bluuebunny/crossref_metadata_2025 huggingface dataset:
Tipping Points in Overturning Circulation Mediated by Ocean Mixing and the Configuration and Magnitude of the Hydrological Cycle: A Simple Model
Authors: Gnanadesikan Anand , Fabiani Gianluca , Liu Jingwen , Gelderloos Renske , Brett G. Jay , Kevrekidis Yannis , Haine Thomas , Pradal Marie-Aude , Siettos Constantinos , Sleeman Jennifer
Published: April 2024

In the modern ocean, the transformation of light surface waters to dense deep waters primarily occurs in the Atlantic basin rather than in the North Pacific or Southern Oceans. The reasons for this remain unclear, as both models and paleoclimatic observations suggest that sinking can sometimes occur in the Pacific. We present a six-box model of overturning that combines insights from a number of previous studies. A key determinant of the overturning configuration in our model is whether the Antarctic Intermediate Waters are denser than the northern subpolar waters, something that depends on the magnitude and configuration of atmospheric freshwater transport. For the modern ocean, we find that although the interbasin atmospheric freshwater flux suppresses Pacific sinking, the poleward atmospheric freshwater flux out of the subtropics enhances it. When atmospheric temperatures are held fixed, North Pacific overturning can strengthen with either increases or decreases in the hydrological cycle, as well as under reversal of the interbasin freshwater flux. Tipping-point behavior, where small changes in the hydrological cycle may cause the dominant location of densification of light waters to switch between basins and the magnitude of overturning within a basin to exhibit large jumps, is seen in both transient and equilibrium states. This behavior is modulated by parameters such as the poorly constrained lateral diffusive mixing coefficient. If hydrological cycle amplitude is varied consistently with global temperature, northern polar amplification is necessary for the Atlantic overturning to collapse. Certain qualitative insights incorporated in the model can be validated using a fully coupled climate model.

Significance Statement

Currently, the global overturning circulation involves the conversion of waters lighter than Antarctic Intermediate Water to deep waters denser than Antarctic Intermediate Water primarily in the North Atlantic, rather than in the North Pacific or Southern Oceans. Many different factors have been invoked to explain this configuration, with atmospheric freshwater transport, basin geometry, lateral mixing, and Southern Ocean winds playing major roles. This paper develops a simple theory that combines previous theories, presents the intriguing idea that alternate configurations might be possible, and identifies multiple possible tipping points between these states.
On the Long-run Sustainability of Current Account Deficits in India: Some Insights from Linear and Non-linear Cointegration Tests
Authors: Deheri Abdhut
Published: April 2024

This article assesses the long-run intertemporal sustainability of the current account deficit in India for the period 1974–2018. We employ various linear and non-linear models, such as the Johansen cointegration test, the non-linear autoregressive distributed lag (ARDL), threshold autoregression (TAR) and momentum autoregression (MTAR) models, to validate the intertemporal budget constraint. The results of the linear cointegration test reveal no cointegration between exports and imports, plus interest payment on external debt. Results from non-linear models, however, provide evidence of cointegration between the variables, implying that the intertemporal budget constraint is validated. The estimates of the TAR model reveal that the current account disequilibrium adjustment process towards the long-run equilibrium follows an asymmetric pattern. Results of the non-linear ARDL model further show that, in the long run, exports react differently to positive and negative changes in imports. Overall, our results show the presence of asymmetries in the current account adjustment process. The estimated cointegrating vector suggests that the current account deficit exhibits weak sustainability. From a policy perspective, the findings recommend implementing suitable macroeconomic and trade policies to reduce the current account deficit.

JEL Codes: C30, D90, F32, F34, F40
Perceived Stress Mediates Associations Between Grit and Health-Related Quality of Life
Authors: Knauft Katherine M. , Holt Cole A. , Kalia Vrinda
Published: April 2024

Grit, characterized by passion and perseverance in the pursuit of long-term goals, may be associated with enhanced quality of life and reduced levels of perceived chronic stress. We hypothesized that reduced levels of perceived stress may mediate the association between facets of grit (i.e., Perseverance and Consistency) and healthy functioning. We conducted two studies, one with college students and one with community adults, to test this hypothesis (cumulative N = 600). In both studies, facets of grit were assessed using the Short Grit Scale, levels of perceived chronic stress were assessed via the Perceived Stress Scale, and health-related quality of life was measured using selected questions from the Medical Outcome Study Short Form-36. Consistent with our hypothesis, perceived stress levels significantly mediated the relation between Grit-Perseverance and health-related quality of life in both college students and community adults. Our data suggest that individuals with high Grit-Perseverance experience lower perceived stress, which may result in improved health-related quality of life. Additionally, perceived stress partially mediated the relation between Grit-Consistency and health-related quality of life, but only in community adults. These novel findings suggest that the association between Grit-Perseverance and perceived chronic stress may differ for college students and community adults. Overall, our work indicates that perceived stress may be a key mediator through which facets of grit are related to healthy functioning in college students and community adults.
Challenges in Diagnosing and Treating Subperiosteal Orbital Hematoma Secondary to Sinusitis: A Case
Authors: Liu Danqing , Xue Kai , Tang Xuxia , He Xiao
Published: April 2024

