bluuebunny/crossref_metadata_2025 huggingface dataset:
How intergroup social connections shape immigrants’ responses to social exclusion
Authors: Marinucci Marco , Riva Paolo
Published: January 2020

K. D. Williams (2009) theorized that chronic social exclusion would inescapably lead to a detrimental stage of resignation, characterized by depression, alienation, unworthiness, and helplessness. However, few studies empirically addressed this assumption. Considering immigrants as a population at risk of persistent exclusion, we investigated how social connections with the native-born majority and other immigrant minorities moderate the exclusion–resignation link. In Study 1 ( N = 112 asylum seekers), participants mainly connected with other immigrants showed a significant association between chronic exclusion and resignation. Crucially, this link vanished for people with social connections mainly composed of native people. In Study 2, we replicated and extended these results running secondary analyses on a data set of 2,206 immigrants (CILS4EU). This work, suggesting that the exclusion–resignation link can be moderated by social factors, highlighted the relevance of immigrants’ connections with the native majority for counteracting the risk of segregation when tackling the social issue of immigrants’ everyday exclusion.
A cultural approach to algorithmic bias in games
Authors: Trammell Aaron , Cullen Amanda LL
Published: January 2020

As algorithms come to govern every aspect of our lives—from bank loans, to job applications, to traffic patterns, to our media consumption patterns—communication research has become increasingly concerned with how we govern algorithms. Building on the methodological frameworks established by critical information researchers like Safiya Noble, Tarleton Gillespie, and Nick Seaver, this essay argues that we do not need to reverse engineer the “black box” to understand its impacts because they can be found through qualitative methodologies instead. This essay rejects the “black box” as an epistemic premise upon which critical algorithmic literacies can be built by using discourse analysis to observe how the unknowable language of the algorithm is deployed discursively within gamer communities to establish and maintain patriarchal power. This essay shows how the “black box” is used by fan communities to advance a patriarchal understanding of what we term paradigms of “balance” and “realism” in game design.
Twisted into knots: Canada’s challenges in lawful access to encrypted communications
Authors: West Leah , Forcese Craig
Published: January 2020

This article addresses the Canadian law governing ‘lawful access’ to potentially encrypted data-in-motion; that is, communications done through electronic means. This article begins by outlining the core agencies responsible for counterterrorism investigations in Canada, and the recent public debate and government consultation on encryption. Next, we identify how older laws designed for a different era may be leveraged to force service and platform providers to assist law enforcement and the Canadian Security Intelligence Service by decrypting communications and data. We will also touch on the legal capacity of these organizations to develop their own ‘workarounds’, including the role of Canada’s signals intelligence agency, the Communications Security Establishment. Throughout, we highlight how Canada’s long-standing ‘intelligence to evidence’ problem affects and, arguably exacerbates, the encryption-prompted ‘going dark’ phenomenon and consequently impairs Canadian counterterrorism efforts. We predict legal reform resolving the ‘going dark’ issue will be impossible without modernization of Canada’s disclosure regime.
Numerical investigation of vortex-induced vibration for two tandem circular cylinders with different diameters
Authors: Liu Ming-ming , Jin Rui-jia , Tang Guo-qiang , Li Cheng-yong
Published: January 2020

Vortex-induced vibration of two tandem circular cylinders with different diameters under low Reynolds number (Re = 200) is investigated numerically by solving the uncompressible two-dimensional Navier–Stokes equations. The arbitrary Lagrange–Euler method is used to simulate the movement of mesh. Effects of diameters and gap ratios are considered. Numerical results show that diameter ratios and gap ratios have little effect on maximum vibration amplitude. Four different vortex shedding modes are detected in this study.
‘King, Warrior, Magician, Lover’: Understanding expressions of care among male prisoners
Authors: Laws Ben , Lieber Elinor
Published: January 2020

Typologies of prison life in men’s establishments have tended to emphasize the most desolate features of prison life such as aggression, violence, exploitation, and stark displays of individualism. Without seeking to contradict these positions, we suggest that competing narratives of care are also operating in male establishments in England and Wales. Through combining data from two recent, but separate, semi-ethnographic studies of prison life in two prisons (total n = 43), we present a completely different kind of typology based around Moore and Gillette’s (1990) archetypes of masculinity, called: ‘King’, ‘Warrior’, ‘Magician’, and ‘Lover’. This archetypal framework foregrounds the role of care in prison and the different manifestations of communal relations among prisoners. Building on recent developments in prison sociology that have explored the nexus between imprisonment, interpersonal relations and masculinity (see Crewe, 2014), this article argues that care is a fundamental feature of prison life that takes on a wide range of forms, including: paternal roles, intellectual expertise, information sharing and close physical bonds. This complicates linear depictions of prison life that are emotionally stolid.
Factors Associated With Completion: Pathways Through Developmental Mathematics
Authors: Howell Elizabeth , Walkington Candace
Published: January 2020

