bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting Soil Cation Exchange Capacity in Entisols with Divergent Textural Classes: The Case of Northern Sudan Soils
Authors: Adam Mutwakil , Ibrahim Ibrahim , Sulieman Magboul , Zeraatpisheh Mojtaba , Mishra Gaurav , Brevik Eric C.
Published: November 2021

Cation exchange capacity (CEC) is an important soil property because it affects the assimilation of nutrients and buffers against soil acidification. Thus, knowledge of CEC is considered key to developing agricultural and environmental models for land management planning. However, in developing countries such as Sudan, there is a lack of soil CEC data due to the absence of research projects and funding to develop this information. Therefore, this research was conducted to predict CEC for large areas using specific soil physical characteristics, including soil texture and saturation percentage (SP), for which there is potentially available data. To achieve this goal, the properties of 430 soil samples (301 for training and 129 for validation) were obtained from the soil database of the Soil Survey Administration, Ministry of Agriculture, Sudan, which had different soil depth intervals (0–0.3 m, 0.3–0.6 m, 0.6–0.9 m, 0.9–1.5 m, and >1.5 m) from Entisols in the Northern State of Sudan. The data were stratified into homogeneous groups based on the textural classes of the main soil order. Then, regression models were performed and evaluated using the coefficient of determination ( R2), standard error of the estimate (SEE), and root mean square error (RMSE). The results indicated that in individual Entisols and textural classes, the combined soil covariates silt, clay, and SP were the best properties to predict CEC values ( R2 ranged from 0.86 to 0.99). The regression models did not provide statistically significant results for the silty clay loam textural class ( R2 ranged from 0.01 and 0.35). The findings of this modeling study could be applied to other Entisols worldwide with divergent textural classes, which could be used to verify the suggested CEC pedotransfer functions and/or improve them. This would help farmers correctly design soil management plans and prevent acidification issues if combined with other soil properties data.
Combination of musculoskeletal and wear models to investigate the effect of daily living activities on wear of hip prostheses
Authors: Mattei Lorenza , Tomasi Matilde , Artoni Alessio , Ciulli Enrico , Di Puccio Francesca
Published: November 2021

Abstract

Numerical wear predictions are gaining increasing interest in many engineering applications, as they allow to simulate complex operative conditions not easily replicable in the laboratory. As far as hip prostheses are concerned, most of the wear models in the literature are based on the simulation of gait (recommended also in experimental wear tests), since gait is considered the most frequent and important motor task to recover after arthroplasty. However, since joint prostheses have been increasingly implanted in younger people, high loads and potentially severe conditions, e.g. due to sporting activities, should also be considered for a more reliable wear assessment of these implants. In this study, we propose a profitable combination of musculoskeletal and analytical wear modelling for the prediction of wear caused by common daily activities in metal-on-plastic hip arthroplasties. Several motion analysis data available in the literature (walking, fast walking, lunge, squat, stair negotiation) were selected and the effects of such motor tasks on prosthesis wear were investigated, both separately and in combination. Additionally, for comparative purposes, wear prediction for simplified gait conditions prescribed by the ISO 14242 standard, were also considered. Results suggest that this latter case produces lower wear depth and volume with respect to a relatively demanding combination of the selected daily activities. The preliminary results of the present study represent a first step towards the auspicious goal of validating the proposed procedure for in silico trials of hip arthroplasties.
Public health, surveillance policies and actions to prevent community spread of COVID-19 in Denmark, Serbia and Sweden
Authors: Andersen Pernille Tanggaard , Loncarevic Natasa , Damgaard Maria Busk , Jacobsen Mette Winge , Bassioni-Stamenic Farida , Eklund Karlsson Leena
Published: November 2021

Aim: This study investigates the non-medical public health and surveillance policies and actions for tackling the community spread of COVID-19 pandemic in Denmark, Serbia and Sweden during the first five months of the pandemic in 2020. Method: The study is inspired by a process-tracing design for case study with a focus on the non-medical measures and surveillance strategies implemented by the three countries. The comprehensive collection and study of national documents formed the basis of the document analysis. Results: The Danish strategy was to prolong the transmission period, preventing high numbers of infected cases from impacting their healthcare capacity. The government’s strategy was characterized by strict governance elements, health guidelines and behavioural recommendations. In Serbia, the main strategy was to prevent the spread and control of the infectious disease by shifting all human and material resources towards the function of controlling the spread. Serbia applied the strictest measures in the fight against coronavirus in relation to other countries in the region and in Europe. The Swedish strategy focused more on recommendations than requirements to motivate the public to modify their behaviours voluntarily. Sweden’s loose pandemic strategy implementation focused on voluntary and stepwise action rather than legislation and compulsory measures. Conclusions: The public health policies and actions implemented to prevent community spread of COVID-19 in Denmark, Serbia and Sweden varied during the first five months of the pandemic. The differences in their response were due to delays in implementation, inconsistencies in perspectives towards the outbreak and the capacity of each country in terms of their pandemic preparedness and response.
Indonesian street children's negotiation of play
Authors: Adriany Vina , Aprilianti Lia , Kurniati Euis
Published: November 2021

