bluuebunny/crossref_metadata_2025 huggingface dataset:
An Analytical Spectral Model for Infragravity Waves over Topography in Intermediate and Shallow Water under Nonbreaking Conditions
Authors: Liao Zhiling , Li Shaowu , Liu Ye , Zou Qingping
Published: June 2021

The theoretical model for group-forced infragravity (IG) waves in shallow water is not well established for nonbreaking conditions. In the present study, analytical solutions of the group-forced IG waves at O(β1) (β1 = hx/(Δkh), hx = bottom slope, Δk = group wavenumber, h = depth) in intermediate water and at in shallow water are derived separately. In case of off-resonance [β1μ−1 = O(β1), where is the resonant departure parameter, cg = group speed] in intermediate water, additional IG waves in quadrature with the wave group forcing (hereinafter, the nonequilibrium response or component) are induced at O(β1) relative to the equilibrium bound IG wave solution of Longuet–Higgins and Stewart (1962) in phase with the wave group. The present theory indicates that the nonequilibrium response is mainly attributed to the spatial variation of the equilibrium bound IG wave amplitude instead of group-forcing. In case of near-resonance [β1μ−1 = O(1)] in shallow water; however, both the equilibrium and nonequilibrium components are at the leading order. Based on the nearly-resonant solution, the shallow water limit of the local shoaling rate of bound IG waves over a plane sloping beach is derived to be ~h−1 for the first time. The theoretical predictions compare favorably with the laboratory experiment by Van Noorloos (2003) and the present numerical model results generated using SWASH. Based on the proposed solution, the group-forced IG waves over a symmetric shoal are investigated. In case of off-resonance, the solution predicts a roughly symmetric reversible spatial evolution of the IG wave amplitude, while in cases of near to full resonance the IG wave is significantly amplified over the shoal with asymmetric irreversible spatial evolution.
Improving the Estimation of Temperature and Salinity by Assimilation of Observed Sound Speed Profiles
Authors: Zhang Jiali , Zhang Liang , Zhang Anmin , Zhang Lianxin , Li Dong , Zhang Xuefeng
Published: June 2021

Sound Speed Profile (SSP) affecting underwater acoustics is closely related to the temperature and the salinity fields. It is of great value to obtain the temperature and the salinity information through the high-precision sound speed profiles. In this paper, a data assimilation scheme by introducing sound speed profiles as a new constraint is proposed within the framework of 3DVAR data assimilation (referenced as SSP-constraint 3DVAR (SSPC-3DVAR) ), which aims at improving the analysis accuracy of initial fields of the temperature and salinity in coastal sea areas. In order to validate the performance of the new assimilation scheme, ideal experiments are firstly carried out to show the advantages of the new proposed SSPC-3DVAR. Then the temperature, the salinity, and the SSP observations from field experiments in a coastal area are assimilated into the Princeton Ocean Model to validate the performance of short-time forecasts, adopting the SSPC-3DVAR scheme. Results show that it is efficient to improve the estimate accuracy by as much as 14.6% (11.1%) for the temperature (salinity), compared with the standard 3DVAR. It demonstrates that the proposed SSPC-3DVAR approach works better in practice than the standard 3DVAR and will primarily benefit from variously and widely distributed observations in the future.
Reducing Constipation-Related Admissions: The Effectiveness of Antegrade Continence Enema Procedures in Children
Authors: Esparaz Joseph R. , Waters Alicia M. , Mathis Michelle S. , Mortellaro Vincent E.
Published: June 2021

Introduction

Constipation in pediatrics remains a common problem. Antegrade continence enema (ACE) procedures have been shown to decrease the distress of daily therapy. Patients are able to administer more aggressive washouts in the outpatient setting. Therefore, we hypothesize that patients following an ACE procedure would have reduced admissions for constipation.

Methods

Patients who underwent an ACE procedure at a large children’s hospital from 2015 to 2018 were included. Demographics, diagnosis, procedure, and preoperative/postoperative hospital admissions were analyzed.

Results

Forty-eight patients were included in the study. Over half were diagnosed with idiopathic constipation. Majority of patients underwent an appendicostomy (88%, n = 42). Preoperatively, 26 patients were admitted for a combined total of 63 times for constipation. Postoperatively, 4 patients were admitted for a total of 5 visits ( P = .021). Twenty-eight patients required a nonscheduled appendicostomy tube replacement.

Conclusion

This study demonstrates ACE procedures can improve constipation-related symptoms in children and are associated with decrease hospital admissions.
Surgical Resection After Talimogene Laherparepvec for Melanoma: Persistent Fuorodeoxyglucose Avidity on Positron Emission Tomography Despite No Viable Disease
Authors: MacArthur Taleen A. , Fahy Aodhnait S. , Jakub James W.
Published: June 2021

Background

Talimogene laherparepvec (TVEC) is an injectable attenuated oncolytic herpes simplex virus (HSV-1) used in the treatment of loco regionally metastatic melanoma. Lesions managed by TVEC are generally considered unresectable at time of initiation of intralesional therapy; however, a subset of patients go on to have surgical resection of loco regionally controlled disease. We sought to review our experience with surgical excision of treated lesions to offer an insight into the radiologic correlate, treatment effect, and pathological findings of intralesional TVEC therapy.

Methods

This is a retrospective descriptive case series of patients who underwent TVEC injection at Mayo Clinic, Rochester, MN, between October 2016 and July 2020. Institutional Institutional Review Board approval was obtained.

