bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiological Study of Parental Obstructive Sleep Apnea and Subsequent Risk of ADHD in Their Children: A Nationwide Population-Based Study
Authors: Chen Iwen , Huang Jing-Yang , Chang Renin , Hung Yao-Min , Wei James Cheng-Chung
Published: September 2022

Objective:

Obstructive sleep apnea (OSA), with daytime drowsiness, nocturnal hypoxia, could result in systemic inflammation and oxidative damage. We hypothesize that parental OSA, with chronic systemic inflammation and oxidative stress, might contribute to children’s neurodevelopmental disorders, such as ADHD.

Method:

By linking National Birth Registry with the National Health Insurance Research Database, Taiwan, we identified 2006–2015 birth cohort, which comprised 1,723,873 singleton live births, and conducted a nested case-control study. We included children with ADHD and compared them with non-ADHD controls matched with ADHD case on index date. Conditional logistic regression was utilized to calculate adjusted odds ratio (aOR) when investigating the association between parental diseases with risk of ADHD in their offspring.

Results:

The aOR (95% CI) of offspring’s ADHD was 1.758 (1.458–2.119) with paternal OSA and 2.159 (1.442–3.233) with maternal OSA. The subgroup analysis revealed different effects of parental diseases among children’s gender.

Conclusion:

Our study demonstrates an association in parental OSA and offspring ADHD, which could inspire further research to clarify the mechanisms.
Power, politics and improvisation: Learning during a prolonged crisis
Authors: Meisiek Stefan , Stanway Bonnie Rose
Published: September 2022

The COVID-19 pandemic has caught most organizations off guard. They have had to adapt their operations rapidly, and with the pandemic persisting, continuously improvise. While such an external jolt to organizations might unsettle operations, it does not remove the fact that organizations are sites of power relations and political activity. In this article, we examine the influence of power and politics on learning from improvisation, through a qualitative longitudinal case study of an Australian university during COVID-19. We trace improvisations with the use of the social media platform WeChat, which was eventually adopted, after several changes in forms of improvisation, as part of the response to the COVID-19 pandemic. Our study contributes to the literature on learning from improvisation, and explains how different forms of improvisation morph into one another under the simultaneous influence of power relations and learning.
Numerical study on the influence of in-plane damage on the out-of-plane seismic performance of masonry infill walls with opening in reinforced concrete frames
Authors: Zhang Maohua , Ding Junnan , Pang Lue , Ding Kang
Published: September 2022

The reinforced concrete (RC) frames with masonry infill walls are always subject to in-plane (IP) and out-of-plane (OOP) interaction under earthquakes, and IP damage will affect OOP seismic performance. In order to study IP and OOP interaction of the masonry infill walls with opening in RC frames, we establish a finite element model of RC frame with solid and opening infill walls based on existing tests. We simulated the influence of opening rate and opening aspect ratio on IP and OOP interaction of RC frames with masonry infill walls. The results show that IP damage significantly reduces the OOP stiffness of the RC frames with masonry infill walls; The IP storey drift between 0.5%–2%, the OOP stiffness is reduced by 58.3%–73.7%; Under the same IP damage, the OOP bearing capacity and stiffness of RC frames with masonry infill wall in a larger opening rate has greater degradation level and faster degradation rate; For a given opening rate, the opening with an aspect ratio that closer of infill wall has the least influence on the IP and OOP interaction. Finally, based on the simulation results, a two-parameter exponential equation is found to describe the relationship between the OOP bearing capacity reduction, IP storey drift and the wall opening rate.
Self-Regulated Learning in the IB Diploma Programme: A qualitative comparison of strategy use by IB Diploma students with learning difficulties and those with a history of high achievement
Authors: Forrest Sandra
Published: September 2022

This investigation set out to explore the self-regulated learning strategies implemented by high-achieving International Baccalaureate (IB) Diploma Programme (DP) students and those with learning difficulties in a context in which teachers were developing their practice to better align with IB philosophy. Specifically, I aimed to determine whether the strategies used by students in the two categories differed and, if so, what accounted for these differences. The sample included four DP students with diagnosed learning difficulties and six high-achieving DP students. Methods included collecting samples of independent work that reflected their strategy use; accompanying written reflections; and semi-structured interviews utilising a combination of stimulated recall and open-ended questions. Results suggest that only slight differences existed in the number and type of strategies used by participants in each category, but there were some important differences in strategy quality. These differences appeared to be related to the epistemic awareness students demonstrated, rather than their categorisation as having learning difficulties or being high-achieving. Although the IB Diploma Programme is widely considered an appropriate secondary programme for high-achieving students, its potential to enhance self-regulated learning suggests this programme may also be an appropriate option for some university-bound students with learning difficulties. As the literature review for this investigation uncovered only one previous study pertaining to IB Diploma Programme students with learning difficulties, this is a significant contribution to knowledge with implications for admissions as well as teaching and learning in IB schools. The investigation also indicates that epistemic awareness may play a more significant role in self-regulated learning than contemporary theories suggest.
The Devil Is in the Details: A Randomized Experiment Assessing the Effect of Providing Examples in a Survey Question across Countries
Authors: Aizpurua Eva , Bottoni Gianmaria , Fitzgerald Rory
Published: September 2022

