bluuebunny/crossref_metadata_2025 huggingface dataset:
ViEWS2020: Revising and evaluating the ViEWS political Violence Early-Warning System
Authors: Hegre Håvard , Bell Curtis , Colaresi Michael , Croicu Mihai , Hoyles Frederick , Jansen Remco , Leis Maxine Ria , Lindqvist-McGowan Angelica , Randahl David , Rød Espen Geelmuyden , Vesco Paola
Published: March 2021

This article presents an update to the ViEWS political Violence Early-Warning System. This update introduces (1) a new infrastructure for training, evaluating, and weighting models that allows us to more optimally combine constituent models into ensembles, and (2) a number of new forecasting models that contribute to improve overall performance, in particular with respect to effectively classifying high- and low-risk cases. Our improved evaluation procedures allow us to develop models that specialize in either the immediate or the more distant future. We also present a formal, ‘retrospective’ evaluation of how well ViEWS has done since we started publishing our forecasts from July 2018 up to December 2019. Our metrics show that ViEWS is performing well when compared to previous out-of-sample forecasts for the 2015–17 period. Finally, we present our new forecasts for the January 2020–December 2022 period. We continue to predict a near-constant situation of conflict in Nigeria, Somalia, and DRC, but see some signs of decreased risk in Cameroon and Mozambique.
Cohabitation and Its Consequences in Ghana
Authors: Obeng-Hinneh Rosemary , Kpoor Albert
Published: March 2021

Although largely considered an unconventional form of domestic partnership, cohabitation is a growing phenomenon in Ghana. The lived experiences of cohabiting couples have, however, received little scholarly attention. Drawing on in-depth interviews conducted with cohabiting couples in Accra, Ghana, this study focuses on the implications of cohabitation on cohabitees. The data showed that cohabitees often face pressures from their families, churches, friends, and neighbors to either convert their unions to marriage or end the relationships. The relationships are also characterized by intimate partner violence and poor relationship quality. Women, more than men, tend to suffer these consequences of cohabitation. The study’s general conclusion is that the implications of cohabitation are mostly negative, and the gendered nature of the experiences reflects the sociocultural landscape of the Ghanaian society and how men and women are viewed differently in terms of their marital status.
Continuous Approximation Model for Hybrid Flexible Transit Systems with Low Demand Density
Authors: Sipetas Charalampos , Gonzales Eric J.
Published: March 2021

Flexible transit systems are a way to address challenges associated with conventional fixed route and fully demand responsive systems. Existing studies indicate that such systems are often planned and designed without established guidelines, and optimization techniques are rarely implemented on actual flexible systems. This study presents a hybrid transit system where the degree of flexibility can vary from a fixed route service (with no flexibility) to a fully flexible transit system. Such a system is expected to be beneficial in areas where the best transit solution lies between the fixed route and fully flexible systems. Continuous approximation techniques are implemented to model and optimize the stop spacing on a fixed route corridor, as well as the boundaries of the flexible region in a corridor. Both user and agency costs are considered in the optimization process. A numerical analysis compares various service areas and demand densities using input variables with magnitudes similar to those of real-world case studies. Sensitivity analysis is performed for service headway, percent of demand served curb-to-curb, and user and agency cost weights in the optimization process. The analytical models are evaluated through simulations. The hybrid system proposed here achieves estimated user benefits of up to 35% when compared with fixed route systems, under different case scenarios. Flexible systems are particularly beneficial for serving corridors with low or uncertain demand. This provides value for corridors with low demand density as well as communities in which transit ridership has dropped significantly because of the COVID-19 pandemic.
Understanding Caregiver Strain in Parkinsonism—A Mixed Methods Approach
Authors: Hand Annette , Oates Lloyd L. , Gray William K. , Dismore Lorelle L. , Baker Katherine , Naisby Jenni , Walker Richard W.
Published: March 2021

Background:

Parkinsonism, including Parkinson’s disease (PD) are progressive neurological conditions. As these condition progress, individuals will need more support with their care needs to maintain independent community-living. Care needs are mainly met by unpaid, informal caregivers, usually close family members or friends. Caregiver strain is thought to lead to the need for care home placement when the caregiver can no longer cope.

Objective:

To understand predictors of caregiver strain and its influence on care home placement for people with moderate to advanced Parkinsonism.

Methods:

This is a convergent mixed methods study. Quantitative data, following an adapted stress-appraisal model, were collected on caregiver profile, tasks performed and causes of caregiver strain. Semi-structured, in-depth interviews were conducted with caregivers of people with PD (PwP) who went into a care home during the study period, to develop a deeper understanding of the caregiver role and the factors influencing caregiver strain.

Results:

Quantitative data were collected from 115 patient caregiver dyads. Interviews were conducted with 10 caregivers. A model to predict caregiver strain was developed and predictors of caregiver strain were identified, such as functional disability and poor caregiver sleep.