Subperiosteal orbital hematoma secondary to sinusitis is rare. Thus far, 19 cases of this disease have been reported, of which none involved postoperative skin anesthesia in the region innervated by the supraorbital nerve. In this article, for the first time we report a case of subperiosteal orbital hematoma secondary to sinusitis with skin anesthesia in the area innervated by the supraorbital nerve after surgery.
Popular logistics for collective unpredictabilities in pandemic Madrid
Authors: Jiménez Alberto Corsín
Published: April 2024

This article develops the concept of collective unpredictability as a socio-geographic gathering and sensibility for redescribing territories of urban habitation. It describes in detail the databases, privacy protocols, call centres, inventory and queue flow management systems, spatial surveys, food supply chains, transport operations, credit and voucher economies, and financial accounting systems designed by community organizations during the COVID-19 pandemic across six neighbourhoods in Madrid. It demonstrates how these various systems of attention, logistical geographies and ecologies of habitation threw into question the ceteris paribus assumptions underpinning the geographical epistemologies of biopolitical models. The emphasis on collective unpredictabilities aims not to confront expert factuals against community counterfactuals, but to insist on the urban liveliness of otherwisefactuals.
‘On the inhalation of the vapour of Æther, with cases’: The first paper on anaesthesia read before a medical society in Australia
Authors: Haridas Rajesh P
Published: April 2024

On 7 September 1847, in Melbourne in the Port Phillip District of the Colony of New South Wales, David John Thomas (1813–1871) presented a paper, ‘On the inhalation of the vapour of Æther, with cases’, at an ordinary monthly meeting of the Port Phillip Medical Association. This is the earliest known presentation of a paper on etherisation in Australia. The partial publication of the manuscript in October 1847 in the Australian Medical Journal may have led to it being returned to Thomas in Melbourne. The handwritten manuscript is now preserved in the Medical History Museum, University of Melbourne, Melbourne, Victoria. A transcript of the complete manuscript is now recorded with relevant historical notes.
Assessing Spatial Distribution of Health Infrastructure in India
Authors: Ghatak Sunetra
Published: April 2024

In India, access to public health care is being criticised in terms of inequities in availability, utilisation and affordability. The role of private facilities is gradually becoming important in the discussions as it is expected to act as a substitute for the public health care systems. With this paradigm change, recent health insurance policies are also designed to cover expenses incurred either in public or private facilities. Therefore, the interplay of public and private establishments has a significant role to play, which positively influences the total allocation of resources. In this scenario, the most important is to examine the spatial distribution of two types of health providers to understand the prospective access of health establishments, whether they coexist, and whether private establishments are adequate to support the needs of the people. The study confirms the coexistence of health establishments, which means health establishments are not distributed evenly and form clusters. The correlation between public and private establishments is strong in urban areas, but it is inconsistent for rural areas. Moreover, findings suggest that existing insurance policies are only boosting demand for health care but are unable to minimise out-of-pocket expenses as health establishments are confined to certain areas. Therefore, universal health care has remained elusive unless the supply-side venture is achieved.
The Vasodilator Effect and Mechanism of 18β-glycyrrhetinic Acid on Isolated Pulmonary Artery Rings in Rats
Authors: Yang Huijuan , Li Hailong , Liu Yuxin , Jiang Jinrui , Hai Mei , Li Cong , Hu Zhiqiang , Zhou Ru
Published: April 2024

Background

The purpose of this study was to evaluate the effect of 18β-glycyrrhetinic acid (18β-GA) on isolated rat pulmonary artery vascular rings as well as the mechanism that lies behind the diastolic effects of this compound.

Materials and Methods

To examine the effects of various doses of 18β-GA on resting normal vascular rings, we used isolated rat pulmonary artery vascular rings. The isolated rat pulmonary artery vascular ring was precontracted with phenylephrine (PE) and potassium chloride solution (KCl), which allowed for the observation of the diastolic effects of 18β-GA, as well as the effects of various concentrations of 18β-GA on blocking the four potassium channels of glibenclamide, barium chloride (BaCl2), tetraethylamine (TEA), or 4-aminopyridine; the impact of various 18β-GA concentrations on the pulmonary artery vasodilation effect pre-use of the nitric oxide synthase inhibitors l-nitroarginine methyl ester and indomethacin.

Results

It was shown that 18β-GA has concentration-dependent diastolic effects on isolated rat pulmonary vascular rings that have been precontracted with PE and KCl but it has no effect on resting isolated thoracic aortic vascular rings.

