bluuebunny/crossref_metadata_2025 huggingface dataset:
Delivery of evidence-based critical care practices across the United Kingdom: A UK-wide multi-site service evaluation in adult units
Authors: Thomson William R , Puthucheary Zudin , Stavrinou Panayiotis , Barghouthy Dalia , Champanerkar Shreekant , Findlay Douglas , Gordon Sarah , McWilliams David , Tantam Kate , Woodward Helen , Stephens Timothy J
Published: November 2024

Background:

The ICU Liberation Bundle was developed to improve outcomes for patients admitted to critical care. Despite a lack of Bundle adoption in the UK, the individual evidence-based practices (EBPs) within the bundle are defined as standards of care by the UK Intensive Care Society. There are limited data on the delivery of these EBPs.

Objective:

To evaluate current delivery of the EBPs of the ICU Liberation bundle in a sample of hospitals in the UK National Health Service (NHS) presenting delivery of EBP’s between hospitals, their stability of delivery across multiple weeks and in comparison to US hospitals in the original ICU Liberation Bundle study

Methods:

Multi-centre service evaluation, using modified definitions of compliance from the ICU Liberation Bundle study. We sampled six representative units from across the UK; data collection totalled 1116 patient days. Data were analysed using descriptive statistics.

Results:

Across all six units, patients received a median of 42.9% (IQR 40%–60%) of all possible bundle EBPs. Unit bundle proportional compliance (number of components completed/eligible number of components) ranged from 40.0% (IQR 28.6%–50.0%) to 71.4% (IQR 57.1%–80.0%). Units completed spontaneous awakening trials most regularly in 80.1% of eligible patients (149/186). Delirium assessments were the least adhered to EBP with only 32.2% (359/1116) of patients receiving at least two validated delirium assessments per day. Full bundle compliance was lower in the UK cohort in comparison to the original trial (4% vs 8%).

Discussion:

We identified substantial variation in the delivery of seven evidence-based practices that are considered standards of care in the UK. Variation existed between hospitals and within each hospital over time. These data begin to describe the current state of EBP adherence in a selection of critical care units.
Raising the bar in ulcerative colitis management
Authors: Fanizzi Fabrizio , Allocca Mariangela , Fiorino Gionata , Zilli Alessandra , Furfaro Federica , Parigi Tommaso Lorenzo , Peyrin-Biroulet Laurent , Danese Silvio , D’Amico Ferdinando
Published: November 2024

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by growing incidence and prevalence around the world in the last few decades. The range of available existing treatment and strategies for its management is being implemented. Given the introduction of newly developed molecules and the lack of specific guidelines, drug positioning may represent a tough clinical challenge. UC management is mostly medical, and it has been shifting toward a more personalized approach with the aim to create a tailored strategy depending on the patient’s profile. A treat-to target strategy seems to be the best approach to reach disease control as it allows to carry out therapeutic choices based on objective and specific parameters: histological, ultrasonographic, and molecular targets may add to the already used clinical, endoscopic, and biochemical targets. In addition, dual-targeted therapy has emerged as an attractive therapeutic strategy for patients not achieving remission. This review aims to provide an overview of the available strategies to raise the bar in UC.
First-line treatment with zolbetuximab plus CAPOX for ClDN18.2-positive gastric or gastroesophageal junction adenocarcinoma: a cost-effectiveness analysis
Authors: Lei Jianying , Zhang Jiahao , You Caicong , Fu Wu , Liu Maobai , Li Na
Published: November 2024

Background:

Patients with HER2-negative locally advanced or unresectable metastatic gastric cancer and gastroesophageal junction (G/GEJ) adenocarcinoma have limited first-line treatment options and a poor prognosis. The GLOW clinical trial showed that zolbetuximab plus capecitabine plus oxaliplatin (CAPOX) significantly prolonged these patients’ overall survival (OS) and progression-free survival (PFS).

Objectives:

This study evaluated the cost-effectiveness of zolbetuximab plus CAPOX as a first-line treatment for HER2-negative locally advanced or unresectable metastatic G/GEJ adenocarcinoma in the United States and China.

Design:

The cost-effective analysis.