Conclusion:

Our findings further demonstrate the complexity of carer strain. Particular dimensions are identified that need to be addressed within clinical practice to reduce carer strain and support people with Parkinsonism to remain within their own home for as long as possible.
Enoxaparin Use and Adverse Events in Outpatients With a Continuous Flow Left Ventricular Assist Device at a Single Institution
Authors: Bernard Allison M. , Alvarez Paulino A. , Bream-Rouwenhorst Heather R. , Horner Kathleen E. , Briasoulis Alexandros , Czerniak Laura C.
Published: March 2021

Background:

Patients with left ventricular assist devices (LVADs) are anticoagulated with warfarin and may receive enoxaparin bridging for a subtherapeutic international normalized ratio (INR). There is no guideline regarding enoxaparin bridging in LVAD patients and a dosing strategy to ensure efficacy and safety is uncertain.

Objective:

The objective was to characterize the use of enoxaparin bridging for subtherapeutic INRs and its impact on thrombotic or major bleeding events (MBE) in patients with an LVAD.

Methods:

A retrospective review from 6/1/17 to 6/30/18 was performed. Patients with an LVAD were excluded if they had less than 60 days of outpatient anticoagulation or age <18 years old. Patients were divided into 2 cohorts based on enoxaparin exposure. MBE and thrombotic events were classified as related to enoxaparin if events occurred while receiving enoxaparin and up to 7 days or 30 days, respectively, after discontinuation.

Results:

Seventy-one LVAD patients met inclusion criteria and 50 patients received enoxaparin bridging. Therapeutic-dose enoxaparin was initiated at a mean INR of 1.8 for a mean duration of 2.8 days. In the enoxaparin exposure group, one MBE occurred 6 days after enoxaparin discontinuation, coinciding with an INR increase from 1.8 to 4.7. One thrombotic event occurred 2 days after enoxaparin discontinuation at an INR of 5.0.

Conclusion:

This institution’s bridging strategy of therapeutic-dose enoxaparin with a short duration has a low rate of bleeding and thrombotic events. Additional prospective studies of anticoagulation bridging based on characteristics such as type of LVAD device are warranted.
Limitations to success in academic data reference support
Authors: McBurney Jenny , Kubas Alicia
Published: March 2021

As secondary data become increasingly integrated into research and coursework across a widening variety of fields and disciplines, data reference is gaining traction as a major area of library research support. To examine the current landscape of data reference, we distributed a survey via regional and international library listservs asking librarians about their experiences and opinions related to their data reference work. For this paper, the full collected dataset was limited to only academic librarians who answer at least one data reference question per month in order to identify the unique needs of respondents doing reference work in academic institutions, with the ultimate goal of improving our own work as academic librarians at our institution. We used a grounded theory approach to analyze the qualitative survey response data, and supplemented this analysis with descriptive statistics and chi-square tests for the quantitative responses. Through this analysis, we identify a theoretical framework consisting of three themes relating to limitations to success where librarians must advocate for change in order to maintain and improve high-quality data reference work in the academic sphere: (1) technology and resource limitations, such as substandard database interfaces; (2) institutional limitations, such as insufficient staff time or resources dedicated to data reference; and (3) personal limitations, such as a lack of data skills. While librarians have varying levels of influence over each of these three areas, identifying and targeting these categories can help librarians and other data professionals focus resources and build cases for additional support from their library and campus administrators.
Ethical Considerations for Social Work Research With Vulnerable Children and Their Families
Authors: Sadzaglishvili Shorena , Gotsiridze Teona , Lekeshvili Ketevan
Published: March 2021

The aim of this article is to impose solutions to the ethical dilemmas that derive from social work research involving vulnerable children. The main concern is how to balance the protection of children while progressing their participation. Several substitute mechanisms were put in place for protecting underage children. In particular, children were informed explicitly that participation was voluntary, they could pull out without risk of sanction, and their anonymity and confidentiality was guaranteed. However, anonymity did not prevent reporting the child abuse cases in line with the referral mechanism established for the current study. The MacArthur competence assessment tool for clinical research was used for measuring children’s competence to consent to research study. Only children with competence participated. Finally, the study highlighted the critical importance of providing research with vulnerable children considering the best interests of children in the absence of parental care.
Khat Chewing Practice and Associated Factors among Medical Students in Gondar Town, Ethiopia, 2019
Authors: Adane Tsegaye , Worku Walelegn , Azanaw Jember , Yohannes Lamrot
Published: March 2021

Background:

Globally, khat chewing practice becoming an alarming and common among the youth generation, especially in higher educational institutions. It may also lead to frequent misbehavior, poor academic performance, and memory impairment among students. This study aimed to determine the prevalence of khat chewing practice and associated factors among medical students in Gondar town, Ethiopia, 2019.

Method:

A cross-sectional study was employed on 422 medical students. Data were collected using a self-administered questionnaire and analyzed using SPSS 20 software. Stratified followed by random sampling was employed to select the samples. A multivariable logistic regression model was fitted to identify the predictors. P ⩽ .05 was used to select statistically significant factors.

Result:

The current prevalence of khat chewing practice among medical students was 21.5%. The odds of khat chewing practice was higher among males (AOR = 3.353; 95%CI [1.460-7.701]), Muslims (AOR = 6.390; 95%CI [1.903-21.460]), fifth and 6 year students (AOR = 3.391; 95%CI [1.354-8.488]), smokers (AOR = 5.081; 95%CI [1.898-13.601]), alcohol users (AOR = 4.872; 95%CI [2.094-11.332]), students who had khat chewer close friends (AOR = 30.645; 95%CI [12.261-76.589]).

