bluuebunny/crossref_metadata_2025 huggingface dataset:
Pre-hospital blood products for hazardous area response team paramedics: A service evaluation to inform decisions on future practice
Authors: Metcalf Matthew , Turnock Matthew , Hall Pippa , Hammett Owen , Cowburn Philip , Godfrey Timothy
Published: April 2023

Aim

To identify the number of incidents, over a 1-year period in a single UK Ambulance Service Trust, where patients attended by Hazardous Area Response Team (HART) paramedics where eligible to receive Pre-hospital Blood Products (PHBP) but did not due to the unavailability of a suitably trained clinician.

Methods

This was a Service Evaluation using a three-stage method of filtering data to reduce bias and improve accuracy when identifying eligible cases. These stages consisted of an initial data request, a peer review filtering stage and then finally an Expert Consensus Panel review of cases to determine whether PHBP should have been administered.

Results

The consensus group considered 14 cases that would have ‘Likely’ or ‘Certainly’ have received PHBP if a suitably trained clinician was available on scene. Twelve cases involved a traumatic cause whilst the remaining two were medical. Similarly, 12 cases involved patients with spontaneous circulation whilst two patients had no pulse. South Western Ambulance Service Foundation Trust (SWASFT) Bristol HART attended eight and Exeter HART six of these cases.

Conclusion

This study reveals that across the South West of England, there were a number of patients, being attended by HART, who may potentially benefit from PHBP but are not receiving this intervention due to the unavailability of a suitably trained clinician. This could be far more in the event of a multi or mass-casualty event. HART paramedic access to PHBPs would enable more patients to access a potentially lifesaving treatment and contribute to narrowing the care gap identified in the Manchester Arena Inquiry. The authors recommend that a local pilot trial is undertaken to explore whether a HART PHBP service is feasible, sustainable, cost-effective, appropriate, and safe.
Reducing delays to surgery and achieving best practice tariff for hip fracture patients on direct oral anticoagulants: A protocol for expediting surgery without increasing peri-operative complications
Authors: Mayor Amy , Brooke Ben , Stephenson John
Published: April 2023

Background

Patients who sustain a hip fracture whilst taking direct oral anticoagulants (DOACs) experience delays to surgery, which can increase morbidity and mortality. Achievement of the prompt surgery aspect of the National Hip Fracture Database (NHFD) best practice tariff (BPT) stipulates surgery within 36 h, which these patients often fail to meet.

Patients and methods

Our protocol for expedited hip fracture surgery in patients taking DOACs was implemented. We compared surgery within 36 h (primary outcome) and peri-operative blood transfusions, 30-day mortality, wound leakage, return to theatre and length of hospital stay (secondary outcomes) with standard care of 80 matched non-anticoagulated controls.

Results

Median times to theatre were 26.0 h (IQR 16.2 h) in DOAC patients and 22.4 h (IQR 16.9 h) in controls: bootstrapped 95% CI for the difference (−0.935, 7.52). Bias-corrected related samples bootstrapped t-test revealed no evidence for a group difference on the primary outcome ( p = 0.133) or any secondary outcome, including post-operative transfusions (χ2(1) = 0.533; p = 0.465, 95% CI for the difference −18.3% to 8.37%); death within 30 days (χ2(1) = 0.667; p = 0.414, 95% CI for the difference −3.48% to 8.48%); wound leakage (χ2(1) = 0.571; p = 0.450, 95% CI −1.79% to 0.792%); return to theatre (χ2(1) = 0.00; p = 1.00); and median length of hospital stay ( p = 0.678, bias-corrected bootstrapped 95% CI for the difference −4.47 to 6.68).

Discussion

Our protocol is simple, does not require plasma DOAC level testing and can be used to achieve the NHFD recommendation of surgery within 36 h without increasing peri-operative transfusions, wound leakage, return to theatre, length of stay or mortality.
The views about Big Data among professionals of police forces: A scoping review of empirical studies
Authors: Neiva Laura , Machado Helena , Silva Susana
Published: April 2023

There is a growing tendency toward the introduction of Big Data in police departments to improve the prevention and investigation of crime. However, there is little systematic knowledge about the perspectives of professionals in police forces regarding this technology. This article fills this gap by presenting a scoping review that systematizes empirical studies of the views of professionals in police forces about Big Data in the field of policing and criminal investigation. Fourteen articles were analyzed following a descriptive–analytical method. Optimistic and oppositional views about Big Data among professionals in police forces were then described. Optimistic views focused on the potential of Big Data to improve the objectivity and efficiency of policing and better manage police resources by providing new capabilities and strategies by which to perform crime predictions, risk assessments, criminal investigations, crime analysis, risk management, cooperation and data exchange. Oppositional views related to the police's awareness of Big Data's biases, the lack of a regulatory landscape, misuse of data, privacy threats, data security, misplaced trust in technology, the absence of major changes in work practices, and practical barriers. Analysis of the co-presence of optimistic and oppositional views adds a comprehensive and interpretative argument that might contribute to critical reflections on the technological feasibility, societal usability, and desirability of Big Data technologies in police departments.
Being, becoming, belonging: Negotiating temporality, memory and identity in life story conversations with care-experienced children and young people
Authors: Staples Eleanor Mary , Watson Debbie , Riches Katie
Published: April 2023