Results

Twenty-one patients underwent intralesional TVEC, met inclusion criteria, and were included in this series. Seven went on to surgical excision of the injected lesions after an initial course of TVEC. Of those 7 patients, 4 had residual melanoma in the specimen on final pathology, while 3 had a complete pathologic response. All 3 patients who had no residual disease on pathology continued to have fluorodeoxyglucose (FDG) avidity on preoperative positron emission tomography scan of the excised lesions.

Discussion

Despite ongoing FDG avidity on PET scan, patients who have well-controlled disease and stability over time of the injected lesions may benefit from surgical excision following a course of TVEC. This may render the patient clinically disease free and/or allow them a reprieve from TVEC treatment.
A Contemporary Analysis of the Effect of Trauma Center Verification Level on Mortality in Severe Injury
Authors: Plurad David S. , Geesman Glenn , Sheets Nicholas W. , Chawla-Kondal Bhani , Ayutyanont Napatakamon , Mahmoud Ahmed
Published: June 2021

Background

Literature demonstrates increased mortality for the severely injured at a Level II vs. Level I center. Our objective is to reevaluate the impact of trauma center verification level on mortality for patients with an Injury Severity Score (ISS) > 15 utilizing more contemporary data. We hypothesize that there would be no mortality discrepancy.

Study Design

Utilizing the ACS Trauma Quality Program Participant Use File admission year 2017, we identified severely injured (ISS >15) adult (age >15 years) patients treated at an ACS-verified Level I or Level II center. We excluded patients who underwent interfacility transfer. Logistic regression was performed to determine adjusted associations with mortality.

Results

There were 63 518 patients included, where 43 680 (68.8%) were treated at a Level I center and 19 838 (31.2%) at a Level II. Male gender (70.1%) and blunt injuries (92.0%) predominated. Level I admissions had a higher mean ISS [23.8 (±8.5) vs. 22.9 (±7.8), <.001], while Level II patients were older [mean age (y) 52.3 (±21.6) vs. 48.6 (±21.0), <.001] with multiple comorbidities (37.7% vs. 34.9%, <.001). Adjusted mortality between Level I and II centers was similar (12.0% vs. 11.8%, .570).

Conclusions

Despite previous findings, mortality outcomes are similar for severely injured patients treated at a Level I vs. Level II center. We theorize that this relates to mandated Level II resourcing as defined by an updated American College of Surgeons verification process.
Subacute Enteritis Two Months After COVID-19 Pneumonia With Mucosal Bleeding, Perforation, and Internal Fistulas
Authors: Abbassi Babak , Deb Anasua , Costilla Vanessa , Bankhead-Kendall Brittany
Published: June 2021

Chronic sequelae of COVID-19 remain undetermined. We report a case of postinfection sequelae in a patient presenting with subacute obstruction 2 months after COVID-19 infection. A 34-year-old man with a prior prolonged hospital stay due to COVID-19 complicated by upper gastrointestinal (GI) bleed presented with subacute obstruction and failure to thrive. Upper GI push enteroscopy revealed residual ulcers and multiple proximal jejuno-jejunal fistulae. Midline laparotomy revealed strictures with dense intra-abdominal adhesions, a large jejuno-jejunal fistula, and evidence of prior jejunal perforation following severe COVID-19 infection. The patient recovered after small bowel resection with anastomoses and was discharged home. Histopathological examination of resected specimen confirmed transmural infarction with evidence of prior hemorrhage, diffuse ulcers, and multifocal inflammation. This is the first report of a chronic GI sequelae resulting from COVID-19. As the pandemic evolves, medical professionals must be vigilant to consider alternative GI diagnoses in the COVID-19 survivors.
Inclusive Transnational Education Partnerships: A Case Study of a Master of Arts in TESOL Program
Authors: Yeo Marie Alina , Newton Jonathan Mark
Published: June 2021

Recent nationalist and isolationist policies coupled with travel restrictions have prompted a shift in perspectives on the internationalization of higher education. Furthermore, criticisms surrounding issues such as the widespread adoption of English as a medium of instruction in higher education and quality assurance of transnational programs have emerged, with increasing calls for more inclusive models and greater emphasis on quality over quantity. This paper presents an evaluative study of a transnational Master of Arts in the Teaching of English to Speakers of Other Languages (MATESOL) program delivered in partnership by an institution in Singapore (SI) and a university in New Zealand (NZU) and designed for English language teachers from the Association of Southeast Asian Nations (ASEAN) region. Drawing on an impact evaluation, the paper identifies key design features in the program that contributed to its effectiveness as an inclusive model of English medium instruction (EMI) and internationalization in transnational higher education (TNHE).
Arteriovenous supercharging: A novel approach to improve reliability of the distally based sural flap
Authors: Agarwal Pawan , Sharma Dhananjaya , Kukrele Rajeev
Published: June 2021

Complex soft-tissue defects of the distal third of the leg, foot and ankle with exposed bones/joints, tendons and implants need a flap for their closure. Distally based sural flap is commonly used, but it has a high partial necrosis rate due to venous insufficiency. We addressed this issue with AV supercharging by dorsalis pedis artery with short saphenous vein. Eight patients (seven males, mean age 34.12 years) with post traumatic lower limb defects over heel and foot were included. All flaps survived and healed although four flaps developed superficial partial epidermolysis. Average healing time was 20.12 days. Closure of the AV fistula was not required in any of the patients. At mean follow-up of two months, all patients were ambulatory with well settled flap. Arteriovenous supercharging of distally based sural flap through short saphenous vein improves the distal arterial perfusion in the flap and prevents distal flap necrosis.
How Does the “Cookie‐Bite” Audiogram Shape Perform in Discriminating Genetic Hearing Loss in Adults?
Authors: Ahmadmehrabi Shadi , Li Binglan , Epstein Douglas J. , Ruckenstein Michael J. , Brant Jason A.
Published: June 2021