Conclusion

The two Kir and Kv channels may be connected to the endothelium-dependent vasodilation mechanism of 18β-GA.
Corporate Sustainability and Capital Costs: A Panel Evidence from BRICS Countries
Authors: Dua Jyoti , Sharma Anil Kumar
Published: April 2024

Global sustainability challenges have triggered a sense of accountability in society, culminating in the growing incorporation of sustainability into corporate operations. This article aims to investigate the influence of environmental, social and governance (ESG) disclosure on a company’s cost of financing in emerging markets. Furthermore, the article examines the criticality of separate pillars of ESG in determining the companies’ capital costs using a panel dataset of 192 non-financial companies drawn from the equity indices from the BRICS countries for 10 years, spanning 2011–2020. Pooled Ordinary Least Square and fixed-effect panel regressions are used to test the hypothesised relationships. The robustness of our findings is validated by the application of the System Generalised Methods of Moments approach. The results show that ESG disclosure scores and their individual component scores are positively associated with the cost of equity and weighted average cost of capital. In contrast, there is a negative relationship with the cost of debt. Results demonstrate the apprehensions of equity providers and the reception of debt providers towards the companies’ ESG adoption. The governance pillar has the most significant influence on capital costs. The study enables managers to evaluate the economically ideal capital structure for ESG-compliant enterprises strategically.
Is Agricultural Production Responsible for Environmental Degradation in India? Implications for Sustainability Based on Panel Data Analysis
Authors: Babu Swati Sinha
Published: April 2024

The study aims to investigate the impact of agricultural production on environmental degradation in the case of India, an emerging market economy, based on time series data from 1990 to 2020. Methane (CH4), nitrous oxide (N2O), and carbon dioxide (CO2) emissions have been used as indicators of degradation. Autoregressive distributive lag bound tests examine the long-run cointegrating relationship among the variables. To investigate the existence of the environmental Kuznets curve (EKC) between agricultural production and CH4, N2O, and CO2, we used a fully modified ordinary least squares (FMOLS) technique, and the robustness of the results of FMOLS were checked by dynamic ordinary least squares estimators. We also used Granger causality to check for unidirectional and bidirectional causalities. Results indicate an inverted U-shaped relationship in the case of both CH4 and N2O emission, thus confirming the EKC hypothesis. The relationship of CO2 emission with agricultural production does not verify the EKC hypothesis, and we find a U-shaped relation in the long-run. Lastly, policy measures have been suggested to mitigate greenhouse gas emissions from agricultural activities that may help attain a more sustainable economy.

JEL Classification Q1, Q22, Q23, Q53, C33
Temperature Rising, Growth Descending: Climate Change Impacts on Asian Economies
Authors: Kaushik Nikhil , Sharma Ashish , Mishra Poornima , Kumar Sunil
Published: April 2024

This study investigates the impact of temperature and rainfall on economic growth in Asian countries using panel data regression analysis from 1991 to 2021. The results reveal a significant negative relationship between temperature and economic growth, with a 1°C rise leading to a 0.385% reduction in growth. High-temperature countries experience a more significant adverse effect compared to low-temperature countries. However, despite displaying a negative trend, rainfall does not significantly influence economic growth statistically. The study also finds differences in the impact of climate variables across different income groups. Additionally, temperature negatively affects the growth rate of agrarian countries, while rainfall does not significantly influence their growth dynamics. These findings underscore the importance of considering climate change in understanding economic growth and highlight the need for policymakers to prioritize climate risk assessment and adopt appropriate climate change mitigation and resilience strategies in Asian countries.

JEL Classification E23, O13, Q54
A new unsymmetrical decomposition of the damage variable
Authors: Voyiadjis George Z , Kattan Peter I
Published: April 2024

This work focuses on the dissection of the damage variable within solid materials. The underlying assumption is that damage within a solid primarily stems from the presence of various defects. The conventional approach to breaking down the damage variable into two parts – one attributed to the first defect type and the other to the second defect type – is both explored and expanded in a coherent mathematical manner. Within this context, a novel and asymmetric dissection of the damage variable is formulated. This fresh asymmetrical approach presents an alternative to the traditional symmetric dissection of the damage variable. Initially, the dissection considerations are carried out in a one-dimensional context using scalar values. However, this methodology is subsequently generalized employing tensors. In the end, an illustrative example is demonstrated.
Nonlinear dynamic meshing force analysis of PEEK-based polymer composite involute spline coupling system
Authors: Xue Xiangzhen , Yu Wei , Lin Kuan , Zhang Ning , He Xindang , Jiang Yiqiang
Published: April 2024

The dynamic meshing force affects the stability and wear life of PEEK polymer composite involute spline couplings, but most of the dynamic meshing force is obtained by empirical formula, and there is no effective calculation method in practice. Aiming at the viscoelasticity and nonlinear behavior of PEEK material, this work established a nonlinear dynamic model of the drive system of PEEK-based polymer composite involute spline pair by using the concentrated mass method, taking into account time-varying meshing stiffness, tooth side gap, and comprehensive transmission error, and obtained a dimensionless dynamic matrix that eliminates rigid body displacement. Aiming at the thermal stability of PEEK material, the dynamic meshing stiffness and dynamic meshing force of the involute spline of PEEK-based polymer composite were calculated by considering the thermal effect of misalignment and meshing deformation. The influence of misalignment on the dynamic characteristics of the system under dynamic and static loads was studied. The results show that the dynamic meshing stiffness and dynamic meshing force of involute spline coupling of PEEK-based polymer composite materials under misalignment represent complex nonlinear characteristics; Vibration, load, and viscoelastic deformation have an impact on transmission accuracy and efficiency; And the optimal selection range for friction coefficient, Poisson's ratio, and Young's modulus were determined within the parameter range of involute spline coupling of PEEK-based polymer composite materials as the matrix. It provides a theoretical foundation for designing high-performance, high-precision, and highly reliable PEEK-based polymer composite components.
Revisiting an historic tool of participatory action research: Consciousness-raising as a methodology for transformative change
Authors: Sankofa Nicole
Published: April 2024