Methods:

Based on the GLOW clinical trial data (NCT03653507), we constructed a 10-year Markov model to assess the cost-effectiveness of the zolbetuximab or placebo plus CAPOX treatment regimen. Only direct medical costs were considered. The primary outcomes of the model were quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). One-way and probabilistic sensitivity analyses were employed to assess the robustness of the model.

Results:

In the United States, zolbetuximab plus CAPOX added 0.24 QALYs and resulted in an incremental cost of $196,791.11 compared with placebo plus CAPOX, which had an ICER of $821,515.65 per QALY gained. For China, the zolbetuximab group gained 0.23 QALYs at an incremental cost of $62,822.69, resulting in an ICER of $273,568.01/QALY. One-way sensitivity analysis revealed that the results were most sensitive to the price of zolbetuximab. Zolbetuximab plus CAPOX had 0% cost-effectiveness at the willingness-to-pay thresholds of $150,000/QALY in the United States and $38,188/QALY in China.

Conclusion:

Zolbetuximab plus CAPOX may be a cost-effective option for patients with locally advanced, unresectable, or metastatic G/GEJ adenocarcinoma when the price of zolbetuximab reduced by 83.37% ($367.7/100 mg) in the United States and 82.25% ($110.8/100 mg) in China.
Catha edulis (Vahl) Endl., a Potential Natural Remedy for Type 2 Diabetes Mellitus or a Complicating Factor: A Narrative Review
Authors: Tolo Casim Umba , Lubogo Patrick , Yadesa Tadele Mekuriya
Published: November 2024

Catha edulis, commonly known as “Khat,” is a large shrub that is native to the Arabian Peninsula (particularly Yemen) and some African countries, including Ethiopia, Kenya, and Somalia, and the plant is used traditionally for its psychostimulant, euphoric, and analgesic properties. C. edulis contains several pharmacologically active compounds, but cathinone is responsible for the vast majority of its pharmacological properties. Traditionally, Khat is known for the treatment of type 2 diabetes in Africa, particularly in Uganda. Numerous studies that explored this area yielded inconclusive findings. Some studies showed that chewing Khat lowers blood glucose levels (BGL) in non-diabetic patients, while others showed that ingesting Khat delays gastric emptying time, and this supported and explained the earlier claim of its benefit in Type 2 diabetes mellitus (DM). However, a recent meta-analysis gave a contradictory submission that Khat is associated with an insignificant reduction in BGLs in non-diabetic humans and animals with a significant increase in BGLs in patients with diabetes. Most importantly, reports suggested that Khat exacerbates common complications of diabetes, such as depression, sexual dysfunction, dyslipidemia, proteinuria, and hypertension. The current findings concluded that Khat does not have a beneficial effect on Type 2 DM. Chewing Khat is believed to be a risk factor for Type 2 DM for raising glucose levels and a possible determinant of its poor outcomes and prognosis.
Double-Stacked One-Third Tubular Plating for Suprasyndesmotic Fibula Fractures Technique Description and Clinical Case Series
Authors: Kaspar Wagner Robert , Borgida Jacob S. , Wong Alice W. , Jensen Bryce , Stenquist Derek S. , Ly Thuan V.
Published: November 2024

Fixation for suprasyndesmotic fibula fractures (AO/OTA type 44C, consistent with Weber C) is classically achieved using a single one-third tubular plate. However, these fractures may sometimes require stronger fixation due to the diaphyseal fracture location and the lack of structural support from injured ligaments. To increase stability, 3.5 mm plates can be used, but these plates are bulky and too stiff to contour. As alternative, the authors present the technique and clinical and patient-reported outcomes (PROs) of using stacked one-third tubular plating for suprasyndesmotic fibula fractures to increase stability of fixation. Between 2021 and 2023, 14 patients were treated with stacked one-third tubular plating. All patients healed uneventfully. One patient developed an infection with wound breakdown and exposed hardware after fracture healing. Thirteen patients (93%) responded to PROs. The median Olerud-Molander ankle score was 75 (interquartile range [IQR]: 30-80), the median EQ-5D-5L score was 80 (IQR: 69-81), and the median numeric rating scale (NRS) score was 3 (IQR: 0-5). The use of double-stacked one-third tubular plates is a simple and safe technique that can be used to increase stability of suprasyndesmotic fibula fractures leading to reliable healing rates and satisfactory PROs.