“Cookie‐bite” or U‐shaped audiograms—specifically, those showing midfrequency sensorineural hearing loss (HL)—are traditionally taught to be associated with genetic HL; however, their utility as a screening tool has not been reported. We aim to determine the performance of a cookie‐bite audiogram shape in stratifying patients carrying putative loss‐of‐function variants in known HL genes from wild‐type controls. We merged audiometric and exome sequencing data from adults enrolled in a large biobank at a tertiary care center. Of 321 patients, 50 carried a putative loss‐of‐function variant in an HL gene. The cookie‐bite shape was present in 9 of those patients, resulting in low sensitivity (18%) and positive predictive value (15%) in stratifying genetic carrier status; 84% of patients with a cookie‐bite audiogram did not carry a genetic variant. A cookie‐bite audiogram should not be used to screen adults for possible genetic testing.
The Ram of Ordination and Qualifying the Priests to Eat Sacrifices
Authors: Grossman Jonathan , Hadad Eliezer
Published: June 2021

The priests qualified for their priestly function in three main ways: being robed in the priestly vestments; being anointed; and undergoing the ceremony of the days of ordination. This article is intended to clarify the contribution of each of the three components of the procedure, but especially that of the ram of ordination. A semantic and literary analysis demonstrates that donning the vestments qualifies the priests to minister in the tabernacle; anointing them makes them ‘holy’; and the ram ceremony qualifies them to eat the sacrifices that are offered on the altar.
Multi-Objective Optimization for Skip-Stop Strategy Based on Smartcard Data Considering Total Travel Time and Equity
Authors: Han Sang-Wook , Lee Eun Hak , Kim Dong-Kyu
Published: June 2021

With the rise of urban sprawl, urban railways extend out further to the city’s outer district, installing additional stations. Passengers who travel from the outer district to the center of the city therefore experience long travel times. Although skip-stop strategy helps save total travel time, deviation of travel time among all origin–destination pairs may be increased, leading to equity problems. This study aims to minimize the inequity and total travel time through train stop planning and train scheduling. A coefficient of variation is adopted as a measure of inequity. The problem is formulated as a multi-objective mixed integer nonlinear programming model. Origin–destination demand is extracted from smartcard data and a case study of four urban railway lines in Seoul is conducted. The results indicate that the number of transfer stations for equity-oriented skip-stop strategy is smaller than that for total-travel-time-oriented skip-stop strategy. We also discover that as the number of transfer stations rises, inequity increases and total travel time is reduced. For skip-stop strategy considering total travel time and equity simultaneously, average total travel time and the average deviation are reduced by up to 10.3% and 10.6%, respectively, compared with those of all-stop strategy. We analyze the gradient of Pareto optimal sets to find out which factors (equity or total travel time) are more significant. Skip-stop strategy on lines 5 and 9 can be designed based on equity, while line 4 can be planned based on total travel time.
Transcranial Magnetic Stimulation in Succinic Semialdehyde Dehydrogenase Deficiency: A Measure of Maturational Trajectory of Cortical Excitability
Authors: Tsuboyama Melissa , Liu Jingjing , Kaye Harper , DiBacco Melissa , Pearl Phillip L , Rotenberg Alexander
Published: June 2021

Background:

Succinic semialdehyde dehydrogenase deficiency (SSADHD) is a disorder of GABA degradation with use-dependent downregulation of postsynaptic GABAA/B receptors. We aim to measure the resulting cortical excitation: inhibition ratio using transcranial magnetic stimulation.

Methods:

In this single-center observational study, 18 subjects with SSADHD and 8 healthy controls underwent transcranial magnetic stimulation. Resting motor threshold, cortical silent period, and long-interval intracortical inhibition were measured in both groups. Resting motor threshold in focal epilepsy patients from an institutional transcranial magnetic stimulation database were also included.

Results:

SSADHD subjects had higher resting motor threshold than healthy controls but lower relative to focal epilepsy patients. Resting motor threshold decreased with age in all groups. Cortical silent period was longer in SSADHD subjects than in healthy controls. No difference was detected in long-interval intracortical inhibition between the 2 groups.