Street children are often constructed as fragile individuals who lose their innocent childhood since they have to work and do not have the opportunity to play like most of their peers. Using Bourdieu's concept of field, capital and habitus, this article seeks to go beyond the existing notion of play by exploring how street children in Bandung, Indonesia, understand and negotiate play with working as part of their everyday lives. The authors took an ethnographic approach to collect data from 14 street children and their guardians, mainly through observation and ongoing conversation. The findings suggest that the children are able not only to navigate the meaning of play, but also to negotiate their social position with adults on the street. This article serves as an invitation for educators and policymakers to develop educational programmes that are sensitive to multiple meanings of play, children and childhood.
Educating to belong: Policy and practice of mother-tongue instruction for migrant students in the Danish welfare state
Authors: Li Jin Hui , Enemark Nanna Ramsing
Published: November 2021

This article explores how the development of mother-tongue instruction (MTI) policies in the Danish welfare state have created varying notions of difference and sameness in the schooling of migrant students and how they experience these notions locally in practice. Based on an analysis of MTI’s policy history and oral history interviews with former migrant students, we analyse MTI policy development within the Danish welfare state as a primary case and discusses whether these developments seem to be unique to the Danish welfare state by considering (West) Germany, the Netherlands and Sweden as a comparative perspective. Noting the paradoxes and dynamics of the welfare-state policy of ‘school for all under one roof’ at the intersections between the policy and practice level, we posit that migrant students are regulated as a homogeneous group that is expected to be ‘the same’ but is simultaneously considered to be ‘different’ from other, majority students. The findings thus reveal the paradox of welfare-state education policies and practice: while macro scale policy for migrant education aims to emphasise difference through MTI, the social consequences at the micro level show the opposite; namely, that MTI produces feelings of sameness and belonging among migrant students.
A review of through-knee amputation
Authors: Panhelleux Brieuc , Shalhoub Joseph , Silverman Anne K , McGregor Alison H
Published: November 2021

Objectives

Through-knee amputation is an umbrella term for several different surgical techniques, which may affect clinical and functional outcomes. This makes it hard to evaluate the benefits and need for a through-knee amputation approach. This article seeks to (1) determine the number of through-knee amputation performed compared with other major lower limb amputations in England over the past decade; (2) identify the theoretical concepts behind through-knee amputation surgical approaches and their potential effect on functional and clinical outcomes and (3) provide a platform for discussion and research on through-knee amputation and surgical outcomes.

Methods

National Health Service Hospital Episodes Statistics were used to obtain recent numbers of major lower limb amputations in England. EMBASE and MEDLINE were searched using a systematic approach with predefined criteria for relevant literature on through-knee amputation surgery.

Results

In the past decade, 4.6% of major lower limb amputations in England were through-knee amputations. Twenty-six articles presenting through-knee amputation surgical techniques met our criteria. These articles detailed three through-knee amputation surgical techniques: the classical approach, which keeps the femur intact and retains the patella; the Mazet technique, which shaves the femoral condyles into a box shape and the Gritti-Stokes technique, which divides the femur proximal to the level of the condyles and attaches the patella at the distal cut femur.

Conclusions

Through-knee amputation has persisted as a surgical approach over the past decade, with three core approaches identified. Studies reporting clinical, functional and biomechanical outcomes of through-knee amputation frequently fail to distinguish between the three distinct and differing approaches, making direct comparisons difficult. Future studies that compare through-knee amputation approaches to one another and to other amputation levels are needed.
Ways of making: Artistic practice which works co-collaboratively, ethically and which celebrates and extends the conversation of what it means to live well with HIV
Authors: Low Katharine E.
Published: November 2021

This letter is the start of a dialogue about ways of making theatre cocollaboratively with women living with HIV. It offers a series of ideas of what I believe constitutes engaging and ethical practice specifically in the field of working co-collaboratively with women living well with HIV, and what is important to do, as well as what the basic non-negotiables are in establishing such a practice.
Determinants of maternal near-miss in private hospitals in eastern Ethiopia: A nested case–control study
Authors: Geze Tenaw Shegaw , Girma Fage Sagni , Assefa Nega , Kenay Tura Abera
Published: November 2021

Objective:

Maternal near-miss refers to a woman who nearly died but survived complications in pregnancy, childbirth, or within 42 days of termination of pregnancy. The study of maternal near-miss has become essential for improving the quality of obstetric care. The objective of this study was to identify the determinants of maternal near-miss among women admitted to major private hospitals in eastern Ethiopia.

Method:

An unmatched nested case–control study was conducted in major private hospitals in eastern Ethiopia from 5 March to 31 March 2020. Cases were women who fulfilled the sub-Saharan African maternal near-miss criteria and those admitted to the same hospitals but discharged without any complications under the sub-Saharan African maternal near-miss tool were controls. For each case, three corresponding women were randomly selected as controls. Factors associated with maternal near-misses were analyzed using binary and multiple logistic regressions with an adjusted odds ratio along with a 95% confidence interval. Finally, p-value < 0.05 was considered as a cut-off point for the significant association.