Conclusion:

Since a significant proportion of students were found to be khat chewers, continuous awareness creation on the impact of khat chewing and counseling services are recommended.
Proximal Fusion Level Above First Coronal Reverse Vertebrae: An Essential Factor Decreasing the Risk of Adjacent Segment Degeneration in Degenerative Lumbar Scoliosis
Authors: Wang Hui , Sun Zhuoran , Wang Longjie , Zou Da , Li Weishi
Published: March 2021

Study Design:

Retrospective radiological analysis.

Objective:

To explore whether proximal fusion level above first coronal reverse vertebrae (FCRV) could decrease risk of adjacent segment degeneration (ASD) in degenerative lumbar scoliosis (DLS).

Methods:

One hundred and 16 DLS patients were divided into 2 groups according to occurrence of ASD: study group (ASD positive group) and control group (ASD negative group). FCRV was defined as the first vertebrae that presents opposite orientation of asymmetric Hounsfield unit (HU) ratio from the other vertebrae within major curve. Incidence of ASD was evaluated in subgroups according to location between FCRV and upper instrumented vertebrae (UIV).

Results:

The fusion level was shorter in study group than that in control group. There were 12 patients presented FCRV 2-level proximal than SV, 32 patients presented FCRV 1-level proximal than SV, 35 patients presented the same vertebra of FCRV with SV, 23 patients presented FCRV 1-level distal than SV, 14 patients presented FCRV 2-level distal than SV. When UIV located above FCRV, no patient presented ASD, while 15.4% patients presented ASD when UIV located on FCRV. In study group, proximal scoliosis progression was detected in 1 patient (3.9%) when UIV located on FCRV, and 17 patients (29.8%) when UIV located below FCRV.

Conclusions:

Proximal fusion level above FCRV could decrease the risk of ASD in DLS, especially for the proximal scoliosis progression. FCRV represent the transitional point of the mechanical load on coronal plane, and may be within a more stable condition than stable vertebrae measured from radiographs.
New-Onset Seizure With Possible Limbic Encephalitis in a Patient With COVID-19 Infection: A Case Report and Review
Authors: Bhagat Riwaj , Kwiecinska Barbara , Smith Nolan , Peters Matthew , Shafer Christopher , Palade Adriana , Sagi Vishwanath
Published: March 2021

With the outbreak of COVID-19 (coronavirus disease 2019) as a global pandemic, various of its neurological manifestations have been reported. We report a case of a 54-year-old male with new-onset seizure who tested positive for severe acute respiratory syndrome coronavirus 2 from a nasopharyngeal swab sample. Investigative findings, which included contrast-enhancing right posterior temporal lobe T2-hyperintensity on brain magnetic resonance imaging, right-sided lateralized periodic discharges on the electroencephalogram, and elevated protein level on cerebrospinal fluid analysis, supported the diagnosis of possible encephalitis from COVID-19 infection. The findings in this case are placed in the context of the existing literature.
Preexisting and treatment-emergent autoimmune cytopenias in patients with CLL treated with targeted drugs
Authors: Vitale Candida , Salvetti Chiara , Griggio Valentina , Porrazzo Marika , Schiattone Luana , Zamprogna Giulia , Visentin Andrea , Vassallo Francesco , Cassin Ramona , Rigolin Gian Matteo , Murru Roberta , Laurenti Luca , Rivela Paolo , Marchetti Monia , Pennese Elsa , Gentile Massimo , Boccellato Elia , Perutelli Francesca , Montalbano Maria Chiara , De Paoli Lorenzo , Reda Gianluigi , Orsucci Lorella , Trentin Livio , Cuneo Antonio , Tedeschi Alessandra , Scarfò Lydia , Gaidano Gianluca , Mauro Francesca Romana , Foà Robin , Boccadoro Mario , Coscia Marta
Published: March 2021

Autoimmune cytopenias (AICs) affect 5% to 9% of patients with chronic lymphocytic leukemia (CLL). Targeted drugs—ibrutinib, idelalisib, and venetoclax—have a prominent role in the treatment of CLL, but their impact on CLL-associated AICs is largely unknown. In this study, we evaluated the characteristics and outcome of preexisting AICs and described the incidence, quality, and management of treatment-emergent AICs during therapy with targeted drugs in patients with CLL. We collected data from 572 patients treated with ibrutinib (9% in combination with an anti-CD20 monoclonal antibody), 143 treated with idelalisib-rituximab, and 100 treated with venetoclax (12% in combination with an anti-CD20 monoclonal antibody). A history of preexisting AICs was reported in 104 (13%) of 815 patients. Interestingly, 80% of patients whose AICs had not resolved when treatment with a targeted drug was started experienced an improvement or a resolution during therapy. Treatment-emergent AICs occurred in 1% of patients during ibrutinib therapy, in 0.9% during idelalisib therapy, and in 7% during venetoclax therapy, with an estimated incidence rate of 5, 6, and 69 episodes per 1000 patients per year of exposure in the 3 treatment groups, respectively. The vast majority of patients who developed treatment-emergent AICs had unfavorable biological features such as an unmutated IGHV and a del(17p) and/or TP53 mutation. Notably, despite AICs, 83% of patients were able to continue the targeted drug, in some cases in combination with additional immunosuppressive agents. Overall, treatment with ibrutinib, idelalisib, or venetoclax seems to have a beneficial impact on CLL-associated AICs, inducing an improvement or even a resolution of preexisting AICs in most cases and eliciting treatment-emergent AICs in a negligible portion of patients.
Impacts of ABO-incompatible platelet transfusions on platelet recovery and outcomes after intracerebral hemorrhage
Authors: Magid-Bernstein Jessica , Beaman Charles B. , Carvalho-Poyraz Fernanda , Boehme Amelia , Hod Eldad A. , Francis Richard O. , Elkind Mitchell S. V. , Agarwal Sachin , Park Soojin , Claassen Jan , Connolly E. Sander , Roh David
Published: March 2021