Conclusion:

Findings suggest abnormal corticospinal tract physiology in SSADHD, but with preserved developmental trajectory for corticospinal tract maturation. Defining features of these transcranial magnetic stimulation metrics in SSADHD will be better elucidated through this ongoing longitudinal study.
Investigation of impact properties of para-aramid composites made with a thermoplastic-thermoset blend
Authors: Khan Muhammad Imran , Umair Muhammad , Hussain Rizwan , Karahan Mehmet , Nawab Yasir
Published: June 2021

During impact, thermoset composites show brittle behaviour, whereas thermoplastic composites show a relatively ductile behaviour with higher absorption of impact energy. The research on the investigation of the impact performance of composites with thermoplastic resin and/or with a blend of thermoplastic and thermoset resins found rare. In the present study, both thermoset (phenolic, vinyl ester) and thermoplastic (Polyvinyl butyral – PVB) matrices were used with Para-aramid reinforcement for the development of five-layered composite samples. Drop weight impact, Charpy impact, flexural (three-point), and hardness tests were conducted to assess the performance of the composite samples. The developed thermoplastic composites showed superior impact properties as compared to thermoset composites except for out-of-plane deformation (trauma). This deformation was reduced using a blend of PVB and Phenolic. The composite made with blend absorbs 8–9% more energy as compared to Phenolic composites with almost the same value of trauma. Overall, damage area is also lesser in the case of composite made using a blend. The experimental results are validated by one-way ANOVA (Tukey) statistical analysis.
Culture Moderates the Relation Between Gender Inequality and Well-Being
Authors: Li Chen , Zuckerman Miron , Diener Ed
Published: June 2021

Research on the relation of gender inequality and subjective well-being (SWB) has produced inconsistent results. We suggest that culture moderates this relation such that inequality has a greater adverse effect in liberal than in conservative societies. The present studies, using aggregate data from 86 countries (Study 1) and 145,975 individuals’ data from 69 countries (Study 2), support this notion. Among liberal countries, inequality was negatively related to SWB for both men and women; there was some evidence that this relation was stronger for women. In conservative countries, the relation was not significant. Previously, the same liberal–conservative continuum moderated the relation between income inequality and SWB for groups with both high and low socioeconomic status (SES) but particularly for the low-SES group. The similarity in results across two different studies strongly supports the notion that the relation between inequality and SWB is contingent on where specific cultures are located on the liberal–conservative continuum.
‘Foreigners are said to be wise and honest but they teach us false things’: ‘On Military Tactics’ (1700/1701) by Ivan Pososhkov and Western military tradition
Authors: Rusakovskiy Oleg
Published: June 2021

This article focuses on ‘On Military Tactics’ (‘O ratnom povedenii’), composed in winter 1700/1701 by Ivan Pososhkov and considered to be one of the first analytical military treatises written in the Russian language. Pososhkov heavily criticized foreign influences on native warfare, in particular, the Western infantry tactics and drill introduced by the tsar Peter the Great and his predecessors and reflected some controversial problems of contemporary military culture. Despite his declared hostility towards Western methods of warfare, Pososhkov acknowledged the utility of a ‘military science’ and read some foreign books on the subject.
Increasing Awareness of Palliative Medicine With the Emergency Department: A Quality Improvement Project
Authors: De Elia Carolina , Macchio Phyllis , Khan Wardah , Perigini Lindsay , Kaell Alan , Haggerty Greg
Published: June 2021

Palliative medicine can be essential in helping to align patients’ goals of care with their treatment team. Referrals for palliative medicine are more advantageous when initiated in the emergency department as this is the first point of contact for seriously ill patients being admitted to the hospital. This paper highlights a quality improvement project initiated to address knowledge gaps in palliative medicine with emergency department (ED) staff and to increase referrals for palliative medicine from the ED. The palliative medicine staff held an in-service training with the ED staff which focused on defining palliative medicine and the importance of early consults when the patient presents in the ED. Palliative medicine staff also highlighted the differences between palliative medicine and hospice care, when and how to initiate a consult for palliative medicine, as well as how to contact the palliative medicine division. The results showed that after this educational intervention the number of palliative medicine consults increased three-fold. Before the educational intervention, monthly averages for palliative medicine were 6 and after rose to 18.9 per month.
Investigation of the Optimal Dose aPCC in Reversing the Effect of Factor Xa Inhibitors—An In Vitro Study
Authors: Schultz Nina Haagenrud , Fareed Jawed , Holme Pål Andre
Published: June 2021

Factor (F) Xa inhibitors are safe and effective alternatives to warfarin. There are concerns about the lack of a reversal strategy in case of serious bleeds or need for emergency surgery in situations when the antidote andexanet alfa is not available. Factor concentrates are widely used, but there are few clinical studies regarding the reversal effect of activated prothrombin complex concentrate (aPCC). Because of the feared thrombogenicity, administration of the lowest effective dose would be desirable. To determine the lowest concentration of aPCC sufficient to reverse the effect of rivaroxaban and apixaban. Blood from 18 healthy volunteers were supplemented with apixaban or rivaroxaban. aPCC was added to obtain 10 different concentrations ranging from 0.08-1.60 U/mL. Thromboelastometry and thrombin generation assay were used to assess the reversal effect. aPCC concentrations of 0.08 and 0.16 U/mL restored thromboelastometry clotting time to baseline in apixaban ( P = 1.0) and rivaroxaban ( P = 1.0)-containing samples, respectively. The concentrations 0.08 U/mL ( P = 0.5) and 0.24 U/mL ( P = 0.2) were sufficient to restore thrombin generation. Concentrations of 0.56 U/mL and higher, caused significantly higher ETP than baseline in apixaban-containing samples ( P < 0.05). aPCC concentrations lower than previously reported were effective in reversing the effect of FXa inhibitors in vitro.
Plain versus paclitaxel-coated balloon angioplasty in arteriovenous fistula and graft stenosis: An umbrella review
Authors: Lazarides Miltos K , Christaina Eleni , Antoniou George A , Argyriou Christos , Trypsianis Gregory , Georgiadis George S
Published: June 2021

An umbrella review was performed to synthesize the evidence from systematic reviews/meta-analyses of clinical trials investigating the efficacy and safety of paclitaxel-coated balloons (PCB) vs. conventional balloon angioplasty in arteriovenous fistulas (AVFs) and grafts stenosis.