This article uses Feminist New Materialist theoretical perspectives on time and temporality to critically explore the social work practice of life story work, designed to help children who are or have been in public care, or are adopted, assemble a coherent narrative of their care journey, adverse experiences and identity. Interview data presented here was produced with 17 participants (foster carers, adoptive parents and social work professionals in care or adoption teams) who were part of a project which sought to understand how aspects of life story work could be transformed into everyday care conversations between children and the adults who care for them (see www.difficultconversations.info ). Our analysis highlights the way participants understood and constructed temporal elements of children’s experiences and identities: their pasts, presents and futures, in the context of having conversations about care with them. Through the discussion, we indicate a need to loosen the configuration of children’s life stories and identities as ‘pre-care’ and ‘post-care’, and instead move toward an acceptance of children’s multiple selves and multiple important others as existing across time.
Study on thermal comfort of aloe viscose seamless knits
Authors: Lu Zhenru , Jin Zimin , Mao Liumeng , Tu Lexi , Ding Xiaojun , Zhao Mingtao
Published: April 2023

Aloe viscose fiber is rich in a variety of active ingredients, with excellent moisturizing and antibacterial properties, and gradually widely used in clothing production. Therefore, this paper focuses on the thermal comfort of aloe viscose seamless knitted clothing, 15 sets of seam knitting sets with different yarn blending ratios and knitted structures were designed. thermal manikin was used in artificial climate to test the thermal resistance and the voting rate of whole body thermal sensation. SPSS two-factor variance analysis and Duncan multiple comparison method were used to analyze the experimental data. The results show that the difference of veil material and knitted structure has an impact on clothing thermal comfort. In all the samples, the veil is made of 100:0 aloe viscose/viscose fiber, and the thermal comfort of the seam knitting garment w Abstract: In order to study the thermal comfort performance of aloe viscose fiber seamless knitted clothing, 15 sets of seam knitting sets with different yarn blending ratios and knitted structures were designed. Thermal manikin was used in artificial climate to test the thermal resistance and the voting rate of whole body thermal sensation. SPSS two-factor variance analysis and Duncan multiple comparison method were used to analyze the experimental data. The results show that the difference of veil material and knitted structure has an impact on clothing thermal comfort. In all the samples, the veil is made of 100:0 aloe viscose/viscose fiber, and the thermal comfort of the seam knitting garment with the knitted structure of 1 + 3 false rib fabric is the best, with the sets thermal resistance of 0.289 m2 K/W and the sets PMV value of −1.75. It provides theoretical basis and guiding significance for the future production of aloe seamless knitted clothing with excellent thermal resistance.
How instructional leaders promote social justice
Authors: Shaked Haim
Published: April 2023

Instructional leadership is a school leadership approach with a strong focus on the development of teaching and learning. This study explores how instructional leaders act to promote social justice and eliminate school inequities. The participants in this qualitative study were 24 Israeli elementary school principals. Data collection was based on semi-structured interviews, and data analysis was theory-driven. The findings revealed that instructional leaders incorporated a social justice perspective into the three key dimensions of instructional leadership—defining the school mission, managing the instructional program, and developing a positive school learning climate—to address three main areas of inequity in the school: outcomes, belongingness, and discipline. This study suggests that as an instructional leader, the principal has to take specific actions supported by particular intentions to ensure fairness and equity.
Influence of different spatial representations on the SNARC effect for letters: Electrophysiological evidence
Authors: Shen Jie , He Hua , Wu Bin , Zhou Jiaxian
Published: April 2023

Studies have previously demonstrated that different spatial representations may affect the spatial-numerical association of response codes (SNARC) effect for numbers; however, limited studies have assessed the SNARC effect for letters. In this study, event-related potentials (ERPs) were used to measure the influence of two spatial representation modes (ruler and clock) on the SNARC effect. The ruler produced a SNARC-like effect; i.e., the left hand reacted faster than the right to the letters that appeared before N in the alphabet; the right hand reacted faster than the left to the letters that appeared after N, whereas the clock produced a reverse SNARC effect. In addition, the ERP data showed that the SNARC-like effect for letters in both representations induced significant activation in the frontal and parietal regions, indicating that the same brain areas are involved in processing letters and numbers in terms of spatial dimensions. This study further identified the conditions for the SNARC effect and proved that the SNARC effect is attributed to the simultaneous participation of brain regions for sequence and spatial information processing.
Perception of threat and intent to harm from vocal and facial cues
Authors: Tompkinson James , Mileva Mila , Watt Dominic , Mike Burton A
Published: April 2023

What constitutes a “threatening tone of voice”? There is currently little research exploring how listeners infer threat, or the intention to cause harm, from speakers’ voices. Here, we investigated the influence of key linguistic variables on these evaluations (Study 1). Results showed a trend for voices perceived to be lower in pitch, particularly those of male speakers, to be evaluated as sounding more threatening and conveying greater intent to harm. We next investigated the evaluation of multimodal stimuli comprising voices and faces varying in perceived dominance (Study 2). Visual information about the speaker’s face had a significant effect on threat and intent ratings. In both experiments, we observed a relatively low level of agreement among individual listeners’ evaluations, emphasising idiosyncrasy in the ways in which threat and intent-to-harm are perceived. This research provides a basis for the perceptual experience of a “threatening tone of voice,” along with an exploration of vocal and facial cue integration in social evaluation.
Tonsillitis
Authors: De Castro Francis , Mahamud Ishtiak , Garg Joshua , Walijee Hussein
Published: April 2023