Levels of Evidence: Level IV Retrospective Case Series
Could Motor Imagery Training Provide a Novel Load Management Solution for Athletes? Recommendations for Sport Medicine and Performance Practitioners
Authors: McNeil Dominic G. , Lindsay Riki S. , Worn Ryan , Spittle Michael , Gabbett Tim J.
Published: November 2024

Context:

Athletes often face the dual challenge of high training loads with insufficient time to recover. Equally, in any team, sports medicine and performance staff are required to progress training loads in healthy athletes and avoid prolonged reductions in training load in injured athletes. In both cases, the implementation of a well-established psychological technique known as motor imagery (MI) can be used to counteract adverse training adaptations such as excessive fatigue, reduced capacity, diminished performance, and heightened injury susceptibility.

Study Design:

Narrative overview.

Level of Evidence:

Level 5.

Results:

MI has been shown to enhance performance outcomes in a range of contexts including rehabilitation, skill acquisition, return-to-sport protocols, and strength and conditioning. Specific performance outcomes include reduction of strength loss and muscular atrophy, improved training engagement of injured and/or rehabilitating athletes, promotion of recovery, and development of sport-specific skills/game tactics. To achieve improvements in such outcomes, it is recommended that practitioners consider the following factors when implementing MI: individual skill level (ie, more time may be required for novices to obtain benefits), MI ability (ie, athletes with greater capacity to create vivid and controllable mental images of their performance will likely benefit more from MI training), and the perspective employed (ie, an internal perspective may be more beneficial for increasing neurophysiological activity whereas an external perspective may be better for practicing technique-focused movements).

Conclusion:

We provide practical recommendations grounded in established frameworks on how MI can be used to reduce strength loss and fear of reinjury in athletes with acute injury, improve physical qualities in rehabilitating athletes, reduce physical loads in overtrained athletes, and to develop tactical and technical skills in healthy athletes.
Intracranial hypertension and papilledema secondary to an unruptured arteriovenous malformation: Review of the literature
Authors: Ghorbani Mohammad , Griessenauer Christoph J , Wipplinger Christoph , Bahrami Reza , Mirsardoo Hojjat , Sahraei Rana , Mortazavi Abolghasem
Published: November 2024

Arteriovenous malformations (AVMs) are abnormal connections of arteries and veins without intermediate capillary components. As such, AVMs can remain asymptomatic or have a variety of clinical presentations ranging from mild headaches to severe symptoms like seizures, hemorrhage, and subsequent coma. Papilledema and increased intracranial pressure without hydrocephalus or hemorrhage are rare forms of presentations of cerebral AVM. The mechanism of intracranial hypertension accompanying brain AVMs is not entirely understood, and the right treatment strategy is controversial. Here, we present the treatment and outcomes of four patients with unruptured AVMs who presented with intracranial hypertension accompanied by visual symptoms, papilledema, and without evidence of hydrocephalus. In cases of AVMs accompanied by intracranial hypertension, AVM treatment should be considered the main target of management.
Impact on mortality at 90 days of acute kidney injuries in endovascularly treated stroke: A systematic review, meta-analysis, and meta-regression
Authors: De Rubeis Gianluca , Alessiani Michele , Fabiano Sebastiano , Bertaccini Luca , Wlderk Andrea , Pezzella Francesca Romana , Anticoli Sabrina , Barber Peter Alan , Saba Luca , Pampana Enrico
Published: November 2024

Aim

To investigate the prognostic implication (mortality at 3 months) of acute kidney injury (AKI) in acute ischemic stroke treated with mechanical thrombectomy (MT).

Material and Methods

A literature search was performed using PubMed/OVID/Cochran’s CENTRAL database (time frame: inception to January 2023). Study characteristics, patient status, clinical outcomes, AKI incidence, and sample size were recorded. The exclusion criteria were non-English literature, no human subjects, and <10 patients as the sample size. Studies were assessed using the MINORS/GRADE system. Meta-analysis and meta-regression with a random-effects model were performed.