Despite the widespread use of examples in survey questions, very few studies have examined their impact on survey responses, and the evidence is mainly based on data collected in the United States using questionnaires in English. This study builds on previous research by examining the effects of providing examples using data from a cross-national probability-based web panel implemented in Estonia ( n = 730), Great Britain ( n = 685), and Slovenia ( n = 529) during Round 8 of the European Social Survey (2017/18). Respondents were randomly assigned a survey question measuring confidence in social media using Facebook and Twitter as examples, or another condition in which no examples were offered. The results show that confidence in social media was significantly lower in the example condition, although the effect size was small. Confidence in social media varied across countries, and the effect of providing examples was heterogeneous across countries and education levels. The implications of these findings are discussed.
Implementation of the infection control estimate: A case study on the use of a newly developed digital tool for outbreak management in the acute setting
Authors: Wynn Matthew Oliver , Brady Sandra , McKenna Josh , Swanson Linda , George Ryan
Published: September 2022

Aim

An Infection Control Estimate (ICE) Tool was developed based on a previously published concept of applying military planning techniques to Infection Prevention and Control (IPC) management strategies in the acute healthcare setting.

Methods

Initial testing of the outbreak management tool was undertaken in a large acute hospital in the North-West of England during a localised outbreak of COVID-19. The tool, developed using Microsoft Excel, was completed by trained IPC practitioners in real-time to log outbreak details, assign and manage meeting actions and to generate surveillance data.

Results

The ICE tool was utilised across five outbreak control meetings to identify and allocate tasks to members of the outbreak control team and to monitor progress. Within the meetings, the tool was used primarily by the trained IPC Specialist Nurses who were guided by and entered data into the relevant sections. Feedback indicated that the tool was easy to use and useful as the sole repository of outbreak information and data. Suggested improvements following the testing period were made and additional functionality was added.

Conclusion

Utilisation of the ICE tool has the potential to improve our understanding of the efficacy of currently employed outbreak management interventions and provides a cognitive support and targeted education for teams responsible for the management of outbreaks. It is hoped that by guiding teams through an outbreak with prompts and guidance, as well as facilitating collection and presentation of surveillance data, outbreaks will be resolved sooner and risks to patients will be reduced.
First-line nivolumab plus ipilimumab or chemotherapy versus chemotherapy alone for advanced esophageal cancer: a cost-effectiveness analysis
Authors: Cao Xueqiong , Cai Hongfu , Li Na , Zheng Bin , Zheng Zhiwei , Liu Maobai
Published: September 2022

Background:

This study evaluated the cost-effectiveness of nivolumab plus chemotherapy (NC) or ipilimumab versus chemotherapy as a first-line treatment for advanced esophageal squamous cell carcinoma (ESCC) in the United States and China.

Methods:

A partitioned survival model was constructed from the perspective of the US third-party payers and Chinese healthcare system. Health states and transition probabilities were modeled based on the survival data from the CheckMate-648 clinical trial (NCT03143153). The time horizon for the model was 10 years. Only direct medical costs were considered. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of the results.

Results:

In the United States, nivolumab plus ipilimumab (NI) led to an incremental cost-effectiveness ratio (ICER) of $155,159.82/quality-adjusted life year (QALY) and $104,297.07/QALY gained in the overall population and in patients with tumor cell programmed death-ligand 1 (PD-L1) expression of ⩾1% (subgroup), respectively. The ICER for the subgroup was between the willingness-to-pay (WTP) threshold values of $100,000/QALY and $150,000/QALY, and the other case was higher than $150,000/QALY. NC led to an ICER of $518,062.85/QALY and $193,169.49/QALY gained in the overall population and the subgroup, respectively. Both ICERs were significantly higher than the WTP threshold of $150,000/QALY. In China, the ICERs for patients treated with the addition of nivolumab were >$90,000/QALY in all cases, significantly exceeding the WTP threshold of $37,654/QALY.

Conclusions:

NI is more cost-effective than NC or chemotherapy alone for treating advanced ESCC with PD-L1 expression ⩾1% in the United States. Chemotherapy alone is the only cost-effective option in China.
Recognising foreign convictions during the sentencing phase: Turning a blind eye to equality?
Authors: Audenaert Nele , De Bondt Wendy
Published: September 2022

