bluuebunny/crossref_metadata_2025 huggingface dataset:
Critical realist perspectives on the urban growth system
Authors: Waite David
Published: June 2022

Why some cities have been able to sustain economic growth more than others, and how particular technological or sectoral break points shift a city's economic performance favourably (or unfavourably), present ongoing conundrums. Whilst single factor accounts – such as the skilled city and the creative city – have the appeal of analytical parsimony, economic geographers suggest that a multiplicity of structures, processes and events typically sit behind how growth originates and is subsequently shaped. Given such complexity, how can we develop appropriate approaches to theorising causality within urban economic systems? This paper presents the case that critical realism may perform a useful ground-clearing role. With a layered ontology at its core, coupled with recent literature providing greater guidance for empirical application, it is argued that critical realism may present a complementary explanatory perspective.
Corporate governance, market conditions and investors’ reaction to information signals
Authors: Almaskati Nawaf , Bird Ron , Yeung Danny , Lu Yue
Published: June 2022

We examine and compare the extent to which the reaction of investors to earnings announcements is influenced by a firm’s governance profile and prevailing market conditions. We find that firms with better governance characteristics experience a larger initial reaction to both good and bad earnings announcements regardless of the prevailing sentiment and uncertainty conditions. However, the influence of governance is constrained to the announcement period. We demonstrate that changes in market uncertainty and/or investor sentiment are related to the post-earnings announcement drift. We also find that a major channel through which greater corporate governance influences the market response to unexpected earnings news is by lowering information uncertainty and so providing greater clarity of the implication of the news for firm value. Finally, we establish that two types of uncertainties (market and information) have very different influence on investor’s response to information signals.

JEL Classification: D81, G10, G14, G30, G32
Drainability and Clogging Behavior of Open-Graded Asphalt Friction Courses with Basic Oxygen Furnace Steel Slag Aggregates
Authors: Pathak Santanu , Choudhary Rajan , Kumar Abhinay
Published: June 2022

Drainability of an open-graded asphalt friction course (OGAFC) is a primary functional requirement, which mainly depends on the presence of a network of interconnected air voids. These mixtures, however, are prone to clogging, which severely limits their drainability. Clogging predominantly occurs as a result of the deposition of external (sand, debris, and dust) and internal (stripped-off bitumen) materials into the pores of OGAFC, which is referred to as particle-related clogging. Another type of clogging is deformation-related clogging and it is observed mainly because of rutting along the wheel path. In this study, the drainability and clogging behavior of OGAFC mixes with basic oxygen furnace (BOF) steel slag as replacement of natural aggregates was studied. BOF steel slag was used as 0% (control mix), 25%, 50%, 75%, and 100% substitution for coarse natural aggregates in the preparation of OGAFC mixes with two types of modified binders. Three different clogging mechanisms: particle-related clogging (caused by intrusion of foreign material such as sand); stripping-related clogging (caused by the deposition of stripped-off bitumen-fines mortar), and deformation-related clogging (reduced drainability caused by permanent deformation) were considered in this study. Comparisons were made to investigate the effect of BOF steel slag on the clogging potential of OGAFC mixes. OGAFC specimens were evaluated for their drainage potential using a flexible-wall falling-head permeameter both before and after being subjected to various clogging environments. BOF-steel-slag-incorporated OGAFC mixes exhibited lower clogging potential and reported better performance in resisting clogging resulting from stripping and permanent deformation.
Station-Level Effects of the COVID-19 Pandemic on Subway Ridership in the Seoul Metropolitan Area
Authors: Jun Myung-Jin , Yun Mi-Young
Published: June 2022

This paper investigates the station-level impacts of the coronavirus disease (COVID-19) pandemic on subway ridership in the Seoul Metropolitan Area. Spatial econometric models are constructed to examine the association between ridership reduction caused by the pandemic and station-level characteristics during the pandemic years 2020 and 2021. The results reveal unequal effects on station-level ridership, based on the pandemic waves, the demographics, and the economic features of pedestrian catchment areas. First, the subway system was severely disrupted by the pandemic, with significant decreases in ridership—by about 27% for each of the pandemic years—compared with the pre-pandemic year (2019). Second, the ridership reduction was sensitive to the three waves in 2020 and responded accordingly; however, it became less sensitive to the waves in 2021, indicating that subway usage was less responsive to pandemic waves during the second year of the pandemic. Third, pedestrian catchment areas with higher numbers of younger residents (in their 20s) and older residents (65 years and older), those with more businesses requiring face-to-face interactions with consumers, and stations located in the employment centers were hit the hardest in ridership reduction caused by the pandemic.
Identifying Important Ports in Maritime Silk Road Shipping Network from Local and Global Perspective
Authors: Yang Yanbin , Liu Wei , Xu Xu
Published: June 2022

Some key ports exist in the Maritime Silk Road shipping network that have a high impact on the whole of maritime transportation. An efficient identification of these crucial ports is of great importance, to alleviate the spread of port congestion, control shipping delays, and improve transportation efficiency. This paper proposes a novel method to identify the key ports by comprehensively considering local propagation and global centrality (LPGC), based on the complex network theory. Taking the ports along the Maritime Silk Road shipping network as an example, the Susceptible–Infected–Susceptible (SIS) model and Kendall’s correlation coefficient are compared with several centrality measures to evaluate the feasibility and efficiency of the LPGC method. The obtained results demonstrate that, compared with the existing methods, the proposed method has higher accuracy and can more accurately identify the influential ports. Finally, the obtained port importance ranking also provides a theoretical basis for the selection of ports that should give a priority to maintaining or ensuring their service capacity in practice.
The pathway from mental health, leaves of absence, and return to work of health professionals: Gender and leadership matter
Authors: Bourgeault Ivy L. , Atanackovic Jelena , McMillan Kim , Akuamoah-Boateng Henrietta , Simkin Sarah
Published: June 2022