This study examines two 5-year longitudinal data sets of community college students ( n = 595 and n = 593) to explore factors associated with successful outcomes in developmental mathematics. Logistic regression models consider the role of demographic factors, course format, and student support structures on the likelihood of a student completing the developmental sequence and subsequently passing a credit-level mathematics course. Additional linear regression models examine the time required to complete developmental coursework. Tutoring has a strong association with positive student outcomes, as does full-time enrollment and developmental mathematics coursework grades. Alternative course formats are also associated with increased likelihood of success for students, but some alternative formats delay a student's time line. Implications for developmental mathematics programs in community college settings are discussed.
MicroRNA-425-5p Inhibits Lung Cancer Cell Growth in Vitro and in Vivo by Downregulating TFIIB-Related Factor 2
Authors: Yu Xi , Zheng Hong , Sun Rongfei , Qian Xuejiao , Jiang Ping , Yang Bo , Liu Jiangbo , Li Xiaoping
Published: January 2020

Lung cancer is the most common cancer type with increasingly high incidence. MicroRNAs provide the potential biomarkers for lung cancer treatment. Thus, we aimed to investigate the function of microRNA-425-5p in lung cancer development and the underlying mechanisms. MicroRNA-425-5p overexpression inhibited A549 lung cancer cell proliferation in vitro and in vivo. On the other hand, microRNA-425-5p inhibition increased A549 proliferation. Mechanistically, the underlying mechanism by which microRNA-425-5p inhibits lung cancer cell growth was mediated through its ability in targeting and downregulating the TFIIB-related factor 2. Our results for the first time identified microRNA-425-5p as a tumor suppressor in lung cancer. Thus, microRNA-425-5p may serve as a potential therapeutic target for lung cancer.
Overall Opioid Consumption Is Not Associated With the Amount of Opioids Administered and Prescribed on the Day of Upper Extremity Surgery
Authors: Hozack Bryan A. , Rivlin Michael , Lutsky Kevin F. , Beredjiklian Pedro K.
Published: January 2020

Background: Orthopedic surgeons need to better understand the effect their opioid-prescribing habits have on patients. The purpose of our study was to evaluate whether the type of procedure or initial amount of opioids prescribed postoperatively leads to increased consumption of opioids. Methods: Consecutive patients undergoing upper extremity surgery were enrolled. The medical record and Pennsylvania Prescription Drug Monitoring Program Web site were used to record all prescriptions of controlled substances consumed intraoperatively, in the recovery room, and in prescriptions filled 6 months postoperatively. Morphine equivalent units (MEUs) were used to quantify the amount of opioids. Results: Two hundred ninety patients were included in the study. The mean MEU administered intraoperatively was 25.1 (0-50). The MEU provided in the recovery room was 2.9 (0-60). The MEU prescribed on the day of surgery was 155.6 (137-178). We used the Pearson correlation coefficient of r = 0, meaning no/weak correlation, and r = 1, meaning a strong correlation. Neither MEUs provided intraoperatively or in recovery, nor MEUs prescribed postoperatively correlated with prescriptions filled ( r = 0.13, 0.02, 0.09, respectively). Although patients undergoing bony procedures were prescribed more opioids ( P < .001), opioid consumption intraoperatively, in recovery, and in prescriptions filled was not significantly different. Conclusions: The MEUs administered and prescribed on the day of surgery did not affect the amount of prescriptions filled postoperatively. Finally, patients undergoing bony procedures were prescribed more opioids than those undergoing soft tissue procedures, but they did not consume or fill more opioids postoperatively.
Using the Tampa Scale for Kinesiophobia Short Form in Patients With Upper Extremity Specific Limitations
Authors: Kortlever Joost T. P. , Karyampudi Prithvi , Ottenhoff Janna S. E. , Ring David , Vagner Gregg A. , Reichel Lee M.
Published: January 2020

Background: The Tampa Scale for Kinesiophobia (TSK) is used to quantify fear of painful movement. A shorter form with only 4 questions (TSK-4) can be used by physicians to look for fear of movement independent of catastrophic thinking with less responder and survey burden. We assessed the difference explained in amount of variation in the Patient-Reported Outcomes Measurement Information System Physical Function Upper Extremity (PROMIS PF UE) between the TSK and TSK-4. Additionally, we looked for other factors that were associated with the PROMIS PF UE, and we assessed reliability and validity of the TSK and TSK-4 by looking at mean scaled scores, internal consistency, floor and ceiling effects, interquestionnaire correlations, and collinearity with the Pain Catastrophizing Scale short form (PCS-4), PROMIS Depression, and PROMIS Pain Interference (PROMIS PI). Methods: One hundred forty eight new and follow-up patients were seen at 5 orthopedic clinics in a large urban area and given the TSK, PROMIS PF UE, PROMIS Depression, PROMIS PI, and PCS-4 questionnaires. Results: Both long and short measures of greater fear of painful movement were independently associated with less physical function (PROMIS PF UE). The longer version accounted for more of the variation in physical function than the short version (TSK, semipartial R2 = 0.12, adjusted R2 full model 0.25; TSK-4, semipartial R2 = 0.03, adjusted R2 full model = 0.16, respectively). The shorter measure had slight floor and ceiling effects. There was high internal consistency for both the TSK and TSK-4. Conclusions: A short measure of fear of painful movement may be an adequate screen in the care of patients with upper extremity problems. Using this short form can help decrease questionnaire burden while accounting for kinesiophobia along with catastrophic thinking.

