Methotrexate (MTX) has been considered as the cornerstone of treatment of poly and oligoarticular subtypes of JIA. However, this treatment is supposed to be for long term, which may involve an obstacle for adherence. The aims of the study were to evaluate adherence of Tunisian JIA patients to MTX and to identify factors associated with high adherence to MTX.

Methods

A cross-sectional study including patients with confirmed JIA diagnosis, according to the International League of Associations for Rheumatology (ILAR) criteria, was performed. Demographic data as well as disease characteristics were obtained from medical records. Laboratory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were collected. Adherence was measured, for patients under MTX for >3 months, using the 5-item Compliance Questionnaire Rheumatology (CQR5) (1). Patients were divided into two groups: group 1: High adherence (HA) for patients having a CQR5 ≥ 80% and group 2: low adherence (LA) for patients having CQR5 < 80%. A p inferior to 0.05 was considered statistically significant.

Results

The study included 29 patients (10 males and 19 females) with a mean age at disease onset of 9.1 ± 3.4 years. The mean disease duration was 61 ± 79 months [7–336]. JIA subtypes were in decreasing order of frequency as follows: enthesitis-related arthritis (n = 13), oligoarticular (n = 8), Polyarticular without rheumatoid factor (n = 4), Polyarticular with rheumatoid factor (n = 2), systemic (n = 1) and, psoriatic arthritis (n = 1).

A biologic inflammatory syndrome was found in 48.3% (n = 14) of cases. The mean ESR and CRP were 20 mm/h ± 11.3 [3–98] and 5 ± 17.8 mg/l [0–56] respectively. Nineteen (65.5%) patients had coxitis. Overall, 55.17% of patients (n = 16) were treated with MTX with a mean weekly dose of 9.2 ± 3.2 mg [5–15]. MTX was orally administrated in all patients. NSAIDs and prednisone were prescribed in 51.7% (n = 15) and 17.2% (n = 5) of cases respectively. The MTX was associated with biological DMARDs in five patients (17.2%). It was about Etanercept in 4 patients and Tocilizumab in 1 patient. Mean CQR5 score was 70.8% ± 18 [25–100]. Only seven patients (43.8%) showed high adherence to MTX. The statistical study revealed no difference between HA and LA in term of gender (P = 0.84), age at disease onset (P = 0.39), disease duration (P = 0.9), prednisone use (P = 0.22), the occurrence of coxitis (P = 0.2), ESR (P = 0.83) and CRP (P = 0.033) rates.

Conclusion

In this study, less than one half of JIA patients were highly adherent to MTX according to CQR5. Low adherence should be considered before declaring MTX treatment failure.
P032 Methotrexate and hepatic tolerance in Juvenile Idiopathic Arthritis
Authors: Miladi S , El Mabrouk Y , Fazaa A , Souabni L , Sallemi M , Ouenniche K , Kassab S , Chekili S , Ben Abdelghani K , Laatar A
Published: November 2021

Background

Methotrexate (MTX) is considered as the main treatment for some juvenile idiopathic arthritis (JIA) subtypes. The hepatic toxicity of MTX has been reported in numerous studies in rheumatoid arthritis which have shown that prolonged treatment can induce hepatic fibrosis and a disturbance of the liver biologic tests. In patients with JIA, the potential hepatic toxicity of MTX needs to be confirmed.

Methods

A retrospective study of patients followed for JIA and treated with MTX was conducted. The results of the hepatic assessment looking for cytolysis or cholestasis performed during the pre-treatment assessment and then during regular checks were noted.

Results

Thirty-nine JIA patients were included. The mean age of disease onset was 8 years [1.5–17 years]. The JIA subtype was systemic in 11 cases, enthesitis related arthritis in 5 cases, rheumatoid factor seronegative polyarthritis in 15 cases and rheumatoid factor seropositive polyarthritis in 2 cases, and oligoarthritis in 2 cases. Patients were treated with low doses of corticosteroids (0.2–0.4 mg/kg) in majority of cases (82%). Non steroid anti-inflammatory drugs were used in 51% of cases. MTX was prescribed as monotherapy in 20 cases, in combination with Sulfasalazine in 6 cases and Anti TNF alpha in 12 cases. MTX has been used on average for 11 years [2 months-26 years]. This drug was stopped for ineffectiveness in 7 cases, for digestive intolerance in 2 cases and in one case for severe hepatic cytolysis after 2 years of treatment with a progressive normalization of hepatic laboratory tests after 6 months. During regular monitoring, no further disturbances of liver function were observed.

Conclusion

MTX hepatotoxicity appears to be very mild and rare in JIA. These results are reassuring given that MTX is a highly effective treatment in JIA.