The international validity of convictions can hardly be called a new topic, certainly not within a European Union context. Within the EU, mutual recognition of foreign convictions has been accepted as a leading principle. Therefore, it already gained considerable attention, both of the EU legislator and of legal scholars. However, analysis reveals that mutual recognition of foreign convictions has only been anchored partially in the current EU legal framework. Whereas foreign convictions are relevant in different phases of the criminal procedure, mutual recognition in one particular phase lacks adequate anchoring. The recognition of a foreign convictions has been dealt with in relation to ‘the prosecution phase’ and ‘the executing phase’, but has been largely left to Member State discretion for ‘the sentencing phase’ that comes in between those phases. As a result, some Member States have opted for sentencing laws which partially or even completely disregard the existence of relevant foreign convictions, whereas other Member States have opted for sentencing laws which – in the spirit of mutual recognition – treat foreign convictions as if it were national convictions. This contribution will argue that an infringement of the equality principle is possibly at stake – not so much between these two types of Member States, but within Member States that partially or completely disregard foreign convictions during sentencing. It does so with specific reference to the case law of both the Court of Justice of the European Union and the European Court of Human Rights.
Students’ Academic Achievement and Satisfaction in a Blended Learning Community of College English in China: A Quasi-experimental Study
Authors: Li Ling
Published: September 2022

The research aimed to make a quasi-experimental study of College English in a Chinese blended learning community environment. A mixed method was adopted to collect data about students’ academic achievement and learning satisfaction. Academic achievement consisted of obtrusive data from the final exam, and learning satisfaction data came from a unified standard questionnaire organized by the university. Utilizing quasi-experimental design, results showed that the experimental class (C1) adopting the framework of blended learning community (BLC) earned a higher level of academic achievement and satisfaction. It is concluded in this research that the BLC framework was shown to have a positive effect on students’ academic achievement and learning satisfaction than face-to-face (FTF) learning in the context of English learning in higher education. Pedagogical implications and future research recommendations were also included.
Prospective Assessment of Clinical Tests Used to Evaluate Tibial Stress Fracture
Authors: Rosenthal Michael D. , Rauh Mitchell J. , Cowan James E.
Published: September 2022

Background:

Tibial stress fracture (SFx) is the most common SFx of the lower extremity. Presently, diagnostic accuracy of clinical examination techniques for tibial SFx remains suboptimal.

Purpose:

To assess the diagnostic effectiveness of 5 clinical tests for tibial SFx individually versus a test item cluster.

Study Design:

Cohort study (diagnosis); Level of evidence, 3.

Methods:

A total of 50 patients with tibial pain (17 with bilateral symptoms) were assessed with 5 clinical examination tests (tibial fulcrum test, focal tenderness to palpation, heel percussion test, therapeutic ultrasound test, and 128-Hz tuning fork test) before they underwent diagnostic imaging (radionuclide bone scan). The application of the clinical tests was counterbalanced to minimize the likelihood of carryover effects. Patients provided a pain rating immediately before and after the application of each clinical test.

Results:

The prevalence of tibial SFx among the study participants was 52.2%. High levels of specificity were produced by the therapeutic ultrasound test (93.8%), tuning fork test (90.6%), and percussion test (90.6%). The fulcrum test had moderate to high specificity (84.4%). All tests demonstrated low levels of sensitivity, with the highest levels found for focal tenderness to palpation (48.6%) and fulcrum (45.7%). The fulcrum test provided the highest positive likelihood ratio (2.93), followed by the therapeutic ultrasound test (2.30). The fulcrum test had the lowest negative likelihood ratio (0.64), with the focal tenderness to palpation and tuning fork tests having negative likelihood ratios >1.0. Combinations of these clinical tests did not improve the prediction of tibial SFx above that observed among the individual tests.

Conclusion:

The clinical tests evaluated were generally highly specific, but all had low sensitivity. The fulcrum test provided the highest level of diagnostic accuracy; however, it was inadequate for definitive clinical management. Combining tests did not improve the diagnostic accuracy of tibial SFx.
Difficult Decisions for Older Canadians Receiving Home Care, and Why They Are So Difficult: A Web-Based Decisional Needs Assessment
Authors: Toi Alfred Kodjo , Ben Charif Ali , Lai Claudia , Ngueta Gérard , Plourde Karine V. , Stacey Dawn , Légaré France
Published: September 2022

Background. Older adults receiving home care services often face decisions related to aging, illness, and loss of autonomy. To inform tailored shared decision making interventions, we assessed their decisional needs by asking about the most common difficult decisions, measured associated decisional conflict, and identified factors associated with it. Methods. In March 2020, we conducted a cross-sectional survey with a pan-Canadian Web-based panel of older adults (≥65 y) receiving home care services. For a difficult decision they had faced in the past year, we evaluated clinically significant decisional conflict (CSDC) using the 16-item Decisional Conflict Scale (score 0–100) with a >37.5 cutoff. To identify factors associated with CSDC, we performed descriptive, bivariable, and multivariable analyses using the stepwise selection method with an assumed entry and exit significance level of 0.15 and 0.20, respectively. Final model selection was based on the Bayesian information criterion. Results. Among 460 participants with an average age of 72.5 y, difficult decisions were, in order of frequency, about housing and safety (57.2%), managing health conditions (21.8%), and end-of-life care (8.3%). CSDC was experienced by 14.6% (95% confidence interval [CI]: 11.5%, 18.1%) of respondents on all decision points. Factors associated with CSDC included household size = 1 (OR [95% CI]: 1.81 [0.99, 3.33]; P = 0.27), household size = 3 (2.66 [0.78, 8.98]; P = 0.83), and household size = 4 (6.91 [2.23, 21.39]; P = 0.014); preferred option not matching the decision made (4.05 [2.05, 7.97]; P < 0.001); passive role in decision making (5.13 [1.78, 14.77]; P = 0.002); and lower quality of life (0.70 [0.57, 0.87]; P<0.001). Discussion. Some older adults receiving home care services in Canada experience CSDC when facing difficult decisions. Shared decision-making interventions could mitigate associated factors.