Freirean consciousness-raising methodology is an historical, emancipatory tool useful in transforming modern socio-political oppressions in the current War on Women as it can simultaneously raise critical consciousness and ignite social action. Unfortunately, there are no systemic guidelines on conducting consciousness-raising as a research method. Therefore, the purpose of this critical literature review is to examine how consciousness-raising has been used as a research methodology and evaluate its associated tools and procedures. The review ( n = 12 studies) revealed ten decision-making processes: assumptions and aims, group composition, governance, environment, rules, session structure, activities, collective data collection and analysis, evaluation, and transition planning. I use an exemplar study of diverse girls exploring how city planning contributed to their experiences of neighborhood violence to integrate experiential knowledge into the literature review findings. The article concludes with a discussion on the implications, limitations, and future directions of the consciousness-raising methodology.
Derivation of Key Attributes and Clusters of Korean Taekwondo Policies and Systems on Social Media: Comparative Big Data Analysis Based on Regime Change
Authors: Park Sung-Un
Published: April 2024

This study analyzed the key attributes and clusters of policies and systems of Korean Taekwondo based on Park Geun-Hye and Moon Jae-in’s regime changes using big data, including 8,030 data points on social media over a period of 8 years. Frequency analysis, term frequency inverse document frequency analysis, and degree centrality analysis were performed using TEXTOM 4.5. In addition, a convergent and correlation analysis was performed using UCINET 6 to visualize related words and analyze clusters. Frequency, term frequency inverse document frequency, and degree centrality analyses revealed 30 high-order terms. A convergence of iterated correlations analysis of the derived words identified three common clusters: improvement, problem, and support. In addition, there were two distinct clusters in the Park Geun-hye government (research and sports policy), and three in the Moon Jae-in government (interview, thoughts, and athlete). The Korean government attempted to improve and address problems related to policies and systems for the development of Taekwondo. However, as Taekwondo policies and systems were implemented from different perspectives by each regime, systematic policies and systems could not be implemented.
Proficiency Development and Learning Curve in Robot-Assisted Spine Surgery Using the ExcelsiusGPS® System: Experience From a Single Institution
Authors: Shi Chen , Tong Yixuan , Harris Liam , Owusu-Sarpong Stephane , Goldstein Jeffrey
Published: April 2024

Study Design

Retrospective Cohort Study Objectives: Robot-assisted spine surgery (RASS) is a rapidly evolving technique with potential benefits for improving surgical outcomes. A number of studies on RASS learning curve have focused on early iterations of the Mazor robot. Limited research exists on the learning curve associated with using the Globus Medical ExcelsiusGPS® system. In this retrospective study, we aimed to evaluate the learning curve of RASS using the ExcelsiusGPS® system at a single institution.

Methods

A total of 95 patients (541 screws) who underwent RASS between 2021 and 2022 were included. Variables including operative time, robot registration time, screw placement time, fluoroscopy utilization, and complications were analyzed. Statistical analysis was performed using descriptive statistics and two-sample t-tests.

Results

The average operative time significantly decreased after the first 14 cases, indicating a learning curve. However, no significant improvement was observed in robot registration time. Notably, screw placement time significantly improved after approximately 13 cases. When controlling for the number of levels fused, the trends remained consistent.

Conclusions

Our study confirmed the presence of a learning curve in RASS using the ExcelsiusGPS® system and demonstrated rapid proficiency development. Our findings highlight the relatively quick learning curve of 1 RASS system.
Introducing a Foundation Programme Aiming at Academic Cognition
Authors: Mohanan K. P. , Mohanan Tara
Published: April 2024

The quality of education of an educational programme is a function of the value of the educational goals that the programme aims at, together with the effectiveness and efficiency of the means that it employs to achieve those goals, including pedagogical strategies and assessment tasks. Hence, in order to raise the quality of education, the current discourse of ‘Outcome Based Education’ needs to shift its focus from what the teacher does in the classroom to raising the quality of student learning. To do this, many universities both in India and abroad have initiated Foundation Programmes as part of both General Education and Specialized Education. This article proposes that such a foundation programme must aim at what we call Academic Cognition, in consonance with what NEP 2020 calls Higher-Order Cognition. We spell out the various strands of Academic Cognition, and explore ways in which foundation programmes in the curricula for Higher Education can provide the foundations for Academic Cognition.
Enhancing quality of life in severe post-COVID-19 survivors through multidisciplinary care
Authors: Cataneo-Piña Daniela Josefina , Castorena-Maldonado Armando , González-Islas Dulce , Galicia-Amor Susana , Orea-Tejeda Arturo , Pelaez-Hernández Viridiana , Gutiérrez-Álvarez Alma Delia , Rojas-Serrano Jorge , Ortiz-Reyes Eduardo , Mendoza-Méndez Aline , Mendoza-Escamilla Ángel , Fabre-Alonso Sinuhe , Buendía-Roldán Ivette , Gochicoa-Rangel Laura , López-García Carlos , Radillo-Gil Marian , Hernández Favela Celia Gabriela , Monraz-Perez Sergio , Salas-Hernández Jorge , Santillán-Doherty Patricio
Published: April 2024

Background

COVID-19 survivors who were hospitalised continue to experience long-term multisystemic sequelae and symptoms, impacting their health-related quality of life (HRQoL). The complexity of post-COVID-19 conditions underscores the importance of adopting a multidisciplinary, patient-centric approach to ensure ongoing care. This study aims to assess HRQoL and post-COVID symptoms in a cohort of severe COVID-19 survivors depending on their participation in a multidisciplinary programme.