Tonsillitis is a common condition characterised by the inflammation of lymphoid tissue within the pharynx, with associated inflammation of the rest of the pharynx (pharyngitis). The tonsils belong to Waldeyer’s ring, the ring of mucous-associated lymphoid tissue in the pharynx consisting of the palatine tonsils (known as the tonsils), tubal tonsils (posterior to the Eustachian tube), lingual tonsil (on the tongue base) and the pharyngeal tonsils (adenoids). Tonsillitis commonly refers to inflammation of the palatine tonsils, located laterally within the oropharynx. They lie within a capsule between the anterior arch and posterior arch, comprised of the muscles palatoglossus and palatopharyngeus respectively.
Is there an optimal sequence of biologic therapies for inflammatory bowel disease?
Authors: Bressler Brian
Published: April 2023

Over the past two decades, 11 biologic agents have been approved for use in most countries for the treatment of moderate-to-severe inflammatory bowel disease (IBD). Antitumor necrosis factor α (anti-TNF) agents are commonly used as the first biologic in clinical practice, and nearly all pivotal studies of induction therapy enrolled patients with and without prior use of anti-TNF therapy. This narrative review presents a reasonable approach to devising treatment sequences, examining the magnitude of benefit for each drug versus placebo or active comparator and then considering how that benefit changes with prior anti-TNF treatment. Data from ULTRA 2, GEMINI 1, VARSITY, and True North in patients with ulcerative colitis indicate that induction adalimumab, vedolizumab, and ozanimod showed lower clinical remission rates after anti-TNF therapy, while UNIFI, OCTAVE 1&2, and U-ACHIEVE/U-ACCOMPLISH show ustekinumab, tofacitinib, and upadacitinib did not. In patients with Crohn’s disease, endoscopic remission or mucosal healing after induction therapy rather than clinical remission as well as assessment of persistent endoscopic remission are good measures of long-term disease outcomes. Considering the drugs for which data on endoscopic remission rates are available, EXTEND and GEMINI 2&3 show adalimumab and vedolizumab with persistently lower endoscopic remission rates after prior anti-TNF therapy, while IM-UNIFI, SEAVUE, and FORTIFY show ustekinumab and risankizumab did not. Data from the multicenter retrospective EVOLVE study indicate that the effectiveness of anti-TNF therapy does not seem to be significantly impacted by prior vedolizumab therapy, and may further suggest the benefit of using vedolizumab as a first-line biologic. As adverse event rates remain low across all treatments, the magnitude of harm from untreated or poorly treated disease far outweighs harm from any individual therapy. Regardless of the treatment sequence, careful monitoring for early signs of treatment nonresponse and switching to another potentially highly active therapy are critical to effective management of IBD.
Qinteng Tongbi Decoction Medicated Serum Exerts Regulates the Proliferation, Migration, and Apoptosis of Synovial Fibroblasts in Adjuvant-Induced Arthritis Rats Model via Phosphatidylinositol 3-Kinase/Protein Kinase B Signaling Pathway
Authors: Liang Guo-Cheng , Duan Wen-Gui , Chen Shu-Yin , Pang Xue-Feng , Fang Jian-Kang
Published: April 2023

Background

Qinteng Tongbi decoction (QTTBD) was an empirical prescription that could effectively prevent and treat rheumatoid arthritis (RA), but there was no report of pharmacological studies on this prescription. The purpose of this paper was to report the effects of QTTBD on the proliferation, migration, and apoptosis of synovial fibroblasts in adjuvant arthritis model rats, and to reveal its anti-RA regulatory mechanism.

Methods

To divide the fibroblast-like synovial (FLS) cells of experimental rats into 6 groups (blank control group, model control group, positive drug group, QTTBD high, medium, and low dose groups) and cultured with serum-containing drugs. And using Cell Counting Kit-8 to detect the proliferation rate of FLS cells, flow cytometry to detect the apoptosis of FLS cells, the enzyme-linked immunosorbent assay method to detect the levels of interleukin (IL)-6, IL-1β, and tumor necrosis factor-α (TNF-α), Western Blot to detect phosphatidylinositol 3-kinase (PI3K), AKT1, p-AKT1, Bax and Bcl-2 gene and protein expression.

Results

Experimental results showed that QTTBD-containing serum could effectively inhibit the proliferation of FLS cells ( p <0 .05), induce the apoptosis of FLS cells, reduce the expression levels of inflammatory factors such as IL-6, IL-1β, and TNF-α ( p <0 .05), reduce expression of PI3K, AKT1, p-AKT1, and Bax ( p <0 .05), while the Bcl-2 expression increased ( p <0 .05).