Highlights

This is the first study in Canada to assess the decisional needs of older adults receiving care at home and to identify their most common difficult decisions. Difficult decisions most frequently made were about housing and safety. The most significant decisional conflict was experienced by people making decisions about palliative care. When their quality-of-life score was low, older adults experienced clinically significant decision conflict.
Wide QRS Tachycardia, What Is the Diagnosis
Authors: Ghanta Somasekhar , Paluru Manohar Reddy , Palaparti Raghuram , Palaparthi Sudarshan
Published: September 2022

Case of wide QRS tachycardia discussing differentiation of supra ventricular tachycardia with aberrancy from ventricular tachyarrhythmia.
The Concept of Cultural Humility as It Relates to Instructional Practices in the General Music Classroom
Authors: Yoo Hyesoo
Published: September 2022

A framework of cultural humility includes three main tenets: (a) commitment to lifelong, critical self-reflection; (b) recognition and mitigation of power imbalances; and (c) accountability to individuals and institutions. In this article, I aim at applying the concept of cultural humility to frame my analysis of musical diversity in music education. Through a cultural humility lens, music teachers may acknowledge their own beliefs, values, biases, and prejudices in relation to diverse musics. A commitment to lifelong introspection through self-reflection and critique may help teachers continue to investigate new ways to redress power imbalances inherent in music education, as well as build their relationships with students and communities bidirectionally.
Optimization of alternative breeding schemes for the genetic improvement of common Tigray highland sheep in northern Ethiopia
Authors: Haileselassie Kiflay Welday , Kebede Solomon Abgaz , Letta Mengistu Ugre , GebreMichael Solomon Gizaw
Published: September 2022

Background

Genetic improvement is one of the major means to enhance the productivity of livestock, and well-designed animal genetic improvement schemes are necessary to achieve genetic gains. The objective of the current study was to design an alternative breeding program to improve the productivity of common Tigray highland sheep. Two village- and two central nucleus-based breeding schemes were simulated and evaluated in terms of genetic gain, bio-economic efficiency and operational feasibility.

Methods

Four breeding schemes were simulated: scheme 1, a one-tier cooperative village-based breeding scheme, scheme 2, a two-tier cooperative village breeding scheme (dispersed village-based nuclei scheme), scheme 3, a central open nucleus-based scheme with 5% nucleus size; and scheme 4, a three-tier breeding schemes (central open nucleus-based linked with multiplier units). Simulation analyses were performed using the ZPLAN computer program, which is based on a deterministic approach to estimate genetic and economic gains in the breeding programs.

Results

Between the two village-based breeding schemes, scheme 2 showed higher genetic gain and economic efficiency in the breeding traits analysed than scheme 1. The central nuclei schemes were more efficient than the village breeding schemes. Scheme 3 was the most efficient with a genetic gain in the breeding objective of US $ 1.03 and a profit of US $ 2.73/ewe/year, but operationally it is also the most difficult to implement as it requires a big central nucleus. A central nucleus linked with the village-based nuclei would be a feasible option to overcome the operational difficulties of the conventional central nucleus schemes. If a village-based breeding program is considered it should be the first step in most low-input systems. In this case, scheme 2 is the most efficient.

Conclusions

With some support from the public sector at the outset and a strong collaboration among the stakeholders including smallholders, scheme 4 could lead to substantial genetic gains in the common Tigray highland sheep breed within its habitat that covers large areas of the Tigray region. Therefore, we recommend a long-term breeding program which should include cross-breeding, genomic selection, updated estimates of genetic and economic values for the common Tigray highland sheep breed.
ATP-citrate lyase B (ACLB) negatively affects cell death and resistance to Verticillium wilt
Authors: Liu Fujie , Ma Zhifeng , Cai Sheng , Dai Lingjun , Gao Jianbo , Zhou Baoliang
Published: September 2022

Background

ATP-citrate lyase (ACL) plays a pivotal role in histone acetylation and aerobic glycolysis. In plant, ACL is a heteromeric enzyme composed of ACLA (45 kD) and ACLB (65 kD). So far, the function of ACL genes in cotton still remains unknown.

