bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hereditary and Inflammatory Bowel Disease-Related Early Onset Colorectal Cancer Have Unique Characteristics and Clinical Course Compared with Sporadic Disease
Authors: Arif Arif A. , Chahal Daljeet , Ladua Gale K. , Bhang Eric , Salh Bill , Rosenfeld Greg , Loree Jonathan M. , Donnellan Fergal 
Published: July 2021

AbstractBackground:Early onset colorectal cancer (EoCRC), diagnosed in those &lt;50 years old, is increasing in incidence. We sought to differentiate characteristics and outcomes of EoCRC in patients with sporadic disease or preexisting conditions.Methods:We evaluated 2,135 patients with EoCRC in a population-based cohort from the Canadian province of British Columbia. Patients were identified on the basis of presence of hereditary syndromes (n = 146) or inflammatory bowel disease (IBD; n = 87) and compared with patients with sporadic EoCRC (n = 1,902).Results:Proportions of patients with preexisting conditions were highest in the youngest decile of 18–29 (34.3%, P &lt; 0.0001). Patients with sporadic EoCRC were older, more likely female, and had increased BMI (P &lt; 0.05). IBD-related EoCRC had the highest rates of metastatic disease, poor differentiation, adverse histology, lymphovascular, and perineural invasion (P &lt; 0.05). Survival was lower in patients with IBD (HR, 1.80; 95% CI, 1.54–3.13; P &lt; 0.0001) and higher in hereditary EoCRC (HR, 0.47; 95% CI, 0.45–0.73; P &lt; 0.0001) compared with sporadic. Prognosis did not differ between ulcerative colitis or Crohn's disease but was lower in those with undifferentiated-IBD (HR, 1.87; 95% CI, 1.01–4.05; P = 0.049). Lynch syndrome EoCRC had improved survival over familial adenomatous polyposis (HR, 0.31; 95% CI, 0.054–0.57; P = 0.0037) and other syndromes (HR, 0.43; 95% CI, 0.11–0.99; P = 0.049). In multivariate analysis controlling for prognostic factors, hereditary EoCRC was unchanged from sporadic; however, IBD-related EoCRC had worse overall survival (HR, 2.21; 95% CI, 1.55–3.16; P &lt; 0.0001).Conclusions:EoCRC is heterogenous and patients with preexisting conditions have different characteristics and outcomes compared with sporadic disease.Impact:Prognostic differences identified here for young patients with colorectal cancer and predisposing conditions may help facilitate treatment planning and patient counseling.See related commentary by Hayes, p. 1775
BCMA-Specific ADC MEDI2228 and Daratumumab Induce Synergistic Myeloma Cytotoxicity via IFN-Driven Immune Responses and Enhanced CD38 Expression
Authors: Xing Lijie , Wang Su , Liu Jiye , Yu Tengteng , Chen Hailin , Wen Kenneth , Li Yuyin , Lin Liang , Hsieh Phillip A. , Cho Shih-Feng , An Gang , Qiu Lugui , Kinneer Krista , Munshi Nikhil , Anderson Kenneth C. , Tai Yu-Tzu 
Published: July 2021

Abstract

Purpose:
Efforts are required to improve the potency and durability of CD38- and BCMA-based immunotherapies in human multiple myeloma. We here delineated the molecular and cellular mechanisms underlying novel immunomodulatory effects triggered by BCMA pyrrolobenzodiazepine (PBD) antibody drug conjugate (ADC) MEDI2228 which can augment efficacy of these immunotherapies.

Experimental Design:
MEDI2228-induced transcriptional and protein changes were investigated to define significantly impacted genes and signaling cascades in multiple myeloma cells. Mechanisms whereby MEDI2228 combination therapies can enhance cytotoxicity or overcome drug resistance in multiple myeloma cell lines and patient multiple myeloma cells were defined using in vitro models of tumor in the bone marrow (BM) microenvironment, as well as in human natural killer (NK)-reconstituted NOD/SCID gamma (NSG) mice bearing MM1S tumors.