Level of Evidence: Prognostic, level II
Evaluating The Virtues Project as a leadership development programme
Authors: Newstead Toby , Dawkins Sarah , Macklin Rob , Martin Angela
Published: January 2020

This article contributes to an emerging field of virtue-based leadership development scholarship by reporting on the first known empirical evaluation of The Virtues Project as a leadership development programme. This exploratory study seeks to understand if or how The Virtues Project might facilitate the development of good leaders. Our understanding of ‘good’ is informed by the notion of virtue and the philosophy of virtue ethics, and we adopt a critical realist evaluation framework to distil what about The Virtues Project works for whom in which contexts and why. Our study employs a longitudinal comparative case design composed of multiple in-depth interviews with nine leader participants and their colleagues over the duration of five months. Findings indicate that (a) The Virtues Project training was experienced as a trigger event that fostered leaders’ new understandings of what virtue is and how virtues inform behaviour, and (b) The Virtues Project training equipped leaders with language-based strategies to incorporate virtues into their leadership practices. In sum, participating leaders felt that The Virtues Project facilitated the development of their leadership by enabling them to understand and recognize the best in themselves and others (virtues) and to incorporate virtues into their leadership practices. Limitations and future research are discussed.
Political Representation by Ethnic Parties? Electoral Performance and Party-Building Processes among Ethnic Parties in Myanmar
Authors: Stokke Kristian
Published: January 2020

What is the role of political representation by ethnic parties in a multi-ethnic state that has undergone a transition from military rule, and is seeking to resolve protracted intrastate conflicts? The present article examines this question through a contextual case study of ethnic parties in Myanmar – a state that is characterised by unresolved ethnic grievances and conflicts; a political transition that has created new opportunities for ethnic representation; and multiple ethnic parties making representative claims on behalf of ethnic groups. Based on a mixed methods approach, the article documents that ethnic parties have been relatively ineffective in ensuring formal and descriptive representation and have had limited possibilities for substantive representation of ethnic interests. The article also identifies key explanations for the weak electoral performance of ethnic parties, emphasising party fragmentation and vote-splitting as well as weak party institutionalisation and limited capacity to make representative claims. Finally, the article analyses strategies for party-building, in preparation for the 2020 election. Based on the common emphasis on vote-splitting, most ethnic states have seen initiatives to merge parties, while a few parties have also sought to develop their political platform and sector policies. The article concludes that ethnic parties may gain improved formal representation after the next election but questions about the parties’ capacity for substantive representation remains. The 2020 election will thus be a new test for how ethnic voters see themselves best represented, in the light of competing representative claims and past experiences: by ethnic parties or non-ethnic democracy parties?
The role of renal mass biopsy in the management of small renal masses – patterns of use and surgeon opinion
Authors: Protani Melinda M , Joshi Andre , White Victoria , Marco David JT , Neale Rachel E , Coory Michael D , Giles Graham G , Bolton Damien M , Davis Ian D , Wood Simon , Jordan Susan J
Published: January 2020

Aims:

Renal mass biopsy (RMB) is advocated to improve management of small renal masses, however there is concern about its clinical utility. This study aimed to elicit opinions about the role of RMB in small renal mass management from surgeons managing renal cell carcinomas (RCC), and examine the frequency of pre-treatment biopsy in those with RCC.

Methods:

All surgeons in two Australian states (Queensland: n = 59 and Victoria: n = 108) who performed nephrectomies for RCC in 2012/2013 were sent questionnaires to ascertain views about RMB. Response rates were 54% for Queensland surgeons and 38% for Victorian surgeons. We used medical records data from RCC patients to determine RMB frequency.

Results:

Most Queensland (81%) and Victorian (59%) surgeons indicated they rarely requested RMB; however 34% of Victorians reported often requesting RMB, compared with no Queensland surgeons. This was consistent with medical records data: 17.6% of Victorian patients with T1a tumours received RMB versus 6.7% of Queensland patients ( p < 0.001). Surgeons’ principal concerns regarding RMB related to sampling reliability (90%) and/or histopathological interpretation (76%).

Conclusions:

Most surgeons report infrequent use of RMB for small renal masses, however we observed practice variation. The principal reasons for infrequent use were concerns about sampling reliability and histopathological interpretation, which may be valid in regions with less access to interventional radiologists and uropathologists. Further evidence is required to define patient groups for whom biopsy results will alter management.