Results

Here, we identified three ACLA homologous sequences and two ACLB homologous in each genome/sub-genome of cotton species. Silencing ACLB in cotton led to cell death at newly-grown leaves and stem apexes. Simultaneously, in ACLB-silenced plants, transcription factors related to senescence including SGR, WRKY23 and Osl57 were observed to be activated. Further investigation showed that excessive H2O2 was accumulated, salicylic acid-dependent defense response and pathogenesis-related gene expressions were evidently enhanced in ACLB-silenced plants, implying that knockdown of ACLB genes leads to hypersensitive response-like cell death in cotton seedlings. However, as noted, serious cell death happened in newly-grown leaves and stem apexes in ACLB-silenced plants, which led to the failure of subsequent fungal pathogenicity assays. To confirm the role of ACLB gene in regulating plant immune response, the dicotyledonous model plant Arabidopsis was selected for functional verification of ACLB gene. Our results indicate the resistance to Verticillium dahliae infection in the Arabidopsis mutant aclb-2 were enhanced without causing strong cell death. Ectopic expression of GausACLB-2 in Arabidopsis weakened its resistance to V. dahliae either in Col-0 or in aclb-2 background, in which the expression level of ACLB is negatively correlated with the resistance to V. dahliae.

Conclusions

These results indicate that ACLB has a new function in negatively affecting the induction of plant defense response and cell death in cotton, which provides theoretical guidance for developing cotton varieties with resistance against Verticillium wilt.
Erector spinae plane block versus its combination with superficial parasternal intercostal plane block for postoperative pain after cardiac surgery: a prospective, randomized, double-blind study
Authors: Dost Burhan , Kaya Cengiz , Turunc Esra , Dokmeci Hilal , Yucel Semih Murat , Karakaya Deniz
Published: September 2022

Background

We aimed to compare the effectiveness of bilateral erector spinae plane (ESP) block and superficial parasternal intercostal plane (S-PIP) + ESP block in acute post-sternotomy pain following cardiac surgery.

Methods

Forty-seven patients aged between 18 and 80 years of age with American Society of Anesthesiologists class II–III due to undergo median sternotomy for cardiac surgery were included in this prospective, randomized, double-blinded study. Following randomization into two groups, one group received bilateral ultrasound-guided ESP and the other S-PIP plus ESP block. Morphine consumption within the first 24 h after surgery was the primary outcome of the study while NRS scores at rest, NRS scores when coughing, time taken until extubation, use of rescue analgesic, presence of nausea/vomiting, length of hospital and intensive care unit (ICU) stay, and patient satisfaction were secondary outcome measures.

Results

Morphine use up to 24 h following surgery was statistically significantly different between the ESP block and ESP + S-PIP block groups (18.63 ± 6.60 [15.84–21.41] mg/24 h vs 14.41 ± 5.38 [12.08–16.74] mg/24 h, p = 0.021). The ESP + S-PIP block group had considerably reduced pain scores compared to the ESP block group across all time points. Rescue analgesics were required in 21 (87.5%) patients in the ESP block group and seven (30.4%) in the ESP + S-PIP group (p < 0.001). PONV, length of stay in the ICU and hospital, and time to extubation were similar between groups.

Conclusions

In open cardiac surgery, the combination of ESP and S-PIP blocks lowers pain scores and postoperative morphine requirement of patients.

Trial registration

Clinicaltrials Registration No: NCT05191953, Registration Date: 14/01/2022.
Effect of differences in extubation timing on postoperative pneumonia following meningioma resection: a retrospective cohort study
Authors: Guo Minna , Shi Yan , Gao Jian , Yu Min , Liu Cunming
Published: September 2022

Background

This study was designed to examine extubation time and to determine its association with postoperative pneumonia (POP) after meningioma resection.

Methods

We studied extubation time for 598 patients undergoing meningioma resection from January 2016 to December 2020. Extubation time was analysed as a categorical variable and patients were grouped into extubation within 21 minutes, 21–35 minutes and ≥ 35 minutes. Our primary outcome represented the incidence of POP. The association between extubation time and POP was assessed using multivariable logistic regression mixed-effects models which adjusted for confounders previously reported. Propensity score matching (PSM) was also performed at a ratio of 1:1 to minimize potential bias.

Results

Among 598 patients (mean age 56.1 ± 10.7 years, 75.8% female), the mean extubation time was 32.4 minutes. Extubation was performed within 21 minutes (32.4%), 21–35 minutes (31.2%) and ≥ 35 minutes (36.4%), respectively, after surgery. Older patients (mean age 57.8 years) were prone to delayed extubation (≥ 35 min) in the operating room, and more inclined to perioperative fluid infusion. When extubation time was analysed as a continuous variable, there was a U-shaped relation of extubation time with POP (P for nonlinearity = 0.044). After adjustment for confounders, extubation ≥35 minutes was associated with POP (odds ratio [OR], 2.73 95% confidence interval [CI], 1.36 ~ 5.47). Additionally, the results after PSM were consistent with those before matching.