Results

3314 studies were retrieved. After applying the exclusion criteria, the final population included of 18/3314 studies (0.5%). Among them, only 6/18 (33.3%) studies reported results in two separate groups (AKI vs non-AKI), allowing for inference statistics for a total population of 3229 (538.6 ± 403.7). The I^2 was 34.6 and Q’s Cochrane was 7.80. The pooled odds ratio (OR) for mortality at 3 months in patients with AKI was 5.8 (95% confidence interval [95% CI] 95% CI 3.62 to 9.52). Leave-one-out meta-analysis showed no significant sources of heterogeneity. In the meta-regression, diabetes prevalence was associated with a higher mortality rate (OR 1.14, 95% CI 1.03 to 1.28), and lower age and a small amount of contrast media were negatively correlated (0.91 [95% CI 0.83 to 0.99] and OR 0.97 [95% CI 0.94 to 1.00], respectively).

Conclusion

AKI was significantly associated with the mortality rate in MT-treated stroke patients (OR 5.8 [95% CI 3.62 to 9.36]).
A systematic review, ANCOVA meta-analysis, and meta-regression of clinical trials: Orlistat and body mass index of overweight and obese patients
Authors: Salim Jonathan , Tandy Sutiono , Puspitasari Gita
Published: November 2024

Background:

Obesity or overfat (i.e., excessive fat accumulation in the host) contributes to cerebrocardiovascular and other diseases. Orlistat is a good obesity medication, unlike other drugs that have higher cardiac toxicity. It reversibly inhibits pancreatic and gastric lipases, and improves oxysterol metabolism. This study summarizes and elaborates the impact of orlistat on BMI in overweight and obese adult patients.

Methods:

All authors systematically searched and retrieved 288 controlled trial articles on orlistat and BMI from three databases, two registries, and citation searches using specific keywords. The quality and bias risks were determined by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), Risk of Bias in Non-Randomized Study (ROBINS-I), and modified Jadad scale. R version 4.2.2 software calculated the effect size and the analysis of covariance (ANCOVA) effect, and subsequently analyzed using metafor.

Results:

This novel meta-analysis included 114 studies with 24,600 overweight or obese participants. We showed that orlistat substantially reduced BMI (mean difference −0.78 [−0.94, −0.63], p < 0.0001; I2 = 90.19%, pheterogeneity < 0.0001). Similarly, meta-regression showed a significant impact of orlistat daily dose (ß = −0.0019), yet not for duration (ß = −0.0024) and location (ß = −0.8591, −0.0190).

Conclusion:

Orlistat has the capacity to reduce BMI in overweight and obese individuals. Medical practitioners shall prescribe orlistat as a BMI lowering agent to complement other intervention in those patients
Novel CNTNAP1 gene variant identified in congenital hypomyelinating neuropathy-3: A case report
Authors: Wang Helen , Chen Dillon , Del Campo Miguel , Del Rosario Pamela , Lee Pei-Shan
Published: November 2024

Contactin-associated protein ( CNTNAP1) gene mutations have been reported in cases of congenital hypomyelinating neuropathy (CHN), a rare hereditary neuropathy. We present a case of a term male infant born at 39 weeks 4 days with respiratory distress, impaired swallow function, and hypotonia. Neurological workup for structural, autoimmune, neuromuscular, and metabolic etiologies was negative and whole exome sequencing revealed a novel mutation in the CNTNAP1 gene, consistent with a diagnosis of CHN3. While CHN3 cases with mutations in the same domain have required long-term respiratory support, our patient, now 2 years old, has not required respiratory support since his initial birth hospitalization. Neurologically, he now has central hypotonia with hypertonia in the bilateral extremities and global developmental delay. This case adds to a growing number of identified pathological CNTNAP1 mutations and their heterogenous clinical phenotypes and highlights a rare neurological etiology for respiratory distress in newborns.
Hormone replacement therapy and non-gynaecological cancers
Authors: Sekar Sindhu , Kumar Bid
Published: November 2024

Hormone replacement therapy (HRT) in cancer survivors gives rise to many uncertainties. The British Menopause Society has recently produced guidance on prescription and use of HRT amongst gynaecological cancer survivors.