Health professions are ranked among the most stressful occupations and have a much higher likelihood of absenteeism from work. In this article, we present findings from four health professional case studies in our Healthy Professional Worker partnership, involving surveys with 1,860 respondents and 163 interviews with nurses, physicians, midwives, and dentists conducted between December 2020 and April 2021. We found that the pathway from mental health experiences through to the decision to take a leave of absence and return to work differed between the health professions and that both gender and leadership matter greatly. There is a need to de-stigmatize mental health issues and encourage greater awareness and support from supervisors and colleagues. Leadership can play an important role in mitigating mental health issues, and as such investment in both leadership training and mentorship are important first steps in acting upon our research findings.
Study on turbocompound system for a heavy-duty diesel engine by combining matching analysis with experiments
Authors: Yong Yin , Zhijun Wu , Rongchao Zhao , Weilin Zhuge , Zongjie Hu
Published: June 2022

In this work, to improve the fuel economy of long-haul commercial vehicles, the effects of turbocompound system matching on engine performance were numerically and experimentally studied. Firstly, a 1D GT-POWER simulation model of an 11 L heavy-duty diesel engine was established and verified by the experimental data. Secondly, the performances of the turbocompound engine matching with different sizes of fixed geometry turbine (FGT) and power turbines were analyzed. It was found that the exhaust energy distribution between the turbocharger turbine and power turbine had a significant impact on engine performance, and the size of the turbocharger turbine had a more noticeable impact than the power turbine. Based on the FGT turbocompound system simulation result, an appropriate variable geometry turbocharger (VGT) and three wastegate turbochargers (WGT) were selected for further simulation and experimental research. In addition, the impacts of the transmission ratio between the power turbine shaft and the engine crankshaft, and the fuel injection timing on the engine performance were experimentally studied. The engine test result showed that the fuel economy was improved by 1.6% under European Steady State (ESC) cycle while keeping the weighted NOx emission the same as the original engine. Finally, the turbocompound engine with WGT was installed on a heavy-duty long-haul commercial vehicle for road tests. The fuel economy of the vehicle was improved by 2.54% under the 80 km/h constant speed road test.
Effect of hybridization of novel African teff and snake grass fibers reinforced epoxy composites with bio castor seed shell filler: Experimental investigation
Authors: K Manickaraj , R Ramamoorthi , S Sathish , M Makeshkumar
Published: June 2022

The main aim of this research was to fabricate novel African teff and snake grass fibers reinforced hybrid epoxy composites with bio castor seed shell powder as filler using compression molding method as a function of varying fiber weight fraction from 5 to 25 wt%. The African teff and snake grass fibers were chemically treated with 5% NaOH to enhance fiber outer surface by removing hemicellulose, lignin, wax, and oil contents. The tensile, flexural, impact, interlaminar shear strength, and hardness of the alkaline treated hybrid composites were determined as per ASTM standards to evaluate the effect of fiber weight fraction on the developed composites. The chemical bonding between the treated fiber and NaOH agents was verified through Fourier transform infrared analysis. The adhesion between the treated fiber and matrix was analyzed by using a scanning electron microscope. The results of the investigation indicated that the mechanical properties improved with the increase in African teff fiber up to 20 wt. % and deteriorated thereafter. It was also observed that the combined influence of bio castor seed shell powder along with natural fibers over the mechanical properties was higher.
Financially engineering a “self-generative” political economy of creditworthiness: Expertocratic exemption problems for sustainable debt and democracy
Authors: Paudyn Bartholomew
Published: June 2022

Repeated crises have proven credit rating agency (CRA) models/methods erroneous and “business-as-usual” unsustainable. Nevertheless, considerable dubious “default risk” management and technoscientific capitalist expertise remain unchanged. Unpacking sovereign ratings, we appreciate how “debt sustainability analysis” (DSA) distortions underpin expertocratic CRA (default) anomaly. Their neoliberal “politics of limits” performance helps market (shareholder) imperatives trump those of democratic (stakeholder) politics. Given surging inflation and debt (distress) to remedy Covid-19-induced shocks, ratings aid constitute and (re)validate the subjectivities/affinities and organizational conditions advancing a “self-equilibrating,” “self-generative” agencement political economy of creditworthiness (PEC). Antagonizing sustainable budgetary government’s programmatic/expertocratic and operational/democratic asymmetry, econophysics ratings diminish fiscal sovereignty. Universal PEC management through hybrid credit risk/uncertainty qualculation mitigates negative externality contestation shielding CRAs from serious reform. Ratings procyclicality and contagion reinforce this precarious sociotechnical agencement PEC as the status quo.
Act or Wait-and-See? Adversity, Agility, and Entrepreneur Wellbeing across Countries during the COVID-19 Pandemic
Authors: Stephan Ute , Zbierowski Przemysław , Pérez-Luño Ana , Wach Dominika , Wiklund Johan , Alba Cabañas Marisleidy , Barki Edgard , Benzari Alexandre , Bernhard-Oettel Claudia , Boekhorst Janet A. , Dash Arobindu , Efendic Adnan , Eib Constanze , Hanard Pierre-Jean , Iakovleva Tatiana , Kawakatsu Satoshi , Khalid Saddam , Leatherbee Michael , Li Jun , Parker Sharon K. , Qu Jingjing , Rosati Francesco , Sahasranamam Sreevas , Salusse Marcus A. Y. , Sekiguchi Tomoki , Thomas Nicola , Torrès Olivier , Tran Mi Hoang , Ward M.K. , Williamson Amanda Jasmine , Zahid Muhammad Mohsin
Published: June 2022