Level of evidence:

Not applicable for this multicentre audit.
A Multidisciplinary Approach to Expedite Surgical Hip Fracture Care
Authors: Burton Alex , Davis Charles M. , Boateng Henry , Fox Edward J. , McQuillan Patrick M. , Mets Berend , Hassenbein Susan , Black Kevin P. , Munyon Ryan , McGillen Brian , Armstrong April D.
Published: January 2020

Introduction:

In 2014, we implemented a geriatric hip fracture patient care pathway at our institution which was designed to improve outcomes and decrease time to surgery.

Materials and Methods:

We analyzed retrospective data from 463 patients, aged greater than 50, who had surgical treatment for a closed hip fracture due to a low-energy injury between 2013 and 2016 at an academic institution. Objective outcome measures included time to surgery, mortality rate, and total hospital length of stay. Our primary goal was to decrease the time to surgery for definitive fracture fixation to within 24 hours of admission to the hospital for patients who were medically fit for surgery.

Results:

We implemented a multidisciplinary, collaborative approach to address the needs of this specific patient population. Prior to implementing the pathway in 2013, our baseline time to surgery within 24 hours was 74.67%. After implementation, we had incremental yearly increases in the percentage of patients operated on within 24 hours, 82.31% in 2014 ( P = .10) and 84.14% in 2015 ( P = .04). During the study period, our overall time to surgery was reduced by 27% with an initial average of 20.22 hours in 2013, decreasing to 15.33 hours in 2014, and 14.63 hours in 2015. Our mortality rate at 1 year was 16% in 2013, 17% in 2014, and 15% in 2015.

Conclusion:

With implementation of the pathway, we were able to expedite surgical care for our patients and demonstrate a 10% improvement in the percentage of patients able to have surgery within 24 hours over a 3-year period. Our mortality and hospital length of stay, however, remained the same. Through this collaborative process and system standardization, we believe we have significantly improved not only direct patient care but their overall hospital experience. We continue to make improvements in our pathway.
Marriage Status Predicts Hospital Outcomes Following Orthopedic Trauma
Authors: Konda Sanjit R. , Gonzalez Leah J. , Johnson Joseph R. , Friedlander Scott , Egol Kenneth A.
Published: January 2020

Introduction:

Rising costs of post-acute care facilities for both the patient and payers make discharge home after hospital stay, with or without home help, a favorable alternative for all parties. Our objectives were to assess the effect of marital status, a large source of social support for many, on disposition following hospital stay.

Methods:

Patients were prospectively entered into an institutional review board-approved, trauma database at a large, academic medical center. Patients aged 55 years or older with any fracture injury between 2014 and 2017 were included. Retrospectively, their relationship status was recorded through review of patient records. A status of “married” was separated from those with a status self-reported as “single,” “divorced,” or “widowed.” Multinomial logistic regression was used to assess whether discharge location differs by marital status while controlling for demographics and injury characteristics.

Results:

Of 1931 patients, 8.3% were divorced, 29.9% were single, 20.0% were widowed, and 41.8% were married. There was a significant correlation between discharge disposition and marital status. Single patients had 1.71 times, and widowed patients had 1.80 times, the odds of being discharged to a nursing home, long-term care facility, or skilled nursing facility compared to married patients after controlling for age, gender, Score for Trauma Triage in the Geriatric and Middle-Aged score, and insurance type. Additionally, single and widowed patients experienced 1.36 and 1.30 times longer length of hospital stay than their married counterparts, respectively.

Discussion:

Patients who are identified as “single” or “widowed” should have early social work intervention to establish clear discharge expectations. Early intervention in this way would allow time for contact with close, living relatives or friends who may be able to provide sufficient support so that patients can return home. Increasing home discharge rates for these patients would reduce lengths of hospital stay and reduce post-acute care costs for both patient and payers without materially altering unplanned readmission rates.
Five Rings, Five Screens? A Global Examination of Social TV Influence on Social Presence and Social Identification During the 2018 Winter Olympic Games
Authors: Brown-Devlin Natalie , Devlin Michael B. , Billings Andrew C. , Brown Kenon A.
Published: January 2020

This study uses social presence theory and social identity theory as theoretical frameworks to examine global social TV usage during a mega-sporting event. A total of 2,296 people from six different nations (Canada, China, Germany, Japan, Sweden, and the United States) were surveyed about their social TV usage, degree of social presence, and team identification in the week following the 2018 Winter Olympics in PyeongChang, South Korea. Primary findings illustrate that increased social TV use predicts increased measures of social presence, social capital, and perceived sociability, which then influences one’s identification with their national team and Winter Olympics fandom. Additional insights are found regarding global social TV engagement and ancillary device usage habits.
Sleep, bark, or bite: Do natural resources make the difference regarding peaceful or violent conflict?
Authors: Basedau Matthias , Roy Vita
Published: January 2020