Acute platelet transfusion after intracerebral hemorrhage (ICH) given in efforts to reverse antiplatelet medication effects and prevent ongoing bleeding does not appear to improve outcome and may be associated with harm. Although the underlying mechanisms are unclear, the influence of ABO-incompatible platelet transfusions on ICH outcomes has not been investigated. We hypothesized that patients with ICH who receive ABO-incompatible platelet transfusions would have worse platelet recovery (using absolute count increment [ACI]) and neurological outcomes (mortality and poor modified Rankin Scale [mRS 4-6]) than those receiving ABO-compatible transfusions. In a single-center cohort of consecutively admitted patients with ICH, we identified 125 patients receiving acute platelet transfusions, of whom 47 (38%) received an ABO-incompatible transfusion. Using quantile regression, we identified an association of ABO-incompatible platelet transfusion with lower platelet recovery (ACI, 2 × 103cells per μL vs 15 × 103cells per μL; adjusted coefficient β, −19; 95% confidence interval [CI], −35.55 to −4.44; P = .01). ABO-incompatible platelet transfusion was also associated with increased odds of mortality (adjusted odds ratio [OR], 2.59; 95% CI, 1.00-6.73; P = .05) and poor mRS (adjusted OR, 3.61; 95% CI, 0.97-13.42; P = .06); however, these estimates were imprecise. Together, these findings suggest the importance of ABO compatibility for platelet transfusions for ICH, but further investigation into the mechanism(s) underlying these observations is required.
Molecular bases for the association of FHR-1 with atypical hemolytic uremic syndrome and other diseases
Authors: Martin Merinero Héctor , Subías Marta , Pereda Amaia , Gómez-Rubio Elena , Juana Lopez Lucia , Fernandez Constantino , Goicoechea de Jorge Elena , Martin-Santamaria Sonsoles , Cañada Francisco Javier , Rodríguez de Córdoba Santiago
Published: March 2021

Factor H (FH)–related proteins are a group of partly characterized complement proteins thought to promote complement activation by competing with FH in binding to surface-bound C3b. Among them, FH-related protein 1 (FHR-1) is remarkable because of its association with atypical hemolytic uremic syndrome (aHUS) and other important diseases. Using a combination of biochemical, immunological, nuclear magnetic resonance, and computational approaches, we characterized a series of FHR-1 mutants (including 2 associated with aHUS) and unraveled the molecular bases of the so-called deregulation activity of FHR-1. In contrast with FH, FHR-1 lacks the capacity to bind sialic acids, which prevents C3b-binding competition between FH and FHR-1 in host-cell surfaces. aHUS-associated FHR-1 mutants are pathogenic because they have acquired the capacity to bind sialic acids, which increases FHR-1 avidity for surface-bound C3-activated fragments and results in C3b-binding competition with FH. FHR-1 binds to native C3, in addition to C3b, iC3b, and C3dg. This unexpected finding suggests that the mechanism by which surface-bound FHR-1 promotes complement activation is the attraction of native C3 to the cell surface. Although C3b-binding competition with FH is limited to aHUS-associated mutants, all surface-bound FHR-1 promotes complement activation, which is delimited by the FHR-1/FH activity ratio. Our data indicate that FHR-1 deregulation activity is important to sustain complement activation and C3 deposition at complement-activating surfaces. They also support that abnormally elevated FHR-1/FH activity ratios would perpetuate pathological complement dysregulation at complement-activating surfaces, which may explain the association of FHR-1 quantitative variations with diseases.
Proteomic and bioinformatic profiling of neutrophils in CLL reveals functional defects that predispose to bacterial infections
Authors: Subramaniam Nirojah , Bottek Jenny , Thiebes Stephanie , Zec Kristina , Kudla Matthias , Soun Camille , de Dios Panal Elena , Lill Julia K. , Pfennig Aaron , Herrmann Ralf , Bruderek Kirsten , Rahmann Sven , Brandau Sven , Johansson Patricia , Reinhardt Hans Christian , Dürig Jan , Seiffert Martina , Bracht Thilo , Sitek Barbara , Engel Daniel Robert
Published: March 2021

