bluuebunny/crossref_metadata_2025 huggingface dataset:
A critical review on the effective utilization of geothermal energy
Authors: Jamil Farrukh , Shafiq Iqrash , Sarwer Asma , Ahmad Muhammad , Akhter Parveen , Inayat Abrar , Shafique Sumeer , Park Young-Kwon , Hussain Murid
Published: February 2023

Rapid growth in the global population and associated elevated reliance on modern technology has resulted in increased demand for energy consumption. This has resulted in an increased focus on the development and generation of advanced sustainable energy systems. The swift implementation of sustainable renewable energy resource utilization and improvement in their efficiency by the modification of current technologies are the possible solutions that gave rise to the emergence of geothermal technology as a potential alternative. Geothermal technology is a non-carbon renewable energy resource that could be utilized efficiently to fulfil the energy demands while mitigating the climate change threat. According to the surveyed literature, the global geothermal energy power plant installation capacity has reached 14.3 GWe to successfully implement this sustainable alternative. In order to have a successful and uninterrupted way forward, it is essential to evaluate the constraints both in terms of technicality and economic feasibility to establish an approved framework. Moreover, the governance and monitoring regarding the social and environmental impact alongside the legal challenges should also be addressed. The significant barriers include increased capital cost, site selection, superiority of resources at diverse levels of rock bottoms, and obstruction from nearby residents that need to be addressed appropriately. As a result, policymakers will continue to seek measure that have least negative impact on environment.
An enhanced approach-based grid flexibility analysis for combined heat and power systems with variable renewable energy systems
Authors: Kalaivani C , Umasankar L , Badachi Chandrashekhar , Karthikumar K
Published: February 2023

An enhanced approach-based grid flexibility analysis for combined heat and power (CHP) systems with variable renewable energy systems is proposed in this article. The proposed system is the combined execution of White Shark Optimizer (WSO) and Pelican Optimization Algorithm (POA). The WSO approach updating behavior is enhanced by the POA approach hence named as enhanced WSO technique. The main purpose of the proposed technique is to provide the optimal grid flexibility by utilizing the CHP systems. Utilizing the proposed method, the demand for the sources is predicted in the year 2030. The proposed approach considers the optimization problem as a reduction of cost and analyzes the flexibility in both upward and downward directions. The sources like photovoltaic, wind turbine, hydropower plants, nuclear, and coal demand power are analyzed. Based on the seasons, the proposed approach analyzed the system flexibility. Finally, the performance of the proposed method is simulated in MATLAB/Simulink platform and the performance is compared to the various existing methods.
Patient Reported Outcomes Using Medical Cannabis for Managing Pain in Charcot-Marie-Tooth Disease
Authors: Canals Priscilla C. , Aguilar Alexia G. , Carter Gregory T. , Shields C. Miyabe , Westerkamp Andrew , D’Elia Meg , Aldrich Joy , Moore Robert N. , Moore Allison T. , Piper Brian J.
Published: February 2023

Objective: Chronic pain is a major problem for patients with Charcot-Marie-Tooth (CMT) disease. This exploratory study examined patient reported efficacy of medical cannabis for pain management in this population. Methods: Participants (N = 56; 71.4% female; Age = 48.9, SD = 14.6; 48.5% CMT1) were recruited though the Hereditary Neuropathy Foundation. The online survey contained 52 multiple choice questions about demographics, medical cannabis use, symptomology, efficacy, and adverse effects. Results: Nearly all (90.9%) of respondents reported experiencing pain, including all (100%) females and 72.7% of males (chi-square P < .05) with 91.7% of respondents indicating cannabis provided at least 50% pain relief. The most frequent response was an 80% reduction in pain. Moreover, 80.0% of respondents reported using less opiates, 69% noted using less sleep medication, and 50.0% reported using less anxiety/antidepressant medications. Negative side effects were noted by 23.5% of respondents. However, almost all (91.7%) of that subgroup did not have plans to stop consuming cannabis. One-third (33.9%) possessed a medical cannabis certificate. Patient perceptions of their physicians’ attitudes regarding patient medical cannabis use greatly impacted whether respondents informed their providers of their usage. Conclusion: The vast majority of patients with CMT reported that cannabis was effective to manage pain symptoms. These data support the need for prospective, randomized, controlled trials using standardized dosing protocols to further delineate and optimize the potential use of cannabis to treat pain related to CMT.
Breach: A Trans*textual Essay
Authors: Richardson jt
Published: February 2023

The author engages the essay form and body in this creative nonfiction essay as trans*textual. A trans*textual essay, as methodological and literary, attends to textual movement and a textual body lacking traditional cohesive devices, such as transitional sentences and naming practices. This article’s approach to the essay privileges ambiguity and not-knowing by using common security questions to authenticate identity in digital spaces in order to structure a personal history. Wrong body and wrong name discourse often oversimplify trans* experience. Taking “identity theft” as its initial provocation, this article unpacks the complexity of naming, identity, intimacy, erasure, and personal history.
“Having One Person Tell Me I Didn’t Do the Wrong Thing”: The Impact of Support on the Post-Sexual Assault Exam Experience
Authors: Wright Elizabeth Novack , Miyamoto Sheridan , Anderson Jocelyn
Published: February 2023