Natural resources can create state-based and other conflicts through several causal mechanisms. Debate, however, has remained silent on forms of conflict, especially why violent or peaceful collective action occurs. Combining the literatures on nonviolent- and armed conflict with work on the resource–conflict link, we developed a number of hypotheses on how resources affect the conditions under which collective actors such as ethnic groups remain dormant, voice grievances peacefully or engage in violent rebellion. A grid-cell analysis of ethnic groups in Africa largely confirmed our expectation on the effect of resources. Resource deposits increased the risk that violent conflict would occur; the effect was reversed and ethnic groups become dormant when groups living in resource regions were politically included. We also found some evidence that lootable resources fuel violent but not peaceful conflict. However, the non-resource context best explained the difference between violent and nonviolent conflict. Democracy, political exclusion and geography such as distance from capital and transborder ethnic kin were key in explaining why violent and not peaceful protest emerged. Future research should dig deeper into mechanisms of how resources affect forms of conflict and should further study non-resource conditions that can have functionally equivalent effects.
Screens, Apps, and Digital Books for Young Children: The Promise of Multimedia
Authors: Bus Adriana G. , Neuman Susan B. , Roskos Kathleen
Published: January 2020

Just beginning to understand the potentials new technologies might bring to the learning environments of young children, we invited authors to submit articles that investigate multimedia sources and their effect on learning settings. Two main themes emerged—how digitization changes the learning environment and adult-child interaction in particular and which digital affordances enrich digital materials and how these changes affect learning. We finish with “alerts” to further explore more the hidden potentials of new technologies and how routines such as book reading might change and become more effective in some respects.
Relationship between Lambl’s excrescences and embolic strokes of undetermined source
Authors: Salehi Omran Setareh , Chaker Salama , Lerario Mackenzie P , Merkler Alexander E , Navi Babak B , Kamel Hooman
Published: January 2020

Introduction

About one-fourth of ischaemic strokes are classified as embolic strokes of undetermined source. Lambl’s excrescences are commonly seen on cardiac valves, and data are limited on whether they may be a source of embolization. We examined the relationship between Lambl’s excrescences and embolic stroke of undetermined source.

Patients and Methods

We performed a case-control study of patients in the Cornell AcutE Stroke Academic Registry. Stroke aetiologies were adjudicated using the Trial of Org 10172 in Acute Stroke Treatment and embolic stroke of undetermined source criteria. We included patients with acute ischaemic stroke between 2011 and 2016 who underwent transthoracic or transoesophageal echocardiography within six months of hospitalisation. Cases were embolic stroke of undetermined source patients and controls were patients with an identified, non-cardioembolic stroke aetiology (i.e. small- or large-vessel strokes). Multiple logistic regression was used to evaluate the association between Lambl’s excrescences and embolic stroke of undetermined source after adjustment for demographics, comorbidities and mode of echocardiography.

Results

A total of 923 patients met the criteria for this analysis, including 530 with embolic stroke of undetermined source and 393 with small- or large-vessel strokes. Lambl’s excrescences were identified in 47 (8.9%) patients with embolic stroke of undetermined source and 11 (2.8%) patients with small- or large-artery strokes, but the majority (54/58) of Lambl’s excrescences were visualised on transoesophageal echocardiogram and embolic stroke of undetermined source patients were more likely to undergo transoesophageal echocardiogram. After adjustment for demographics, comorbidities and mode of echocardiography, we found no association between the presence of Lambl’s excrescences and embolic stroke of undetermined source (odds ratio 0.9; 95% confidence interval 0.4–2.3).

Conclusion

We found no association between Lambl’s excrescences and embolic stroke of undetermined source. These results do not support the hypothesis that Lambl’s excrescences are an occult cause of embolic stroke of undetermined source.
miR-147b-modulated expression of vestigial regulates wing development in the bird cherry-oat aphid Rhopalosiphum padi
Authors: Fan Yinjun , Li Xiuxia , Mohammed Abd Allah A. H. , Liu Ying , Gao Xiwu
Published: January 2020

Background

Most aphids exhibit wing polyphenism in which wingless and winged morphs produce depending on the population density and host plant quality. Although the influence of environmental factors on wing polyphenism of aphids have been extensively investigated, molecular mechanisms underlining morph differentiation (i.e. wing development /degeneration), one downstream aspect of the wing polyphenism, has been poorly understood.

Results

We examined the expression levels of the twenty genes involved in wing development network, and onlyvestigial (vg) showed significantly different expression levels in both whole-body and wall-body of third instar nymphs, with 5.4- and 16.14- fold higher expression in winged lines compared to wingless lines, respectively inRhopalosiphum padi.vgexpression was higher in winged lines compared to wingless lines in third, fourth instar nymphs and adults. Larger difference expression was observed in third (21.38-fold) and fourth (20.91-fold) instar nymphs relative to adults (3.12-fold). Suppression ofvgusing RNAi repressed the wing development of third winged morphs. Furthermore, dual luciferase reporter assay revealed that the miR-147 can target thevgmRNA. Modulation of miR-147b levels by microinjection of its agomir (mimic) decreasedvgexpression levels and repressed wing development.