Patients with chronic lymphocytic leukemia (CLL) typically suffer from frequent and severe bacterial infections. Although it is well known that neutrophils are critical innate immune cells facilitating the early defense, the underlying phenotypical and functional changes in neutrophils during CLL remain largely elusive. Using a murine adoptive transfer model of CLL, we demonstrate aggravated bacterial burden in CLL-bearing mice upon a urinary tract infection with uropathogenic Escherichia coli. Bioinformatic analyses of the neutrophil proteome revealed increased expression of proteins associated with interferon signaling and decreased protein expression associated with granule composition and neutrophil migration. Functional experiments validated these findings by showing reduced levels of myeloperoxidase and acidification of neutrophil granules after ex vivo phagocytosis of bacteria. Pathway enrichment analysis indicated decreased expression of molecules critical for neutrophil recruitment, and migration of neutrophils into the infected urinary bladder was significantly reduced. These altered migratory properties of neutrophils were also associated with reduced expression of CD62L and CXCR4 and correlated with an increased incidence of infections in patients with CLL. In conclusion, this study describes a molecular signature of neutrophils through proteomic, bioinformatic, and functional analyses that are linked to a reduced migratory ability, potentially leading to increased bacterial infections in patients with CLL.
Advances in pleural infection and malignancy
Authors: Bedawi Eihab O. , Guinde Julien , Rahman Najiib M. , Astoul Philippe
Published: March 2021

Pleural infection and malignancy are among the most common causes of pleural disease and form the mainstay of pleural practice. There has been significant research and increase in scientific understanding in these areas in the past decade. With regard to pleural infection, the rising incidence remains worrying. An increased awareness allowing earlier diagnosis, earlier escalation of therapy and the use of validated risk stratification measures may improve outcomes. In pleural malignancy, research has enabled clinicians to streamline patient pathways with focus on reducing time to diagnosis, definitive management of malignant pleural effusion and achieving these with the minimum number of pleural interventions. Trials comparing treatment modalities of malignant pleural effusion continue to highlight the importance of patient choice in clinical decision-making. This article aims to summarise some of the most recent literature informing current practice in these two areas.
Heart rate variability-derived features based on deep neural network for distinguishing different anaesthesia states
Authors: Zhan Jian , Wu Zhuo-xi , Duan Zhen-xin , Yang Gui-ying , Du Zhi-yong , Bao Xiao-hang , Li Hong
Published: March 2021

Background

Estimating the depth of anaesthesia (DoA) is critical in modern anaesthetic practice. Multiple DoA monitors based on electroencephalograms (EEGs) have been widely used for DoA monitoring; however, these monitors may be inaccurate under certain conditions. In this work, we hypothesize that heart rate variability (HRV)-derived features based on a deep neural network can distinguish different anaesthesia states, providing a secondary tool for DoA assessment.

Methods

A novel method of distinguishing different anaesthesia states was developed based on four HRV-derived features in the time and frequency domain combined with a deep neural network. Four features were extracted from an electrocardiogram, including the HRV high-frequency power, low-frequency power, high-to-low-frequency power ratio, and sample entropy. Next, these features were used as inputs for the deep neural network, which utilized the expert assessment of consciousness level as the reference output. Finally, the deep neural network was compared with the logistic regression, support vector machine, and decision tree models. The datasets of 23 anaesthesia patients were used to assess the proposed method.

Results

The accuracies of the four models, in distinguishing the anaesthesia states, were 86.2% (logistic regression), 87.5% (support vector machine), 87.2% (decision tree), and 90.1% (deep neural network). The accuracy of deep neural network was higher than those of the logistic regression (p < 0.05), support vector machine (p < 0.05), and decision tree (p < 0.05) approaches. Our method outperformed the logistic regression, support vector machine, and decision tree methods.

Conclusions

The incorporation of four HRV-derived features in the time and frequency domain and a deep neural network could accurately distinguish between different anaesthesia states; however, this study is a pilot feasibility study. The proposed method—with other evaluation methods, such as EEG—is expected to assist anaesthesiologists in the accurate evaluation of the DoA.
Prognostic dynamic nomogram integrated with metabolic acidosis for in-hospital mortality and organ malperfusion in acute type B aortic dissection patients undergoing thoracic endovascular aortic repair
Authors: Liu Jitao , Liu Weijie , Ma Wentao , Chen Lyufan , Liang Hong , Fan Ruixin , Zeng Hongke , Geng Qingshan , Yang Fan , Luo Jianfang
Published: March 2021

Background

Organ malperfusion is a lethal complication in acute type B aortic dissection (ATBAD). The aim of present study is to develop a nomogram integrated with metabolic acidosis to predict in-hospital mortality and organ malperfusion in patients with ATBAD undergoing thoracic endovascular aortic repair (TEVAR).

Methods

The nomogram was derived from a retrospectively study of 286 ATBAD patients who underwent TEVAR from 2010 to 2017 at a single medical center. Model performance was evaluated from discrimination and calibration capacities, as well as clinical effectiveness. The results were validated using a prospective study on 77 patients from 2018 to 2019 at the same center.