Results:

A total of 432 women (108 cases and 324 controls) participated in the study. History of prior cesarean section (AOR = 4.33; 95% CI = 2.36–7.94), anemia in index pregnancy (AOR = 4.38; 95% CI = 2.43–7.91), being ⩾ 35 years of age (AOR = 2.94; 95% CI = 1.37–6.24), not attending antenatal care (AOR = 3.11; 95% CI = 1.43–6.78), and history of chronic medical disorders (AOR = 2.18; 95% CI = 1.03–4.59) were independently associated with maternal near-miss.

Conclusion:

Maternal age ⩾ 35 years, had no antenatal care, had prior cesarean section, being anemic in index pregnancy, and have history of chronic medical disorders were the determinants of maternal near-miss. Improving maternal near-misses requires strengthening antenatal care (including supplementation of iron and folic acid to reduce anemia) and prioritizing women with a history of chronic medical illnesses. Interventions for preventing primary cesarean sections are crucial in this era of the cesarean epidemic to minimize its effect on maternal near-miss.
Do cognitive load and ADHD traits affect the tendency to prioritise social information in scenes?
Authors: Priscilla Martinez-Cedillo Astrid , Dent Kevin , Foulsham Tom
Published: November 2021

We report two experiments investigating the effect of working memory (WM) load on selective attention. Experiment 1 was a modified version of Lavie et al. and confirmed that increasing memory load disrupted performance in the classic flanker task. Experiment 2 used the same manipulation of WM load to probe attention during the viewing of complex scenes while also investigating individual differences in attention deficit hyperactivity disorder (ADHD) traits. In the image-viewing task, we measured the degree to which fixations targeted each of two crucial objects: (1) a social object (a person in the scene) and (2) a non-social object of higher or lower physical salience. We compared the extent to which increasing WM load would change the pattern of viewing of the physically salient and socially salient objects. If attending to the social item requires greater default voluntary top-down resources, then the viewing of social objects should show stronger modulation by WM load compared with viewing of physically salient objects. The results showed that the social object was fixated to a greater degree than the other object (regardless of physical salience). Increased salience drew fixations away from the background leading to slightly increased fixations on the non-social object, without changing fixations on the social object. Increased levels of ADHD-like traits were associated with fewer fixations on the social object, but only in the high-salient, low-load condition. Importantly, WM load did not affect the number of fixations on the social object. Such findings suggest rather surprisingly that attending to a social area in complex stimuli is not dependent on the availability of voluntary top-down resources.
Massive haemorrhage: an unusual presentation of systemic lupus erythematosus
Authors: Qayyum Wajeeha , Khan Sohail , Iqbal Muhammad Shahid , Khan Muhammad Fozan , Yousafzai Zaland Ahmed , Afaq Saima
Published: November 2021

Summary

Systemic lupus erythematosus (SLE) usually affects young females and its presentation with haemorrhage is unusual. Intracerebral bleed (ICB) has been described in a few case reports, but massive haematuria has not been reported in the literature so far. Here, we present a case of a 56 year-old-lady who presented with expanding lobar bleed and massive haematuria as the first presentation of SLE secondary to vasculitis. Lupus vasculitis usually presents with thrombosis-related complications and although bleeding in this context is rare, it can lead to catastrophic consequences. Hence, vasculitis-related bleeding should be taken under consideration in a challenging situation like ours.
Cross-Modal Associations Between Harmonic Dissonance and Visual Roughness
Authors: Giannos Konstantinos , Athanasopoulos George , Cambouropoulos Emilios
Published: November 2021

Visual associations with auditory stimuli have been the subject of numerous studies. Colour, shape, size, and several other parameters have been linked to musical elements like timbre and pitch. In this article, we aim to examine the relationship between harmonisations with varying degrees of dissonance and visual roughness. Based on past research in which high sensory dissonance was associated with angular shapes, we argued that nontonal and highly dissonant harmonisations will be associated with angular and rough images, while more consonant stimuli will be associated with the images of low visual roughness. A fixed melody was harmonised in 7 different styles, including highly tonal, nontonal, and random variations. Through a listening task, musically trained participants rated the stimuli in terms of enjoyment, familiarity, and matched them to images of variable roughness. The overall consonance of the stimuli was calculated using two distinct models (Harrison & Pearce, 2020; Wang et al., 2013 ) and a variant of the aggregate dyadic consonance index ( Huron, 1994 ). Our results demonstrate that dissonance, as calculated by all models, was highly correlated with visual roughness, and enjoyment and familiarity followed expected patterns compared to tonal and nontonal stimuli. In addition to sensory dissonance, however, it appears that other factors, such as the typicality of chord progressions and the sense of tonality may also influence this cross-modal interaction.
Radiofrequency Energy-Assisted Wire Atrial Septostomy to Easily Create a Large Atrial Septal Defect
Authors: Nishibata Masahiro , Kitano Masataka , Sato Seiich
Published: November 2021

Wire atrial septostomy, a new transcatheter technique, combines 2 atrial septal defects (ASDs) into a large one in a thickened atrial septum. Although the thin-wire-looped atrial septum between ASDs needs to be pulled deeply into a hard catheter to tear the septum, this action might harm the surrounding cardiac structures. We utilized radiofrequency wire energy to facilitate the tearing of the septum, making the procedure easier and safer. This technical article presents the modified procedure in detail; the procedure was performed in a 6-month-old boy with double outlet right ventricle and intact ventricular septum.