Conclusions

Delayed extubation after meningioma resection is associated with increased pneumonia incidence. Therefore, extubation should be performed as early as safely possible in the operation room.
Losing hope or keep searching for a golden solution: an in-depth exploration of experiences with extreme challenging behavior in nursing home residents with dementia
Authors: Veldwijk-Rouwenhorst Annelies E. , Zuidema Sytse U. , Smalbrugge Martin , Persoon Anke , Koopmans Raymond T. C. M. , Gerritsen Debby L.
Published: September 2022

Background

Situations of extreme challenging behavior such as very frequent and/or severe agitation or physical aggression in nursing home residents with dementia can be experienced as an impasse by nursing home staff and relatives. In this distinct part of our WAALBED (WAAL-Behavior-in-Dementia)-III study, we aimed to explore these situations by obtaining the experiences and perspectives of nursing home staff and relatives involved. This can provide a direction in providing tools for handling extreme challenging behavior of nursing home residents with dementia and may improve their quality of life.

Methods

Qualitative multiple case study with individual interviews and focus group discussions. Interviewees were elderly care physicians, psychologists, care staff members, unit managers and relatives (n = 42). They were involved with nursing home residents with dementia and extreme challenging behavior living on dementia special care units in the Netherlands. For these residents, external consultation by the Centre for Consultation and Expertise was requested. Audio-recordings of the interviews were transcribed verbatim and analyzed with thematic analysis, including conventional content analysis.

Results

Seven cases were included. Forty-one individual interviews and seven focus group discussions were held. For six stakeholder groups (resident, relative, care staff, treatment staff, nursing home staff, and the organization), three main factors could be identified that contributed to experiencing a situation of extreme challenging behavior as an impasse: 1) characteristics and attitudes of a stakeholder group, 2) interaction issues within a stakeholder group and 3) interaction issues among (groups of) stakeholders. The experienced difficulties with the resident’s characteristics, as well as suboptimal interdisciplinary collaboration and communication among the nursing home staff are remarkable. Nursing home staff kept searching for a golden solution or lost hope.

Conclusions

This study offers important insights into situations of extreme challenging behavior in nursing home residents with dementia and offers caregivers targets for improving care, treatment and interdisciplinary collaboration, such as working uniformly and methodically.
Healthcare-associated infection prevention and control practices in Israel: results of a national survey
Authors: Najjar-Debbiny Ronza , Chazan Bibiana , Lobl Rona , Greene M. Todd , Ratz David , Saint Sanjay , Carmeli Yehuda , Schwaber Mitchell J. ,   the Israel IPC Working Group, Ben-David Debby , Shitrit Pnina , Paz Alona , Brosh-Nissimov Tal , Mor Meirav , Regev-Yochay Gili , Ciobotaro Pnina , Yinnon Amos M. , Mar-Chaim Dror , Rubinovitch Bina , Hussein Khetam , Benenson Shmuel
Published: September 2022

Background

Healthcare-associated infection (HAI) is a common and largely preventable cause of morbidity and mortality. The COVID-19 pandemic has presented unprecedented challenges to health systems. We conducted a national survey to ascertain hospital characteristics and the use of HAI prevention measures in Israel.

Methods

We e-mailed surveys to infection prevention and control (IPC) leads of acute care hospitals in Israel. The survey included questions about the use of practices to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and Clostridioides difficile infection (CDI). The survey also assessed COVID-19 impact and healthcare worker well-being.

Results

IPC leads from 15 of 24 invited hospitals (63%) completed the survey. Only one-third of respondents reported strong support for IPC from hospital leadership. Although several prevention practices were used by all hospitals (e.g., maximum sterile barrier precautions for CLABSI and real-time assessment of environmental cleaning for CDI), use of other practices was suboptimal—particularly for CAUTI and VAP. COVID-19 had a profound impact on Israeli hospitals, with all hospitals reporting opening of new units to care for COVID patients and most reporting moderate to extreme financial hardship. All hospitals reported highly successful plans to vaccinate all staff and felt confident that the vaccine is safe and effective.

Conclusion

We provide a status report of the IPC characteristics and practices Israeli hospitals are currently using to prevent HAIs during the COVID-19 era. While many globally accepted IPC practices are widely implemented, opportunities to increase the use of certain IPC practices in Israeli hospitals exist.
Hyperperfusion in the cerebellum lobule VIIb in patients with epileptic seizures
Authors: Sato Kazuaki , Nakahara Kazuki , Obata Kaoru , Matsunari Ryota , Suzuki-Tsuburaya Rie , Tabata Hiromitsu , Kinoshita Masako
Published: September 2022

Background

The cerebellum plays an important role in motor control, however, its involvement in epilepsy has not been fully understood. Arterial spin labelling perfusion magnetic resonance image (ASL) is a noninvasive method to evaluate cerebral and cerebellar blood flow. We investigated cerebellar perfusion in patients with epileptic seizures using ASL.

Methods

Adult patients with epileptic seizures who underwent ASL in three post labeling delay (PLD) conditions (1525, 1800, and 2500 msec) and conventional electroencephalography (EEG) on the same day were investigated. Clinical and EEG characteristics of them were retrospectively analyzed.