Results:
MEDI2228 enriched IFN I signaling and enhanced expression of IFN-stimulated genes in multiple myeloma cell lines following the induction of DNA damage–ATM/ATR-CHK1/2 pathways. It activated cGAS-STING-TBK1-IRF3 and STAT1-IRF1–signaling cascades and increased CD38 expression in multiple myeloma cells but did not increase CD38 expression in BCMA-negative NK effector cells. It overcame CD38 downregulation on multiple myeloma cells triggered by IL6 and patient BM stromal cell-culture supernatant via activation of STAT1-IRF1, even in immunomodulatory drug (IMiD)- and bortezomib-resistant multiple myeloma cells. In vitro and in vivo upregulation of NKG2D ligands and CD38 in MEDI2228-treated multiple myeloma cells was further associated with synergistic daratumumab (Dara) CD38 MoAb-triggered NK-mediated cytotoxicity of both cell lines and autologous drug-resistant patient multiple myeloma cells.

Conclusions:
These results provide the basis for clinical evaluation of combination MEDI2228 with Dara to further improve patient outcome in multiple myeloma.
‘You would not want to be the murderer of our dreams and options, right?’
Authors: Rodríguez Velasco David , Ainciburu María Cecilia , Liu Xiaoxu Katia 
Published: July 2021

Abstract
Studies of how adult Chinese speakers express disagreement at work or in business have a well-established tradition; whereas, studies on young students and university lecturers are scarcer. In general, the description of relationships with authority figures has been characterised by evidence of greater distance and a greater rituality than equivalent Western uses. The objective of this work is to verify whether, in a mutated communicative situation, students express their opposition to lecturer via email using predominantly indirect and attenuated linguistic forms—as might be expected—or whether linguistics changes are evident. For this purpose, 149 university students wrote a letter to their language lecturer in which they express their disagreement with the grade received. The results of the analysis reveal that, contrary to what was predicted, acts of direct speech are prevalent.
The essential role of early-spring westerly wind burst in generating the centennial extreme 1997/98 El Niño
Authors: Lian Tao , Chen Dake 
Published: July 2021

AbstractWhile both intrinsic low-frequency atmosphere–ocean interaction and multiplicative burst-like event affect the development of the El Niño–Southern Oscillation (ENSO), the strong nonlinearity in ENSO dynamics has prevented us from separating their relative contributions. Here we propose an online filtering scheme to estimate the role of the westerly wind bursts (WWBs), a type of aperiodic burst-like atmospheric perturbation over the western-central tropical Pacific, in the genesis of the centennial extreme 1997/98 El Niño using the CESM coupled model. This scheme highlights the deterministic part of ENSO dynamics during model integration, and clearly demonstrates that the strong and long-lasting WWB in March 1997 was essential for generating the 1997/98 El Niño. Without this WWB, the intrinsic low-frequency coupling would have only produced a weak warm event in late 1997 similar to the 2014/15 El Niño.
Statistical Calibrations of Surface Air Temperature Forecasts over East Asia using Pattern Projection Methods
Authors: Lyu Yang , Zhi Xiefei , Zhu Shoupeng , Fan Yi , Pan Mengting 
Published: July 2021

AbstractIn this study, two pattern projection methods, i.e., the Stepwise Pattern Projection Method (SPPM) and the newly proposed Neighborhood Pattern Projection Method (NPPM), are investigated to improve forecast skills of daily maximum and minimum temperatures (Tmax and Tmin) over East Asia with lead times of 1–7 days. Meanwhile, the decaying averaging method (DAM) is conducted in parallel for comparison. These post-processing methods are found to effectively calibrate the temperature forecasts on the basis of the raw ECMWF output. Generally, the SPPM is slightly inferior to the DAM, while its insufficiency decreases with increasing lead times. The NPPM shows manifest superiority for all lead times, with the mean absolute errors of Tmax and Tmin decreased by ~0.7°C and ~0.9°C, respectively. Advantages of the two pattern projection methods are both mainly concentrated on the high-altitude areas such as the Tibetan Plateau, where the raw ECMWF forecasts show most conspicuous biases. In addition, aiming at further assessments of these methods on extreme event forecasts, two case experiments are carried out towards a heat wave and a cold surge, respectively. The NPPM is retained as the optimal with the highest forecast skills, which reduces most of the biases to < 2°.C for both Tmax and Tmin over all the lead days. In general, the statistical pattern projection methods are capable of effectively eliminating spatial biases in forecasts of surface air temperature. Compared with the initial SPPM, the NPPM not only produces more powerful forecast calibrations, but also provides more pragmatic calculations and greater potential economic benefits in practical applications.
Globalisation and local economic development: Place-based and bottom-up public policies in Switzerland and Mexico
Authors: Palavicini Corona Eduardo I 
Published: July 2021