Mini-abstract

This technical article describes modified wire atrial septostomy for thickened atrial septum in detail. Radiofrequency energy facilitated a thin wire-loop in tearing the septum between 2 atrial septal defects to combine the defects into a large one. We believe that this transcatheter procedure is easier and safer than the original one not using a radiofrequency wire energy.
Early Right Heart Chambers Reverse Remodeling in Patients Operated in Adulthood for Congenital Lesions Associated with Right Heart Chambers Enlargement
Authors: Panaioli Elena , Graziani Francesca , Lillo Rosa , Delogu Angelica Bibiana , Grandinetti Maria , Di Molfetta Arianna , Perri Gianluigi , Pasquini Annalisa , Colizzi Christian , Lombardo Antonella , Locorotondo Gabriella , Amodeo Antonio , Secinaro Aurelio , Bruno Piergiorgio , Lanza Gaetano Antonio , Massetti Massimo
Published: November 2021

Background

Progressive right heart chambers dilatation is frequent in the adult congenital heart disease (ACHD) population. We evaluated the immediate and mid-term response of right heart chambers to surgery performed in adulthood for lesions associated with right heart chambers enlargement.

Methods

Thirty-six adult patients with lesions associated with right heart chambers enlargement submitted to surgery were studied . We collected echocardiographic data of right ventricle (RV) mid-diameter, right atrial volume indexed, RV systolic pressure, and tricuspid annular plane systolic excursion (TAPSE) prior to surgery (T0), at 2 to 5 days (T1), and 3 to 6 months (T2) after surgery.

Results

At T1, we observed a significant decrease of RV mid-diameter (47.2 ± 8.4 vs. 39.6 ± 7.4 mm, P < .001), right atrial volume indexed (45.6 ± 26.6 vs. 27.2 ± 11 ml/m2, P < .001), and RV systolic pressure (39 ± 14.8 vs. 32.8 ± 11.3 mm Hg, P = .03). At T2, a further significant deviation in the rate of RV diameter (39.6 ± 7.4 vs. 34.5 ± 5.1 mm, P < .001), in RV systolic pressure (32.8 ± 11.3 vs. 25.3 ± 5 mm Hg, P = .03) and TAPSE (13.9 ± 3.2 vs. 15.8 ± 2.6 mm, P < .001) was observed.

Conclusions

Positive right heart chambers remodeling occurs as early as in the immediate post-operative period in most ACHD patients operated for lesions associated with right heart chambers enlargement.
Systemic Semilunar Valve Repair/Replacement With Fontan Circulation: The Mayo Clinic Experience
Authors: Graham Gabriel , Phillips Amanda L. , Stephens Elizabeth H. , Niaz Talha , Dearani Joseph A. , O’Leary Patrick W. , Cetta Frank
Published: November 2021

Background: There is a paucity of literature regarding systemic semilunar valve (SSLV) dysfunction in patients with Fontan circulation. We sought to describe our center's 47-year experience with systemic semilunar valve replacement or repair (SSLVR) in patients with Fontan circulation. Methods: The Mayo Clinic Fontan Database is a comprehensive institutional database that stores clinical information of 1176 patients from 1973 to 2021. It was reviewed to identify patients who had a SSLV intervention at the time of or after Fontan. A cohort of 15 patients was identified and a retrospective review of their records was performed. Results: Fourteen patients had SSLV replacement (all mechanical) and one had a repair. SSLVR occurred up to 29 years following the Fontan (mean 11.3 ± 9 years, median 14 years). Thirteen of 14 with SSLVR were performed after Fontan and one was done at the time of initial Fontan. This was an older cohort and mean age at the time of Fontan was 8.7 ± 9.4 years (median 4 years). Indication for the operation was > moderate SSLV regurgitation in all patients. Six patients had decreased ventricular function (EF < 50%) prior to SSLVR and 8 had reduced function after SSLVR. Conclusion: Fortunately, the need for SSLV intervention after Fontan was rare, as evidenced by our small cohort extracted from a large single-institution database spanning a 47-year time period. Reduced preoperative and postoperative ejection fraction was common but did not seem to impact the outcome. Optimal timing for SSLV intervention after Fontan remains unclear.
Stage-1 Hybrid Palliation for High-Risk 2-Ventricle Patients with Ductal-Dependent Systemic Circulation in the Era of High Prenatal Detection
Authors: Evans William N. , Acherman Ruben J. , Ciccolo Michael L. , Lehoux Juan , Galindo Alvaro , Rothman Abraham , Mayman Gary A. , Restrepo Humberto
Published: November 2021

Objective

We reviewed our center's prenatal detection and surgical experience with high-risk, 2-ventricle patients, with complex congenital heart disease that underwent stage-1 hybrid palliation.