Methods

This prospective study was conducted in a post-COVID clinic staffed by a multidisciplinary team (physical rehabilitator, nutritionist, psychologist, including experts in pulmonary rehabilitation, nutrition, psychology and others). Subjects over 18 years old who were hospitalised due to severe COVID-19 during the acute phase and had attended the post-COVID clinic within the first 3 months following discharge were included. Subjects who were unable or unwilling to provide informed consent to participate in the protocol were excluded. Linear mixed-effect models were employed to examine changes in 12-Item Short-Form Health Survey (SF-12) component scores. The resolution of post-COVID symptom clusters was compared using the Cox model.

Results

A total of 730 patients were included, with a mean±sdage of 55.78±15.43 years; 60.55% were male and 90.62% required mechanical ventilation during hospitalisation. Programme attendants demonstrated improved SF-12 physical and mental component scores at 3 and 12 months. A reduction in the prevalence of post-COVID symptoms was observed in both groups, with greater reductions in those attending the programme.

Conclusion

Our study showed that patients enrolled on the multidisciplinary programme experienced improvements in fatigue, musculoskeletal, gastrointestinal, neuropsychiatric and respiratory symptoms, along with enhanced SF-12 mental and physical component scores.
Healthcare utilisation and economic burden of migraines among bank employees in China: a probabilistic modelling study
Authors: Wei Du , Wong Li Ping , He Xun , Loganathan Tharani
Published: April 2024

Background

Despite the recognised high prevalence of migraines among bank employees, yet their healthcare utilisation patterns and the economic burden of migraines remain underexplored.

Aim

To examine migraine-related healthcare utilisation among bank employees in China, and to estimate the economic burden of migraines.

Methods

A cross-sectional survey was conducted in Guizhou province, China between May and October 2022. The HARDSHIP questionnaire was used to identify migraine-positive individuals and enquire about their healthcare utilisation and productivity losses. A probabilistic decision-analytic model with a micro-costing approach was used to estimate the economic burden from the perspectives of the healthcare system, employers, and society. All costs were expressed in 2022 United States dollars. One-way and probabilistic sensitivity analyses were performed.

Results

Nearly half of individuals with migraines reported not seeking medical care. Only 21.8% reported seeking outpatient consultations, 52.5% reported taking medicines, and 27.1% reported using complementary therapies. Chronic migraine patients had significantly higher healthcare utilisation than episodic migraine patients. Among individuals with a monthly migraine frequency of 15 days or more, 63.6% took inappropriate treatments by excessively using acute medications. Migraines in the banking sector in Guizhou cost the healthcare system a median of $7,578.0 thousand (25th to 75th percentile $4,509.2–$16,434.9 thousand) per year, employers $89,750.3 thousand (25th to 75th percentile $53,211.6–$151,162.2 thousand), and society $108,850.3 thousand (25th to 75th percentile $67,370.1–$181,048.6 thousand). The median societal cost per patient-year is $3,078.1. Migraine prevalence and productivity losses were identified as key cost drivers.

Conclusions

The study points to the need to raise awareness of migraines across all stakeholders and to improve the organisation of the migraine care system. A substantial economic burden of migraines on the healthcare system, employers, and society at large was highlighted. These cost estimates offer evidence-based benchmarks for assessing economic savings from improved migraine management, and can also draw the attention of Chinese policymakers to prioritise migraine policies within the banking and other office-based occupations.
Application of metagenomic next-generation sequencing in the diagnosis of Bartonella neuroretinitis: a case report and literature review
Authors: Li Pengcheng , Qian Zhuyun , Tao Yong
Published: April 2024

Background

Cat-scratch disease (CSD) is caused by Bartonella henselae infection. In atypical cases of CSD, pathogen determination is challenging. We report a case of Bartonella neuroretinitis with neither a clear history of scratches nor typical general symptoms. The diagnosis was made using metagenomic next-generation sequencing (mNGS), a high-throughput sequencing technology.

Case presentation

A female patient presented to the ophthalmologist with complaint of blurred vision in her right eye. Although with history of raising a cat, she reported no clear history of scratches or typical general symptoms, except a fever of unknown origin which resolved spontaneously. The best corrected visual acuity (BCVA) of the right eye was count fingers. Fundus examination showed optic disc oedema, macular exudates and inferior exudative retinal detachment. Laboratory examination results showed increased value of serum C-reactive protein and erythrocyte sedimentation rate. Ocular involvement of toxoplasmosis, syphilis and tuberculosis were excluded. To identify the possible causative pathogen of the disease, mNGS of aqueous humour sample was performed and 521 reads of B. henselae were identified. Serological test results further showed a positive immunoglobulin G (IgG) titre of 1:64. Taking the contact history, clinical manifestations, mNGS and serological results into consideration, the diagnosis of Bartonella neuroretinitis (ocular CSD) was made. After appropriate treatment, the BCVA of the right eye improved to 20/25 in the last follow-up. Fundus examination showed a normal optic disc and macula, and the exudates had reduced.