Results

In the multivariate analysis of the derivation cohort, the independent predictors of in-hospital mortality and organ malperfusion identified were base excess, maximum aortic diameter ≥ 5.5 cm, renal dysfunction, D-dimer level ≥ 5.44 μg/mL and albumin amount ≤ 30 g/L. The penalized model was internally validated by bootstrapping and showed excellent discriminatory (bias-corrected c-statistic, 0.85) and calibration capacities (Hosmer–Lemeshow P value, 0.471; Brier Score, 0.072; Calibration intercept, − 0.02; Slope, 0.98). After being applied to the external validation cohort, the model yielded a c-statistic of 0.86 and Brier Score of 0.097. The model had high negative predictive values (0.93–0.94) and moderate positive predictive values (0.60–0.71) for in-hospital mortality and organ malperfusion in both cohorts.

Conclusions

A predictive nomogram combined with base excess has been established that can be used to identify high risk ATBAD patients of developing in-hospital mortality or organ malperfusion when undergoing TEVAR.
Emergency department use by patients with end-stage renal disease in the United States
Authors: Wang Ningyuan , Pei Jiao , Fan Hui , Ali Yaseen , Prushinskaya Anna , Zhao Jian , Zhang Xingyu
Published: March 2021

Background

We sought to describe the national characteristics of ED visits by patients with end-stage renal disease (ESRD) in the United States in order to improve the emergency treatment and screening of ESRD patients.

Methods

We analyzed data from 2014 to 2016 ED visits provided by the National Hospital Ambulatory Medical Care Survey. We sampled adult (age ≥ 18 years) ED patients with ESRD. By proportion or means of weighted sample variables, we quantified annual ED visits by patients with ESRD. We investigated demographics, ED resource utilization, clinical characteristics, and disposition of patients with ESRD and compared these to those of patients without ESRD. Logistic regression models were used to estimate the association between these characteristics and ESRD ED visits.

Results

Approximately 722,692 (7.78%) out of 92,899,685 annual ED visits represented ESRD patients. Males were more likely to be ESRD patients than females (aOR: 1.34; 95% CI: 1.09–1.66). Compare to whites, non-Hispanic Blacks were 2.55 times more likely to have ESRD (aOR: 2.55; 95% CI: 1.97–3.30), and Hispanics were 2.68 times more likely to have ESRD (95% CI: 1.95–3.69). ED patients with ESRD were more likely to be admitted to the hospital (aOR: 2.70; 95% CI: 2.13–3.41) and intensive care unit (ICU) (aOR: 2.21; 95% CI: 1.45–3.38) than patients without ESRD. ED patients with ESRD were more likely to receive blood tests and get radiology tests.

Conclusion

We described the unique demographic, socioeconomic, and clinical characteristics of ED patients with ESRD, using the most comprehensive, nationally representative study to date. These patients’ higher hospital and ICU admission rates indicate that patients with ESRD require a higher level of emergency care.
A community-based nurse-led medication self-management intervention in the improvement of medication adherence in older patients with multimorbidity: protocol for a randomised controlled trial
Authors: Yang Chen , Hui Zhaozhao , Zeng Dejian , Zhu Song , Wang Xiuhua , Lee Diana Tze Fan , Chair Sek Ying
Published: March 2021

Background

Older patients suffering from multimorbidity are at high risk of medication nonadherence. It has been well established that self-management support is an effective strategy to enhance medication adherence for patients with chronic conditions. However, little is known about the effect of the medication self-management intervention in older patients with multimorbidity. This paper presents the protocol for a study that aims to evaluate the effectiveness of a nurse-led medication self-management intervention in improving medication adherence and health outcomes for community-dwelling older patients with multimorbidity.

Methods

The study protocol follows the recommendations of the Standard Protocol Items: Recommendations for Interventional Trials 2013 statement. This study is a multicentre, single-blind, two-arm randomised controlled trial. Older patients with multimorbidity will be recruited from three community health centres in Changsha, China. A total of 136 participants will be randomly allocated to receive usual care or usual care plus the medication self-management intervention. The intervention will be delivered by community nurses. The 6-week intervention includes three face-to-face education sessions and two weekly follow-up phone calls. Participants in the control group continue to receive all respects of usual care offered by community healthcare providers, including chronic disease management, drug prescription, referral to hospital specialists, health education and consultations regarding patients’ diseases and treatments during centre visits. The primary outcome is medication adherence as measured by the 5-item Medication Adherence Report Scale. Secondary outcomes include medication self-management capacity (medication knowledge, medication beliefs, medication social support, medication skills, and medication self-efficacy), treatment experiences (medication treatment satisfaction and treatment burden), quality of life, and utilisation of healthcare services. All outcomes will be measured at baseline, immediately post-intervention, and at 3-month post-intervention.

Discussion

This study will provide evidence about the effectiveness of a medication self-management intervention, delivered by nurses, for older patients with multimorbidity and adherence problems. It is expected that the results of the study, if proven effective in improving patients’ adherence and health outcomes, will provide evidence-based self-management support strategies for healthcare providers in routine chronic disease management in community settings.

Trial registration

The trial is registered at ChiCTR.org.cn (ChiCTR2000030011; date February 19, 2020).
Case report: exome sequencing achieved a definite diagnosis in a Chinese family with muscle atrophy
Authors: Jiang Hui , Guo Chunmiao , Xie Jie , Pan Jingxin , Huang Ying , Li Miaoxin , Guo Yibin
Published: March 2021

Background

Due to large genetic and phenotypic heterogeneity, the conventional workup for Charcot-Marie-Tooth (CMT) diagnosis is often underpowered, leading to diagnostic delay or even lack of diagnosis. In the present study, we explored how bioinformatics analysis on whole-exome sequencing (WES) data can be used to diagnose patients with CMT disease efficiently.