Methods

We retrospectively identified those born between March 2008 and March 2021 with 2-ventricle hearts, complex congenital cardiovascular malformations, and ductal-dependent systemic circulation that underwent stage-1 hybrid palliation consisting of surgical bilateral pulmonary artery banding and interventional catheterization placed ductus arteriosus stents.

Results

We identified 30 patients. Of the 30, 19 (63%) were male. For the 30, median gestational age was 35 weeks (29-39 weeks), and median birth weight was 2.2 kg (0.6-4.5 kg). Of the 30, 1 was transferred from an adjacent state, and 29 were born in Nevada. Of the 29 born in Nevada, overall statewide prenatal detection was 18 of 29 (62%); however, for 2008 to 2011 the prenatal detection rate was 3 of 10 (30%) and 15 of 19 (79%) for 2012 to 2021, P = .03. For the last 5 years, prenatal detection for Nevada-born patients was 8 of 8 (100%). Two full-term newborns, without a prenatal diagnosis, presented postnatally in extremis. For the 30 patients, there were 0 stage-1 hybrid palliation mortalities, 1 subsequent repair mortality, and 3 late nonsurgical deaths.

Conclusions

Stage-1 hybrid palliation may result in excellent surgical outcomes for high-risk, 2-ventricle patients. Additionally, high rates of population-wide prenatal detection are possible for high-risk congenital heart disease, allowing prenatal planning and possibly reducing postnatal extremis presentations.
Beyond Hip Fractures: Other Fragility Fractures’ Associated Mortality, Functional and Economic Importance: A 2-year-Follow-up.
Authors: Wiedl Andreas , Förch Stefan , Otto Alexander , Lisitano Leonard , Rau Kim , Nachbaur Thilo , Mayr Edgar
Published: November 2021

Background

Hip fractures are well researched in orthogeriatric literature. Equivalent investigations for fragility-associated periprosthetic and periosteosynthetic femoral, ankle joint, pelvic ring, and rib fractures are still rare. The purpose of this study was to evaluate mortality, functional outcome, and socioeconomic parameters associated to the upper-mentioned fragility fractures prospectively in a 2-year follow-up.

Methods

Over the course of a year, all periprosthetic and periosteosynthetic femoral fractures (PPFF), ankle joint fractures (AJ), pelvic ring fractures (PR), and rib fractures (RF), that were treated on a co-managed orthogeriatric ward, were assessed. Parker Mobility Score (PMS), Barthel Index (BI), place of residence, and care level were recorded. After 2 years, patients and/or relatives were contacted by mailed questionnaires or phone calls in order to calculate mortality and reevaluate the mentioned parameters.

Results

Follow-up rate was 77.7%, assessing 87 patients overall. The relative mortality risk was significantly increased for PR (2.9 (95% CI: 1.5–5.4)) and PPFF (3.5 (95% CI: 1.2–5.8)) but not for RF (1.5 (95% CI: 0.4–2.6)) and AJ (2.0 (95% CI: 0.0–4.0)). Every fracture group except AJ showed significantly higher BI on average at follow-up. PMS was, respectively, reduced on average for PR and RF insignificantly, but significantly for PPFF and AJ in comparison to pre-hospital values. 10.0–27.3% (each group) of patients had to leave their homes permanently; care levels were raised in 30.0–61.5% of cases.

Discussion

This investigation provides a perspective for further larger examinations. PR and PPFF correlate with significant increased mortality risk. Patients suffering from PPFF, PR, and RF were able to significantly recover in their activities of daily living. AJ and PPFF conclude in significant reduction of PMS after 2 years.

Conclusion

Any fragility fracture has its impact on mortality, function, and socioeconomic aspects and shall not be underestimated. Despite some fractures not being the most common, they are still present in daily practice.
Bourdieu and the Quest for Intercultural Transformations
Authors: Pöllmann Andreas
Published: November 2021

Building and expanding on Bourdieu’s notions of cultural capital, habitus, and field, this conceptual article aims to contribute to a better understanding of intercultural transformations. Distancing itself from essentialist reductionism in the analysis of cultures, it associates intercultural transformations with habitus crises through “culture shock,” with the realization of intercultural capital, and with changes in the scope and configuration of cultural pluriformity. In going beyond Bourdieu without abandoning him along the way, the approach outlined in the course of this article combines a range of conceptual tools which may prove to be useful in sustaining struggles for social justice in educational institutions and in society at large.
Testing the Effectiveness of Retrieval-Based Learning in Naturalistic School Settings
Authors: Ortega-Tudela Juana M. , Lechuga María-Teresa , Bermúdez-Sierra Miriam , Gómez-Ariza Carlos J.
Published: November 2021