How can entrepreneurs protect their wellbeing during a crisis? Does engaging agility (namely, opportunity agility and planning agility) in response to adversity help entrepreneurs safeguard their wellbeing? Activated by adversity, agility may function as a specific resilience mechanism enabling positive adaption to crisis. We studied 3162 entrepreneurs from 20 countries during the COVID-19 pandemic and found that more severe national lockdowns enhanced firm-level adversity for entrepreneurs and diminished their wellbeing. Moreover, entrepreneurs who combined opportunity agility with planning agility experienced higher wellbeing but planning agility alone lowered wellbeing. Entrepreneur agility offers a new agentic perspective to research on entrepreneur wellbeing.
Fight. Heal. Repeat: A Look at Rhetorical Devices in Grinding Game Mechanics
Authors: Sgandurra Sabrina A.
Published: June 2022

Background

Common definitions of rhetoric in games such as Bogost’s ‘procedural rhetoric’ have their basis in the Aristotelian definition of rhetoric, which concerns itself with discovering all means of persuasion in language.

Purpose

Gaming rhetoric has more to do with inducing action in players, and therefore falls more in line with Kenneth Burke’s definition of rhetoric. Grinding is a gaming mechanic that can be analysed using rhetorical devices if Burke’s definition of rhetoric is held at the core of this understanding. This article posits that games that employ a particular game mechanic, that of ‘grinding’, are relying on a specific rhetorical device in their design known as ploke, which then persuades the player to continue to do an action multiple times over, and therefore persuade players to form attitudes that align with the designer’s rhetorical goals.

Analysis

An analysis of ploke was applied to three specific games: Runescape (2001), Ha des (2018) and Animal Crossing: New Horizons (2020). These games were chosen based on the ability to look at multiple genres as well as multiple different points in modern game development history. Ploke provided the ability to understand the method in which grinding communicates with players, enticing and incentivizing them to continue to complete actions repeatedly, whether for story progression or skill enhancement. The rhetorical power of ploke is found in its repetition, and since ploke describes the use of repetition in rhetorical contexts, thus grinding’s rhetorical power can be explained through this rhetorical phenomenon.

Conclusion

Ploke is just one rhetorical device, and grinding is just one game mechanic. There are several other game mechanics that can be analysed through rhetorical devices. This analysis allows researchers in interdisciplinary fields of games and linguistics, communication or humanities to explore how games communicate and influence player decisions.
‘You Took me Back to the sea:’ Using Narrative to Explore and Inform the Practice of Social Work with Dying People
Authors: Turner Denise
Published: June 2022

This article centres on a qualitative interview extract, the ‘Story of the Pebble’, in which a West African Hospital Social Worker Ado, working in a UK context, and identifying as a Shaman, describes successfully trusting his instincts to create a symbol for a dying patient. Despite criticisms from colleagues, Ado's capacity to understand his patients needs are justified both before and after her death.

The article discusses significant themes from the interview extract, including the meaning of professionalism, practice wisdom and cultural influences in a UK social work context, as well as through Ado's heritage and identification as a Shaman. The article considers holistic patient care in a medical context and suggests this has some useful lessons for social workers, particularly those involved with dying people. Although the extract, and wider research study from which it is drawn, pre-date the Covid 19 pandemic, this is referenced throughout, linking the interview extract to ways of helping practitioners and educators to consider people holistically at end of life.
Evidence-Based Home Visiting Provisions and Child Maltreatment Report Rates: County-Level Analysis of US National Data From 2016 to 2018
Authors: Kim Hyunil , Song Eun-Jee , Windsor Liliane
Published: June 2022

This observational ecological study examined county-level associations between evidence-based home visiting (EHV) provisions and child maltreatment report (CMR) rates, using national county-level data from 2016–2018. We found that longitudinal changes of EHV provisions were significantly negatively associated with county CMR rates while controlling for potential confounders. Our model estimated that after EHV provisions were launched in counties, their CMR rates decreased (or after they were ceased, rates increased) by 2.21 per 1000 children overall, 2.88 per 1000 children aged 0–5, 2.59 per 1000 children aged 6–11, 2.13 per 1000 male children, and 2.24 per 1000 female children. When limiting attention to EHV provisions funded by the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program, we found no significant association perhaps because MIECHV-funded EHV provisions were a small subset of all EHV provisions. These findings propose potential protective impacts of county EHV provisions on overall county CMR rates. Yet, the small effect sizes suggest that EHV provisions should be considered as a part of a complete response to child maltreatment rather than in isolation. Given that EHV is provided to a very small part of the population, nevertheless, our findings suggest that expanding coverage would increase effect sizes.
Genetic evaluation in phenotypically discordant monozygotic twins with Coats Disease
Authors: Lizzio Rosario Alfio Umberto , Monfrini Edoardo , Romano Simona , Brescia Gloria , Vujosevic Stela , Sacchi Matteo , Di Fonzo Alessio , Nucci Paolo
Published: June 2022

Purpose

To report the unique case of a pair of phenotypically discordant monozygotic twins, with one of them affected by unilateral Coats disease.

