bluuebunny/crossref_metadata_2025_split huggingface dataset:
Content Validity of an Integrated Yoga Module for Practice During Remission in Relapsing–Remitting Multiple Sclerosis Patients
Authors: Palukuru Sreedhar , Patil Suchitra S. , Nagarathna R. , Singh Amit , Nibedita K. S. 
Published: September 2021

Background: Some investigations point to the beneficial effects of yoga in alleviating the motor and cognitive dysfunctions in multiple sclerosis (MS) patients by using varying combinations of physical, breathing, and meditative practices of yoga. There is a need for a validated yoga module with a holistic approach that can be used as a standardized protocol by researchers and therapists. Purpose: To develop and validate an integrated yoga module for practice in relapsing–remitting MS patients to improve their quality of life. Methods: We did a thorough review of the literature for the development of the yoga module. We formed an expert group with 24 experts and a neurologist and used two rounds of interactive Delphi method to combine their opinion to obtain content validity of the module through online structured questionnaire prepared for the purpose on a Google Form. We incorporated all suggestions obtained by the experts. The final module (60 min per session, twice a day, five days per week) included warm-up exercises, customized asanas, relaxation techniques, and OM meditation. Advice on yogic diet and discussion using yogic concepts for stress management also form a part of the holistic approach to yoga lifestyle modification. Results: Analysis divulged that 30 out of 39 practices exhibited a content validity ratio value greater than or equal to 0.42. Conclusion: The study has shown good content validity of the integrated yoga module. Future clinical studies are being planned to rule the feasibility and reliability of this module.
An eLearning program to prepare residents for a rotation in pediatric emergency medicine: A qualitative study
Authors: Tyebally Arif , Dong Chaoyan 
Published: September 2021

Background: To meet ACGME-I (Accreditation Council for Graduate Medical Education–International) training and duty hour requirements, we converted our 3-week-long pediatric emergency medicine induction program to an eLearning program. Objectives: The study aimed to identify areas of the eLearning program residents perceived useful and the components that helped them prepare for clinical work. Methods: The qualitative study took place in a tertiary pediatric emergency department. Twenty-seven residents from family medicine, emergency medicine, and pediatric medicine participated in focus group discussions to explore how they perceived the eLearning program helped prepare them for work. The interviews were audio-recorded, and transcripts were analyzed and coded into categories and themes. Results: Four themes emerged from the data analysis: residents’ access to the eLearning program, instructional methods, eLearning design elements, and supplementary learning. Residents valued autonomy to control their pace of learning and use online features that matched their preferred learning styles. Design features such as the use of questions and quizzes helped stimulate learning, but attention had to be paid to the order of questions in the modules and the format of the questions. Written guidelines served as a good reference for learners and face-to-face sessions accompanying the eLearning program helped reinforce knowledge and offered opportunities to interact with faculty members to clarify questions. Conclusion: Systematic planning focusing on access, instructional methods, and design is essential when creating eLearning programs for residency training. eLearning programs can be enhanced by the incorporation of team-based learning and having accompanying written content to reference.
Exploring the role of telehealth: A novel approach to group-based smoking cessation treatment for men incarcerated in a rural state prison
Authors: Valera Pamela , Malarkey Sarah , Smith Nadia , McLaughlin Christopher 
Published: September 2021