While the learning benefits of retrieval activities have been clearly demonstrated in laboratory settings, evidence on their usefulness in naturalistic school settings is still scant. The goal of the present studies was to investigate the feasibility and effectiveness of retrieval-based learning in children (fourth and sixth grades) when school teachers themselves design and implement retrieval activities relating to genuine curriculum contents. Three studies were conducted in a public elementary school with fourth and sixth graders and their teachers. Two of the studies involved mathematics and one dealt with social sciences. Teachers used learning activities that required students to recall part of previously taught concepts, while different concepts in the same unit were worked through with those learning activities that were normally used by each teacher. Two out of three studies revealed that, relative to business-as-usual learning activities, performing retrieval activities during classes led to better performance in the assessments at the end of the lessons. Overall, our finding provides preliminary evidence that retrieval activities can enhance learning in elementary school children when they are devised by teachers in the exercise of their professional duties. These results have important practical implications and suggest that, if teachers are aware of the value of retrieval activities in fostering meaningful learning, these activities could be successfully embedded in their daily duties even when considering the constraints imposed by school reality.
Beyond Professional Licensure: A Statement of Principle on Culturally-Responsive Healthcare
Authors: Ijaz Nadine , Steinberg Michelle , Flaherty Tami , Neubauer Tania , Thompson-Lastad Ariana
Published: November 2021

This work calls on healthcare institutions and organizations to move toward inclusive recognition and representation of healthcare practitioners whose credibility is established both inside and outside of professional licensure mechanisms. Despite professional licensure’s advantages, this credentialing mechanism has in many cases served to reinforce unjust sociocultural power relations in relation to ethnicity and race, class and gender. To foster health equity and the delivery of culturally-responsive care, it is essential that mechanisms other than licensure be recognized as legitimate pathways for community accountability, safety and quality assurance. Such mechanisms include certification with non-statutory occupational bodies, as well as community-based recognition pathways such as those engaged for Community Health Workers (including Promotores de Salud) and Indigenous healing practitioners. Implementation of this vision will require interdisciplinary dialogue and reconciliation, constructive collaboration, and shared decision making between healthcare institutions and organizations, practitioners and the communities they serve.
Study of hydrocellular functional material as microbicidal wound dressing for diabetic wound healing
Authors: Rodrigues Michael , Govindharajan Thilagavati
Published: November 2021

A hydrocellular functional material as a wound dressing is developed and it is found to be superior in its efficacy as compared to some of the comparator controls in diabetic wound healing studies. A study on wound contraction and Histopathological analysis is done in rats. The efficacy of the dressing is comparable to the established wound dressings like Carboxymethyl cellulose alginate dressings and autolytic enzyme based hydrogel. It is found to be superior to Polyhexamethylene biguanide dressing used as reference controls in this study.

The reason for good wound healing performance of the dressing can be attributed to a combined property of effective exudates management and broad spectrum antimicrobial effect. The concept of functional hydro cellular material has shown good results due to the excellent balance of exudates pickup and drying it out. This ensures moist wound healing conditions on the wound. Because of its porous nature it allows good air flow and gaseous exchange in the structure.

The cationic sites created on the surface of the dressing ensure a good antimicrobial action on the exudates in the dressing. It reduces the infection load on the wound. The nonleaching property of the dressing also helps in preventing the generation of more resistant and mutant strains of the microbes.

The developed dressing can be used as a relatively durable long lasting dressing for wound management in diabetic wounds. The need of repetitive wound dressing changes can be brought down with this concept of dressing. It is not only cost effective in terms of its material cost but also is a cost effective solution when entire wound management cost is considered. Such novel wound dressing material can change the quality of life of diabetic wound patients especially in developing world, where access to functional advanced wound care dressings is limited.
Equilibrium in Competitive Insurance Markets with Medical Tourism
Authors: Shi Xinyan , Gan Lydia
Published: November 2021

In recent years, the rising healthcare costs in the United States have led many citizens to travel outside the country for medical care. Although such practice, commonly known as ‘medical tourism’, has become more and more popular, many insurance companies hesitate to incorporate a medical tourism option into insurance contracts. In this article, we wish to understand the theoretical rationale of that by designing an insurance contract in an environment where medical tourism is available. One crucial characteristic that influences consumers’ decision on whether to choose medical tourism is their tolerance levels associated with unexpected costs when travelling abroad for healthcare. In this article, we wish to investigate how the individuals with preference heterogeneity would self-select between the options of domestic treatment and treatment abroad offered in the contract. The results suggest that when the healthcare costs from both the treatment abroad and the domestic treatment are high and/or there is a higher chance of needing an elective treatment for the individual, insurance companies will more likely incorporate medical tourism in the contract.