Conclusion

QTTBD could effectively regulate the proliferation, migration, and apoptosis of FLS cells in adjuvant-induced arthritis (AIA) rats, and its mechanism might be related to regulating the level of inflammatory factors and intervening in the PI3K/protein kinase B (AKT) signaling pathway.
Synthesis and Anticancer Activity of Ergosterol Peroxide Hybrids With Paclitaxel Side Chain Inducing Apoptosis in Human Hepatoma Carcinoma Cells
Authors: Guo Xiaoshan , Ren Wenkang , Lv Zhen , Li Gang , Li Hongling , Sun Mingrui , Li Xiaoming , Chen Gang , Zhang Zhiguo , Zhang Wenting , Bu Ming
Published: April 2023

The antitumor activities of natural paclitaxel (PTX), semisynthetic docetaxel, and cabazitaxel are highly dependent on their C-13 side chains. Therefore, using natural ergosterol peroxide (EP, 1) as the lead compound, two EP-PTX hybrids (EP-A2 and EP-B2) were prepared and their antitumor activities were evaluated against 4 kinds of human MCF-7, HepG2, HCT-116, and A549 cell lines in vitro. The results showed that both EP-A2 and EP-B2 inhibited the growth of all four kinds of tested tumor cell lines. For paclitaxel-resistant MCF-7 cells, both EP-A2 and EP-B2 showed significant inhibitory activity with relatively low IC50 values (9.39 μM and 8.60 μM, respectively). In addition, EP-B2 inhibited the growth of the HepG2 cells (IC50 = 7.82 μM) more successfully than EP. Preliminary studies of the mechanism suggest that EP-B2 could arrest the G1 phase transition in HepG2 cells. In addition, EP-B2 showed an obvious apoptosis-inducing effect in HepG2 cells, as detected by the Annexin V/PI binding assay and the Western blot assay. Hybrid EP-B2 has the potential to become a novel antitumor drug through further study of the mechanism of action and its structural modifications.
Opioid Usage After Hallux Valgus Correction Surgery
Authors: Jackson J. Benjamin , Thier Zachary T. , Barfield Matthew E. , Altobello Kenna Courtney Stephanie , Gonzalez Tyler A.
Published: April 2023

Background

Given the lack of objective data on opioid use and the difficulty of addressing a patient’s postoperative pain, we sought to quantify patient’s narcotic use after hallux valgus surgery. The purpose of our study was to determine the average quantity and type of postoperative opioids consumed after hallux valgus surgery and to assess potential predictive factors for increased opioid consumption.

Methods

At the preoperative visit, patients were consented and completed a demographical questionnaire. Data were collected from the operative record, 2, 6, and 12-week postoperative visits. Type and number of pills prescribed were recorded as well as number of pills consumed at each postoperative visit. A logistic regression was performed to determine the average quantity consumed postoperatively and any statistically significant correlations.

Results

The average number of opioid pills collectively consumed at the 2-week and 12-week postoperative visit was 20 and 23, respectively. At the 2-week postoperative visit, only patient body mass index (BMI) showed a correlation with increased opioid use.

Conclusion

Patients consumed an average of 23 of 40 (57.5%) narcotic pain pills prescribed after hallux valgus reconstruction surgery through the 12-week postoperative period. Owing to the opioid epidemic and potential for narcotic diversion, surgeons should counsel their patients on proper nonopioid postoperative pain management.

Level of Evidence:

II Therapeutic
Rape as a tool of political mobilisation: The experience of Indian muslim
Authors: Haque Mohammad Mohibul , Khan Nousheen Baba
Published: April 2023

The use of rape as a tool for political control and mobilization has been seen throughout history, particularly in times of conflict and war. Rape is used to exert power and authority, with the intention of oppressing and dehumanizing a particular group of people. In many cases, rape is used to assert dominance and control over a community, to exert social, political and economic control, and to further marginalise and silence the victims. The motivations behind the use of rape as a tool in politics can vary, but they often stem from a desire to maintain power and control over a population, to spread fear and destabilise a community, and to assert dominance over a particular group. The consequences of rape used in this manner can be far-reaching, including physical, psychological, and emotional trauma for the victims, as well as a long term impact on their communities. This paper is an attempt to explain how rape has been used as a tool of political mobilisation for committing violence against women in general and the weaker sections in particular especially the Muslim women in India.
Understanding the research on tracking, diagnosing, and intervening in sleep disorders using mHealth apps: Bibliometric analysis and systematic reviews
Authors: Nuo Mingfu , Fang Hongjuan , Wang Tong , Liang Jun , He Yunfan , Han Hongbin , Lei Jianbo
Published: April 2023

Objectives

In solving the global challenge of sleep disorders, Mobile Health app is one of the important means to monitor, diagnose, and intervene in sleep disorders. This study aims to (1) summarize the status and trends of research in this field; (2) assess the production and usage of sleep mHealth apps; (3) calculate the conversion rate of grants that the proportion of newly developed apps from being funded and developed to published on application stores.

Methods

Using bibliometric and content analysis methods, based on “Research Paper-Product Output-Product Application” chain and considering the “Research Grants” of articles, we conducted a systematic review of eight databases, to identify relevant studies over the last decade.

Results

Over the past decade, 1399 authors published 313 papers in 182 journals and conferences. The number of publications increased with an average annual growth of 41.6%. The current focus area is research using cognitive behavioral therapy to intervene in sleep. Sleep-staging tracking is a shortcoming of this field. A total 368 sleep mHealth apps (233 newly developed and 135 existing) were examined in 313 papers; 323 grants supported 178 articles (56.9%). Only 12 of the newly developed apps are used in the real world, resulting in a 9% grant conversion rate.