Social support following a sexual assault (SA) may help minimize or prevent the myriad of negative sequelae impacting individuals who experience SA. Receiving a SA exam may provide initial support during the SA exam and set up individuals with needed resources and supports post-SA exam. However, the few individuals who receive a SA exam may not stay connected to resources or support post-exam. The purpose of this study was to understand individuals’ post-SA-exam social support pathways including individuals’ ability to cope, seek care, or accept support following a SA exam. Interviews were conducted with individuals who experienced SA and then received a SA exam through a telehealth model. The findings revealed the importance of social support during the SA exam and in the months that followed. Implications are discussed.
The Participation of the Private Sector in Achieving Gender Equality: How Working With Men Can Promote Shared Responsibility
Authors: Vargas Urías Mauro A.
Published: February 2023

The goal of this essay is to contribute to the study of public policies, specifically those oriented towards the promotion of shared responsibility between men and women in care work, both from a human rights approach and a gender perspective. We will quickly revise Gendes’ story and its theoretical-practical approach used with the private sector, to finally sum up our experiences and challenges of our interventions.
Different Patterns of the Revitalization of Collective Memory in Shanghai and Hong Kong: The Cases of Columbia Circle and the Blue House Cluster
Authors: Chen Yueying , Lu Shaoming
Published: February 2023

Collective memory in cities reflects urban spatial alterations and historic developments. Collective memory can be preserved and reflected by revitalization projects. To build a framework and compare different patterns of collective memory, this study utilized a comprehensive methodology, comprising comparison research, investigations, and literature research. The framework includes institutions and the tangible intangible features of cultural heritages. To clearly articulate its framework and the relevant issues of collective memory, the article selects Columbia Circle in Shanghai and the Blue House Cluster in Hong Kong as typical cases, comparing their revitalizations and preservations of collective memory. This comparison offers a new and holistic perspective for analyzing the relationship between institutions and the revitalizations of urban heritage, for how heritage can be adapted to suitable modern uses and relevant cultural events, and for how collective memory can be preserved through revitalization.
Heritage tourism brand experiences: The influence of emotions and emotional engagement
Authors: Steriopoulos Effie , Khoo Catheryn , Wong Ho Yin , Hall John , Steel Marion
Published: February 2023

Despite growing research on the role of emotions in tourist experiences, there is limited research on how emotional engagement enhances the brand experience at tourist heritage sites, in particular when negative or mixed emotions are involved. The aim of the research is to explore how emotional engagement influences heritage tourism brand experiences (HTBEs). This study provides an understanding of the type of mixed emotions that are experienced by visitors during heritage tourism brand engagement and how their emotional engagement influences HTBEs. Data for this study came from 36 interviews conducted with visitors who participated in an HTBE – the Australian New Zealand Army Corps (ANZAC) Gallipoli; and supported by other data triangulation methods including photos, journals and memo analyses. Findings not only reveal several mixed emotions that influence the heritage brand experience but also uncover the factors (such as story-showing) that elicit these mixed emotions. The research makes an explicit theoretical contribution through a heritage tourist brand framework that explains the process of emotional engagement during heritage tourist brand experiences.
‘If I’m just me, I doubt I’d get the job’: A qualitative exploration of autistic people’s experiences in job interviews
Authors: Finn Mikaela , Flower Rebecca L , Leong Han Ming , Hedley Darren
Published: February 2023

Autistic people face many challenges entering the workforce, for example, during job interviews where performance is reliant on particular social skills. To be competitive during job interviews, autistic people may experience pressure to conceal or ‘camouflage’ their autistic traits and behaviour. This qualitative study used semi-structured interviews to explore the job interview experiences of 10 autistic people. Based on the literature, we were curious as to whether participants would report behaviour consistent with the camouflaging hypothesis. Thematic analysis identified six themes reflecting individual and environmental factors. Participants reported engaging in camouflaging behaviour during job interviews, with external factors (e.g. avoid being treated differently) cited as the primary reason. Participants reported that camouflaging required effort, leading to stress, anxiety, exhaustion and feeling ‘burnt out’. They expressed a desire for an inclusive, understanding and accommodating environment where they would feel more comfortable disclosing their diagnosis without feeling they needed to conceal their autistic traits and behaviour. These preliminary findings add to the current literature regarding autism, camouflaging and employment.

Lay abstract

When applying for a job, autistic job candidates are likely to face a number of challenges. Job interviews are one of these challenges – they require communicating and relationship-building with unfamiliar people and involve expectations about behaviour (that may vary between companies and are not made clear to job candidates). Given autistic people communicate differently to non-autistic people, autistic job candidates may be disadvantaged in the interview process. Autistic candidates may not feel comfortable or safe sharing with organisations their autistic identity and may feel pressure to hide any characteristics or behaviour they feel might indicate they are autistic. To explore this issue, we interviewed 10 autistic adults about their job interview experiences in Australia. We analysed the content of the interviews and found three themes that related to the individual person and three themes that related to environmental factors. Participants told us that they engaged in camouflaging behaviour during job interviews, feeling pressure to conceal aspects of themselves. Those who camouflaged during job interviews reported that it took a lot of effort, which resulted in increased stress, anxiety and exhaustion. The autistic adults we spoke to reported a need for inclusive, understanding and accommodating employers to help them feel more comfortable disclosing their autism diagnosis in the job application process. These findings add to current research that has explored camouflaging behaviour and barriers to employment for autistic people.
Prevalence of Alcohol and Other Drug Use in Patients Presenting to Hospital for Violence-Related Injuries: A Systematic Review
Authors: Lau Georgina , Ang Jia Y. , Kim Nayoung , Gabbe Belinda J. , Mitra Biswadev , Dietze Paul M. , Reeder Sandra , Scott Debbie , Beck Ben
Published: February 2023