JEL Classification: C73, I13, D82, D86
Dural Follicular Lymphoma: Case Report and Literature Review
Authors: Altshuler Ellery , Richhart Raymond , Iqbal Umar , Chaffin Joanna
Published: November 2021

Follicular lymphoma (FL) usually has an indolent course and presents with painless, waxing and waning lymphadenopathy in the absence of systemic symptoms. It is uncommon for FL to present outside of lymph nodes, although it can develop in the gastrointestinal tract, skin, thyroid, and testes. Central nervous system (CNS) involvement in FL is rare. Most CNS lymphomas are diffuse large B-cell lymphoma, although Burkitt lymphoma, lymphoblastic lymphoma, and peripheral T-cell lymphoma are also observed. These tumors usually involve white matter but may also involve gray matter. Lymphomas of the dura are very uncommon and are usually mucosa-associated lymphoid tissue lymphomas. Here, we present a case of FL of the dura arising in a 62-year-old woman that was responsive to chemotherapy. According to a literature review, there have been 15 previously reported cases of FL of the dura. Dural FL has been most frequently treated with radiation and chemotherapy. Patients were still alive in all cases in which follow-up was reported. Although the sample size is small, these data suggest that dural FL, like other forms of FL, is an indolent disease that is associated with prolonged survival despite usually being incurable.
A Rare Case of Restrictive Cardiomyopathy Presenting With Large, Recurrent Pericardial Effusions
Authors: Cordova Sanchez Andres , Nealy Zachariah , Azhar Atika , Banerjee Sanchari , Bisen Maneesh , Kozman Hani
Published: November 2021

The association between large pericardial effusion and restrictive cardiomyopathy (RCM) is uncommon and has seldom been described. We describe an uncommon case of a 31-year-old male with RCM who presented with large, recurrent pericardial effusion, heart failure, and echocardiographic findings showing progressive worsening of diastolic function even after total pericardiectomy who was eventually transferred for cardiac transplant evaluation.
A Case of Pseudoprogression in Hepatocellular Carcinoma Treated With Atezolizumab Plus Bevacizumab
Authors: Watanabe Yukinobu , Ogawa Masahiro , Tamura Yu , Suda Seiichiro , Kaneko Masahiro , Kumagawa Mariko , Hirayama Midori , Matsumoto Naoki , Yamamoto Toshiki , Moriyama Mitsuhiko
Published: November 2021

A 74-year-old man was diagnosed with hepatocellular carcinoma. The tumor in the liver showed a complete response after transcatheter arterial chemoembolization, but lung, bone, and lymph node metastases were observed, so treatment with atezolizumab plus bevacizumab was initiated. After administration, the scans showed tumor growth, but after continuous administration of atezolizumab plus bevacizumab, the tumors finally reduced in size and showed a partial response. The transient growth of the tumors was considered to be pseudoprogression. Herein, we report a case of pseudoprogression in hepatocellular carcinoma treated with atezolizumab plus bevacizumab.
Resource Allocation in a National Dental Service Using Program Budgeting Marginal Analysis
Authors: Vernazza C.R. , Carr K. , Holmes R.D. , Wildman J. , Gray J. , Exley C. , Smith R.A. , Donaldson C.
Published: November 2021

Introduction:

In any health system, choices must be made about the allocation of resources (budget), which are often scarce. Economics has defined frameworks to aid resource allocation, and program budgeting marginal analysis (PBMA) is one such framework. In principle, patient and public values can be incorporated into these frameworks, using techniques such as willingness to pay (WTP). However, this has not been done before, and few formal resource allocation processes have been undertaken in dentistry. This study aimed to undertake a PBMA with embedded WTP values in a national dental setting.

Methods:

The PBMA process was undertaken by a panel of participant-researchers representing commissioners, dentists, dental public health staff, and academics. The panel reviewed current allocations and generated a set of weighted criteria to evaluate services against. Services to be considered for removal and investment were determined by the panel and wider discussion and then scored against the criteria. Values from a nationally representative WTP survey of the public contributed to the scores for interventions. Final decisions on removal and investment were taken after panel discussion using individual anonymous electronic voting.

Results:

The PBMA process resulted in recommendations to invest in new program components to improve access to general dentists, care home dentistry, and extra support for dental public health input into local government decisions. Disinvestments were recommended in orthodontics and to remove routine scaling and polishing of teeth.

Discussion:

The PBMA process was successful in raising awareness of resource allocation issues. Implementation of findings will depend on the ability of decision makers to find ways of operationalizing the decisions. The process illustrates practical aspects of the process that future dental PBMAs could learn from.

Knowledge Transfer Statement:

This study illustrates a framework for resource allocation in dental health services and will aid decision makers in implementing their own resource allocation systems.
Is Medical Tourism Really Unethical? An Alternate Perspective for Developing Countries
Authors: Chaudhry Divya
Published: November 2021

This article makes a case for leveraging medical tourism (MT) from the perspective of improving healthcare access in developing countries. The expansion of MT at an unprecedented rate has given rise to a number of ethical concerns in both home and destination countries. Ethical debates in this field have transcended the realm of global public health and have emerged across various disciplines including development, social justice, legal, trade and policy studies. Much of the academic literature in these domains has categorically held MT responsible for commodification of healthcare, creating a duality in healthcare systems of developing countries and making healthcare inaccessible and unaffordable for the disadvantaged sections of the population.