Medline (via PubMed) and SCOPUS databases were searched up to July 15th 2020. All meta-analyses that enrolled randomized controlled trials (RCTs) comparing PCB with plain balloons in AVFs and grafts were included. Re-analysis of original data was performed assessing predictive intervals (PI). Quality of the included meta-analyses was assessed using AMSTAR score. Eight meta-analyses were included and four clinical outcomes [target lesion primary patency (TLPP), circuit primary patency, mortality, complication rate] derived from 14 RCTs, were analyzed. There were no significant differences in the TLPP in meta-analyses providing data purely from autologous AVFs. Significant benefits regarding TLPP and circuit primary patency at 3, 6, and 12-months in favor of PCB were reported in four meta-analyses mixing AVFs and grafts; however when PI were assessed, in all but one meta-analysis these included the null value, indicating no significant benefit. In only one meta-analysis significant difference of TLPP at 12-months in favor of PCB was noticed. (Odds Ratio 0.0009 PI: 0.28-0.85) No mortality difference was noticed in four meta-analyses providing data up to 24 months. In conclusion this overview revealed a modest benefit of using PCB angioplasty compared to plain angioplasty in AVFs and graft stenosis. No increased mortality was noticed in the PCB group.
School Nurses on the Front Lines of Healthcare: Getting aHEAD of EmergENT Eye, Ear, Nose, and Throat Infections
Authors: Patel Shivam , Olympia Robert P.
Published: June 2021

School nurses may deal with various common infectious eye, ear, nose, and throat–related chief complaints in regular practice. Recognizing the signs and symptoms of severe infection is paramount to preventing life-threatening complications that can have both acute and long-term implications. Distinguishing urgent and emergent eye, ear, nose, and throat conditions to send to the emergency department is integral to reducing the morbidity associated with these conditions. This article discusses three different students presenting with various chief complaints, from the initial assessment by the school nurse to the appropriate disposition and follow-up.
Risk factors and prognostic factors for inflammatory breast cancer with bone metastasis: A population-based study
Authors: Gao Tianyuan , Shao Fang
Published: June 2021

Purpose:

Inflammatory breast cancer (IBC) is a rare type of breast cancer with poor prognosis. IBC patients with bone metastasis (BM) often suffer from many complications. This study was performed to identify risk factors with strong capability of predicting high BM risk for IBC patients and find prognostic factors for those patients.

Methods:

The Surveillance, Epidemiology and End Results (SEER) database was used to collect the clinicopathological and survival information of IBC patients. 966 IBC patients diagnosed between 2010 and 2015 were included to study the risk factors for developing BM by using Multivariable logistic regression. A total of 194 and 176 patients were included to analyze independent prognostic factors for overall survival (OS) and cancer specific survival (CSS) of IBC patients with BM respectively.

Results:

Of the 966 IBC patients, 194 (20.1%) patients were with BM. The risk factors for developing BM in IBC patients included unmarried marital status, double breast tumor, N1 stage, N3 stage, and liver metastases had higher risk of BM, while those of uninsured status and triple negative breast cancer (TNBC) were less likely to have BM. Analysis of prognostic factors for OS and CSS of IBC patients with BM showed that TNBC subtype and liver metastases were independently significantly associated with poorer OS and CSS of BM patients, while chemotherapy could serve as an independent prognostic factor for better OS and CSS of BM patients.

Conclusion:

Marital status, double breast tumor, N1 stage, N3 stage, and liver metastases should be considered for prediction of BM in IBC patients. TNBC subtype and liver metastases may indicate poor survival and chemotherapy can indicate improved survival for IBC patients with BM.
Collagen/heparin sulfate scaffold combined with mesenchymal stem cells treatment for canines with spinal cord injury: A pilot feasibility study
Authors: Deng Wu-Sheng , Yang Kun , Liang Bing , Liu Ying-Fu , Chen Xu-Yi , Zhang Sai
Published: June 2021

Background:

Due to endogenous neuronal deficiency and glial scar formation, spinal cord injury (SCI) often leads to irreversible neurological loss. Accumulating evidence has shown that a suitable scaffold has important value for promoting nerve regeneration after SCI. Collagen/heparin sulfate scaffold (CHSS) has shown effect for guiding axonal regeneration and decreasing glial scar deposition after SCI. The current research aimed to evaluate the utility of the CHSSs adsorbed with mesenchymal stem cells (MSCs) on nerve regeneration, and functional recovery after acute complete SCI.

Methods:

CHSSs were prepared, and evaluated for biocompatibility. The CHSSs adsorbed with MSCs were transplanted into these canines with complete SCI.

Results:

We observed that MSCs had good biocompatibility with CHSSs. In complete transverse SCI models, the implantation of CHSS co-cultured with MSCs exhibited significant improvement in locomotion, motor evoked potential, magnetic resonance imaging, diffusion tensor imaging, and urodynamic parameters. Meanwhile, nerve fibers were markedly improved in the CHSS adsorbed with MSCs group. Moreover, we observed that the implantation of CHSS combined with MSCs modulated inflammatory cytokine levels.