Case report

Both patients underwent a complete ophthalmologic evaluation and were genetically tested with whole-exome sequencing (WES). Any known or unknown potential genetic determinant of Coats disease wasn't found.

Conclusion

It may suggest a non-genetic etiology for this disorder. This represents, to the best of our knowledge, the first case of genetic analysis of monozygotic twins, one of whom is affected by Coats disease. Further studies are warranted, including performing genetic analysis directly on retinal biopsy tissue.
Exploring the Structural and Functional Effects of Nonsynonymous SNPs in the Human Serotonin Transporter Gene Through In Silico Approaches
Authors: Mia Md Arzo , Uddin Md Nasir , Akter Yasmin , Jesmin  , Wal Marzan Lolo
Published: June 2022

The sodium-dependent serotonin transporter SLC6A4 (solute carrier family 6 member 4) gene encodes an intrinsic membrane protein that transmits the serotonin neurotransmitter from synaptic clefts into presynaptic neurons. The product of the SLC6A4 gene is related to the regulation of mood and social behavior, sleep, appetite, memory, digestion, and sexual desire. This protein is a target for antidepressant and psychostimulant drugs, thus prolonged neurotransmitter signaling remains blocked. In this study, the functional consequences of nsSNPs in the human SLC6A4 gene were explored through computational tools: PhD-SNP, SIFT, Align GVGD, PROVEAN, PMut, nsSNP Analyzer, SNPs&GO, SNAP2, PolyPhen2, and PANTHER to identify the most deleterious and damaging nsSNPs. Then the mutant protein stabilities were assessed using I-Mutant, MUpro, and MutPred2; amino acid conservation using ConSurf, and posttranslational modification analysis using MusiteDEEP and PROSPER. Furthermore, the 3-dimensional (3D) model of the mutated proteins was predicted and validated using SPARKS-X, Verify3D, and PROCHECK. The protein–ligand binding sites were analyzed using the COACH meta-server. Results from this study predicted that T192M, G342E, R607C, W282S, R104C, P131L, P156L, and N351S were the most structurally and functionally significant nsSNPs in the human SLC6A4 gene. Arg607 and Pro156 were the predicted sites for posttranslational modifications, and Thr192 and Try282 were the ligand-binding sites in the human SLC6A4 gene. The analyzed data also suggested that R104C, P131L, P156L, T192M, G342E, and W282S mutants might affect the binding of sodium ions with this protein. Taken together, this study provided important information on structurally and functionally important nsSNPs of the human SLC6A4 gene for further experimental validation. In the future, these damaging nsSNPs of the SLC6A4 gene have the potential to be evaluated as prognostic biomarkers for SLC6A4-related disorder diagnosis and research.
“Google Is Not a Good Neighbor”: The Google Campus Protests in Berlin
Authors: Hartmann Maren
Published: June 2022

When Google announced, in October 2018, that it would not pursue its plan to open a Google Campus in Berlin-Kreuzberg, the local anti-gentrification protesters were triumphant. The retreat was widely seen to be the result of a 2-year-long fight between the tech company and local activist groups. Next to the usual gentrification issues, the protests had additionally addressed what Google as a company stands for and focused on their data policies and the underlying (economic) rationale. The article asks what role this additional critique played in the protests. It will begin with a brief introduction to the key concepts before retracing the history of the planned Google Campus in Berlin as well as of the protests against it.
Between cabinet membership and opposition: Commitment and responsibility of support parties
Authors: Hjermitslev Ida B
Published: June 2022

Existing research suggests that government participation is crucial for how voters evaluate party performance and how they cast their votes. However, in real life the distinction between government and opposition is not as straight-forward as one would think. Minority governments often enjoy the legislative support of external support parties, which play an ambiguous role in politics: while they are formally part of the opposition, they are simultaneously committed to keeping the government in office and passing its bills. How do voters evaluate parties that support a minority government? Will they respond to different frames about the significance of the commitment that support parties have made to government policy and survival? In a survey experiment, I test whether framing a written agreement as effective will cause voters to attribute more or less responsibility to the support parties and find that they respond to different frames by altering their perceptions of the importance of the agreement, but not their responsibility attribution.
Test-Retest, Interrater Reliability, and Minimal Detectable Change of the Dynamic Exertion Test (EXiT) for Concussion
Authors: Sinnott Aaron M. , Eagle Shawn R. , Kochick Victoria , Bricker Indira R. , Collins Michael W. , Sparto Patrick J. , Flanagan Shawn D. , Elbin R. J. , Connaboy Christopher , Kontos Anthony P.
Published: June 2022

Background:

The Dynamic Exertion Test (EXiT) was developed to inform return-to-play (RTP) decision-making following clinical recovery from sport-related concussion (SRC). The purpose of the current study was to document intrarater and test-retest reliability and minimal detectable change (MDC) scores for physiological [heart rate (HR) and blood pressure], performance (change-of-direction task completion time and errors), and clinical outcomes (endorsed symptoms, perceived exertion) of EXiT, and interrater reliability of performance outcomes.