Background

There is lack of knowledge and awareness about HRT use in non-gynaecological cancer survivors. The decision to advocate or discourage HRT in such women depends on various factors, including cancer type, hormone sensitivity, and individual patient characteristics. The paucity of available good quality clinical evidence and epidemiological data leads to lack of consensus in such cases. This article aims to address this knowledge gap by conducting a comprehensive qualitative analysis of the existing literature pertaining to HRT use in non-gynaecological cancer survivors.

Materials and Methods

We conducted a literature review. A systematic review was not possible because of lack of good quality research. We excluded case reports.

Results

A total of 55 papers were identified and all of these have been referenced. We have presented the inconsistencies and uncertainties in the evidence available from the limited information available from cohort studies.

Conclusion

Prescription of HRT in cancer survivors of many hormone dependent non-gynaecological cancers needs careful consideration of histology of the cancer and consideration about liaison with the concerned oncology team.
Three-Dimensional Imaging Defines Straddling Mitral Valve Anatomy to Allow Successful Biventricular Repair
Authors: Doctor Pezad , Islam Irtiza S , Ikemba Catherine M , Fares Munes , Moore Jay , Sturgeon Gregory , Jaquiss Robert DB , Andersen Nicholas D
Published: November 2024

Biventricular repair of a straddling mitral valve (MV) can involve relocating ectopic papillary muscles and chordae. However, this increases operative complexity and risks MV incompetence. We describe a nine-month-old with D-transposition of the great arteries and straddling MV. Three-dimensional imaging identified ventricular septum malposition and defined a simple repair strategy via ventricular septal defect patch closure rightward of the ectopic papillary muscle along with the arterial switch operation. This case highlights the role of 3D imaging in planning safe biventricular repair of straddling MV in an infant.
Use of 1 mm Cerclage Cables in Surgical Treatment of Periprosthetic Femur Fractures
Authors: Brown Harrison S. , Wall Bryce , Mears Simon C. , Stronach Benjamin M. , Siegel Eric R. , Stambough Jeffrey B.
Published: November 2024

Introduction

1 mm cerclage cables have been introduced that can be placed under plates and hold reduction of periprosthetic femur fractures (PPFFx) around total hip arthroplasty (THA). Their utilization remains controversial due to the risk of nonunion secondary to periosteal stripping associated for their application. We compared surgical outcomes in patients with THA PPFFx treated with open reduction internal fixation (ORIF) and cables vs patients with PPFFx treated with ORIF without cables. We hypothesized that cable use would decrease hardware failure and nonunion rates.

Materials & Methods

We retrospectively reviewed 42 cases of PPFFx around THA performed from 2015 to 2021. Twenty-three PPFFx were treated with plate and 1 mm cerclage cables, and 19 PPFFx were treated with plate without cables. Primary surgical outcomes included hardware failure, nonunion, reoperation, and time to radiographic union.

Results

There was no significant difference in nonunion rates: 9% in the cerclage cable group vs 16% in the plate-only group ( P = .64). The average time to union was 6.0 months among 17 observed unions in the cerclage cable group, vs 8.0 months among 15 observed unions in the plate-only group, but this failed to reach significance ( P = .12). There was no statistical difference in overall complication rates (13% cerclage vs 16% plate) requiring reoperation ( P = 1.0).

Discussion & Conclusion

The utilization of 1 mm cerclage cables to hold reduction of PPFFx provides an easy method to hold fixation with a low overall complication rate and no significant differences in nonunion rate or time to union when compared to cases performed without cables.
Is Cervical Disc Degeneration a Compensatory Mechanism in Hirayama Disease? A Retrospective Case‒Control Study
Authors: Wang Zhaoxuan , Ren Jianhua , Chang Hengrui , Xue Rui , Liang Guzhen , Kou Junkai , Meng Xianzhong
Published: November 2024

Study Design

Retrospective Cohort Study.

Objective

This study aimed to explore the association between cervical disc degeneration and disease progression in patients with Hirayama disease, with a particular focus on changes in the cervical intervertebral disc space height and potential compensatory mechanisms.