The XXI century has reached the end of its first 20 years. Along the years, it has posed complex challenges to economists and economic geographers. For example, the results of elections and consultations in different countries have shown a strong sympathy with political positions that question the benefits of free international flows of goods, services, labour and capital. By the same token, some academics argue that despite international economics theory clearly acknowledges that free trade causes winners and losers, the expected higher gains have not been effectively used to compensate the losers. This article explores the main challenges of international economic integration in sub-national territories in Switzerland and Mexico to better understand the importance of delivering relevant and competent public policies based on territorial specificity.
Efficacy of lenvatinib plus pembrolizumab in hepatocellular carcinoma with metachronous lung metastasis: a report of two cases
Authors: Li JieLang , Chen Ting , Bi Feng , Yang Yu 
Published: July 2021

Introduction: Immune checkpoint inhibitors (ICIs) and a combination of ICIs with targeted antiangiogenic agents are effective in treatment of advanced hepatocellular carcinoma (HCC). Studies have not explored effective biomarkers for prediction of HCC sensitivity to immunotherapy. Case description: The current study explored two consecutive patients with HCC with metachronous lung metastasis who were treated with lenvatinib and pembrolizumab as first-line treatment and third-line treatment, respectively. The two cases showed significant tumor shrinkage and long progression-free survival (>19 months and 12 months, respectively). Conclusions: The findings of the current study and recently published data indicate lung metastasis as a potential clinical therapeutic indicator for efficacy of immunotherapy against HCC.
Emotional and Behavioral Problems in Children With a Cleft Lip With or Without Palate or an Infantile Hemangioma
Authors: van Dalen Marije , Hermans Mireille M. , Leemreis Willem H. , Kraaij Vivian , De Laat Peter C. J. , Pasmans Suzanne G. M. A. , Versnel Sarah L. , Koudstaal Maarten J. , Hillegers Manon H. J. , Utens Elisabeth M. W. J. , Okkerse Jolanda M. E. 
Published: July 2021

Objective: Life can be challenging for children with a visible difference due to a medical condition, and they might be at risk for emotional and behavioral problems. This study examines emotional and behavioral problems in children with a cleft lip with or without palate (CL ± P) or an infantile hemangioma (IH) in relation to the visibility of the condition, the presence of additional condition-related problems, and parental affect. Setting: This cross-sectional study took place in an academic medical hospital in the Erasmus MC Sophia Children’s Hospital, the Netherlands. Participants: A total of 309 parents (mean age = 40.34, 44.00% male) of 182 children with CL ± P and 48 parents (mean age = 39.21, 37.50% male) of 33 children with an IH completed questionnaires. Children were 1.5 to 12 years old. Results: Parents reported fewer child emotional and behavioral problems compared to normative data. Problems reported were mainly related to learning difficulties and parent gender, while visibility of the condition had no significant influence. Parental negative affect was related to child internalizing problems. Parental positive affect was not related to any of the outcome measures. Conclusions: Parents reported fewer problems for their children compared to normative data. This is inconsistent with previous research, showing similar or worse scores for these children compared to peers. Our findings may be explained by a protective parenting style, a response shift in parents, or problems developing at a later point in life.
Resilience, Insight, Self-Compassion, and Empowerment (RISE): A Randomized Controlled Trial of a Psychoeducational Group Program for Nurses
Authors: Sawyer Amanda T. , Bailey Amanda K. , Green Jeanette F. , Sun Jingwei , Robinson Patricia Stearnes 
Published: July 2021