Conclusions

Our findings suggest thatvgis essential for wing development inR. padiand that miR-147b modulates its expression.
Aging-simulation experience: impact on health professionals’ social representations
Authors: Giner Perot Julie , Jarzebowski Witold , Lafuente-Lafuente Carmelo , Crozet Cyril , Belmin Joël
Published: January 2020

Background

Health professionals working with older persons are not sufficiently aware of the sensory and functional difficulties experienced by older patients. Innovative educational activities, such as the aging-simulation experience, can facilitate this awareness. This study describes the effects of an aging-simulation experience on health professionals’ representations towards age-related limitations.

Methods

306 health professionals, enrolled in university training in geriatrics/gerontology in the 2015–2016 and 2016–2017 academic years, experienced an aging-simulation session wearing a special suit according to a predefined scenario. Before and after the aging-simulation experience, participants completed free association tests, with the inductive words vision, hearing, movement, fine dexterity and balance. Semantic categories were created from participants’ free evocations using a correspondence table manually produced in Excel 2013 for Windows (Microsoft Corporation, Redmond, Washington). Moreover, participants’ opinions on difficulties experienced by older people in relation to age-related limitations were studied using Likert scale questions.

Results

In total, 3060 free evocations were collected, and ten semantic categories were created. These categories were composed of participants’ geriatric knowledge, about age-related limitations, and participants’ feelings, about the experience of these limitations. These two aspects were impacted by the aging-simulation experience. Moreover, changes observed resulted in a better consideration of difficulties associated with age-related limitations.

Conclusions

The aging-simulation experience is an effective educational tool to raise awareness among health professionals of age-related difficulties. This sensory activity allows health professionals to put themselves in the shoes of older patients and to feel age-related difficulties.
Impaired consciousness and decreased glucose concentration of CSF as prognostic factors in immunocompetent patients with cryptococcal meningitis
Authors: Zhang Chen , Tan Zheren , Tian Fafa
Published: January 2020

Background

Cryptococcal meningitis (CM) is the most common fungal infection of the central nervous system and has high morbidity and mortality. Almost studies about prognostic factors have largely focused on the immunocompromised population rather than immunocompetent patients. So that we sought to conduct a retrospective study to determine prognostic factors which predict the outcomes in immunocompetent patients with CM.

Methods

We retrospectively collected and analyzed the demographic and clinical data of 76 apparently immunocompetent patients with cryptococcal meningitis from January 2003 to June 2019 in China. The clinical outcome was graded by the Glasgow outcome scale (GOS) at discharge, and patients were divided into good (score of 5) and unfavorable (score of 1–4) outcome groups, potential prognostic factors were analyzed.

Results

Non-parametric test confirmed that unfavorable outcome was associated with lower glucose level of CSF(P = 0.001), and Pearson’s χ2 analysis confirmed that unfavorable outcome was associated with opening pressure of CSF(>300mmH20, P = 0.038), impaired consciousness (P = 0.001), hydrocephalus(P = 0.045), and Shunt surgery (P = 0.045), and then multiple logistic regression analysis confirmed that impaired consciousness(P = 0.015) and lower glucose concentration of CSF(P = 0.012) increased the likelihood of unfavorable outcome in CM patients.

Conclusion

Impaired consciousness and decreased glucose concentration of CSF were independently prognostic factors which predict the unsatisfactory outcome in immunocompetent patients with CM.
Familial autosomal recessive bestrophinopathy: identification of a novel variant in BEST1 gene and the specific metabolomic profile
Authors: Ye Panpan , Xu Jia , Luo Yueqiu , Su Zhitao , Yao Ke
Published: January 2020

Background

Autosomal recessive bestrophinopathy (ARB) is a retinal degenerative disorder caused by BEST1 mutations with autosomal recessive inheritance. We aim to map a comprehensive genomic and metabolomic profile of a consanguineous Chinese family with ARB.

Methods

Ophthalmic examinations were performed on the affected patients with ARB. The proband was screened for potential causative mutations in a panel with 256 known retinal disease genes by using target capture sequencing. The related mutation was further validated and segregated in the family members by Sanger sequencing. In silico prediction tools were used for pathogenicity assessment. A UHPLC-MS/MS metabolomic analysis was performed to explore the disease-associated metabolic feature.

Results

The affected patients from this family were characterized by low vision, the presence of subretinal fluid, macular edema, and hyperopia with coincidental angle closure. DNA sequencing identified a novel missense mutation in the BEST1 gene c.646G > A (p.Val216Ile) of the proband. Sanger sequencing further confirmed the mutation. The missense mutation was co-segregation across the pedigree and predicted to be deleterious by SIFT (0.017). The blood metabolic profiles were highly similar among all family members probably because of the same lifestyle, habitat and genomic background. However, ARB patients presented a significant deregulation of metabolites, such as citric acid, L-Threonic acid, and eicosapentaenoic acid.