Conclusions

In the last decade, the field of tracking, diagnosing, and intervening in sleep disorders using mHealth apps has shown a trend of rapid development. However, the conversion rate of products from being funded and developed for use by end-users is low.
“Putting His Off-Field Issues Aside…”: Exploring Online Sport Fan Community Response to Allegations Against Deshaun Watson
Authors: Nason Jacob
Published: April 2023

In March 2022, a Texas grand jury chose not to indict NFL quarterback Deshaun Watson with sexual misconduct, facilitating his trade from the Houston Texans to the Cleveland Browns. This study used publicly accessible Reddit posts ( n = 273) to explore sport fan conversations about Watson from the day a grand jury announced it would not indict him to the day the Cleveland Browns issued an official statement about the trade. I analyzed post text, top-level comments, and replies to the top-level comment on each post using reflexive thematic analysis. Results suggest that while most conversations about Watson avoided discussion of sexual violence, fans also supported or resisted rape culture. Few fans shared an intention to no longer support a team that traded for Watson, highlighting the cognitive dissonance fans may face when navigating opinions about sexual violence and the importance of fandom to their identity. The presence of conversations supporting rape culture and limited space for civil discussions of athlete-perpetrated violence may impact some fans’ attitudes toward sexual violence while making online fan communities an unsafe space for others. These findings have implications for understanding sport fan cultures vis-à-vis sexual violence and situational prevention targeting sport fans.
Comparison of Wiltse Approach of Pedicle Screw Fixation With or Without Vertebroplasty in the Treatment of Genant III Degree Osteoporotic Thoracolumbar Fractures: Analysis of Clinical Findings, Radiographic Parameters, and Follow-Up Complications
Authors: Liu Xiaolei , Zhou Qinqin , Yu Xiao , Tian Jiwei , Sun Zhongyi , Wang Haibin
Published: April 2023

Study Design

A retrospective case-control study.

Objective

This study aimed to compare the effects of the Wiltse approach of pedicle screw fixation (PSF) either in combination with or without vertebroplasty (VP) in the treatment of Genant III degree osteoporotic thoracolumbar fractures (Genant III-OTLFs).

Methods

A retrospective study of Genant III-OTLFs was performed from January 2018 to December 2019, including 54 cases of PSF + VP and 56 cases of PSF. Clinical indicators [visual analog scale (VAS) score, Oswestry disability index (ODI)], radiographic parameters [local kyphosis angle (LKA), percentage of anterior, central, and posterior vertebral heights (AVH%, CVH%, and PVH%, respectively)] and follow-up complications [adjacent vertebral fracture (AVF), residual pain (RP), vertebral height loss (VHL), and internal fixation failure (IFF)] were compared between the 2 groups.

Results

No differences in surgical outcomes, clinical indicators, and radiographic parameters were observed between the 2 groups during the preoperation period and 7 days post-operatively (P > .05). However, the VAS score [2.0 (.6), 1.9 (.5)], ODI [23.7 (4.0), 22.6 (3.0)], LKA [9.5 (1.8), 10.6 (3.0)], AVH% [90.1 (2.7), 87.7 (6.0)], CVH% [92.5 (2.6), 91.3 (3.7)], and PVH% [93.4 (2.0), 92.7 (2.4)] at 1 year post-operatively and last follow-up of the PSF + VP group were better than those of the PSF group [2.5 (.8), 3.1 (1.1), 26.6 (3.8), 29.6 (4.6), 12.2 (1.6), 16.6 (3.2), 84.9 (4.0), 69.9 (6.6), 88.1 (3.1), 78.2 (5.1), 89.7 (2.3), 84.8 (4.6)], respectively (P < .001). During follow-up, the incidence of AVF had no difference (P > .05), while that of RP (32.1 vs 14.8%), VHL (33.9 vs 9.3%) and IFF (17.9 vs 5.6%) had statistical differences between them (P < .05).

Conclusion

The Wiltse approach of PSF combined with VP for Genant III-OTLFs can not only effectively relieve pain, restore vertebral height, and correcte kyphosis, but also better maintain vertebral height, delay kyphosis progression, and reduce complications during follow-up.
Matching the Needs in an Emerging Market: An Investigation of Multinational Companies’ Marketing Strategies by Using the 4As Framework
Authors: Alteren Gro
Published: April 2023

Making the multinational companies’ (MNCs) products attractive among the low- and the high-income consumers is challenging in an emerging market. This study uses the 4As framework (affordability, accessibility, acceptability and awareness) to investigate the marketing activities that three Western companies from the industries such as telecoms, brewery and decorative paint implemented to match the needs in the Indian market. By proposing to split affordability into three categories, the study extends the 4As framework. Three general strategies emerged, each one composed of six 4As marketing activities. The strategies, one for each industry, show different approaches to how companies could develop the demand for their products. Each strategy is linked to one of the three categories of affordability: (a) Serving consumers across economic classes (affordable to everyone). (b) Serving consumers looking for an international lifestyle (affordable to the mainstream and the premium segments). (c) Serving consumers seeking a higher level of materialism (affordable to the premium segment). The study presents theoretical and managerial implications, and suggestions for future research.
Opioid Prescription Patterns 90 Days After Arthroscopic Rotator Cuff Repair: A 10-Year National Database Analysis
Authors: Day Wesley , Tang Kevin , Joo Peter Y. , Grauer Jonathan N. , Yalcin Sercan , Wilhelm Christopher V. , Medvecky Michael J.
Published: April 2023

Background:

Arthroscopic rotator cuff repair (ARCR) is a common procedure that typically requires opioid prescription for postoperative pain management.