Substance use is a risk factor for being both a perpetrator and a victim of violence. The aim of this systematic review was to report the prevalence of acute pre-injury substance use in patients with violence-related injuries. Systematic searches were used to identify observational studies that included patients aged ≥15 years presenting to hospital after violence-related injuries and used objective toxicology measures to report prevalence of acute pre-injury substance use. Studies were grouped based on injury cause (any violence-related, assault, firearm, and other penetrating injuries including stab and incised wounds) and substance type (any substance, alcohol only, drugs other than alcohol only), and they were summarized using narrative synthesis and meta-analyses. This review included 28 studies. Alcohol was detected in 13%–66% of any violence-related injuries (five studies), 4%–71% of assaults (13 studies), 21%–45% of firearm injuries (six studies; pooled estimate = 41%, 95% CI: 40%–42%, n = 9,190), and 9%–66% of other penetrating injuries (nine studies; pooled estimate = 60%, 95% CI: 56%–64%, n = 6,950). Drugs other than alcohol were detected in 37% of any violence-related injuries (one study), 39% of firearm injuries (one study), 7%–49% of assaults (five studies), and 5%–66% of penetrating injuries (three studies). The prevalence of any substance varied across injury categories: any violence-related injuries = 76%–77% (three studies), assaults = 40%–73% (six studies), firearms = n/a, other penetrating injuries = 26%–45% (four studies; pooled estimate = 30%, 95% CI: 24%–37%, n = 319).Overall, substance use was frequently detected in patients presenting to hospital for violence-related injuries. Quantification of substance use in violence-related injuries provides a benchmark for harm reduction and injury prevention strategies.
Interventions to Reduce Parental Substance Use, Domestic Violence and Mental Health Problems, and Their Impacts Upon Children’s Well-Being: A Systematic Review of Reviews and Evidence Mapping
Authors: Barrett Simon , Muir Cassey , Burns Samantha , Adjei Nicholas , Forman Julia , Hackett Simon , Hirve Raeena , Kaner Eileen , Lynch Rebecca , Taylor-Robinson David , Wolfe Ingrid , McGovern Ruth
Published: February 2023

Introduction:

Children exposed to parental intimate partner violence and abuse, mental illness, and substance use experience a range of problems which may persist into adulthood. These risks often co-occur and interact with structural factors such as poverty. Despite increasing evidence, it remains unclear how best to improve outcomes for children and families experiencing these adversities and address the complex issues they face.

Aims and Methods:

Systematic review of systematic reviews. We searched international literature databases for systematic reviews, from inception to 2021, to provide an evidence overview of the range and effectiveness of interventions to support children and families where these parental risk factors had been identified.

Results:

Sixty-two systematic reviews were included. The majority ( n = 59) focused on interventions designed to address single risk factors. Reviews mostly focused on parental mental health ( n = 38) and included psychological interventions or parenting-training for mothers. Only two reviews assessed interventions to address all three risk factors in combination and assessed structural interventions. Evidence indicates that families affected by parental mental health problems may be best served by integrated interventions combining therapeutic interventions for parents with parent skills training. Upstream interventions such as income supplementation and welfare reform were demonstrated to reduce the impacts of family adversity.

Conclusion:

Most intervention approaches focus on mitigating individual psychological harms and seek to address risk factors in isolation, which presents potentially significant gaps in intervention evidence. These interventions may not address the cumulative impacts of co-occurring risks, or social factors that may compound adversities.
Irreversible Electroporation-Assisted Resection for Locally Advanced Pancreas Cancer
Authors: Davis Joshua MK , Salibi Patrick N , Motz Benjamin M , Vrochides Dionisios , McKillop Iain H , Iannitti David A
Published: February 2023

Background

A significant number of patients with advanced pancreatic cancer are unable to undergo resection due to vascular involvement. Irreversible electroporation (IRE) has shown promise in improving survival. This study sought to assess a novel IRE application whereby IRE was performed pre-resection to alter tissue plasticity and assist tumor removal from underlying vasculature when surgical excision was otherwise precluded.

Methods

After multidisciplinary evaluation appropriate patients were consented for IRE therapy. All IRE cases were tracked prospectively using an institutional review board-approved database that was retrospectively queried for patients undergoing IRE-assisted resection (IRE-AR) for pancreatic adenocarcinoma located in the head/uncinate process. Patients who underwent other IRE therapy or had disease location elsewhere were excluded.

Results

5 patients met the study inclusion criteria with a mean tumor size of 3.2 cm (range 2.4-4.1 cm). Using IRE-AR median recurrence free survival was 10.6 months, with 21.6 month overall survival. The average comprehensive complication index score was 23.23. One patient had grade 3 [or higher] complications and there were no 90 day mortalities.

Discussion

Employing a high-starting voltage for ablation along resection margins allows for resection when margins are anticipated to be positive. Patients with locally advanced pancreatic adenocarcinoma who underwent IRE-AR had promising outcomes.