Background: Nurses tend to be vulnerable to burnout and compassion fatigue due to constant workplace stressors. There is a need to provide advocacy, education, programming, and resources in the areas of positive coping and self-care to reduce burnout symptoms and promote well-being. RISE is an 8-week psychoeducational group intervention for nurses with four themes: resilience, insight, self-compassion, and empowerment. Aims: This randomized controlled trial examined the effects of RISE on mental well-being. Methods: The sample included 75 registered nurses who work in a hospital-based setting. Outcomes included resilience, insight, self-compassion, empowerment, stress mind-set, perceived stress, and burnout. Independent-samples t tests were conducted to compare outcomes between intervention and wait-list control groups at baseline and 1-month follow-up, as well as at 3-month follow-up. Supplemental analyses included paired-samples t tests and linear mixed models to compare the outcomes of the intervention group participants at baseline to 1-month follow-up, as well as at 3-month and 6-month follow-ups. Results: Participants in the intervention group showed improved levels of insight (i.e., engagement in self-reflection), perceived stress, and burnout (i.e., emotional exhaustion) when compared with the control group and improved levels of resilience, self-compassion, stress mind-set, and perceived stress when compared with their baseline. Conclusions: This study informs how RISE affects nurse well-being and may be an effective intervention for reducing burnout and stress. This type of whole-person intervention can support nurses to improve their well-being and ability to cope amid the complex interplay of factors at the individual, unit, and organizational levels.
Effects of indwelling centrally inserted central catheter on tip location of peripherally inserted central catheter with intracavitary electrocardiogram guidance: A retrospective case-control study
Authors: Sun Wenyan , Li Jiaqian , Liu Bing , Liu Yue , Ge Ruibin , Wang Kai , Zhang Jingyan , Wu Xinjuan 
Published: July 2021

Background: Intracavity electrocardiogram (IC-ECG) guidance is an effective technology for monitoring the tip locations of centrally inserted central catheters (CICCs) and peripherally inserted central catheters (PICCs). However, for patients with an indwelling CICC, there has been no study on whether the CICC affects PICC tip positioning with IC-ECG guidance. Methods: Thirty people with a CICC requiring PICC insertion, matched with age to controls without a CICC. The stability of IC-ECG waveforms, the amplitude of P-waves, and the accuracy of PICC tip location were compared. Results: There was no significant difference in the stability of the IC-ECG waveforms (χ2 = 0.22, p = 0.64). The amplitudes of baseline P-waves and ideal P-waves also showed no significant difference ( t1 = 0.06, p1 = 0.96, t2 = 0.80, p2 = 0.43). Neither the accuracy of tip location (χ2 = 1.40, p = 0.50) nor the distance of PICC tip ( t = −0.03, p = 0.98) were significantly different. Conclusion: For patients with an indwelling CICC, the position of PICC tip can be accurately determined by the dynamic changes in the P-wave amplitude.
Comparison of ethical decision-making and interpersonal communication skills training effects on nurses’ ethical climate
Authors: Maghsoudi Shahrokh , Mohsenpour Mohaddeseh , Nazif Hamed 
Published: July 2021

Introduction Ethical climate in medical contexts is referred to the organizational environment consisting of medical staff interpersonal relationships regarding patient care. This element affects staff behavior in an organization. The investigation and comparison of the effects of the interventions promoting ethical climate are among important nursing challenges that should be considered by researchers. The present study was conducted to compare the effect of nurses’ ethical decision-making skills and interpersonal communication training on their ethical climate. Materials and methods This experimental study was performed on 90 nurses working in the general teaching hospitals of Mashhad, Iran. The sampling process was conducted in two stages. Nurses were divided into three groups: intervention 1 (ethical decision-making skills group), intervention 2 (interpersonal communication skills group) and control group. The intervention was separate 12-h workshops for each of the intervention groups. The ethical climate questionnaire by Victor and Cullen was used to assess the score of ethical climate in the three groups both at the beginning and 4 weeks after the workshop. The data were analyzed in Statistical Package for Social Sciences software (version 16) using descriptive statistics, analysis of variance, Kruskal–Wallis, paired sample t-test, Wilcoxon test, and post hoc Tukey’s test. Ethical considerations were as follows: The study design was approved by the Research Ethics Committee of Mashhad University of Medical Sciences. Informed consent was obtained from all subjects, and they were ensured about the confidentiality terms. Results The mean scores of the ethical climate test at the first stage were obtained as 66.0 ± 5.5, 67.8 ± 6.9, and 67.7 ± 7.2 in the ethical decision-making, interpersonal communication, and control groups, respectively. Accordingly, the three groups were not significantly different in terms of this variable (df = 87, f = 0.70, P = 0.005). However, after the intervention (i.e. second stage), a significant difference was observed among the three groups regarding the mean scores of the ethical climate test In this regard, the calculated mean scores in the ethical decision-making, interpersonal communication, and control groups were 99.3 ± 6.3, 90.4 ± 7.7, and 67.4 ± 7.9, respectively (df = 87, f = 152.00, P < 0.001). Conclusion Training workshops about ethical decision-making skills and interpersonal communication on the ethical professional climate of nurses was effective. Nonetheless, the effect of ethical decision-making skill training was found to be higher than interpersonal communication skill training. Therefore, it is recommended that nursing managers hold training workshops to improve the ethical climate for nurses.
Utilization, Complications, and Costs of Inpatient versus Outpatient Total Elbow Arthroplasty
Authors: Baxter Natalie B. , Davis Elissa S. , Chen Jung-Sheng , Lawton Jeffrey N. , Chung Kevin C. 
Published: July 2021