Purpose:

To investigate the current prescription patterns and factors influencing 90-day postoperative opioid prescription trends for opioid-naïve patients who underwent ARCR.

Study Design:

Case series; Level of evidence, 4.

Methods:

Opioid-naïve adult patients who underwent ARCR between January 2010 and September 2020 and had a record of opioid prescriptions during the 90-day postoperative period were identified in the PearlDiver Mariner91 national administrative database. Exclusions included patients with prior shoulder procedures, a history of chronic pain, and opioid prescription records dated earlier than 4 weeks before surgery. Covariates included age group, sex, Elixhauser Comorbidity Index, and prescriber specialty (orthopaedic or nonorthopaedic). The primary outcome—90-day postoperative morphine milligram equivalents (MMEs) prescribed per patient—was compared using univariate and multivariate regression analyses, and 90-day postoperative opioid prescription trends over the 10-year study period were analyzed with linear regression.

Results:

In total, 55,345 ARCR cases were identified. The mean ± SD amount prescribed within the first 90 days was 742.4 ± 256.5 MMEs, and the median was 487.5 MMEs. Multivariate linear regression analysis predicted higher 90-day postoperative MMEs for female patients and younger patients ( P < .01 for both). From 2010 to 2020, there was a 66% decrease in mean MME prescribed per patient (▵ = 660.4 MME; P < .01), with a mean reduction of 55.1 MME per patient per year. In 2020, the mean 90-day postoperative amount prescribed was 341.1 MME, which is equivalent to 51 tablets of 5-mg oxycodone (Percocet).

Conclusion:

Female sex and younger age were predictors of more MME being prescribed after ARCR. While opioid prescriptions following ARCR have substantially decreased over the past decade, the amount prescribed warrants further attention.
Return to Play, Performance, and Economic Analysis of National Football League Players After Lisfranc Injury
Authors: Abed Varag , Fine Rebecca , Fine Rachel , Hawk Gregory S. , Conley Caitlin , Jacobs Cale , Stone Austin V.
Published: April 2023

Background:

A Lisfranc injury can occur to either the ligament or bone, which causes instability when attempting to perform strength and balance maneuvers.

Purpose/Hypothesis:

The study's aims were to (1) analyze the return-to-play (RTP) rate and performance level of players in the National Football League (NFL) after Lisfranc injury and (2) determine the economic and financial impact of Lisfranc injuries to the NFL. We hypothesized that there would be a low RTP rate following Lisfranc injury in the NFL.

Study Design:

Case series; Level of evidence, 4.

Methods:

Multiple online public records were used to identify NFL players with Lisfranc injuries between the 2009 and 2020 seasons. Players were assessed according to their RTP statistics: snap count, approximate value (AV), games played, and games started. Nonparametric methods were used to compare player statistics before and after injury. Also, player salaries while injured were calculated (in 2022 US dollars after adjusting for inflation) to approximate economic loss for those players who returned to play.

Results:

A total of 33 NFL athletes sustained a Lisfranc injury during the study period. Most Lisfranc injuries were experienced by offensive linemen (n = 8; 24.2%), followed by running backs (n = 7; 21.2%). Overall 27 players (81.8%) returned to play after injury at a median of 11.0 months (IQR, 10.2-11.8 months). There were no significant differences between pre- and postinjury snap counts or number of games played and started. In terms of player performance, there was a statistically significant decrease in AV at 1 year postinjury (median [IQR], 6.0 [4.0-10.0] preinjury vs 5.0 [2.5-7.5] postinjury; P = .022). The overall cost of recovery amounted to $104.7 million, with quarterbacks (n = 4) accounting for the greatest cost at $32.6 million. The next 2 most expensive positions were offensive and defensive linemen (n = 5 each) at $19.4 million each.

Conclusion:

Our results did not support the hypothesis, as the RTP rate for NFL athletes sustaining Lisfranc injuries was 81.8%. This injury was associated with a significant decrease in AV 1 year postinjury. In terms of economic impact, quarterbacks accounted for almost one-third of expenses while constituting only 14.8% of injuries.
The Patient Experience of the Future is Personalized: Using Technology to Scale an N of 1 Approach
Authors: Bucher Amy
Published: April 2023