Methods

This retrospective study included 35 patients diagnosed with Hirayama disease (HD), who were compared with 35 healthy control subjects matched for age and sex. This study focused on collecting and analyzing cervical disc grades and intervertebral space heights from C2 to C7, aiming to assess the extent of cervical disc degeneration between HD patients and the control group. The analysis used independent sample t tests and Mann‒Whitney U tests for demographic data and Spearman’s correlation coefficient to explore the relationship between disc degeneration and age.

Results

Compared with the control group, patients with Hirayama disease presented significant reductions in intervertebral disc height ( P < .01) and increased disc degeneration. Within the HD group, most patients displayed multisegment degeneration (30 out of 35), and more than half presented with full-segment disc degeneration (20 out of 35), which was significantly different from the normal population ( P < .01).

Conclusion

Patients with Hirayama disease exhibit disc degeneration and reduced intervertebral space height, which may represent a compensatory response.
The Safety of Spinal Surgery in Patients over 80 Years of Age: Propensity Score Matching Study
Authors: Bang Chungwon , Kwon Kihyun , Ahn Joonghyun , Kim Young-Hoon
Published: November 2024

Study Design

Retrospective cohort study.

Objectives

Using propensity match score to remove those confounding bias and focuses on age factor to compare clinical outcomes and perioperative complications following spinal surgery in cohort of Korean octogenarians treated at a single tertiary hospital.

Methods

We classified patients of 80s as the octogenarian group (group O), those 65 and older, and under 80 as the elderly group (group E). We strategically employed the Propensity Score Matching (PSM) analysis as a method to counteract potential confounding variables. 1: 1 nearest-neighbor PSM for fusion level, estimated blood loss (EBL), transfusion, body mass index (BMI), American society of anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI) surgical method and operation time was performed. After PSM, 98 patients are categorized each group evenly (group O, n = 49 vs group E, n = 49). Demographics, clinical, radiologic and postoperative complications were analyzed.

Results

The clinical outcomes showed no significant differences in the VAS and ODI preoperatively or postoperatively. And most of hospitalization related factors shows no differences between 2 groups. However, follow-up period was longer in group E (1053.37 ± 684.14 days) than group O (640.29 ± 496.68, P = 0.001) and group O has higher incidences of medical complication (38.77% vs 16.32%, P = 0.013), especially in delirium (34.69% vs 6.12%, P = 0.001) than group E.

Conclusions

With the preparation for the prevention and treatment of postoperative delirium, age itself should not be a reason to hesitate in performing the spinal surgery.
Women’s Land Ownership in India: The Impact of Caste and Religion
Authors: Malarchitra K. R. , Sasirekha P.
Published: November 2024

This study empirically examines the role of caste and religion in shaping women’s land ownership in India using data from the National Sample Survey Office 77th round survey. The findings reveal significant disparities in land ownership among women across religious and caste lines. Hindu, Muslim and Christian women are consistently less likely to own land compared to those from other religious backgrounds, reflecting the influence of religious laws and customs on property rights. Similarly, women from Scheduled Tribes, Scheduled Castes and Other Backward Classes face heightened barriers to land ownership, highlighting socio-economic inequalities perpetuated by the caste system. Addressing legal ambiguities, cultural norms and socio-economic inequalities can foster a more inclusive and equitable land ownership landscape, empowering women economically and socially. Such measures contribute to broader goals of sustainable development and gender equality as outlined in the United Nations’ Sustainable Development Goals.
Evaluating Patient Experiences with Patient-Centered and Inclusive Care in Academic Obstetrics and Gynecology Outpatient Clinics
Authors: Bhuiyan Julia , Loder Charisse
Published: November 2024