Introduction Tobacco smoking remains an important public health issue in the United States (US), specifically among people who are incarcerated. There is little to no information about smoking behaviors of incarcerated people in rural areas and there is a lack of resources for smoking cessation interventions in rural settings. Telehealth might be efficient for delivering care to incarcerated people in rural areas. The purpose of this study was to determine the feasibility of delivering group-based smoking cessation treatment via telehealth to incarcerated male smokers in a rural prison. Methods A 6-week group-based smoking cessation treatment program was conducted with 1-month follow up. Video conferencing was used from Weeks 2–5 to deliver treatment. A cross-sectional survey was administered collecting measures including criminal justice experience, smoking behaviors, withdrawal and triggers, mental health, physical health, and substance use. Baseline exhaled carbon monoxide (CO) levels were collected at Session 1, and a final CO level at Session 6 and 1-month follow-up. Results Twenty ( n = 20) incarcerated male smokers were recruited from a rural prison facility. The majority of the inmates were White (85%). Approximately, 80% of the inmates smoked about 20 or more cigarettes per day, and on average smoked for 28 years (SD = 9). Most inmates scored a moderate or high dependence score on the Fagerström Test for Nicotine Dependence. Conclusion Telehealth programs such as video conferencing smoking cessation treatment ought to be implemented to reduce tobacco-related disparities among incarcerated smokers housed in rural prisons.
The Optimum Level of Income Inequality in South Asia: An Econometric Analysis
Authors: Khatun Fahmida , Saadat Syed Yusuf 
Published: September 2021

Inequality in the distribution of income can be beneficial or detrimental for economic growth depending on the level of inequality. This study advocates that when income inequality is low, increase in income inequality increases economic growth, whereas when income inequality is high, increase in income inequality decreases economic growth. The level of inequality that maximizes economic growth is defined as the optimum level of income inequality. This article attempts to determine the optimum level of income inequality for South Asia through an econometric analysis. It uses panel data from Bangladesh, India, Nepal, Pakistan and Sri Lanka, over a 34-year period to undertake a systematic investigation using panel instrumental variables techniques. The results of this study confirm that an optimum level of income inequality does exist, and occurs at a Gini coefficient value of 0.4492. Thus, this research empirically confirms that the relationship between income inequality and economic growth is non-linear. Further calculations show that for an economy that is at the optimum level of income inequality, the per capita gross domestic product can be expected to double within approximately 13 years, provided all other factors are held constant. However, a change in the Gini coefficient by 0.10 units in either direction—higher or lower—away from the optimum level, can increase the number of years for the per capita gross domestic product to double by 55 to 57 years, depending on the method of approximation. JEL: D31, D63, O15, O40
Effects of Acupuncture and Moxibustion on Breast Cancer-Related Lymphedema: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Gao Yu , Ma Tingting , Han Mei , Yu Mingwei , Wang Xiuhui , Lv Yiren , Wang Xiaomin 
Published: September 2021

Objective: The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the effects of acupuncture and moxibustion (AM) in women with breast cancer-related lymphedema (BCRL). Methods: We retrieved RCTs published before January 24, 2021, from the MEDLINE, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (VIP), and Wanfang databases. RCTs that compared acupuncture and/or moxibustion intervention with other treatments were included. A random effects or fixed effects model was used based on the heterogeneity findings. Study quality was evaluated using the Cochrane risk of bias tool. Results: We included 14 RCTs in the analyses, of which 4 RCTs adopted acupuncture, 4 RCTs used moxibustion, and the rest used both. AM significantly reduced arm circumference at the elbow crease compared to routine care (Mean deviation (MD) = −7.26, 95% confidence interval (CI) = −8.30 to −6.21, P < .00001). There was a significant difference between AM and diosmin tablets in the effective index for upper limb lymphedema (MD = 24.68, 95% CI = 24.82-30.53, P < .00001), the range of motion of the shoulder during protraction (MD = 6.77, 95% CI = 2.81-10.73, P = .0008), and adduction (MD = 4.17, 95% CI = 1.02-7.32, P = .01). There was a significant difference between moxibustion and pneumatic circulation (MD = −0.51, 95% CI = −0.85 to −0.17, P = .003) in the visual analog score (VAS) for swelling. Finally, compared to the blank control, acupuncture reduced the VAS for pain (MD = −1.33, 95% CI = −1.52 to −1.15, P < .00001; heterogeneity ( I2) = 0%, P = .57). Conclusion: Our results suggest that AM is effective in the treatment of BCRL. AM may reduce arm circumference at the elbow crease (compared to routine care), increase effective index for upper limb lymphedema (compared to oral diosmin tablets), improve the range of motion of the shoulder during protraction and adduction (compared to oral diosmin tablets), and decrease the VAS for both swelling (compared to pneumatic circulation) and pain (compared to blank control).
Automated Reporting of Patient Outcomes in Hand Surgery: A Pilot Study
Authors: Franko Orrin I. , London Daniel A. , Kiefhaber Thomas R. , Stern Peter J. 
Published: September 2021