Conclusions

We identified a novel disease-associated variant in the BEST1 gene as well as a disease-specific metabolic feature in familial ARB. Our findings helped improve the understanding of ARB mechanisms.
Vaginal leiomyoma: medical imaging and diagnosis in a resource low tertiary hospital: case report
Authors: Egbe Thomas Obinchemti , Kobenge Fidelia Mbi , Metogo Junette Arlette Mbengono , Manka’a Wankie Emmanuella , Tolefac Paul N. , Belley-Priso Eugene
Published: January 2020

Background

In the literature under review there are about 300 reported cases of vaginal leiomyomas with none from Cameroon. We report a case of vaginal leiomyoma and highlight the diagnostic challenges faced at the Douala Referral Hospital (DRH), Cameroon.

Case presentation

A 36-year-old G3P3002 sexually active Cameroonian married woman reported dysuria, dyspareunia, cessation of sexual intercourse and offensive smelling vaginal discharge for 6 months and a 3-year history of a vaginal tumour; she was misdiagnosed despite ultrasonography and magnetic resonance imaging (MRI) but was corrected by an experienced radiologist. She underwent first look laparoscopy, surgical excision of the tumour through the vagina and histopathology analysis that confirmed leiomyoma.

Conclusion

Posterior location of vaginal leiomyomas found in this case is a rare occurrence. The diagnosis is based on careful examination and preoperative imaging (ultrasonography and MRI). However, the definitive diagnosis is usually made intra-operatively. We combined laparoscopic exploration of the internal genital organs and per vaginal excision of the vaginal leiomyoma. Thus, we recommend frozen section biopsy to exclude leiomyosarcoma.
“Navigation to prioritizing the patient” – first-line nurse managers’ experiences of participating in a quality improvement collaborative
Authors: Sjølie Berit Mosseng , Hartviksen Trude Anita , Bondas Terese
Published: January 2020

Background

First-line nurse managers are central to quality improvement work when changing work practices into better patient outcomes. Quality improvement collaboratives have been adopted widely to support quality management in healthcare services and shared learning. We have little knowledge of the first-line nurse managers’ own perspectives concerning their need for support and knowledge in quality improvement work. Therefore, the aim of this study was to gain understanding of first line nurse managers’ experiences in leading quality improvement work in their own organization when participating in a quality improvement collaborative.

Methods

An interpretive approach was chosen following Graneheim and Lundman’s qualitative content analysis. Data was collected through three focus group interviews with first-line nurse managers representing different workplaces: the local hospital, a nursing home, and a homecare service in a rural area of Norway.

Results

“Navigation to prioritizing the patient” emerged as an overarching metaphor to describe the first-line nurse managers experiences of leading quality improvement work, based on three themes: 1) fellowship for critical thinking and prioritizing the patient; 2) mastering the processes in quality improvement work; and 3) the everyday reality of leadership as a complex context.

Conclusions

A quality improvement collaborative encompassing knowledge transfer and reflection may create an important fellowship for health care leaders, encouraging and enabling quality improvement work in their own organization. It is crucial to invite all leaders from an organization to be able to share the experience and continue their collaboration with their staff in the organization. Continuity over time, following up elements of the quality improvement work at joint meetings, involvement by users, and self-development of and voluntary involvement in the quality improvement collaborative seem to be important for knowledge development in quality improvement. The supportive elements of the quality improvement collaborative fellowship were crucial to critical thinking and to the first-line nurse managers’ own development and security in mastering the quality improvement work processes. They preferred prioritizing the patients in quality improvement work, despite haste and obstructive situations in an everyday context.
Prevalence and characteristics of medication errors at an emergency department of a teaching hospital in Malaysia
Authors: Shitu Zayyanu , Aung Myat Moe Thwe , Tuan Kamauzaman Tuan Hairulnizam , Ab Rahman Ab Fatah
Published: January 2020

Background

Medication use process in the emergency department (ED) can be challenging and the risk for medication error (ME) to occur is high. In Malaysia, several studies on ME have been conducted in various hospital settings. However, little is known about the prevalence of ME in emergency department (ED) in these hospitals.

The objective of this study was to determine the prevalence and characteristics of ME at an ED of a teaching hospital in Malaysia.

Methods

A cross-sectional study was conducted over the period of 9 weeks in patients who visited the ED of Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia. Data on patient medication orders and demographic information was collected from the doctor’s clerking sheet. Observations were made on nursing activities and these were documented in the data collection form. Other information related to the administration of medications were obtained from the nursing care records.

Results

Observations and data collections were made for 547 patients who fulfilled the study criteria. From these, 311 patient data were randomly selected for analysis. Ninety-five patients had at least one ME. The prevalence of ME was calculated to be 30.5%. The most common types of ME were wrong time error (46.9%), unauthorized drug error (25.4%), omission error (18.5%) and dose error (9.2%). The most frequently drug associated with ME was analgesics. No adverse event was observed.

Conclusions

The prevalence of ME in our ED setting was moderately high. However, the majority of them did not result in any adverse event. Intervention measures are needed to prevent further occurrence.
Delayed haemolysis after treatment with intravenous artesunate in patients with severe malaria in India
Authors: Savargaonkar Deepali , Das Manoj Kumar , Verma Amar , Mitra Jeevan K. , Yadav C. P. , Srivastava Bina , Anvikar Anupkumar R. , Valecha Neena
Published: January 2020

Background

Parenteral artesunate is the treatment of choice for severe malaria. It is safe, efficacious and well tolerated anti-malarial. However, delayed haemolysis has been reported in travellers, non-immune individuals and in African children.