Conclusions:

The results preliminarily demonstrated that the transplantation of MSCs on a CHSS could improve the recovery of motor function after SCI. Thus, implanting the MSCs-laden CHSS is a promising combinatorial therapy for treatment in acute SCI.
A Rare Case of an Intramedullary Spinal Cord Abscess Due to Escherichia coli in a Pediatric Patient
Authors: Sehgal Rachel , Budnik Elizabeth , Mallik Atul , Bonwit Andrew , Leischner Matthew
Published: June 2021

Spinal cord abscess is a rare entity, particularly in the pediatric population. Spinal cord abscesses can be located in extradural, subdural and intradural (intramedullary or extramedullary) regions of the cord. Among these locations, intramedullary is extremely uncommon. There have been few case reports of intramedullary spinal cord abscess since its first description in 1830. We describe a 2 year-old boy with a history of neonatal meningitis due to E.coli who presented with refusal to walk and was subsequently found to have intramedullary spinal cord abscesses at multiple levels. Culture of the abscesses again revealed E.coli. The patient was noted to have a pit located just superiorly to his sacral spine. Imaging revealed the presence of a dorsal dermal sinus tract. It is important to evaluate anatomical abnormalities, especially in the setting of serious bacterial infections, such as meningitis, as they have the potential to serve as a reservoir for infection.
Commentary on “Alignment Between Children’s Numeracy Performance, the Kindergarten Common Core State Standards for Mathematics, and State-Level Early Learning Standards”
Authors: Fuson Karen C. , Clements Douglas H. , Sarama Julie
Published: June 2021

Litkowski et al. compare preschoolers’ performance on three counting items to various standards. We clarify that the items Litkowski and colleagues found to be too easy for kindergarten were actually goals for 4s/PKs in the National Research Council’s report Mathematics Learning in Early Childhood: Paths Toward Excellence and Equity but that they were included as kindergarten standards to ensure that all children had an opportunity to learn these crucial competencies. The helpful analysis in their article of the variability across present state early childhood standards indicates that the kindergarten Common Core State Standards–Mathematics need to remain unchanged for the same reason. We suggest that research funding in early childhood is better spent on research on high-quality instructional contexts for all children than on survey research. And we address the important question of what more-advanced children should learn in kindergarten by pairing standards those children already know with crucial standards that need a lot of time and attention.
Bringing Child Buddhist Monks into the Alternative Care Conversation: Reflections on an Under-considered Group of Children
Authors: Parkes Deborah W.
Published: June 2021

Tens of thousands of children in India, Bhutan, Nepal, Sri Lanka, and other Asian countries are living as child Buddhist monks. Many are in temples and monasteries far from home and do not see their parents for months, even years. Some are as young as 6 years of age. The aim of this article is to engage scholars, practitioners, child rights advocates, and others in a conversation around the rights and vulnerabilities of child Buddhist monks and children susceptible to being entrusted to monasteries to live as child monks. This group of children receives relatively little attention in alternative care conversations despite many parallels and overlaps with children in orphanages and care homes. This article identifies risks and vulnerabilities that child monks can face, including sexual abuse. It reflects on how aspects of entrusting young children to live as child monks do not necessarily fit with principles articulated in the Convention on the Rights of the Child ( UNGA, 1989 ) and the United Nations Guidelines for the Alternative Care of Children ( UNGA, 2009 ).
Add-on Ayurveda Treatment for Early Stage COVID-19: A Single Center Retrospective Cohort Study From Gujarat, India
Authors: Thakar Anup , Panara Kalpesh , Patel Falgun , Bhagiya Shital , Goyal Mandip , Bhinde Sagar , Chaudhari Swapnil , Chaturvedi Sarika
Published: June 2021

The retrospective cohort study aimed to evaluate the clinical outcomes of Ayurveda treatment exposure as an add-on to conventional care in early stage COVID-19 patients admitted at Samaras COVID care center, Ahmedabad, India. Conventional care included Vitamin-c, Azithromycin, and Paracetamol. Ayurveda formulations used as add-on were Dashamula and Pathyadi decoctions along with Trikatu powder , Sanshamani tablet, AYUSH-64 tablet AND Yastimadhu Ghana tablet for oral administration. Considering Add-on Ayurveda medicines as exposure of interest, patients who received Add-on Ayurveda medicines at least for 7 days were included in the exposed group while those who received only conventional care in unexposed group. Data was collected through record review and telephonic interviews. The outcomes of interest were the development of symptoms, duration of symptomatic phase in those progressing to symptomatic stage and mortality. Total 762 participants were included-[541 (71%) in the exposed group and 221 (29%) in the unexposed. Progression to symptomatic phase did not differ significantly between groups [27.6% in exposed, 24.6% in unexposed, adjusted RR 0.85; 95% CI 0.6-1.2]. The total duration of symptomatic phase among those progressing to the symptomatic stage was significantly decreased in the exposed group (x¯ = 3.66 ± 1.55 days in exposed (n = 133); x¯ = 5.34 ± 3.35 days in unexposed (n = 61), p < 0.001). No mortality was observed in either of the groups. Ayurveda Treatment as adjunctive to conventional care reduced the duration of symptomatic phase in early stage COVID-19 as compared to standalone conventional care. Add-on Ayurveda treatment has promising potential for management of early stage COVID-19.
Effect of Axial Deformation on Elastic Properties of Irregular Honeycomb Structure
Authors: Wang Ning , Deng Qingtian
Published: June 2021