Conclusion

mNGS, a fast and unbiased method, can be used to detect B. henselae (if present) in intraocular fluid samples.; however, the results should be interpreted together with the clinical symptoms and other auxiliary test results.
Double lumen endobronchial tube intubation: lessons learned from anatomy
Authors: Cameron Robert B. , Peacock Warwick J. , Chang Xinlian Grace , Shin John S. , Hoftman Nir
Published: April 2024

Background

Double lumen endobronchial tubes (DLTs) are frequently used to employ single lung ventilation strategies during thoracic surgical procedures. Placement of these tubes can be challenging even for experienced clinicians. We hypothesized that airway anatomy, particularly of the glottis and proximal trachea, significantly impacts the ease or difficulty in placement of these tubes.

Methods

Images from 24 randomly selected Positron Emission Tomography – Computed Tomography (PET-CT) scans were evaluated for several anatomic aspects of the upper airway, including size and angulation of the glottis and proximal tracheal using calibrated CT measurements and an online digital protractor. The anatomic issues identified were confirmed in cadaveric anatomic models.

Results

Proximal tracheal diameter measurements in PET-CT scans demonstrated a mean ± standard deviation of 20.4 ± 2.5 mm in 12 males and 15.5 ± 0.98 mm in 12 females (p < 0.001), and both were large enough to accommodate 39 French and 37 French DLTs in males and females, respectively. Subsequent measurements of the posterior angulation of the proximal trachea revealed a mean angle of 40.8 ± 5.7 degrees with no sex differences. By combining the 24 individual posterior tracheal angles with the 16 angled distal tip measurements DLTs (mean angle 24.9 ± 2.1 degrees), we created a series of 384 patient intubation angle scenarios. This data clearly showed that DLT rotation to a full 180 degrees decreased the mean intubation angle between the DLT and the proximal trachea from a mean of 66.6 ± 5.9 to only 15.8 ± 5.9 degrees.

Conclusions

Rotation of DLTs a full 180 instead of the recommended 90 degrees facilitates DLT intubations.
50% efficacy dose of intravenous lidocaine in supressing sufentanil-induced cough in children: a randomised controlled trial
Authors: Hu Yang , Du Ming-cheng , Zhu Guo-hong , Long Xiang , Jiang Jing-jing , Gong Yuan
Published: April 2024

Background

Opioids such as sufentanil are used as anaesthetics due to their rapid action and superior analgesic effect. However, sufentanil induces a huge cough in paediatric patients. In contrast, intravenous (IV) lidocaine suppresses opioid-induced cough in children, but its use is limited due to anaesthetists’ concern about its toxicity. Therefore, this study aimed to evaluate the effect of dose-dependent IV lidocaine on sufentanil-induced cough (SIC) in paediatric patients.

Methods

A total of 188 patients aged 3–12 years scheduled for elective tonsillectomy with or without adenoidectomy were enrolled and divided into four groups depending on different dose of lidocaine: A (0 mg.kg-1), B (1 mg.kg-1), C (1.5 mg.kg-1), and D (2 mg.kg-1). The primary outcome was the SIC grade observed during the induction of general anaesthesia. The secondary outcomes were the incidence of SIC, mean arterial pressure, and heart rate at T0, T1, T2, T3, T4, and T5.

Results

The SIC grade was significantly different between groups A and D (P = 0.04) and between groups B and D (P = 0.03). Moreover, the incidence of SIC in groups A, B, C, and D was 81%, 87%, 68%, and 64%, respectively, and the difference between groups B and C (P = 0.03) and between groups B and D (P = 0.0083) was statistically significant. No statistical differences were observed in the hemodynamic parameters between the groups. The incidence of severe cough was statistically different between group D and group A (P < 0.0001), between group D and group B (P < 0.0001), and between group D and group C (P < 0.0001) respectively.

Conclusions

Lidocaine suppresses SIC in a dose-dependent manner without severe adverse events. IV lidocaine can be used in paediatric patients safely and efficiently, and the median effective dose was 1.75 mg/kg.

Trial registration

This study was approved by the Institutional Review Board of Yichang Central People’s Hospital (HEC-KYJJ-2020-038-02), The trial was registered at www.chictr.org.cn (ChiCTR2100053006).
Application of causal inference methods in individual-participant data meta-analyses in medicine: addressing data handling and reporting gaps with new proposed reporting guidelines
Authors: Hufstedler Heather , Mauer Nicole , Yeboah Edmund , Carr Sinclair , Rahman Sabahat , Danzer Alexander M. , Debray Thomas P. A. , de Jong Valentijn M.T. , Campbell Harlan , Gustafson Paul , Maxwell Lauren , Jaenisch Thomas , Matthay Ellicott C. , Bärnighausen Till
Published: April 2024