Conclusion

This study reports IRE-AR as a novel approach for resecting locally advanced pancreatic adenocarcinoma. A prospective trial of IRE-AR for inoperable pancreatic adenocarcinoma will provide additional data for the long-term application of this approach.
Physical Activity Behaviors and Campus Recreation Use of Students Enrolled in Summer Transition Programs at a Large Northeastern United States University
Authors: Wilson Oliver W. A. , Elliott Lucas D. , Cardinal Bradley J. , Duffey Michele , Bopp Melissa
Published: February 2023

The purpose of this study was to examine the physical activity behaviors and campus recreation use of students enrolled in a summer transition (high school to university) program. The physical activity behaviors and socio-demographic characteristics of summer transition program students from a large Northeastern United States university were collected via an online survey. Descriptive statistics were computed, and disparities between genders were examined using independent samples t-tests. Women participated in less aerobic and muscle-strengthening activity compared to men ( p < .05); and, among those who used the primary campus recreation facility, women reported lower use of both weights and informal sports areas, and higher use of group exercise compared to men ( p < .05). Cardio area and indoor running track use did not differ between men and women. In summary, there appears to be an opportunity for university summer transitional programs to address disparities in physical activity by expanding coverage to address a currently unmet need for physical activity promotion.
Evaluation of the self-expanding effect of carotid stents in the early postoperative period
Authors: Ergun Onur , Eraslan Onder , Hekimoglu Azad , Birgi Erdem , Ceylan Arda H , Conkbayir Isık
Published: February 2023

Purpose

To evaluate the expansion effect of self-expandable stents during the first week after carotid artery stenting (CAS) procedure and to examine the variation of the effect according to the carotid plaque type.

Methods

Seventy stenotic carotid arteries of 69 patients were stented by using self-expanding Wallstents with diameters of 7 and 9 mm, after detection of stenosis and plaque type by Doppler ultrasonography. Post-stent aggressive ballooning was avoided and residual stenosis rates were measured with digital subtraction angiography. After the stenting procedure, the caudal, narrowest, and cranial diameters of stents were measured with ultrasonography at 30 min, first day and first week. Stent diameter increase and change according to plaque type were evaluated. Two-way repeated measure ANOVA test was used for statistical analysis.

Results

A significant increase was observed in the mean stent diameter in the three stent regions (caudal, narrow, and cranial) from the 30th minute to the first and seventh days ( p < 0.001). The most prominent stent expansion occurred in the cranial and narrow segments within the first day. In the narrow stent region; Stent diameter increase between 30th minute-first day, 30th minute-first week, and first day-first week were all significant ( p < 0.001). At 30 min, first day, and first week, no significant difference was detected between plaque type and stent expansion in caudal, narrow, and cranial regions ( p = 0.286).

Conclusion

We think that keeping the lumen patency limited to 30% residual stenosis after CAS procedure by applying minimal post-stenting balloon dilatation and leaving the remaining lumen expansion to the self-expanding feature of the Wallstent might be a sensible approach in order to avoid embolic events and excessive carotid sinus reactions (CSR).
Patterns of natural health product use at an outpatient heart function clinic
Authors: Tress Kaitlyn , Chiu Ada , Kwan Leanne , Gordon Wendy
Published: February 2023

Background:

Natural health product (NHP) use is common among Canadians, but the NHPs used by outpatients with cardiovascular conditions such as atrial fibrillation and heart failure have not been identified.

Objectives:

Describe NHP use among outpatient cardiac patients, assess drug interactions and their potential implications and determine NHP documentation by health care providers.

Methods:

Telephone interviews were conducted by the main researcher with patients who attended the Cardiac Clinics at the Royal Columbian Hospital. Medication reconciliation was performed to elicit information regarding NHP use and clinic charts were used to supplement demographic information.

Results:

There were 119 successful interviews. Most patients were approximately 65 years old and male, were diagnosed with atrial fibrillation, had 2 to 3 queried comorbidities and took 2 cardiovascular medications. It was found that 62% of patients use NHPs, and 239 individual NHPs were identified. The most common NHPs used were vitamins and minerals (63%), especially vitamin D (13%), multivitamins (8%) and omega-3s (8%). Interactions between cardiac medications and NHPs occurred in 86% of patients. NHP use was completely documented by health care providers in 24% of patients.

Conclusion:

NHP use is common among patients who attend outpatient cardiac clinics. Interactions between NHPs and cardiovascular medications are prevalent and may carry specific individual patient risks. NHP documentation by health care providers is often incomplete.
Factors associated with self-reported pain and hand function following dorsal wrist ganglion excision
Authors: Greminger Martina , Koopman Jaimy Emerentiana , van Kooij Yara Eline , Hoogendam Lisa , Smit Jeroen , Slijper Harm Pieter , Selles Ruud Willem , Calcagni Maurizio ,   the SUpExOr Study Group,   the Hand-Wrist Study Group
Published: February 2023

This study aimed to analyse which factors contribute to pain and limited hand function after dorsal wrist ganglion excision. We included 308 patients who underwent surgery between September 2017 and August 2021. Patients completed baseline questionnaires and the patient-rated wrist/hand evaluation questionnaire at baseline and 3 months postoperatively. We observed an improvement in postoperative pain and hand function, but individual outcomes were highly variable. We performed stepwise linear regression analyses to examine which patient characteristics, disease characteristics and psychological factors were associated with postoperative pain and hand function. Higher postoperative pain intensity was associated with recurrence following previous surgery, treatment of the dominant hand, higher baseline pain intensity, lower credibility the patient attributes to the treatment and longer symptom duration. Worse hand function was associated with recurrence following prior surgery, worse baseline hand function and lower treatment credibility. Clinicians should take these findings into account during patient counselling and expectation management.