Background Obtaining patient-reported outcomes (PROs) is becoming a standard component of patient care. For nonacademic practices, this can be challenging. From this perspective, we designed a nearly autonomous patient outcomes reporting system. We then conducted a prospective, cohort pilot study to assess the efficacy of the system. Methods We created an automated system to gather PROs. All operative patients for 4 surgeons in an upper-extremity private practice were asked to participate. These patients completed the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaires preoperatively and received follow-up e-mails requesting patients to complete additional QuickDASH questionnaires at 3, 6, and 12 weeks postoperatively and to complete a 13-week postoperative satisfaction survey. Response rates and satisfaction levels are reported with descriptive statistics. Results Sixty-two percent of participants completed the 3-week assessment, 55% completed the 6-week assessment, and 43% completed the 12-week assessment. Overall, 35% of patients completed all questionnaires, and 73% completed at least 1 postoperative assessment. The collection of follow-up questionnaires required no additional time from the clinical staff, surgeon, or a research associate. Conclusions Automated e-mail assessments can collect reliable clinical data, with minimal surgeon or staff intervention required to administer and collect data, minimizing the financial cost. For nonacademic practices, without access to additional research resources, such a system is feasible. Further improvements in communication with patients could increase response rates.
Temperature dependency of the long-term thermal conductivity of spray polyurethane foam
Authors: Holcroft Neal 
Published: September 2021

The thermal properties of closed-cell foam insulation display a more complex behaviour than other construction materials due to the properties of the blowing agent captured in their cellular structure. Over time, blowing agent diffuses out from and air into the cellular structure resulting in an increase in thermal conductivity, a process that is temperature dependent. Some blowing agents also condense at temperatures within the in-service range of the insulation, resulting in non-linear temperature dependent relationships. Moreover, diffusion of moisture into the cellular structure increases thermal conductivity. Standards exist to quantify the effect of gas diffusion on thermal conductivity, however only at standard laboratory conditions. In this paper a new test procedure is described that includes calculation methods to determine Temperature Dependent Long-Term Thermal Conductivity (LTTC(T)) functions for closed-cell foam insulation using as a test material, a Medium-Density Spray Polyurethane Foam (MDSPF). Tests results are provided to show the validity of the method and to investigate the effects of both conditioning and mean test temperature on change in thermal conductivity. In addition, testing was conducted to produce a moisture dependent thermal conductivity function. The resulting functions were used in hygrothermal simulations to assess the effect of foam aging, in-service temperature and moisture content on the performance of a typical wall assembly incorporating MDSPF located in four Canadian climate zones. Results show that after 1 year, mean thermal conductivity increased 15%–16% and after 5 years 23%–24%, depending on climate zone. Furthermore, the use of the LTTC(T) function to calculate the wall assembly U-value improved accuracy between 3% and 5%.
Comparison of single-shot nebuliser protocol between dexmedetomidine and ketamine in children undergoing magnetic resonance imaging
Authors: Geetha K , Padhy Shibani , Karishma K 
Published: September 2021