Irregular honeycomb structures occur abundantly in nature and in man-made products, and are an active area of research. In this paper, according to the optimization of regular honeycomb structures, two types of irregular honeycomb structures with both positive and negative Poisson’s ratios are presented. The elastic properties of irregular honeycombs with varying structure angles were investigated through a combination of material mechanics and structural mechanics methods, in which the axial deformation of the rods was considered. The numerical results show that axial deformation has a significant influence on the elastic properties of irregular honeycomb structures. The elastic properties of the structure can be considered by the enclosed area of the unit structure, the shape of the unit structure, and the elastic properties of the original materials. The elastic properties considering the axial deformation of rods studied in this study can provide a reference for other scholars.
Randomized test-treatment studies with an outlook on adaptive designs
Authors: Hot Amra , Bossuyt Patrick M. , Gerke Oke , Wahl Simone , Vach Werner , Zapf Antonia
Published: June 2021

Background

Diagnostic accuracy studies aim to examine the diagnostic accuracy of a new experimental test, but do not address the actual merit of the resulting diagnostic information to a patient in clinical practice. In order to assess the impact of diagnostic information on subsequent treatment strategies regarding patient-relevant outcomes, randomized test-treatment studies were introduced. Various designs for randomized test-treatment studies, including an evaluation of biomarkers as part of randomized biomarker-guided treatment studies, are suggested in the literature, but the nomenclature is not consistent.

Methods

The aim was to provide a clear description of the different study designs within a pre-specified framework, considering their underlying assumptions, advantages as well as limitations and derivation of effect sizes required for sample size calculations. Furthermore, an outlook on adaptive designs within randomized test-treatment studies is given.

Results

The need to integrate adaptive design procedures in randomized test-treatment studies is apparent. The derivation of effect sizes induces that sample size calculation will always be based on rather vague assumptions resulting in over- or underpowered study results. Therefore, it might be advantageous to conduct a sample size re-estimation based on a nuisance parameter during the ongoing trial.

Conclusions

Due to their increased complexity, compared to common treatment trials, the implementation of randomized test-treatment studies poses practical challenges including a huge uncertainty regarding study parameters like the expected outcome in specific subgroups or disease prevalence which might affect the sample size calculation. Since research on adaptive designs within randomized test-treatment studies is limited so far, further research is recommended.
Excretion of urine extracellular vesicles bearing markers of activated immune cells and calcium/phosphorus physiology differ between calcium kidney stone formers and non-stone formers
Authors: Zhang Jiqing , Kumar Sanjay , Jayachandran Muthuvel , Herrera Hernandez Loren P. , Wang Stanley , Wilson Elena M. , Lieske John C.
Published: June 2021

Backgrounds:

Previous studies have demonstrated that excretion of urinary extracellular vesicles (EVs) from different nephron segments differs between kidney stone formers and non-stone formers (NSFs), and could reflect pathogenic mechanisms of urinary stone disease. In this study we quantified selected populations of specific urinary EVs carrying protein markers of immune cells and calcium/phosphorus physiology in calcium oxalate stone formers (CSFs) compared to non-stone formers (NSFs).

Methods

Biobanked urine samples from CSFs (n = 24) undergoing stone removal surgery and age- and sex- matched NSFs (n = 21) were studied. Urinary EVs carrying proteins related to renal calcium/phosphorus physiology (phosphorus transporters (PiT1 and PiT2), Klotho, and fibroblast growth factor 23 (FGF23); markers associated with EV generation (anoctamin-4 (ANO4) and Huntington interacting protein 1 (HIP1)), and markers shed from activated immune cells were quantified by standardized and published method of digital flow cytometry.

Results

Urine excretion of calcium, oxalate, phosphorus, and calcium oxalate supersaturation (SS) were significantly higher in CSFs compared to NSFs (P < 0.05). Urinary excretion of EVs with markers of total leukocytes (CD45), neutrophils (CD15), macrophages (CD68), Klotho, FGF23, PiT1, PiT2, and ANO4 were each markedly lower in CSFs than NSFs (P < 0.05) whereas excretion of those with markers of monocytes (CD14), T-Lymphocytes (CD3), B-Lymphocytes (CD19), plasma cells (CD138 plus CD319 positive) were not different between the groups. Urinary excretion of EVs expressing PiT1 and PiT2 negatively (P < 0.05) correlated with urinary phosphorus excretion, whereas excretion of EVs expressing FGF23 negatively (P < 0.05) correlated with both urinary calcium and phosphorus excretion. Urinary EVs with markers of HIP1 and ANO4 correlated negatively (P < 0.05) with clinical stone events and basement membrane calcifications on papillary tip biopsies.

Conclusions

Urinary excretion of EVs derived from specific types of activated immune cells and EVs with proteins related to calcium/phosphorus regulation differed between CSFs and NSFs. Further validation of these and other populations of urinary EVs in larger cohort could identify biomarkers that elucidate novel pathogenic mechanisms of calcium stone formation in specific subsets of patients.
Factors associated with informal caregiving and its effects on health, work, and social activities of adult informal caregivers in Malaysia: findings from the National Health and Morbidity Survey 2019
Authors: Kong Yuke-Lin , Anis-Syakira Jailani , Jawahir Suhana , R’ong Tan Yeung , Rahman Noor Hasidah Ab , Tan Ee Hong
Published: June 2021

Background

The increase in the elderly population, chronic and degenerative diseases, as well as accidents at work and on the road in Malaysia would result in an increased demand for informal care. This paper aimed to determine the associated factors of informal caregiving and its effects on health, work and social activities of adult informal caregivers in Malaysia.