Level of evidence: II
Shifting the paradigm: ankylosis arthroplasty for the proximal interphalangeal joint with a novel collateral ligament reconstruction
Authors: Miranda Ben H. , Kosasih Sebastian R. , Krishnamoorthy Ramakrishnan
Published: February 2023

Silicone arthroplasty for proximal interphalangeal joint ankylosis is rarely performed, partly due to the potential for lateral joint instability. We present our experience performing proximal interphalangeal joint arthroplasty for joint ankylosis, using a novel reinforcement/reconstruction technique for the proper collateral ligament. Cases were prospectively followed-up (median 13.5 months, range 9–24) and collected data included range of motion, intraoperative collateral ligament status and postoperative clinical joint stability; a seven-item Likert scale (1–5) patient-reported outcomes questionnaire was also completed. Twenty-one ankylosed proximal interphalangeal joints were treated with silicone arthroplasty, and 42 collateral ligament reinforcements undertaken in 12 patients. There was improvement in range of motion from 0° in all joints to a mean of 73° (SD 12.3); lateral joint stability was achieved in 40 out of 42 of collateral ligaments. High median patient satisfaction scores (5/5) suggest that silicone arthroplasty with collateral ligament reinforcement/reconstruction should be considered as a treatment option in selected patients with proximal interphalangeal joint ankylosis.

Level of evidence: IV
Serum cytokine variations among inpatients with major depression, bipolar disorder, and schizophrenia versus healthy controls: a prospective ‘true-to-life’ study
Authors: Schmitt Junior Antonio Augusto , Primo de Carvalho Alves Lucas , Padilha Barbara Larissa , da Rocha Neusa Sica
Published: February 2023

Background:

There is increasing evidence of the association between chronic low-grade inflammation and severe mental illness (SMI). The objective of our study was to assess serum cytokine levels (SCLs) at admission and discharge in a true-to-life-setting population of inpatients with major depression (MD), bipolar disorder (BD), and schizophrenia (Sz), as well as of healthy controls.

Methods:

We considered MD, BD, and Sz to be SMIs. We evaluated 206 inpatients [MD, N = 92; BD, N = 26; mania (Ma), N = 44; Sz, N = 44). Generalized estimating equations were used to analyze variations in SCL [interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), interleukin (IL)-2, IL-4, IL-6, IL-10, and IL-17] at hospital admission and discharge. Results of 100 healthy controls were compared with those of SMI patients at both time points. We evaluated patients’ improvement during in-hospital treatment in terms of general psychiatric symptoms, global clinical impression, functionality, and manic and depressive symptoms with validated scales.

Results:

In all, 68.9% of patients completed the study. Overall, SMI inpatients had higher SCL when compared with controls regardless of diagnosis. There was a significant decrease in Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression–Severity Scale (CGI-S) scores, and an increase in Global Assessment of Functioning (GAF) scores for all disorders evaluated ( p < 0.001), as well as a significant decrease in HDRS-17 scores among MD inpatients ( p < 0.001) and in YMRS scores among Ma inpatients ( p < 0.001). IL-2 and IL-6 levels decreased significantly between admission and discharge only among MD inpatients ( p = 0.002 and p = 0.03, respectively). We found no further statistically significant changes in SCL among the remaining disorders (BD, Ma, and Sz). There was no significant decrease in IFN-γ ( p = 0.64), TNF-α ( p = 0.87), IL-4 ( p = 0.21), IL-10 ( p = 0.88), and IL-17 ( p = 0.71) levels in any of the evaluated diagnoses.

Conclusion:

MD inpatients had a decrease in IL-2 and IL-6 levels during hospitalization, which was accompanied by clinical improvement. No associations were found for the remaining SMIs (BD, Ma, and Sz).
Safety and efficacy of methylprednisolone versus dexamethasone in critically ill patients with COVID-19 acute respiratory distress syndrome: a retrospective study
Authors: Kellogg Dean , Gutierrez G. Christina , Small Clay E. , Stephens Benjamin , Sanchez Paloma , Beg Moezzullah , Keyt Holly L. , Restrepo Marcos I. , Attridge Rebecca L. , Maselli Diego J.
Published: February 2023

Background:

Corticosteroids (CSs), specifically dexamethasone (DEX), are the treatment of choice for severe acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia (CARDS). However, data from both ARDS and relatively small CARDS clinical trials have suggested improved outcomes with methylprednisolone (MP) versus DEX. The objective of this retrospective cohort study was to compare the safety and effectiveness of MP and DEX in critically ill CARDS patients.

Methods:

The study cohort included CARDS patients admitted to a tertiary referral intensive care unit (ICU) between April and September 2020 who received at least 5 days of CSs for CARDS.