Observational data provide invaluable real-world information in medicine, but certain methodological considerations are required to derive causal estimates. In this systematic review, we evaluated the methodology and reporting quality of individual-level patient data meta-analyses (IPD-MAs) conducted with non-randomized exposures, published in 2009, 2014, and 2019 that sought to estimate a causal relationship in medicine. We screened over 16,000 titles and abstracts, reviewed 45 full-text articles out of the 167 deemed potentially eligible, and included 29 into the analysis. Unfortunately, we found that causal methodologies were rarely implemented, and reporting was generally poor across studies. Specifically, only three of the 29 articles used quasi-experimental methods, and no study used G-methods to adjust for time-varying confounding. To address these issues, we propose stronger collaborations between physicians and methodologists to ensure that causal methodologies are properly implemented in IPD-MAs. In addition, we put forward a suggested checklist of reporting guidelines for IPD-MAs that utilize causal methods. This checklist could improve reporting thereby potentially enhancing the quality and trustworthiness of IPD-MAs, which can be considered one of the most valuable sources of evidence for health policy.
Cost of care pathways before and after appropriate and inappropriate transfers to the emergency department among nursing home residents: results from the FINE study
Authors: Gombault-Datzenko E. , Costa N. , Mounié M. , Tavassoli N. , Mathieu C. , Roussel H. , Lagarrigue J. M. , Berard E. , Rolland Y. , Molinier L.
Published: April 2024

Background

Transfers of nursing home (NH) residents to the emergency department (ED) is frequent. Our main objective was to assess the cost of care pathways 6 months before and after the transfer to the emergency department among NH residents, according to the type of transfer (i.e. appropriate or inappropriate).

Methods

This was a part of an observational, multicenter, case-control study: the Factors associated with INappropriate transfer to the Emergency department among nursing home residents (FINE) study. Sixteen public hospitals of the former Midi-Pyrénées region participated in recruitment, in 2016. During the inclusion period, all NH residents arriving at the ED were included. A pluri-disciplinary team categorized each transfer to the ED into 2 groups: appropriate or inappropriate. Direct medical and nonmedical costs were assessed from the French Health Insurance (FHI) perspective. Healthcare resources were retrospectively gathered from the FHI database and valued using the tariffs reimbursed by the FHI. Costs were recorded over a 6-month period before and after transfer to the ED. Other variables were used for analysis: sex, age, Charlson score, season, death and presence inside the NH of a coordinating physician or a geriatric nursing assistant.

Results

Among the 1037 patients initially included in the FINE study, 616 who were listed in the FHI database were included in this economic study. Among them, 132 (21.4%) had an inappropriate transfer to the ED. In the 6 months before ED transfer, total direct costs on average amounted to 8,145€ vs. 6,493€ in the inappropriate and appropriate transfer groups, respectively. In the 6 months after ED transfer, they amounted on average to 9,050€ vs. 12,094€.

Conclusions

Total costs on average are higher after transfer to the ED, but there is no significant increase in healthcare expenditure with inappropriate ED transfer. Support for NH staff and better pathways of care could be necessary to reduce healthcare expenditures in NH residents.

Trial registration

clinicaltrials.gov, NCT02677272.
Immunogenicity and safety of a recombinant COVID-19 vaccine (ZF2001) as heterologous booster after priming with inactivated vaccine in healthy children and adolescents aged 3-17 years: an open-labeled, single-arm clinical trial
Authors: Huang Tao , Hu Qianqian , Zhou Xiang , Yang Huaiyu , Xia Wei , Cao Feng , Deng Minglu , Teng Xiaoxue , Ding Fan , Zhong Zaixin , Gao Lidong , Sun Jiufeng , Gong Lihui
Published: April 2024

Considering that neutralizing antibody levels induced by two doses of the inactivated vaccine decreased over time and had fallen to low levels by 6 months, and homologous and heterologous booster immunization programs have been implemented in adults in China. The booster immunization of recombinant COVID-19 vaccine (ZF2001) after priming with inactivated vaccine in healthy children and adolescents has not been reported. We performed an open-labeled, single-arm clinical trial to evaluate the safety and immunogenicity of heterologous booster immunization with ZF2001 after priming with inactivated vaccine among 240 population aged 3-17 years in China. The primary outcome was immunogenicity, including geometric mean titers (GMTs), geometric mean ratios (GMRs) and seroconversion rates of SARS-CoV-2 neutralizing antibodies against prototype SARS-CoV-2 and Omicron BA.2 variant at 14 days after vaccination booster. On day 14 post-booster, a third dose booster of the ZF2001 provided a substantial increase in antibody responses in minors, and the overall occurrence rate of adverse reactions after heterologous vaccination was low and all adverse reactions were mild or moderate. The results showed that the ZF2001 heterologous booster had high immunogenicity and good safety profile in children and adolescents, and can elicit a certain level of neutralizing antibodies against Omicron.

Trial registration NCT05895110 (Retrospectively registered, First posted in ClinicalTrials.gov date: 08/06/2023)
Cost-utility analysis of palivizumab for preventing respiratory syncytial virus in preterm neonates and infants in Colombia
Authors: Ordóñez Jaime E. , Huertas Victor M.
Published: April 2024

Aim

Palivizumab has proven effective in reducing hospitalizations, preventing severe illness, improving health outcomes, and reducing healthcare costs for infants at risk of respiratory syncytial virus (RSV) infection. We aim to assess the value of palivizumab in preventing RSV infection in high-risk infants in Colombia, where RSV poses a significant threat, causing severe respiratory illness and hospitalizations.