Case presentation

The proband is a 29-year-old female presented with a severe amyotrophy and distal skeletal deformity that plagued her family for over 20 years since she was 5-year-old. No other aberrant symptoms were detected in her speaking, hearing, vision, and intelligence. Similar symptoms manifested in her younger brother, while her parents and her older brother showed normal. To uncover the genetic causes of this disease, we performed exome sequencing for the proband and her parents. Subsequent bioinformatics analysis on the KGGSeq platform and further Sanger sequencing identified a novel homozygousGDAP1nonsense mutation (c.218C > G, p.Ser73*) that responsible for the family. This genetic finding then led to a quick diagnosis of CMT type 4A (CMT4A), confirmed by nerve conduction velocity and electromyography examination of the patients.

Conclusions

The patients with severe muscle atrophy and distal skeletal deformity were caused by a novel homozygous nonsense mutation inGDAP1(c.218C > G, p.Ser73*), and were diagnosed as CMT4A finally. This study expanded the mutation spectrum of CMT disease and demonstrated how affordable WES could be effectively employed for the clinical diagnosis of unexplained phenotypes.
Pseudomembranous conjunctivitis with hand, foot and mouth disease in a pregnant woman : a case report
Authors: Kim Yoo Jin , Kim Tae Gi
Published: March 2021

Background

Hand, foot, and mouth disease (HFMD) is a common systemic infection that is caused by an enterovirus, normally Coxsackie A16. Generally, it affects children or immunocompromised adults. Only a few reports have described pseudomembranous conjunctivitis associated with HFMD. We aim to describe the clinical outcomes and ocular findings of a 37-year-old female with HFMD and concurrent severe pseudomembranous conjunctivitis, who was 28 weeks pregnant.

Case presentation

A female patient who was 28-weeks pregnant was referred for an ophthalmological review due to pain and injection in both eyes. The patient was hospitalized under obstetrics and gynecology and evaluated for Behcet’s disease with oral and perineal ulcers. In an ophthalmic examination, both eyes were observed to have a conjunctival injection. Behcet’s disease-associated conjunctivitis was diagnosed. Topical steroids and antibiotics were administered every 6 h. Two days after her presentation, a maculopapular eruption occurred on her palms. Enterovirus type 71 was detected in a serum virus antibody test, and the patient was diagnosed with HFMD. After 7 days, severe pseudomembranous conjunctivitis and corneal epithelial defects occurred in both eyes. Topical steroids were administered every 3 h, and the pseudomembrane was removed every 2 to 3 days. The pseudomembrane did not occur after 3 weeks, but corneal erosion persisted. After 3 months, the corneal erosion had completely resolved.

Conclusions

HFMD-associated conjunctivitis is a rare complication in adults, however it can appear as a severe pseudomembranous conjunctivitis. In this case, the removal of the pseudomembrane and topical steroids helped improve the symptoms.
Study protocol: a multicenter, uncontrolled, open-label study of palivizumab in neonates, infants, and preschool children at high risk of severe respiratory syncytial virus infection
Authors: Mori Masaaki , Watabe Shinichi , Taguchi Tomoaki , Hasegawa Hisaya , Ishige Mika , Tanuma Naoyuki , Hirakawa Akihiro , Koike Ryuji , Kusuda Satoshi
Published: March 2021

Background

The prophylactic use of anti-respiratory syncytial virus (RSV) antibody (palivizumab) for severe RSV infection is not approved in Japan in specified groups of infants with neuromuscular diseases or other rare diseases associated with reduced ventilation competence or difficulty in expectoration, which increase the risk of exacerbation of severe RSV infection. The objective of this study is to investigate the efficacy, safety, and pharmacokinetics of palivizumab in pediatric patients with those rare diseases for which palivizumab is not indicated at present.

Methods/design

This study is a multicenter, uncontrolled, open-label study planned to be carried out between July 1, 2019 and June 30, 2022 at 7 medical institutions in Japan. The study population will be recruited from among neonates, infants, or children aged 24 months or younger with a condition falling under any of the following 5 disease groups: pulmonary hypoplasia, airway stenosis, congenital esophageal atresia, inherited metabolic disease, or neuromuscular disease. The planned sample size is 18 subjects, including at least 3 subjects per disease group. Throughout the RSV season, at least 4 continuous doses of palivizumab will be administered intramuscularly at 15 mg/kg at intervals of 30 days. The efficacy and safety of palivizumab will be comprehensively evaluated based on the incidence of RSV-related hospitalization, and serum palivizumab concentration, serum anti-palivizumab antibody concentration, and the occurrence of adverse events/reactions after the start of palivizumab treatment.

Discussion

This study will evaluate the efficacy and safety of palivizumab in pediatric patients with rare diseases which place them at high risk of severe RSV infection, but which fall outside the current indications for palivizumab prophylaxis. The generated data will have implications for the regulatory approval of prophylactic palivizumab treatment in this patient group.