Hypothesis:

Healthy athletes would exhibit stable physiological responses to the EXiT across visits, demonstrate consistent change-of-direction task completion time between consecutive trials at each visit, and the fastest time (of 2 trials) across visits, and endorse equivocal symptoms and effort across visits.

Study Design:

Cross-sectional, test-retest.

Level of Evidence:

Level 3.

Methods:

Seventy-nine (female: 34 [43%], 19.6 ± 5.0 years) athletes completed the EXiT at 2 study visits (8.7 ± 4.7 days between visits). Two-way, mixed, intraclass correlation coefficients (ICCs) were used to evaluate intrarater and test-retest reliability. Cronbach’s alpha was used to document the internal consistency of symptoms at each visit, and MDC scores were calculated on the physiological, performance, and clinical outcomes.

Results:

Measured and percentage of age-estimated maximum HR were reliable following EXiT (ICC = 0.579-0.618). Change-of-direction task completion time (MDC range = 0.75-8.70 s) had good-to-excellent test-retest (ICC = 0.703-0.948) and interrater (ICC = 0.932-0.965) reliability. Symptoms had a high internal consistency at visits 1 ( α = 0.894) and 2 ( α = 0.805) and were reliable across visits (ICC = 0.588).

Conclusion:

The current investigation established test-retest reliability in addition to MDC scores of an objective dynamic exercise assessment among healthy adolescent and adult athletes. The EXiT may be an objective approach to inform RTP decision-making following SRC recovery.

Clinical Relevance:

The EXiT is a clinically feasible exertion-based assessment that can be readily administered in a variety of outpatient clinical settings.
“Make our communities better through data”: The moral economy of smart city labor
Authors: Burns Ryan , Welker Preston
Published: June 2022

Smart cities are now an established context in which data and digital technologies shape urban politics. Despite increased scholarly focus on algorithmic governance, smart cities and their data production still heavily rely on human labor, raising questions about how that labor is recruited and the implications of different recruitment strategies. In this paper, we illuminate the relations and practices mobilized to recruit the labor required to produce, analyze, and enact data that (re)produce smart cities. We argue that smart cities recruit such digital labor by producing and circulating moral values and sentiments to claim that such participation is a social good. In this article we draw on a 6-year ongoing project in Calgary, Canada to explore how these “moral economies” underwrite smart city ecosystems. We explore three projects related to data and digital labor in the Calgary smart city: a wearable technology collaborative project, a civic hacking group, and the community social media platform Nextdoor. We suggest that moral economies of smart cities signal a new juncture between urban planning and profiting from data, with the potential for creating new socio-political risks. These moral economies signal a shift toward a “new spirit of capitalism” in which labor is managed through indirect persuasion rather than direct compulsion and mandate.
Type-II fuzzy approach with explainable artificial intelligence for nature-based leisure travel destination selection amid the COVID-19 pandemic
Authors: Lin Yu-Cheng , Chen Tin-Chih Toly
Published: June 2022

During the coronavirus disease 2019 (COVID-19) pandemic, it is difficult for travelers to choose suitable nature-based leisure travel destinations because many factors are related to health risks and are highly uncertain. This research proposes a type-II fuzzy approach with explainable artificial intelligence to overcome this difficulty. First, an innovative type-II alpha-cut operations fuzzy collaborative intelligence method was used to derive the fuzzy priorities of factors critical for nature-based leisure travel destination selection. Subsequently, a type-II fuzzy Vise Kriterijumska Optimizacija I Kompromisno Resenje method, which is also novel, was employed to evaluate and compare the overall performance of nature-based leisure travel destinations. Furthermore, several measures were taken to enhance the explainability of the selection process and result. The effectiveness of the proposed type-II fuzzy approach was evaluated in a regional experiment conducted in Taichung City, Taiwan, during the COVID-19 pandemic.
Multidisciplinary Approach to Deprescribing Sedative-Hypnotic Medications in Geriatric Primary Care
Authors: Fixen Danielle R. , Farro Samantha A. , Shanbhag Prajakta , Parnes Bennett L. , Vejar Maria V.
Published: June 2022

Introduction/Objectives:

Due to the risks associated with sedative hypnotic medications in older adults, our study evaluated the impact of a multidisciplinary approach to deprescribing in geriatric primary care clinics.

Methods:

The study was a retrospective review of older adults at 2 academic, geriatric primary care clinics who were prescribed sedative-hypnotic medications. Patients were mailed an education packet of information that included working with the clinical pharmacy team, behavioral health team, or both in order to deprescribe their sedative-hypnotic medication. The study assessed the rate of discontinuation of sedative-hypnotic medications between the different intervention groups.

Results:

The study included 93 older adults with a mean age of 81.3 years and 39.8% discontinuation rate of their medication. The number of falls decreased in patients who discontinued use compared to when previously using a sedative hypnotic medication.