Results:

The cohort was notable for a high severity of illness (overall, 88.5% of patients required mechanical ventilation and 16% required vasopressors on admission). The DEX group ( n = 62) was significantly older with a higher illness severity [Sequential Organ Failure Assessment (SOFA) 6 (4.75–8) versus 4.5 (3–7), p = 0.008], while the MP group ( n = 51) received significantly more loading doses [19 (37.3%) versus 4 (6.5%), p < 0.0001]. MP was associated with a shorter time to intubation and more rapid progression to mortality [days to death: 18 (15–23) versus 27 (15–34), p = 0.026]. After correction for baseline imbalances in age and SOFA score, DEX was associated with improved mortality at 90 days compared with MP [hazard ratio (HR) = 0.43, 95% confidence interval (CI) = 0.23–0.80, p = 0.008]. However, there were no differences between rates of secondary infections during hospitalization or insulin requirements at 7 and 14 days.

Conclusion:

In this cohort of critically ill CARDS, choice of CS was associated with mortality but not adverse event profile, and thus warrants further investigation.
Long-Term Surgical Outcomes of Patients With Isomeric Right and Left Atrial Appendages
Authors: Chowdhury Ujjwal Kumar , Anderson Robert H , Pandey Niraj Nirmal , George Niwin , Sankhyan Lakshmi Kumari , Khan Maroof A , Goja Shikha , Ramakrishnan Sivasubramanian , Gupta Saurabh Kumar
Published: February 2023

Objectives: To compare the long-term outcomes of biventricular, univentricular, and so-called one-and-one-half ventricular repairs in patients with left and right isomerism. Methods: Surgical correction was undertaken, between 2000 and 2021, in 198 patients with right, and 233 with left isomerism. Results: The median age at operation was 24 days (interquartile range [IQR]: 18-45) and 60 days (IQR: 29-360) for those with right and left isomerism, respectively. Multidetector computed-tomographic angiocardiography demonstrated more than half of those with right isomerism had superior caval venous abnormalities, and one-third had a functionally univentricular heart. Almost four-fifths of those with left isomerism had an interrupted inferior caval vein, and one-third had complete atrioventricular septal defect. Biventricular repair was achieved in two-thirds of those with left isomerism, but under one-quarter with right isomerism ( P < .001). Hazard regression for mortality revealed odds for prematurity at 5.5, pulmonary atresia at 2.81, atrioventricular septal defect with a common valvar orifice at 2.28, parachute mitral valve at 3.73, interrupted inferior caval vein at 0.53, and functionally univentricular heart with a totally anomalous pulmonary venous connection at 3.77. At a median follow-up of 124 months, the probability of survival was 87% for those with left, and 77% for those with right isomerism ( P = .006). Conclusions: Multimodality imaging characterizes and delineates the relevant anatomical details, facilitating surgical management of individuals with isomeric atrial appendages. Continuing higher mortality despite surgical intervention in those with right isomerism points to the need for the reassessment of strategies for management.
The Impact of Academic Optimism, Institutional Policy and Support, and Self-Efficacy on University Instructors’ Continuous Professional Development in Mainland China
Authors: Scott Timothy , Guan Wenyu , Han Huimin , Zou Xiaolei , Chen Yanzhu
Published: February 2023

The implementation of China’s Education Modernization Plan 2035 has signified the Chinese government’s commitment to advancing the quality of education. Recent studies have shown that the prioritization of instructor continuous professional development (CPD) through the Ministry of Education mandates has positively affected talent development and student achievement at the K12 level; however, examination of the reform’s impact on Chinese higher education is limited. This paper explored the effect academic optimism, institutional policy and support, and instructor self-efficacy had on instructors’ CPD within Chinese higher education institutions. This study collected data from 456 Chinese higher education instructors, employing a structural equation model to examine the relationship between the independent and dependent variables. Findings indicate academic optimism and institutional policy and support have a significant positive effect on CPD, β = .645 and .2, respectively, while instructor self-efficacy has nearly no effect on CPD, β = −.031. Institutional policy and support have a significant, influential effect on academic optimism, β = .652; however, there is nearly zero impact on instructor self-efficacy, β = .032. The implications of the findings indicate that institutional leadership is crucial in developing an academic culture that promotes and supports continuous professional development; however, individual drive to pursue CPD is limited.
Failure Rates After Anterior Cruciate Ligament Repair With Suture Tape Augmentation in an Active-Duty Military Population
Authors: Cruz Christian A. , Mannino Brian J. , Venrick Connor B. , Miles Rebecca N. , Peterson David R. , Zhou Liang , Min Kyong S. , Bottoni Craig R.
Published: February 2023

Background:

Anterior cruciate ligament (ACL) repair had previously been considered the standard of care for a ruptured ACL; however, ACL reconstruction has became the standard of care because of poor midterm outcomes after ACL repair. Recently, studies have suggested that the treatment paradigm should shift back to ACL repair.

Purpose/Hypothesis:

The purpose of this study was to evaluate the outcomes of ACL repair augmented with suture tape in a high-demand military population. We hypothesized that for proximal ACL avulsions, ACL repair with suture tape augmentation would lead to acceptable failure rates, satisfactory knee stability, excellent functional outcomes, and high rates of return to preinjury activity levels.

Study Design:

Case series; Level of evidence, 2.

Methods:

Patients who were treated with ACL repair by a single surgeon between March 2017 and June 2019 and who had a minimum of 2 years of follow-up were included. Intraoperatively, all patients first underwent an arthroscopic examination. If an ACL avulsion of the proximal insertion with adequate remaining tissue was visualized, then ACL repair was performed. The primary outcome assessed was ACL repair failure, defined as reruptures or clinical instability requiring revision to ACL reconstruction. Analysis of the risk factors for ACL repair failure was conducted, with age at surgery, sex, body mass index, level of competition, and tobacco use evaluated.