Background Sedation for magnetic resonance imaging mandates deep sedation to ensure patient immobility. The nebulised route of drug delivery carries the advantage of good bioavailability and safety profile. We aimed to compare the efficacy and safety of nebulised dexmedetomidine and ketamine for sedation in children undergoing magnetic resonance imaging. Methods A total of 71 children, aged two to eight years scheduled for outpatient magnetic resonance imaging were randomly allocated to receive nebulised dexmedetomidine 2 μg/kg (group D) or nebulised ketamine 2 mg/kg (group K) 30min before magnetic resonance imaging. Results Nebulised dexmedetomidine (2 μg/kg) resulted in faster onset and significantly better sedation scores with rapid clear-headed recovery. Ketamine resulted in better venepuncture scores but was associated with more neuropsychological events at recovery. Conclusion Nebulised dexmedetomidine at 2 μg/kg provides rapid onset of satisfactory sedation, with good parental separation and a quicker and more clear-headed recovery, allowing for a smooth magnetic resonance imaging experience.
The Chondrogenic Potential of First-Trimester and Term Placental Mesenchymal Stem/Stromal Cells
Authors: James Joanna L. , Umapathy Anandita , Srinivasan Sonia , Barker Claire N. , Brooks Anna , Hearn James , Chhana Ashika , Williams Eloise , Sheppard Hilary , McGlashan Sue R. 
Published: September 2021

Objectives Mesenchymal stem/stromal cells (MSCs) are a well-established cell source for cartilage engineering, but challenges remain as differentiation often results in chondrocyte hypertrophy. Chondrogenic potential also varies with MSC source and donor age. We assessed the chondrogenic potential of first-trimester and term placental MSCs and compared their response to commonly used bone marrow MSCs (BM-MSCs). Design MSCs were isolated from first-trimester and term placentae. BM-MSCs were commercially obtained. Chondrogenesis was induced by micromass culture in commercial chondrogenic media for 7, 14, or 21 days. Pellets were assessed for glycosaminoglycan (GAG) content, and types I, II, and X collagen. Gene expression was profiled using Qiagen RT2 human MSC arrays. Results At day 0, first-trimester and term MSCs expression levels of many chondrogenic genes to BM-MSC after 21 days of culture. Only first trimester MSCs showed significant changes in chondrogenic gene expression during induction compared to day 0 undifferentiated MSCs (greater BMP4, KAT2B, and reduced GDF6 expression). Additionally, first-trimester MSCs showed significantly greater expression of ABCB1 (at days 14 and 21) and BMP4 (at days 7, 14, 21) compared with term MSCs. Both first-trimester and term pellets showed increased GAG content over time and term MSCs had significantly GAG greater compared with BM-MSCs at days 7 and 14. Type II collagen was present in all pellets but unlike BM-MSCs, type I collagen was not observed in first-trimester or term MSC pellets. Conclusions These data highlight differences in BM-MSC and placental MSC chondrogenesis and demonstrate that placental MSCs may be an alternative cell source.
Athletes With Anterior Shoulder Instability: A Prospective Study on Player Perceptions of Injury and Treatment
Authors: Fink Barnes Leslie A. , Jobin Charles M. , Popkin Charles A. , Ahmad Christopher S. 
Published: September 2021