Methods

We conducted a decision tree analysis to compare five doses of palivizumab with no palivizumab. The study considered three population groups: preterm neonates (≤ 35 weeks gestational age), infants with bronchopulmonary dysplasia (BPD), and infants with hemodynamically significant congenital heart disease (CHD). We obtained clinical efficacy data from IMpact-RSV and Cardiac Synagis trials, while we derived neonatal hospitalization risks from the SENTINEL-1 study. We based hospitalization and recurrent wheezing management costs on Colombian analyses and validated them by experts. We estimated incremental cost-effectiveness ratios and performed 1,000 Monte Carlo simulations for probabilistic sensitivity analyses.

Results

Palivizumab is a dominant strategy for preventing RSV infection in preterm neonates and infants with BPD and CHD. Its high efficacy (78% in preventing RSV in preterm infants), the substantial risk of illness and hospitalization, and the high costs associated with hospitalization, particularly in neonatal intensive care settings, support this finding. The scatter plots and willingness-to-pay curves align with these results.

Conclusion

Palivizumab is a cost-saving strategy in Colombia, effectively preventing RSV infection in preterm neonates and infants with BPD and CHD by reducing hospitalizations and lowering healthcare costs.
Contrast extravasation mimicking intracerebral and intraventricular hemorrhage after intravenous thrombolytic treatment of ischemic stroke: a case report
Authors: Tang Jiuning , Zhang Xinhai , Yu Jinhui , Liu Zhi , Ding Huaqiang
Published: April 2024

Background

Although contrast extravasation on follow-up head computed tomography (CT) is frequently visualized after endovascular treatment, this phenomenon is rare after intravenous thrombolytic treatment in patients with acute ischemic stroke (AIS). Here, we report a case of contrast extravasation mimicking intracerebral hemorrhage (ICH) with intraventricular extension after intravenous thrombolytic treatment and computed tomography angiography (CTA).

Case presentation

A 52-year-old man presented with right-sided hemiparesis and hypoesthesia. Initial non-contrast head CT was negative for intracranial hemorrhage and acute ischemic changes. He received intravenous treatment with tenecteplase 3.8 h after the onset of stroke. CTA of the head and neck was performed at 4.3 h after stroke onset. It showed no stenosis or occlusion of the carotid and major intracranial arteries. At about 1.5 h after CTA, the right-sided hemiparesis deteriorated, accompanied by drowsiness, aphasia, and urinary incontinence. Immediate head CT showed hyperdense lesions with mild space-occupying effect in the left basal ganglia and both lateral ventricles. The hyperdense lesions were reduced in size on follow-up CT after 5 h. Two days later, CT showed that the hyperdense lesions in the lateral ventricles almost completely disappeared and only a small amount remained in the infarcted area.

Conclusions

Contrast extravasation into the brain tissue and lateral ventricles, mimicking ICH with intraventricular extension, could occur after intravenous thrombolytic treatment and CTA in a patient with AIS, which might lead to misdiagnosis and wrong treatment of the patient. The rapid resolution of intracranial hyperdense lesions is key to differentiate contrast extravasation from ICH on serial non-enhanced CT.
Exploring women’s experiences of care during hospital childbirth in rural Tanzania: a qualitative study
Authors: Metta Emmy , Unkels Regine , Mselle Lilian Teddy , Hanson Claudia , Alvesson Helle Molsted , Al-beity Fadhlun M. Alwy
Published: April 2024

Background

Women’s childbirth experiences provide a unique understanding of care received in health facilities from their voices as they describe their needs, what they consider good and what should be changed. Quality Improvement interventions in healthcare are often designed without inputs from women as end-users, leading to a lack of consideration for their needs and expectations. Recently, quality improvement interventions that incorporate women’s childbirth experiences are thought to result in healthcare services that are more responsive and grounded in the end-user’s needs.

Aim

This study aimed to explore women’s childbirth experiences to inform a co-designed quality improvement intervention in Southern Tanzania.

Methods

This exploratory qualitative study used semi-structured interviews with women after childbirth (n = 25) in two hospitals in Southern Tanzania. Reflexive thematic analysis was applied using the World Health Organization’s Quality of Care framework on experiences of care domains.

Results

Three themes emerged from the data: (1) Women’s experiences of communication with providers varied (2) Respect and dignity during intrapartum care is not guaranteed; (3) Women had varying experience of support during labour. Verbal mistreatment and threatening language for adverse birthing outcomes were common. Women appreciated physical or emotional support through human interaction. Some women would have wished for more support, but most accepted the current practices as they were.

Conclusion

The experiences of care described by women during childbirth varied from one woman to the other. Expectations towards empathic care seemed low, and the little interaction women had during labour and birth was therefore often appreciated and mistreatment normalized. Potential co-designed interventions should include strategies to (i) empower women to voice their needs during childbirth and (ii) support healthcare providers to have competencies to be more responsive to women’s needs.