Background Although total hip and knee arthroplasty have largely moved to the outpatient setting, total elbow arthroplasty (TEA) remains a predominantly inpatient procedure. Currently, evidence on the safety and potential cost savings of outpatient TEA is limited. Therefore, we aimed to compare the costs and complications associated with performing TEA in the inpatient versus outpatient setting. Methods We identified patients who received elective TEA using the Truven Health MarketScan database. Outcomes of interest were 90-day complication rate, readmission rate, and procedure costs in the inpatient and outpatient settings. We used propensity score matching and logistic regression analysis to assess how patient comorbidities and surgical setting influenced complications and readmission rates. The median cost per patient was compared using the Mann-Whitney U test. Results We identified 307 outpatient and 414 inpatient TEA procedures over a 9-year period. Elixhauser comorbidity scores were higher for the inpatient cohort. The incidence of surgical complications was significantly higher in the inpatient than the outpatient cohort (27% vs 9%). The odds of 90-day readmissions were similar in the 2 groups (37% vs 25%). In terms of cost, the median inpatient TEA was more expensive than outpatient TEA ($26 817 vs $18 412). However, the median cost for occupational therapy within 90 days of surgery was higher for outpatient TEA patients ($687 vs $571). Conclusions The results of this study demonstrate that surgeons can consider a transition toward outpatient TEA for patients without significant comorbidities, as this will substantially reduce health care costs.
Early cholangioscopy-assisted electrohydraulic lithotripsy in difficult biliary stones is cost-effective
Authors: Alrajhi Saad , Barkun Alan , Adam Viviane , Callichurn Kashi , Martel Myriam , Brewer Olaya , Khashab Mouen A. , Forbes Nauzer , Almadi Majid A. , Chen Yen-I 
Published: July 2021

Background and Aims: Single-operator cholangioscopy-assisted electrohydraulic lithotripsy (SOC-EHL) is effective and safe in difficult choledocholithiasis. The optimal timing of SOC-EHL use, however, in refractory stones has not been elucidated. The following aims to determine the most cost-effective timing of SOC-EHL introduction in the management of choledocholithiasis. Methods: A cost-effectiveness model was developed assessing three strategies with a progressively delayed introduction of SOC-EHL. Probability estimates of patient pathways were obtained from a systematic review. The unit of effectiveness is complete ductal clearance without need for surgery. Cost is expressed in 2018 US dollars and stem from outpatient US databases. Results: The three strategies achieved comparable ductal clearance rates ranging from 97.3% to 99.7%. The least expensive strategy is to perform SOC-EHL during the first endoscopic retrograde cholangiography pancreatography (ERCP) (SOC-1: 18,506$). The strategy of postponing the use of SOC-EHL to the third ERCP (SOC-3) is more expensive (US$18,895) but is 2% more effective. (0.9967). SOC-EHL during the second ERCP in the model (SOC-2) is the least cost-effective. Sensitivity analyses show altered conclusions according to the cost of SOC-EHL, effectiveness of conventional ERCP, and altered willingness-to-pay (WTP) thresholds with early SOC-1 being the most optimal approach below a WTP cut-off of US$20,295. Conclusions: Early utilization of SOC-EHL (SOC-1) in difficult choledocholithiasis may be the least costly strategy with an effectiveness approximating those achieved with a delayed approach where one or more conventional ERCP(s) are reattempted prior to SOC-EHL introduction.