Personalized experiences are more effective at creating sustained behavior change. Digitally enabled personalized outreach can improve patient’s experience by providing relevant, meaningful calls to action at a time when labor-intensive human-to-human personalization is challenged by systemic health staffing shortages. Strategic use of digital tools to engage patients and supplement human-to-human care scale personalization to the benefit of patient and provider experience. Specifically, digital personalization can support: Identification of patients eligible for a procedure, service, or outreach Engaging patients with a personalized call to action Augmenting care through the use of digital tools, and Monitoring patient progress over time to ensure continued support. The technology to support a more personalized patient experience includes infrastructure to consolidate rich data, an intelligence capability to identify candidates for each call to action, and an engagement layer that presents patients with personalized output. Steps to develop and execute a personalization strategy are provided.
The Influence of 6-Month Interdisciplinary Accompaniment on Family Caregivers’ Knowledge and Self-Efficacy Regarding Diabetic Wound Care
Authors: Wantonoro Wantonoro , Komarudin Komarudin , Imania Dika Rizki , Harun Sigit , Nguyen Tuan Van
Published: April 2023

Introduction

Diabetes mellitus (DM) is a global health issue. Diabetic wounds have become a severe health complication. Interdisciplinary education and the use of homecare have led to improvements in the health of patients with chronic disease. The family caregiver's knowledge and self-efficacy positively impact the DM patient's self-care in the physical and psychological dimensions. There is still a need for interdisciplinary education to enhance family caregivers’ knowledge and self-efficacy regarding diabetic wound care.

Objective

To determine the effect of 6 months of interdisciplinary education on family caregivers’ knowledge and self-efficacy regarding diabetic wound care.

Methods

A quantitative longitudinal study with a quasi-experimental, one-group, pretest–posttest design was conducted. Family caregivers received 6 months of interdisciplinary education regarding diabetic wound care. The Foot Care Confidence Scale (FCCS) was used to measure the family caregivers’ knowledge and self-efficacy regarding diabetic wound care. The dependent samples t test and the Wilcoxon signed-rank test were used for statistical analysis.

Results

Sixteen caregivers of patients with diabetic ulcer wounds in the homecare unit participated in this intervention with a 6-month follow-up. Six months of interdisciplinary education significantly increased the family caregivers’ knowledge ( p = 0.001) and self-efficacy ( p = 0.001). However, there was no significant correlation between self-efficacy and gender, age, education level, or duration of wound care ( p = 0.91; 0.93; 0.38; 0.40, respectively). Long-term interdisciplinary education improved caregiver performance across genders, ages, education levels, and wound care experience durations.

Conclusion

Long-term interdisciplinary education of family caregivers is recommended as one method to enhance the family support system with respect to diabetic ulcer care management. In addition, interprofessional collaboration could be performed to enhance the understanding of healthcare, especially diabetic ulcer care.
Disentangling Waterworlds: The role of ‘agential cuts’ and ‘method assemblages’ in ontological politics – an example from Loweswater, the English Lake District
Authors: Tsouvalis Judith
Published: April 2023

This article explores the intra-active collective politics of the Loweswater Care Project (LCP), a ‘new collective’ of humans and nonhumans that assembled in the English Lake District in 2007 to grapple with the potentially toxic blue-green algae ( cyanobacteria) that were proliferating in Loweswater lake. The LCP was motivated by questions similar to those asked by the editors of this Special Issue on ‘Water Matters’ in their call for contributions and to which this article responds, namely ‘how can we acknowledge the agency of more-than-humans in our political ecologies?’ and ‘how can this help us compose better, more balanced, human–environment interactions?’ To answer these questions, the paper examines how the LCP put intra-active collective politics into practice, a form of ontological politics informed by the work of Bruno Latour on object-orientated politics and Karen Barad on agential realism. It explains the key role played in ontological politics by what Barad calls agential cuts and what Law refers to as a method assemblage, both of which can be used grasp the intra-acting agencies entangled in matters of concern. Two examples are given to illustrate this: first, the scientific modelling the LCP undertook to understand connections between land use and water quality, and second, the hydro-geomorphology survey it conducted of the catchment to grasp the links between hydrological processes, land forms, and earth materials. While the first example highlights how method assemblages perform agential cuts and craft realities and presences for new collectives to do ontological politics with, the second illustrates how the realities crafted by the hydro-geomorphology survey impacted on the LCP's sense of collective agency. The paper ends by reflecting on the ethical dimensions of intra-active collective politics directed at composing a better common world and on the issue of ‘care’, both of which require further attention.
Toward a Race-Conscious Entrepreneurship Education
Authors: Monroe-White Thema , McGee Ebony
Published: April 2023

This article advocates for race-conscious science, technology, engineering/computer science, and mathematics (STEM) innovation and entrepreneurship (I&E) education. Results from a national survey of the academic plans and career trajectories of underrepresented and minoritized (URM) STEM students and alumni suggest that URM STEM students need robust opportunities to apply their scientific and engineering insights to societal problems, while empowering them to be entrepreneurs. Specifically, we find evidence of a relationship between racialized stress and racial activism for nascent URM STEM entrepreneurs among master’s and doctoral STEM students the majority of whom identify as African American/Black and/or Latinx/Hispanic/Chicano. Furthermore, entrepreneurial intent among Black STEMers is greatest among those who have experienced social suffering coupled with a desire for racial justice, and this relationship is amplified for students and alumni of minority serving institutions (MSIs). This study makes the case for advancing a critical and socio-historical scholarship of STEM I&E education to promote URM STEM entrepreneurship.
Excess COVID-19 Mortality in India: An Estimation Using the Published Death Rate by the Civil Registration System
Authors: Hariharan Hariprasad Thazhathedath , Surendran Anish Thekkumkara
Published: April 2023

Background

An unbiased estimate of the COVID-19 deaths is essential to compare and contrast the public health actions adopted by governments from time to time. It also helps them in their policy-making in the future. But unfortunately, there is gross underreporting of COVID-19 deaths across the world, and also from India, as reported by many researchers, which can be estimated by modelling exercises only.