Trial registration

This study has been prospectively registered in Japic Clinical Trials Information, which is managed and administered by the Japan Pharmaceutical Information Center (registration number: JapicCTI-194946, registration date: September 10, 2019).
Validation of a three-item Fatigue Severity Scale for patients with substance use disorder: a cohort study from Norway for the period 2016–2020
Authors:   for the INTRO-HCV Study Group, Vold Jørn Henrik , Gjestad Rolf , Aas Christer F. , Meland Eivind , Johansson Kjell Arne , Fadnes Lars Thore
Published: March 2021

Background

Little attention has been paid to customising fatigue questionnaires for patients with Substance Use Disorders (SUDs). The present study aims to validate and shorten the nine-item Fatigue Severity Scale (FSS-9) and Visual Analogue Fatigue Scale (VAFS) for use with this population.

Methods

We used data from a nested cohort with annual health assessments with responses on the FSS-9 and VAFS. During the period 2016–2020, 917 health assessments were collected from 655 patients with SUD in Bergen and Stavanger, Norway. A total of 225 patients answered the health assessment at least twice. We defined baseline as the first annual health assessment when the health assessments were sorted chronologically per patient. We checked for internal consistency, and we used longitudinal confirmatory factor analysis (CFA) and linear mixed model (LMM) analysis to validate and shorten the FSS-9 and VAFS.

Results

The internal consistency of the FSS-9 was excellent with a Cronbach’s α of 0.94 at baseline and 0.93 at the second annual health assessment. When shortening the FSS-9 to a three-item FSS (FSS-3, items 5–7), the Cronbach’s α was 0.87 at baseline and 0.84 at the second health assessment. The internal consistency was not affected when the VAFS was added to the FSS-3 and the FSS-9. The longitudinal CFA model showed a well-fitting model for the FSS-3 (χ2 = 13.33, degree of freedom = 8, P = 0.101). The LMM analysis showed equal linear changes at the individual level for the FSS-3 (slope: 0.00, P > 0.05) and FSS-9 (slope: 0.01, P > 0.05) between the health assessments.

Conclusion

The FSS-9 could be shortened to the FSS-3 with high validity and reliability for patients with SUDs and the addition of VAFS did not provide much added variability.
Microendoscopy-assisted extraforaminal lumbar interbody fusion for treating single-level spondylodesis
Authors: Shibayama Motohide , Li Guang Hua , Zhu Li Guo , Ito Zenya , Ito Fujio
Published: March 2021

Background

Lumbar interbody fusion is a standard technique for treating degenerative lumbar disorders involving instability. Due to its invasiveness, a minimally invasive technique, extraforaminal lumbar interbody fusion (ELIF), was introduced. On surgically approaching posterolaterally, the posterior muscles and spinal canal are barely invaded. Despite its theoretical advantage, ELIF is technically demanding and has not been popularised. Therefore, we developed a microendoscopy-assisted ELIF (mELIF) technique which was designed to be safe and less invasive. Here, we aimed to report on the surgical technique and clinical results.

Methods

Using a posterolateral approach similar to that of lateral disc herniation surgery, a tubular retractor, 16 or 18 mm in diameter, was placed at the lateral aspect of the facet joint. The facet joint was partially excised, and the disc space was cleaned. A cage and local bone graft were inserted into the disc space. All disc-related procedures were performed under microendoscopy. The spinal canal was not invaded. Bilateral percutaneous screw-rod constructs were inserted and fixed.

Results

Fifty-five patients underwent the procedure. The Oswestry Disability Index and visual analogue scale scores greatly improved. Over 90% of the patients obtained excellent or good results based on Macnab’s criteria. There were neither major adverse clinical effects nor the need for additional surgery.

Conclusions

mELIF is minimally invasive because the spinal canal and posterior muscles are barely invaded. It produces good clinical results with fewer complications. This technique can be applied in most single-level spondylodesis cases, including those involving L5/S1 disorders.
Interactions between the amygdala and medial prefrontal cortex as upstream regulators of the hippocampus to reconsolidate and enhance retrieved inhibitory avoidance memory
Authors: Fukushima Hotaka , Zhang Yue , Kida Satoshi
Published: March 2021

Memory reconsolidation is thought to maintain or enhance an original memory or add new information to the memory. Retrieved inhibitory avoidance (IA) memory is enhanced through memory reconsolidation by activating gene expression in the amygdala, medial prefrontal cortex (mPFC), and hippocampus. However, it remains unclear how these regions interact to reconsolidate/enhance IA memory. Here, we found the interactions between the amygdala and mPFC as upstream regulators of the hippocampus for IA memory reconsolidation. Pharmacological inactivation of the amygdala, mPFC, or hippocampus immediately after IA memory retrieval blocked IA memory enhancement. More importantly, inactivation of the amygdala or mPFC blocked the induction of c-Fos in the amygdala, mPFC, and hippocampus, whereas hippocampal blockade inhibited it only in the hippocampus. These observations suggest interactions between the amygdala and mPFC and they both function as upstream regulators of the hippocampus to reconsolidate IA memory. Our findings suggest circuitry mechanisms underlying IA memory enhancement through reconsolidation between the amygdala, mPFC, and hippocampus.