Methods

A prospective, observational study was carried out in admitted severe malaria patients receiving parenteral artesunate. The patients were followed up until day 28 for monitoring clinical as well as laboratory parameters for haemolytic anaemia.

Results

Twenty-four patients with severe malaria receiving injection artesunate were enrolled in the study. Post-artesunate delayed haemolysis following parenteral artesunate therapy was observed in three of 24 patients (12.5%, 95% confidence interval 4.5–31.2%). Haemolysis was observed in two more patients possibly due to other reasons. The haemoglobin fall ranged from 13.6 to 38.3% from day 7 to day 28 in these patients.

Conclusion

The possibility of delayed haemolysis should be considered while treating the severe malaria patients with parenteral artesunate. The study highlights the need for further studies in different epidemiological settings.
Impact of preoperative risk factors on outcome after gastrectomy
Authors: Eichelmann Ann-Kathrin , Saidi Meltem , Lindner Kirsten , Lenschow Christina , Palmes Daniel , Pascher Andreas , Hummel Richard
Published: January 2020

Background

Gastrectomy is associated with relevant postoperative morbidity. However, outcome of surgery can be improved by careful selection of patients. The objective of the current study was therefore to identify preoperative risk factors that might impact on patients’ further outcome after surgical resection.

Methods

Preoperative risk factors having respectively different surgical risk scores for major complex surgery (including Cologne Risk Score, p-/o-POSSUM, and NSQIP risk score) of patients that underwent gastrectomy for AEG II/III tumors and gastric cancer were correlated with complications according to Clavien-Dindo and outcome. Patients who underwent surgery in palliative intention were excluded from further analysis.

Results

Subtotal gastrectomy was performed in 23%, gastrectomy in 59%, and extended gastrectomy in 18% in a total of 139 patients (mean age: 64 years old). Thirty six percent experienced a minor complication (Dindo I-II) and 24% a major complication (Dindo III-V), which resulted in a prolonged hospital stay (p < 0.001). In-hospital mortality (=Dindo V) was 2.5%. Besides age, type of surgical procedure impacted on complications with extended gastrectomy showing the highest risk (p = 0.005). The o-POSSUM score failed to predict mortality accurately. We observed a highly positive correlation between predicted morbidity respectively mortality and occurrence of complications estimated by p-POSSUM (p = 0.005), Cologne Risk (p = 0.007), and NSQIP scores (p < 0.001).

Conclusion

The results demonstrate a significant association between different risk scores and occurrence of complications following gastrectomy. The p-POSSUM, Cologne Risk, and NSQIP score exhibited superior performance than the o-POSSUM score. Therefore, these scores might allow identification and selection of high-risk patients and thus might be highly useful for clinical decision making.
The Manila Declaration on Migration and Health: commentary of the Association of Pacific Rim Universities Global Health Program
Authors: Withers Mellissa , Wipfli Heather , Schenker Marc , Jahangir Tasfia , Herbosa Teodoro , Tigno Jorge
Published: January 2020

Background

Migration has played, and continues to play, an important role in shaping our global economy. As of 2017, there were 258 million international migrants worldwide, over 100 million of whom came from the Asia-Pacific region. Migration is increasingly recognized as a social determinant of health, as migrants often experience vulnerabilities that make them susceptible to a range of negative health outcomes. Addressing the health and human rights concerns of migrants requires concerted and global efforts from many stakeholders, including universities.

Methods

The Global Health Program of the Association of Pacific Rim Universities (APRU), a non-profit network of more than 50 universities in the region, is an example of an avenue to foster research, innovation, collaborative engagement, and large-scale advocacy around migration and health. In 2017, a special half-day workshop was held in Manila, convening 167 participants from 10 economies and 21 disciplines. The goal of the workshop was to delineate the role of universities in promoting migrant health and well-being. The global health experts from a diverse set of backgrounds collaboratively developed a policy statement to be used to better address migrant health and human rights. The objective of this paper is to disseminate the policy statement, highlighted specific action items that universities can take to protect and promote migrant health.

Results

The Manila Declaration on Migration and Health highlights that universities must ensure that their campuses are safe, supportive, and empowering environments for all migrants and their families. Universities are also urged to capitalize on their educational and research expertise to generate data on migrant experiences and communicate this research to policymakers.

Conclusions

This commentary highlights how institutions of higher education can serve as powerful avenues for promoting migrant health and human rights. Universities can play a vital role in building awareness and sensitivity to migrant challenges and needs, as well as helping to develop policy frameworks appropriate to their diverse contexts to guide, promote, and reinforce commitment to migrant rights and health. Universities should also ensure that their campuses are safe, supportive, and empowering environments for all migrants and their families.