Methods

In this article, we estimated the number of COVID-19 deaths among the Indian states using a time series analysis approach with the mortality data published by the civil registration system since 2011. We excluded the trend in non-COVID mortality due to the prevailing causes to prevent it from being counted erroneously as due to COVID-19.

Results

Accordingly, the number of COVID-19 deaths in India is estimated as 25.8 lakh (95% confidence interval [CI]: 11.1L, 35.4L), with Bihar being the largest under-reporter of COVID-19 mortality (98.4% [95% CI: 98.0, 98.7] deaths not reported). On the contrary, there are states with zero underreporting (Kerala, Goa, Mizoram, Sikkim, and all the union territories). We also found out that the measures of social and economic development, like the multidimensional poverty index, infant mortality, literacy rate, per capita state domestic product, and the NITI Aayog Health Index, are significantly correlated to the proportion of underreporting.

Discussion and Conclusion

The underreporting of COVID-19 deaths in India is very much linked to its social and economic development. There is intentional nonreporting of the deaths of children, women, and the poor for a much longer period of time. Poor quality of data-grabbing mechanisms, the social stigma associated with the disease, inadequate testing of the population, the inefficiency of the administration, and omission of the socially and economically vulnerable groups had intensified the scenario.
Examining the Risk of Concussion in Children With Facial Fractures: A Large Emergency Department-Based Analysis
Authors: Irgebay Zhazira , Glenney Anne E. , Bruce Madeleine K. , Zhang Casey , Cheng Lucille , Kueper Janina , Smetona John , Losee Joseph E. , Goldstein Jesse A.
Published: April 2023

Background:

Children who sustain injuries resulting in facial fractures are at risk for concomitant concussion. Prompt diagnosis and appropriate management of concussions are crucial in preventing neurocognitive impairment. The goal of this study is to examine the relationships between distinct craniofacial fracture patterns, injury mechanism, and concussion in pediatric patients.

Methods:

A retrospective review of 3334 patients <18 years of age who were evaluated at a pediatric level I trauma center from 2006 to 2021 for facial fractures was performed. Data collected included patient demographics, mechanism of injury, documentation of concussion, and facial fracture type. Patients with an intracranial injury were excluded.

Results:

Two hundred twenty-seven patients met inclusion criteria (67.9% male), mean age at injury was 12.3 ± 4.3 years. Overall, concussions were more common in children >12 years old (54.2%), with sports as the most common cause of injury (32.5%). In patients <12 years, motor vehicle accidents were the main cause of injury (30.6%, P < .001). Zygomaticomaxillary complex and maxillary fractures were associated with higher rates of concomitant concussion. Patients with a history of prior concussion were 3.4 times more likely to present with another concussion (odds ratio, 3.4; 95% Cl, 1.7-6.9).

Conclusions:

Nearly 7% of pediatric patients with facial fractures in this retrospective series were diagnosed with a concomitant concussion. The results suggest that a higher index of suspicion for concussions should be maintained for patients with midface fractures and those with a previous history of concussions.
Mechanisms of Inhibition of Human Monoclonal Antibodies in Immune Thrombotic Thrombocytopenic Purpura
Authors: Halkidis Konstantine , Meng Chan , Liu Szumam , Mayne Leland , Siegel Don L. , Zheng X. Long
Published: April 2023

Antibody binding to a plasma metalloprotease ADAMTS13 is necessary for the development of immune thrombotic thrombocytopenic purpura (iTTP). Inhibition of ADAMTS13-mediated VWF cleavage by such antibodies clearly plays a role in the pathophysiology of the disease, though the mechanisms by which they inhibit ADAMTS13 enzymatic function are not fully understood. At least some immunoglobulin G-type antibodies appear to affect the conformational accessibility of ADAMTS13 domains involved in both substrate recognition and inhibitory antibody binding. We utilized single chain fragments of the variable region (scFv's) previously identified via phage display from patients with iTTP to explore the mechanisms of action of inhibitory human monoclonal antibodies. Using recombinant full-length ADAMTS13, truncated ADAMTS13 variants, and native ADAMTS13 in normal human plasma, we found that, regardless of the conditions tested, all three inhibitory monoclonal antibodies affect enzyme turnover rate much more than substrate recognition of von Willebrand factor (VWF). Hydrogen-deuterium exchange plus mass spectrometry (HX-MS) experiments with each of these inhibitory antibodies demonstrated that residues in the active site of the catalytic domain of ADAMTS13 are differentially exposed to solvent in the presence and absence of monoclonal antibody binding. These results support the hypothesis that inhibition of ADAMTS13 in iTTP may not necessarily occur because the antibodies directly prevent VWF binding, but instead rely on allosteric effects that impair VWF cleavage, likely by affecting the conformation of the catalytic center in the protease domain of ADAMTS13. Our findings provide novel insight into the mechanism of autoantibody-mediated inhibition of ADAMTS13 and pathogenesis of iTTP.