Results

Six patients (6 women, age; 36.2 ± 17.9 years (mean ± SD)) showed hyperperfusion in selective areas in the cerebellar paravermis of lobule VIIb. One patient with generalized epilepsy (tentative diagnosis of juvenile myoclonic epilepsy or epilepsy with myoclonic absences) showed unilateral hypoperfusion in PLD 1525 msec and hyperperfusion in PLD 1800 and 2500 msec at the area while EEG showed generalized spike-wave complexes. After successful treatment, these perfusion abnormalities disappeared. In two patients with focal epilepsy manifesting with asymmetrical motor symptoms, cerebellar hyperperfusion was found on the opposite side to the seizure focus estimated by seizure semiology. Besides hyperperfusion of the VIIb lobule, hypoperfusion at the same area was detected in shorter PLD condition in four patients and in longer PLD condition in one patient.

Conclusion

The cerebellar paravermis of lobule VIIb can be a component of motor circuit and participate in epileptic network in humans. Cerebellar perfusion abnormalities can be associated with neurovascular coupling via capillary bed.
Worries about inadequate medical treatment in case of a COVID-19 infection: the role of social inequalities, COVID-19 prevalence and healthcare infrastructure
Authors: Schmitz Alina , Garten Claudius , Kühne Simon , Brandt Martina
Published: September 2022

Background

This study investigates individual and regional determinants of worries about inadequate medical treatment in case of a COVID-19 infection, an important indicator of mental wellbeing in pandemic times as it potentially affects the compliance with mitigation measures and the willingness to get vaccinated. The analyses shed light on the following questions: Are there social inequalities in worries about inadequate medical treatment in case of a COVID-19 infection? What is the role of the regional spread of COVID-19 infections and regional healthcare capacities?

Methods

Based on data derived from the German Socioeconomic Panel (SOEP), a representative sample of the German population aged 18 years and over, we estimated multilevel logistic regression models with individual-level (level 1) and regional-level (level 2) variables. The regional variables of interest were (a) the number of COVID-19 infections, (b) the number of hospital beds as an overall measure of the regional healthcare capacities, and (c) the number of free intensive care units as a measure of the actual capacities for treating patients with severe courses of COVID-19.

Results

Women, older respondents, persons with migrant background and those with a lower socioeconomic status were more likely to report worries about inadequate medical treatment in case of a COVID-19 infection. Moreover, respondents with chronic illness, lower subjective health and those who consider COVID-19 as a threat for their own health were more likely to report worries. In addition, also regional characteristics were relevant. Worries were more common in poorer regions with higher COVID-19 infections and worse health infrastructure as indicated by the number of hospital beds.

Conclusions

The analysis not only indicates that several social groups are more concerned about inadequate medical treatment in case of a COVID-19 infection, but also highlights the need for considering regional-level influences, such as the spread of the virus, poverty rates and healthcare infrastructure, when analyzing the social and health-related consequences of the pandemic.
Bayesian spatial modelling of malaria burden in two contrasted eco-epidemiological facies in Benin (West Africa): call for localized interventions
Authors: Damien Barikissou Georgia , Sode Akoeugnigan Idelphonse , Bocossa Daniel , Elanga-Ndille Emmanuel , Aguemon Badirou , Corbel Vincent , Henry Marie-Claire , Glèlè Kakaï Romain Lucas , Remoué Franck
Published: September 2022

Background

Despite a global decrease in malaria burden worldwide, malaria remains a major public health concern, especially in Benin children, the most vulnerable group. A better understanding of malaria’s spatial and age-dependent characteristics can help provide durable disease control and elimination. This study aimed to analyze the spatial distribution of Plasmodium falciparum malaria infection and disease among children under five years of age in Benin, West Africa.

Methods

A cross-sectional epidemiological and clinical survey was conducted using parasitological examination and rapid diagnostic tests (RDT) in Benin. Interviews were done with 10,367 children from 72 villages across two health districts in Benin. The prevalence of infection and clinical cases was estimated according to age. A Bayesian spatial binomial model was used to estimate the prevalence of malaria infection, and clinical cases were adjusted for environmental and demographic covariates. It was implemented in R using Integrated Nested Laplace Approximations (INLA) and Stochastic Partial Differentiation Equations (SPDE) techniques.

Results

The prevalence of P. falciparum infection was moderate in the south (34.6%) of Benin and high in the northern region (77.5%). In the south, the prevalence of P. falciparum infection and clinical malaria cases were similar according to age. In northern Benin children under six months of age were less frequently infected than children aged 6–11, 12–23, 24–60 months, (p < 0.0001) and had the lowest risk of malaria cases compared to the other age groups (6–12), (13–23) and (24–60): OR = 3.66 [2.21–6.05], OR = 3.66 [2.21–6.04], and OR = 2.83 [1.77–4.54] respectively (p < 0.0001). Spatial model prediction showed more heterogeneity in the south than in the north but a higher risk of malaria infection and clinical cases in the north than in the south.