Results:

Included were 46 patients (32 male and 14 female; mean age, 28.3 ± 8.4 years) who underwent ACL repair with suture tape augmentation. There were 12 cases of failure (26.1%; 8 male and 4 female). The mean time from injury to surgery in the failure group was 164.1 ± 59.4 days compared to 107.3 ± 98.0 days in the nonfailure group ( P = .02). According to multivariate regression analysis, patients aged ≤17 and ≥35 years, elite/competitive/operational patients, and current smokers had a higher chance of ACL repair failure. The mean time to pass a military physical fitness test was 5.0 months. There were no complications other than ACL repair failure.

Conclusion:

Primary arthroscopic ACL repair with suture tape augmentation resulted in unacceptably high failure rates at a minimum of 2 years of follow-up in a highly active military population. Age ≤17 and ≥35 years, elite level of competition, time from injury to surgery, and active tobacco use were independent risk factors for ACL repair failure.
The amorality of rent gaps: A response to Elvin Wyly
Authors: Kallin Hamish
Published: February 2023

This short intervention offers a sympathic criticism of Elvin Wyly's paper ‘The Moral Rent Gap: Views from an Edge of an Urban World’. Whilst welcoming the invitation to reconsider the implications of the rent gap in relation to long histories of racism, morality, and dispossession, I highlight three issues with the neologism itself. ‘The moral rent gap’, I suggest, risks foreclosing too much in its temporal insistence on generations past; risks complicating too much by making the rent gap about everything it connects to; risks depoliticising too much in shifting the functionality of the rent gap from profit to morality.
Multicenter Phase 2 Study of Oral azacitidine (CC-486) plus CHOP as initial treatment for peripheral T-cell lymphoma
Authors: Ruan Jia , Moskowitz Alison J , Mehta-Shah Neha , Sokol Lubomir , Chen Zhengming , Kotlov Nikita , Nos Grigorii , Sorokina Maria , Maksimov Vladislav , Sboner Andrea , Sigouros Michael , van Besien Koen , Horwitz Steven M , Rutherford Sarah C. , Mulvey Erin , Revuelta María V. , Xiang Jenny Z , Alonso Alicia , Melnick Ari M. , Elemento Olivier , Inghirami Giorgio GA , Leonard John P. , Cerchietti Leandro , Martin Peter
Published: February 2023

PTCL with T-follicular helper phenotype (PTCL-TFH) has recurrent mutations affecting epigenetic regulators, which may contribute to aberrant DNA methylation and chemoresistance. This phase 2 study evaluated oral azacitidine (CC-486), a DNA methyltransferase inhibitor, plus CHOP as initial treatment for PTCL (ClinicalTrials.gov - NCT03542266). CC-486 at 300 mg daily was administered for 7 days prior to C1 of CHOP, and for 14 days before CHOP C2-6. The primary endpoint was end-of-treatment CR. Secondary endpoints included ORR, safety and survival. Correlative studies assessed mutations, gene expression and methylation in tumor samples. Grade 3-4 hematologic toxicities were mostly neutropenia (71%), with febrile neutropenia uncommon (14%). Non-hematologic toxicities included fatigue (14%) and GI symptoms (5%). In 20 evaluable patients, CR was 75%, including 88.2% for PTCL-TFH (n=17). At a median follow-up of 21 months, 2-yr PFS was 65.8% for all and 69.2% for PTCL-TFH, while 2-yr OS was 68.4% for all and 76.1% for PTCL-TFH. The frequencies of the TET2, RHOA, DNMT3A, and IDH2 mutations were 76.5%, 41.1%, 23.5% and 23.5%, respectively, with TET2 mutations significantly associated with CR (p=0.007), favorable PFS (p=0.004) and OS (p=0.015), and DNMT3A mutations associated with adverse PFS (p=0.016). CC-486 priming contributed to the reprograming of the tumor microenvironment by upregulation of genes related to apoptosis (p<0.01) and inflammation (p<0.01). DNA methylation did not show significant shift. This safe and active initial therapy regimen is being further evaluated in the ALLIANCE randomized study A051902 in CD30-negative PTCL.
Lung volume reduction surgeryversusendobronchial valves: a randomised controlled trial
Authors: Buttery Sara C. , Banya Winston , Bilancia Rocco , Boyd Elizabeth , Buckley Julie , Greening Neil J. , Housley Kay , Jordan Simon , Kemp Samuel V. , Kirk Alan J.B. , Latimer Lorna , Lau Kelvin , Lawson Rod , Lewis Adam , Moxham John , Rathinam Sridhar , Steiner Michael C. , Tenconi Sara , Waller David , Shah Pallav L. , Hopkinson Nicholas S.
Published: February 2023

Background

Lung volume reduction surgery (LVRS) and bronchoscopic lung volume reduction (BLVR) with endobronchial valves can improve outcomes in appropriately selected patients with emphysema. However, no direct comparison data exist to inform clinical decision making in people who appear suitable for both procedures. Our aim was to investigate whether LVRS produces superior health outcomes when compared with BLVR at 12 months.