Methods

The data from the 2019 National Health and Morbidity Survey (NHMS), a nationwide cross-sectional survey with a two-stage stratified random sampling design, was used in this research. The study included respondents who were 18 years and older (n = 11,674). Data were obtained via face-to-face interviews using validated questionnaires. Descriptive and complex sample logistic regression analyses were employed as appropriate.

Results

5.7% of the adult population were informal caregivers. Provision of informal care were significantly associated with the female sex (OR = 1.52, 95% CI [1.21, 1.92]), those aged 36–59 years (OR = 1.61, 95% CI [1.15, 2.25]), and those who reported illness in the past 2 weeks (OR = 1.79, 95% CI [1.38, 2.33]). The risk of having their health affected were associated with female caregivers (OR = 3.63, 95% CI [1.73, 7.61]), those who received training (OR = 2.10, 95% CI [1.10, 4.00]) and those who provided care for 2 years or more (OR = 1.91, 95% CI [1.08, 3.37]). The factors associated with the effects on work were ethnicity, received training and had no assistance to provide the care. In terms of effect on social activities, female caregivers (OR = 1.96, 95% CI [1.04, 3.69]) and caregivers who received training were more likely (OR = 2.19, 95% CI [1.22, 3.93]) to have their social activities affected.

Conclusion

Our study revealed that sex, age, and self-reported illness were factors associated with being an informal caregiver in Malaysia. Informal caregivers faced effects on their health, work, and social activities which may be detrimental to their well-being. This understanding is crucial for planning support for caregivers.
Relationship between BMI with percentage body fat and obesity in Singaporean adults – The Yishun Study
Authors: Chen Kexun Kenneth , Wee Shiou-Liang , Pang Benedict Wei Jun , Lau Lay Khoon , Jabbar Khalid Abdul , Seah Wei Ting , Ng Tze Pin
Published: June 2021

Background

The main aim of this study was to the determine relationship between Body Mass Index (BMI) and percentage body fat (BF%) in Singaporean adults, derive a prediction model to estimate BF%, and to report population BF%. The secondary aim was to determine the prevalence of overweight and obesity based on BF% threshold and the new risk categories for obesity in Singaporean population.

Methods

This was a population-based study of 542 community-dwelling Singaporeans (21–90 years old, 43.1% men). Anthropometry and body composition were assessed. Relationship between BMI and BF% were analysed using multiple regression models. Prevalence of overweight and obesity were estimated using WHO and Singapore Ministry of Health (MOH) Clinical Practice Guidelines for BMI classification, and BF% cut-off points of 25 and 35% for men and women respectively.

Results

We derived a prediction model to estimate BF% based on BMI, age and sex. The current cohort of Singaporeans when compared to Caucasians in the US and Europe as well as a Singapore cohort from 20 years age have higher BF% when matched for BMI, age, and sex. The overall population-adjusted prevalence of obesity according to WHO International classification (BMI ≥30 kg/m2) was 12.9% (14.9% men; 11.0% women); and 26.6% (30.7% men; 22.8% women) according to the MOH classification (BMI ≥27.5 kg/m2). However, using the BF% cut-off (> 25% for men and > 35% for women) resulted in very high prevalence of obesity of 82.0% (80.2% men; 83.8% women).

Conclusion

There is a large discrepancy between BF% and BMI measured obesity in Singaporean adults. The results confirmed that Singaporean adults have higher BF% at lower BMI compared to US and Europe white counterparts; and that BF% in our population has increased over two decades.
Home food environment and associations with weight and diet among U.S. adults: a cross-sectional study
Authors: Kegler Michelle C. , Hermstad April , Haardörfer Regine
Published: June 2021

Background

The home provides the physical and social context for the majority of eating behaviors for U.S. adults. This study describes eleven dimensions of the home food environment among a national sample of U.S. adults and identifies which are associated with diet quality and overweight/obesity.

Methods

A national sample of U.S. adults ages 18 to 75 was recruited from an online survey panel. Respondents (n = 4942) reported on foods available in the home, including 1) fruit and vegetables, 2) salty snacks/sweets, 3) less healthy beverages, as well as 4) food placement, 5) shopping practices for fruits and vegetables, 6) food preparation, 7) portion control methods, 8) family meals from restaurants, 9) family household practices around TV and eating, 10) presence of a TV in the dining area, and 11) ownership of a scale. Self-reported height and weight, fruit and vegetable intake, and percent calories from fat were also assessed.

Results

Mean household size was 2.6, 32.7% had children in the home, and 23.1% lived alone. The majority were White (67.7%), with 12.3% Black and 14.3% Hispanic. Mean age was 44.4 and 48.3% were men. In multivariable models, seven features of the home food environment were associated with meeting the recommended fruit and vegetable intake guidelines, with food placement, meal preparation, frequency of shopping for fruit, and a greater variety of fruits and vegetables available in the home most strongly associated. Eight of 11 features were associated with percent energy from fat, including restaurant food for family meals, salty snacks and sweets availability, less healthy beverages availability, food placement, meal preparation, frequency of shopping for fruit, family eating with the TV on, and having a TV in the dining area. More diverse fruit and vegetable availability was associated with lower odds of overweight/obesity, and more frequent family eating while watching TV was associated with increased odds of overweight/obesity.

Conclusion

Targeting these dimensions of the home food environment may be a promising approach for future intervention research.