Conclusion:

Patients are more likely to discontinue their sedative hypnotic medication with a multidisciplinary approach, specifically with primary care provider support.
An Evaluation of the Online Social Learning Environment Instrument (OSLEI) Using Rasch Model Analysis
Authors: Che Lah Noor Hidayah , Tasir Zaidatun , Jumaat Nurul Farhana
Published: June 2022

One of the questionnaires that will be used to evaluate social learning environments such as Facebook is the Online Social Learning Environment Instrument (OSLEI). The aim of this study was to evaluate the OSLEI using alternative method of analysis via Rasch model toward 49 undergraduate students in Malaysia. To date, no study has evaluated the OSLEI through the lens of Rasch model analysis among Malaysian samples. Firstly, the OSLEI underwent content validation by three experts. The results of the overall percent agreement on eight constructs ( perceived usefulness, usage of learning groups, learning outcomes, affective outcomes, self-efficacy, trust, privacy, and teaching member presence) of the OSLEI was 86% for 48 items. Next, 10 measurement properties of Rasch model analysis were employed with the OSLEI. The results revealed that 23 respondents needed to be dropped. Subsequently, the data from the remaining 26 respondents proceeded to Rasch Model analysis of the 43 items in the OSLEI. The results of the item analysis revealed that 13 items and the construct of privacy needed to be dropped. The findings demonstrated that 35 items were robust, valid, and reliable, and could be used to measure online social learning environments.
An Anti-Racism Public Health Graduate Program: Mentoring of Students and Igniting Community
Authors: Samari Goleen , Bryant Monét , Grilo Stephanie
Published: June 2022

Black, Indigenous, and other people of color (BIPOC) are underrepresented in the public health workforce. Strengthening the public health pipeline through graduate institutions of public health is a necessary anti-racist approach to address health disparities. Programs that provide effective mentoring are one strategy for evidence-based anti-oppressive instructional practice, proven to help racial and ethnic students historically targeted by oppression in propelling career trajectories, professional development, and overall institutional experience in graduate school. The Mentoring of Students and Igniting Community (MOSAIC) program was founded in 2019 as a comprehensive and anti-racist faculty-to-student mentorship initiative for BIPOC and first-generation students. Through a scoping review of mentorship programs at schools of public health and an iterative feedback process that included faculty, students, and staff, the MOSAIC model was created. Built on the tenets of successful mentorship approaches, MOSAIC focuses on increasing equity and educational justice with a focus on professional development and academic success through faculty-to-student mentorship. The growth of MOSAIC has demonstrated it fills a critical gap for students of color and first-generation students in a school of public health. MOSAIC intends to act as a programmatic model for replication at other schools of public health to provide necessary support and mentorship for BIPOC students.
Nurselike cells sequester B cells in disorganized lymph nodes in chronic lymphocytic leukemia via alternative production of CCL21
Authors: Zaaboub Rim , Vimeux Lene , Contremoulins Vincent , Cymbalista Florence , Lévy Vincent , Donnadieu Emmanuel , Varin-Blank Nadine , Martin Antoine , Dondi Elisabetta
Published: June 2022

Tumor microenvironment exerts a critical role in sustaining homing, retention, and survival of chronic lymphocytic leukemia (CLL) cells in secondary lymphoid organs. Such conditions foster immune surveillance escape and resistance to therapies. The physiological microenvironment is rendered tumor permissive by an interplay of chemokines, chemokine receptors, and adhesion molecules as well as by direct interactions between malignant lymphocytes and stromal cells, T cells, and specialized macrophages referred to as nurselike cells (NLCs). To characterize this complex interplay, we investigated the altered architecture on CLL lymph nodes biopsies and observed a dramatic loss of tissue subcompartments and stromal cell networks as compared with nonmalignant lymph nodes. A supplemental high density of CD68+ cells expressing the homeostatic chemokine CCL21 was randomly distributed. Using an imaging flow cytometry approach, CCL21 mRNA and the corresponding protein were observed in single CD68+ NLCs differentiated in vitro from CLL peripheral blood mononuclear cells. The chemokine was sequestered at the NLC membrane, helping capture of CCR7-high-expressing CLL B cells. Inhibiting the CCL21/CCR7 interaction by blocking antibodies or using therapeutic ibrutinib altered the adhesion of leukemic cells. Our results indicate NLCs as providers of an alternative source of CCL21, taking over the physiological task of follicular reticular cells, whose network is deeply altered in CLL lymph nodes. By retaining malignant B cells, CCL21 provides a protective environment for their niching and survival, thus allowing tumor evasion and resistance to treatment. These findings argue for a specific targeting or reeducation of NLCs as a new immunotherapy strategy for this disease.
Impact of the COVID-19 outbreak on out-of-hospital cardiac arrest management and outcomes in a low-resource emergency medical service system: a perspective from Thailand
Authors: Riyapan Sattha , Chantanakomes Jirayu , Roongsaenthong Pakorn , Tianwibool Parinya , Wittayachamnankul Borwon , Supasaovapak Jirapong , Pansiritanachot Wasin
Published: June 2022

Background

The impact of the coronavirus disease 2019 (COVID-19) outbreak on out-of-hospital cardiac arrest (OHCA) has been of interest worldwide. However, evidence from low-resource emergency medical service systems is limited. This study investigated the effects of the COVID-19 outbreak on the prehospital management and outcomes of OHCA in Thailand.

Methods

This multicentered, retrospective, observational study compared the management and outcomes of OHCA for 2 periods: pre-COVID-19 (January–September 2019) and during the outbreak (January–September 2020). Study data were obtained from the Thai OHCA Network Registry. The primary outcome was survival rate to hospital discharge. Data of other OHCA outcomes and prehospital care during the two periods were also compared.