Methods

This multicentre, single-blind, parallel-group trial randomised patients from five UK hospitals, who were suitable for a targeted lung volume reduction procedure, to either LVRS or BLVR and compared outcomes at 1 year using the i-BODE score. This composite disease severity measure includes body mass index, airflow obstruction, dyspnoea and exercise capacity (incremental shuttle walk test). The researchers responsible for collecting outcomes were masked to treatment allocation. All outcomes were assessed in the intention-to-treat population.

Results

88 participants (48% female, mean±sdage 64.6±7.7 years, forced expiratory volume in 1 s percent predicted 31.0±7.9%) were recruited at five specialist centres across the UK and randomised to either LVRS (n=41) or BLVR (n=47). At 12 months follow-up, the complete i-BODE was available in 49 participants (21 LVRS/28 BLVR). Neither improvement in the i-BODE score (LVRS −1.10±1.44versusBLVR −0.82±1.61; p=0.54) nor in its individual components differed between groups. Both treatments produced similar improvements in gas trapping (residual volume percent predicted: LVRS −36.1% (95% CI −54.6– −10%)versusBLVR −30.1% (95% CI −53.7– −9%); p=0.81). There was one death in each treatment arm.

Conclusion

Our findings do not support the hypothesis that LVRS is a substantially superior treatment to BLVR in individuals who are suitable for both treatments.
Efficacy of erector spinae plane block for postoperative analgesia lumbar surgery: a systematic review and meta-analysis
Authors: Sun Qianchuang , Zhang Chengwei , Liu Shuyan , Lv Hui , Liu Wei , Pan Zhenxiang , Song Zhimin
Published: February 2023

Objectives

The erector spinae plane (ESP) block is a newly defined regional anesthesia technique first described in 2016. The aim of this meta-analysis is to assess the efficacy of ESP block in improving analgesia following lumbar surgery.

Methods

PubMed, EMBASE, Cochrane Library, and Web of Science were searched for randomized controlled trials (RCTs) that compared the analgesic efficacy of the ESP block with non-block care for lumbar surgery from inception 3 August 2021. The primary outcomes were postoperative opioid consumption and pain scores during the first 24 h. Postoperative pain was measured as pain at rest and on movement at postoperative 0, 4, 8, 12, and 24 h expressed on a visual analog scale (VAS), where 0 = no pain and 10 = the most severe pain.

Results

11 studies involving 775 patients were included in our analysis. The use of ESP block significantly decreased 24-h opioid consumption (WMD, -8.70; 95% CI, -10.48 to -6.93; I2 = 97.5%; P < 0.001) compared with the non-block. Moreover, ESP block reduced pain scores at postoperative time-points up to 24 h. ESP block also prolonged the time to first analgesic request (WMD = 6.93; 95% CI: 3.44 to 10.43, I2 = 99.8%; P < 0.001). There was less PONV with ESP block versus non-block group (RR, 0.354; 95% CI, 0.23 to 0.56; I2 = 25.2%; P < 0.001), but no difference in pruritus.

Conclusions

ESP block provides less opioid consumption and PONV, lower pain scores, and longer time to first analgesic request in patients undergoing lumbar surgery compared to general anesthesia alone.
Knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain: a survey study in the province of Quebec, Canada
Authors: Lowry Véronique , Lavigne Patrick , Zidarov Diana , Perreault Kadija , Roy Jean-Sébastien , Desmeules François
Published: February 2023

Background

Shoulder pain is difficult to diagnose and treat with half of those affected still symptomatic six months after initial consultation. This may be explained by primary care management not conforming to evidence-based practice. This survey evaluated physiotherapists (PTs) and family physicians' (FPs) knowledge and appropriateness of care in shoulder pain management.

Methods

A survey sent to PTs and FPs in the province of Quebec, Canada presented four clinical vignettes with cases of rotator cuff (RC) tendinopathy, acute full-thickness RC tear, adhesive capsulitis and traumatic anterior glenohumeral instability. Respondents indicated diagnosis, indications for imaging, specialists’ referrals, and choice of treatments. Answers were compared to recommendations from clinical practice guidelines (CPGs). Participants’ responses were compared between types of providers with Fisher’s exact test.

Results

Respondents (PTs = 175, FPs = 76) were mostly women with less than ten years of experience. More than 80% of PTs and 84% of FPs correctly diagnosed cases presented. Despite this practice not being recommended, more FPs than PTs recommended an imaging test in the initial management of RC tendinopathy (30% compared to 13%,p = 0.001) and adhesive capsulitis (51% compared to 22%,p = 0.02). For full-thickness RC tear and shoulder instability, up to 72% of FPs and 67% of PTs did not refer to a specialist for a surgical opinion, although recommended by CPGs. For RC tendinopathy, 26% of FPs and 2% of PTs (p < 0.001) would have prescribed a corticosteroid infiltration, which is not recommended in the initial management of this disorder. For adhesive capsulitis, significantly more FPs (76%) than PTs (62%) (p < 0.001) suggested an intra-articular corticosteroid infiltration, as recommended by CPGs. For all presented vignettes, up to 95% of family physicians adequately indicated they would refer patients for physiotherapy. In prioritizing rehabilitation interventions, up to 42% of PTs did not consider active exercises as a priority and up to 65% selected passive modalities that are not recommended for all shoulder pain vignettes.

Conclusions

Most FPs and PTs were able to make adequate diagnoses and select appropriate treatments for shoulder pain, but practices opposed to evidence-based recommendations were chosen by several respondents. Further training of FPs and PTs may be needed to optimize primary care management of different shoulder disorders.