While all these claims normatively seem justified, this article asserts that despite the several ethical concerns that have been raised, MT may not necessarily exacerbate healthcare equity issues in developing countries. In fact, MT may benefit destination countries by creating a highly specialised private sector which may provide services not only to foreign patients but also to wealthier domestic patients. Voluntary opting-out of domestic patients from public healthcare will result in decongestion of public healthcare facilities, which in turn could be accessed to a greater extent by the underprivileged population at affordable cost. In addition to contributing to the limited academic literature on this particular aspect of MT, this article presents an alternate view to promote MT in developing countries from the perspective of addressing challenges related to healthcare access.
Clonal hematopoiesis is associated with increased risk of progression of asymptomatic Waldenström macroglobulinemia
Authors: Tahri Sabrin , Mouhieddine Tarek H. , Redd Robert , Lampe Luisa , Nilsson Katarina I. , El-Khoury Habib , Su Nang Kham , Nassar Amin H. , Adib Elio , Bindra Govind , Abou Alaiwi Sarah , Trippa Lorenzo , Steensma David P. , Castillo Jorge J. , Treon Steven P. , Ghobrial Irene M. , Sperling Adam S.
Published: November 2021

Clonal hematopoiesis (CH) is associated with adverse outcomes in patients with non-Hodgkin lymphoma (NHL) and multiple myeloma undergoing autologous stem cell transplantation. Still, its implications for patients with indolent NHL have not been well studied. We report the prevalence of CH in patients with Waldenström macroglobulinemia (WM) and its association with clinical outcomes. To unambiguously differentiate CH mutations from those in the WM clone, CH was defined by the presence of somatic mutations in DNMT3A, TET2, or ASXL1 (DTA) and was detected in 14% of 587 patients with IgM monoclonal gammopathy of undetermined significance (MGUS), smoldering WM (SWM) or WM. The presence and size of DTA clones were associated with older age. Patients with CH had an increased risk of progression from MGUS or SWM to WM, but not worse overall survival in this cohort. These findings further illuminate the clinical effects of CH in patients with indolent NHL such as WM.
The effects of preoperative intestinal dysbacteriosis on postoperative recovery in colorectal cancer surgery: a prospective cohort study
Authors: Liu Yuwei , He Wanbin , Yang Jie , He Yuhua , Wang Ziqiang , Li Ka
Published: November 2021

Background

Accumulating evidence suggests a critical role of intestinal dysbacteriosis in surgical site infections and anastomotic leakage after abdominal surgery. However, a direct correlation between pre-existing dysbacteriosis and postoperative infectious complications has not yet been established clinically.

Methods

A total of 353 consecutive patients who underwent colorectal cancer (CRC) surgery were enrolled. Gram-stained faecal smears were tested at admission and the first defecation after surgery. Intestinal dysbacteriosis was graded into three groups: normal or slightly decreased intestinal microflora (grade 1), moderate dysbacteriosis (grade 2), and severe dysbacteriosis (grade 3). Clinical outcomes were postoperative infections and anastomotic leakage within 30 days after surgery.

Results

At the preoperative assessment, 268 (75.9%) patients had normal or slightly decreased intestinal microflora, 58 (16.4%) patients had moderate dysbacteriosis, and 27 (7.6%) patients had severe dysbacteriosis. The patients with preoperative dysbacteriosis had a higher rate of early postoperative diarrhoea (grade 2: OR = 4.53, 95% CI 2.28–9.00, grade 3: OR = 4.52, 95% CI 1.81–11.31), total complications (grade 3 40.7% vs. grade 2 25.9% vs. grade 1 12.7%, P < 0.001), and anastomotic leakage (grade 3 11.1% vs. grade 2 5.2% vs. grade 1 1.5%, P = 0.002). An interaction effect among preoperative dysbacteriosis and early postoperative diarrhoea on total complications was observed in rectal cancer patients (P for interaction = 0.007).

Conclusions

An imbalance of the intestinal microbiome exists in a considerable proportion of CRC patients before surgery. Preoperative dysbacteriosis is associated with higher rates of early postoperative diarrhoea, which further correlates with infectious complications and anastomotic leakage. However, the contribution of preoperative dysbacteriosis to the occurrence of anastomotic leakage needs to be clarified in further studies.

Trial registration ChiCTR, ChiCTR1800018755. Registered 8 October 2018—Retrospectively registered, http://www.chictr.org.cn/ChiCTR1800018755.
Re-thinking reablement strategies for older adults in residential aged care: a scoping review
Authors: Lewis Lucy K. , Henwood Tim , Boylan Jo , Hunter Sarah , Lange Belinda , Lawless Michael , Milte Rachel , Petersen Jasmine
Published: November 2021

Background

The number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to systematically explore the effectiveness of reablement strategies in residential aged care for older adults’ physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness).

Method

This scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored.

Results

Five thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness.

Conclusions

There has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted.

Trial registration

Prospectively registered review protocol (Open Science Framework: DOIhttps://doi.org/10.17605/OSF.IO/7NX9M).