Results

The study enrolled 691 patients: 341 (49.3%) in the pre-COVID-19 period and 350 (50.7%) in the COVID-19 period. There was a significant decrease in the survival rate to discharge during the COVID-19 outbreak (7.7% vs 2.2%; adjusted odds ratio [aOR], 0.34; 95% confidence interval [CI], 0.15–0.95). However, there were no significant differences between the 2 groups in terms of their rates of sustained return of spontaneous circulation (33.0% vs 31.3%; aOR, 1.01; 95% CI, 0.68–1.49) or their survival to intensive care unit/ward admission (27.8% vs 19.8%; aOR, 0.78; 95% CI, 0.49–1.15). The first-responder response interval was significantly longer during the COVID-19 outbreak (median [interquartile range] 5.3 [3.2–9.3] min vs 10 [6–14] min; P < 0.001). There were also significant decreases in prehospital intubation (66.7% vs 48.2%; P < 0.001) and prehospital drug administration (79.5% vs 70.6%; P = 0.024) during the COVID-19 outbreak.

Conclusion

There was a significant decrease in the rate of survival to hospital discharge of patients with OHCA during the COVID-19 outbreak in Thailand. Maintaining the first responder response quality and encouraging prehospital advanced airway insertion might improve the survival rate during the COVID-19 outbreak.
Longitudinal changes in cardiac function in Duchenne muscular dystrophy population as measured by magnetic resonance imaging
Authors: Batra Abhinandan , Barnard Alison M. , Lott Donovan J. , Willcocks Rebecca J. , Forbes Sean C. , Chakraborty Saptarshi , Daniels Michael J. , Arbogast Jannik , Triplett William , Henricson Erik K. , Dayan Jonathan G. , Schmalfuss Carsten , Sweeney Lee , Byrne Barry J. , McDonald Craig M. , Vandenborne Krista , Walter Glenn A.
Published: June 2022

Background

The lack of dystrophin in cardiomyocytes in Duchenne muscular dystrophy (DMD) is associated with progressive decline in cardiac function eventually leading to death by 20–40 years of age. The aim of this prospective study was to determine rate of progressive decline in left ventricular (LV) function in Duchenne muscular dystrophy (DMD) over 5 years.

Methods

Short axis cine and grid tagged images of the LV were acquired in individuals with DMD (n = 59; age = 5.3–18.0 years) yearly, and healthy controls at baseline (n = 16, age = 6.0–18.3 years) on a 3 T MRI scanner. Grid-tagged images were analyzed for composite circumferential strain (ℇcc%) and ℇcc% in six mid LV segments. Cine images were analyzed for left ventricular ejection fraction (LVEF), LV mass (LVM), end-diastolic volume (EDV), end-systolic volume (ESV), LV atrioventricular plane displacement (LVAPD), and circumferential uniformity ratio estimate (CURE). LVM, EDV, and ESV were normalized to body surface area for a normalized index of LVM (LVMI), EDV (EDVI) and ESV (ESVI).

Results

At baseline, LV ℇcc% was significantly worse in DMD compared to controls and five of the six mid LV segments demonstrated abnormal strain in DMD. Longitudinal measurements revealed that ℇcc% consistently declined in individuals with DMD with the inferior segments being more affected. LVEF progressively declined between 3 to 5 years post baseline visit. In a multivariate analysis, the use of cardioprotective drugs trended towards positively impacting cardiac measures while loss of ambulation and baseline age were associated with negative impact. Eight out of 17 cardiac parameters reached a minimal clinically important difference with a threshold of 1/3 standard deviation.

Conclusion

The study shows a worsening of circumferential strain in dystrophic myocardium. The findings emphasize the significance of early and longitudinal assessment of cardiac function in DMD and identify early biomarkers of cardiac dysfunction to help design clinical trials to mitigate cardiac pathology. This study provides valuable non-invasive and non-contrast based natural history data of cardiac changes which can be used to design clinical trials or interpret the results of current trials aimed at mitigating the effects of decreased cardiac function in DMD.
Psychometric evaluation of the Arabic version of the 5-item Problem Areas in Diabetes (AR-PAID-5) scale
Authors: Sayed Ahmed Hazem A. , Mohamed Samar F. , Mostafa Mona , Elotla Sally Fawzy , Shah Asghar , Shah Jaffer , Fouad Ahmed Mahmoud
Published: June 2022

Background

Screening for diabetes distress is recommended when caring for patients with type 2 diabetes mellitus (T2DM) in primary healthcare (PHC). The 5-item Problem Areas in Diabetes (PAID-5) scale is widely used to measure diabetes distress, but its Arabic validation studies are scarce, so this study was carried to assess the psychometric properties of the Arabic version of the PAID-5 (AR-PAID-5) in Egyptian PHC patients with T2DM.

Methods

We conducted a cross-sectional study including 260 participants from six rural PHC settings in Ismailia governorate, Egypt. Internal consistency using Cronbach’s α and one-month test-retest reliability using intraclass correlation coefficient (ICC) were investigated. Confirmatory factor analysis (CFA) was used to evaluate the one-factor structure of the AR-PAID-5. Correlations of the AR-PAID-5 with the Arabic versions of the 20-item Problem Areas in Diabetes (PAID), Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), 5-item World Health Organization Well-Being Index (WHO-5) scales and glycated hemoglobin (HbA1c) were investigated for supporting the convergent validity. Associations of the PAID-5 with sociodemographic, and clinical characteristics were assessed for demonstrating the discriminant validity. Criterion validity was also evaluated.