Conclusion

Integrated and periodic risk mapping of Plasmodium falciparum infection and clinical cases will make interventions more evidence-based by showing progress or a lack in malaria control.
COVID-Inconfidentes: how did COVID-19 and work from home influence the prevalence of leisure-time physical inactivity? An analysis of before and during the pandemic
Authors: Moura Samara Silva , Menezes-Júnior Luiz Antônio Alves , Rocha Ana Maria Sampaio , Lourenção Luciano Garcia , Carraro Júlia Cristina Cardoso , Machado-Coelho George Luiz Lins , Meireles Adriana Lúcia
Published: September 2022

Background

The COVID-19 pandemic has brought drastic changes to the lives of the global population. The restrictions imposed by government agencies impacted the daily lives of citizens, influencing several health behaviors, such as physical activity (PA). Thus, the present study aimed to assess the prevalence of physical inactivity (PI) and its associated factors before and during the COVID-19 pandemic.

Methods

A population-based household seroepidemiological survey was conducted in two Brazilian municipalities located in the state of Minas Gerais, in which 1750 volunteers were interviewed between October and December 2020. Face-to-face interviews were conducted using a structured questionnaire in an electronic format. The moments considered for the PI analysis were M0 (before the pandemic), M1 (from March to July 2020), and M2 (from October to December 2020). Descriptive statistics and univariate and multivariate logistic regression were used to examine the factors associated with PI before (M0) and during the pandemic (M1 and M2).

Results

The prevalence of PI was higher in the first months of the pandemic (M1) (67.3%; 95% confidence interval (CI): 62.4–71.9) than in the months from October to December 2020 (M2) (58.7%; 95% CI: 52.8–64.3); however, at both times (M1 and M2), PI was more prevalent than in the period before the pandemic started (M0) (39.7%; 95% CI: 35.6–43.8). Individuals who were overweight, obese, and had low educational levels were more likely to be physically inactive. At both M1 and M2, individuals who worked at a work from home were less likely to have PI.

Conclusions

The results suggest that the COVID-19 pandemic negatively influenced PA, substantially increasing the prevalence of PI. The determinants associated with PI were education, body mass index, and work from home.
Hyoid bone position as an indicator of severe obstructive sleep apnea
Authors: Jo Jung Hwan , Park Ji Woon , Jang Ji Hee , Chung Jin Woo
Published: September 2022

Background

The objective of this study was to evaluate the relationship between hyoid bone position and severity of obstructive sleep apnea (OSA), and to investigate its value as a complementary diagnostic method.

Methods

A total of 133 patients who were diagnosed as OSA with an apnea-hypopnea index ≥ 5 were included. Clinical examination, level I polysomnography (PSG) and lateral cephalographic analysis were done. Comprehensive PSG characteristics were compared according to hyoid bone position and the predictive power of the distance between the mandible and hyoid was assessed.

Results

The distance between the hyoid bone and mandibular plane was significantly longer in the severe OSA group (p = 0.013). The distance from hyoid bone to third vertebrae (C3) and hyoid bone to mentum were also longer in the severe OSA group but the difference did not reach statistical significance. The distance between hyoid bone and mandibular plane was effective in predicting severe OSA, with a cut-off value of 19.45 mm (AUC = 0.623, p = 0.040). When grouped according to a distance cut-off value of 19.45 mm, those with a longer distance between the hyoid bone and mandibular plane showed more respiratory disturbance, lower oxygen saturation levels, less deep slow wave sleep, and more fragmented sleep with arousals.

Conclusions

The distance between the hyoid bone and mandibular plane derived from cephalometric analysis can be a valuable diagnostic parameter that can be easily applied in differentiating severe OSA patients.
Can indocyanine green during laparoscopic sleeve gastrectomy be considered a new intraoperative modality for leak testing?
Authors: Pavone Giovanna , Fersini Alberto , Pacilli Mario , De Fazio Michele , Panzera Piercarmine , Ambrosi Antonio , Tartaglia Nicola
Published: September 2022

Background

Indocyanine green (ICG) when injected intravenously into the bloodstream allows us to show stomach vascularity in real time. The aim of our study was to observe the preliminary results of the application of indocyanine green fluorescence (IGF) during laparoscopic sleeve gastrectomy (LSG) in our center and how the perfusion of the staple line of the stomach affects the onset of fistula.

Materials and methods

82 patients underwent LSG with ICG fluorescence angiography at our center from January 2020 to December 2021. 5 ml of ICG was injected intravenously to identify the blood supply of the stomach, carefully assessing the angle of His.

Results

In the ICG-tested LSG, we recorded adequate perfusion in all patients but one: the leakage rate was 1.2%. This data is inferior to the non-tested patients’ group.

Conclusion

Intraoperative ICG testing may be helpful in determining which patients are at an increased risk for leakage but there are multiple factors contribute to the pathophysiology and the incidence of gastric fistula not only the perfusion.

Trial registration Retrospectively registrated