Background: Many in-season athletes choose to delay or avoid surgery in order to continue playing and avoid downtime such as missed games or seasons. Purpose: To learn about the attitudes toward the injury and treatment of in-season shoulder instability in competitive athletes who have suffered a shoulder dislocation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A study-specific questionnaire about athletes’ perceptions of injury and treatment was administered to injured players. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) score and the Western Ontario Shoulder Instability Index (WOSI). Mean scores and standard deviations were calculated, and between-group analyses with t tests were performed to compare the ASES and WOSI scores. The Mann-Whitney U test was used for analyses performed on the following groups: early operative versus nonoperative management; age <18 versus ≥18 years; first-time dislocators versus recurrent dislocators; self-reducing subluxations versus dislocations requiring assistance; and dominant arm affected versus nondominant arm. Results: There were 45 patients included in this study (33 male, 12 female) with a mean age of 18 ± 2.8 years. Several sports were represented, with the most common being football, baseball, soccer, and rugby. In this study of in-season athletes with shoulder instability, 13 (28.9%) chose early surgery, 4 (8.9%) chose surgery at season’s end, while 28 (62.2%) chose physical therapy followed by a wait-and-see approach, with 13 (46.4%) of these patients ultimately requiring surgery. Athletes who chose nonoperative treatment were statistically more likely to believe that their shoulder would heal on its own ( P < .001) or with physical therapy ( P < .025); they were also more likely to agree that they would rather stop sports than undergo surgery ( P < .04). Athletes with worse ASES and WOSI scores at injury were more likely to choose surgery ( P < .03 and P < .05, respectively). Athletes with >1 dislocation were less likely to believe that the shoulder would heal without surgery ( P < .025). Most athletes agreed that seasonal timing and recruitment prospects were an important factor in their decision in favor of surgery ( P < .038), and most agreed that their doctor influenced their ultimate treatment decision ( P < .006). Most athletes also agreed that a repeat dislocation would cause further injury to the shoulder. Conclusion: Treatment decisions were most strongly related to the athletes’ perceptions of injury severity and the influence of the treating surgeon.
Outcomes of acute lymphoblastic leukemia with KMT2A (MLL) rearrangement: the MD Anderson experience
Authors: Richard-Carpentier Guillaume , Kantarjian Hagop M. , Tang Guilin , Yin C. Cameron , Khoury Joseph D. , Issa Ghayas C. , Haddad Fadi , Jain Nitin , Ravandi Farhad , Short Nicholas J. , DiNardo Courtney D. , Takahashi Koichi , Konopleva Marina Y. , Daver Naval G. , Kadia Tapan , Garcia-Manero Guillermo , Garris Rebecca , O’Brien Susan , Jabbour Elias 
Published: September 2021

Abstract
Acute lymphoblastic leukemia (ALL) with t(4;11)(q21;q23)-KMT2A-AFF1 is associated with a poor prognosis. The impact of KMT2A rearrangements other than t(4;11) is uncertain, and the benefit of allogeneic stem cell transplantation (HSCT) is unclear. We reviewed adult patients with ALL treated at our institution from 1984 to 2019 and identified 50 out of 1102 (5%) with KMT2A rearrangement, including 42 (84%) with t(4;11)/KMT2A-AFF1 and 8 (16%) with other gene partners. The median age was 45 years (range, 18-78 years); median white blood cell count was 109.0 3 109/L (range, 0.5-1573.0). The complete remission (CR) rate was 88%, and the rate of measurable residual disease negativity by flow cytometry at CR was 41% (76% overall during follow-up). At the last follow-up, 14 patients were alive. The 5-year overall survival (OS) rate was 18% (95% confidence interval [CI], 9% to 35%), with no difference between t(4;11) and other KMT2A rearrangements (P 5 .87). In a 4-month landmark analysis, the 5-year OS rate was 32% (95% CI, 14% to 70%) in patients who underwent HSCT vs 11% (95% CI, 3-39) in others (P 5 .10). Our study confirms the poor prognosis of ALL with any KMT2A rearrangement and the role of HSCT in these patients.
Juvenile myelomonocytic leukemia in the molecular era: a clinician’s guide to diagnosis, risk stratification, and treatment
Authors: Wintering Astrid , Dvorak Christopher C. , Stieglitz Elliot , Loh Mignon L. 
Published: September 2021

Abstract
Juvenile myelomonocytic leukemia is an overlapping myeloproliferative and myelodysplastic disorder of early childhood . It is associated with a spectrum of diverse outcomes ranging from spontaneous resolution in rare patients to transformation to acute myeloid leukemia in others that is generally fatal. This unpredictable clinical course, along with initially descriptive diagnostic criteria, led to decades of productive international research. Next-generation sequencing now permits more accurate molecular diagnoses in nearly all patients. However, curative treatment is still reliant on allogeneic hematopoietic cell transplantation for most patients, and additional advances will be required to improve risk stratification algorithms that distinguish those that can be observed expectantly from others who require swift hematopoietic cell transplantation.