Results

There was a good internal consistency (α = 0.88) and a stable test-retest reliability (ICC = 0.74). The CFA confirmed the one-factor structure of the AR-PAID-5. Significant positive correlations existed between the AR-PAID-5 with diabetes distress evaluated by the Arabic version of the PAID (rho = 0.93, p < 0.001), depressive symptoms (PHQ-9) (rho = 0.56, p < 0.001), anxiety symptoms (GAD-7) (rho = 0.47, p < 0.001), emotional well-being (WHO-5) (rho = − 0.38, p < 0.001), and HbA1c (rho = 0.16, p = 0.003). A satisfactory discriminant validity, and an acceptable criterion validity were demonstrated.

Conclusions

The AR-PAID-5 scale is a reliable and valid tool that can be used for diabetes distress screening and in research in Arabic speaking PHC patients with T2DM.
Prognosis of incompletely resected small rectal neuroendocrine tumor using endoscope without additional treatment
Authors: Cha Boram , Shin Jongbeom , Ko Weon Jin , Kwon Kye Sook , Kim Hyungkil
Published: June 2022

Background

In recent years, the incidence of rectal neuroendocrine tumors (NET)s has markedly increased due to the widespread use of screening colonoscopy. However, many patients are referred from local clinics after undergoing conventional endoscopic mucosal resection (EMR) for polyps without perceived NET, with a pathological report of incomplete resection. We evaluated the prognosis of incompletely resected small rectal NET without additional endoscopic resection for small rectal NET less than 10 mm in diameter present within the submucosal layer showing good prognosis, due to its rare metastatic potential.

Methods

We retrospectively reviewed patients from 2008 to 2018 at a single center who had had small rectal NET (located in the rectum from the anal verge to 20 cm in proximity) and had undergone ‘incomplete resection’ using endoscopy with a positive deep margin or with a very small safe deep margin (< 100 um). A small rectal NET was defined as a tumor ≤ 10 mm in diameter, without lymph node nor distant metastasis, and with low grade (G1) according to the WHO grading system.

Results

Of 267 patients who were diagnosed with small rectal NET, 77 were diagnosed with incomplete resection or possible remnant NET. Of those, 55 patients (55/77, 71.4%) were referred from local clinics post EMR diagnosed as polyps. The rate of histologically incomplete resection was highest in endoscopic submucosal dissection (11/21, 52.4%) and lowest in surgical resection (0/9, 0%), while endoscopic submucosal resection with band ligation showed an incomplete resection rate of 4.4% (5/113). After exclusion of 36 patients, namely 21 patients had undergone additional surgical (n = 6) or endoscopic (n = 15) resection and 25 patients who were lost during the follow-up period of 2 years, 31 patients had undergone surveillance with endoscopic evaluation or either a biopsy or radiological evaluation for distant metastasis during a median follow-up duration of 2 years. None of the incompletely resected small rectal NET patients showed local or distant metastasis.

Conclusion

Incomplete resection of small rectal NET with G1 grade has a good prognosis without additional treatment.
Using outbreak data to estimate the dynamic COVID-19 landscape in Eastern Africa
Authors: Wamalwa Mark , Tonnang Henri E. Z.
Published: June 2022

Background

The emergence of COVID-19 as a global pandemic presents a serious health threat to African countries and the livelihoods of its people. To mitigate the impact of this disease, intervention measures including self-isolation, schools and border closures were implemented to varying degrees of success. Moreover, there are a limited number of empirical studies on the effectiveness of non-pharmaceutical interventions (NPIs) to control COVID-19. In this study, we considered two models to inform policy decisions about pandemic planning and the implementation of NPIs based on case-death-recovery counts.

Methods

We applied an extended susceptible-infected-removed (eSIR) model, incorporating quarantine, antibody and vaccination compartments, to time series data in order to assess the transmission dynamics of COVID-19. Additionally, we adopted the susceptible-exposed-infectious-recovered (SEIR) model to investigate the robustness of the eSIR model based on case-death-recovery counts and the reproductive number (R0). The prediction accuracy was assessed using the root mean square error and mean absolute error. Moreover, parameter sensitivity analysis was performed by fixing initial parameters in the SEIR model and then estimating R0, β and γ.

Results

We observed an exponential trend of the number of active cases of COVID-19 since March 02 2020, with the pandemic peak occurring around August 2021. The estimated mean R0 values ranged from 1.32 (95% CI, 1.17–1.49) in Rwanda to 8.52 (95% CI: 3.73–14.10) in Kenya. The predicted case counts by January 16/2022 in Burundi, Ethiopia, Kenya, Rwanda, South Sudan, Tanzania and Uganda were 115,505; 7,072,584; 18,248,566; 410,599; 386,020; 107,265, and 3,145,602 respectively. We show that the low apparent morbidity and mortality observed in EACs, is likely biased by underestimation of the infected and mortality cases.

Conclusion

The current NPIs can delay the pandemic pea and effectively reduce further spread of COVID-19 and should therefore be strengthened. The observed reduction in R0 is consistent with the interventions implemented in EACs, in particular, lockdowns and roll-out of vaccination programmes. Future work should account for the negative impact of the interventions on the economy and food systems.