Ensuring patient satisfaction is crucial in obstetrics and gynecology (OB/GYN) care. This study aimed to assess patient satisfaction and experiences with respectful and culturally competent care in an institution's OB/GYN clinics following the initiation of diversity, equity, and inclusion programming. A survey was conducted from September 2021 to February 2022 among patients who had completed outpatient OB/GYN visits, focusing on staff and provider cultural competency, treatment discussion, clinic accommodations, and comfort during sensitive exams. Results from 246 participants indicated that most had positive interactions with clinic staff and healthcare providers. However, disparities emerged, with black or African American participants reporting lower satisfaction and a higher incidence of unfair treatment due to race. These findings highlight the need for additional educational endeavors to equip clinical care teams with skills for providing respectful, inclusive, and culturally competent care. Future qualitative research can further explore patient experiences with inclusive practices in OB/GYN care.
“We Don’t Talk About Race in the Classroom”: Examining Chinese Dual Language Bilingual Education Teachers’ Raciolinguistic Ideologies and Literacy Pedagogy
Authors: Xu Nuo , Valdez Verónica E.
Published: November 2024

Drawing on a raciolinguistic perspective and theoretical constructs of critical consciousness, this study examines Chinese dual language bilingual education (DLBE) teachers’ lived experiences and the raciolinguistic ideologies shaping their perceived language and literacy pedagogy in the classroom. We conducted semistructured interviews with 10 Utah secondary Chinese DLBE teachers to capture and understand their stories. The findings reveal that teachers’ diverse experiences influenced their ideologies toward language and race as well as their language and literacy instructional practices. While the teachers invested various efforts to facilitate bilingual and biliteracy learning by leveraging students’ background knowledge, they did not engage students in discussing and learning critical topics on race, power, and equity, setting aside the DLBE foundational goal of developing critical consciousness. We argue for the need to support Chinese DLBE teachers to critically examine their raciolinguistic ideologies and practice critical language and literacy pedagogies that challenge oppressive practices and advance equity in Mandarin Chinese DLBE classrooms. Implications for educators, school leaders, policymakers, and families are also discussed.
Does Medical Education Require Radical Change?
Authors: Chatzistamou Ioulia
Published: November 2024

Over the last decades, the amount of knowledge that is required from learners in the medical field has become incredibly wide and deep, posing a burden for all stakeholders including medical schools, training hospitals, students, and society. The trajectory that has been established will soon render medical education ineffective, both from the perspective of the students who will not be able to productively internalize and effectively integrate the information they receive, and of the institutions and medical programs that will be unable to keep up with the pace of the medical progress and the relevant subject matter that needs to be taught. To address this burden, sooner than later, bold actions should be taken toward the radical transformation of the medical curriculum both in terms of its duration and its implementation and of the type of knowledge that the medical students will need to excel in, as a prerequisite for their subsequent training.
Valuing the ‘new normal’? Housing markets under COVID-19: Insights from a hybrid hedonic repeat sales model
Authors: Hincks Stephen , Leishman Chris , Pham Hung , Preece Jenny
Published: November 2024

This study considers the impact of the COVID-19 pandemic on sub-national housing markets in Wales, focusing on the contribution of environmental and productivity attributes on house price change. Using a hybrid hedonic/repeat sales framework, we examine trends before, during, and after the pandemic. Initially, higher-quality environmental and productivity attributes were associated with a positive premium in price growth, while lower quality attributes were associated with a negative premium. However, during the pandemic’s second phase, these effects reversed but positive premiums for higher-quality attributes did not fully unwind during the transition to less acute phases of the pandemic. When we disaggregate the analysis for the urban-rural gradient, we find that both contexts placed a premium on high quality environmental housing, but lower quality productivity attributes negatively affected urban areas. The contribution of the study lies in revealing the complex, evolving and unequal relationship between the COVID-19 pandemic, housing preferences, and prices that, in our study context, have been subject to much conjecture but with little empirical investigation.
Optimising Private Sector Participation in Local Economic Development: A Study of Kwahu South Municipal Assembly in the Eastern Region of Ghana
Authors: Mintah Kelvin Omari , Domfeh Kwame Ameyaw , Ahenkan Albert , Bawole Justice Nyigmah , Nakouwo Solomon Nborkan
Published: November 2024

This article focused on the preferred partnership arrangement in undertaking local economic development (LED) initiatives and the constraints to the effective participation of the private sector in LED initiatives in Ghana using the experience of the Kwahu South Municipal Assembly. With the help of a qualitative case study, key informants were purposively selected from the study area and primary data were collected using in-depth interviews. The findings of the study posit that the overarching form of partnership used in undertaking LED initiatives is Build Own Operate and Transfer and Joint Venture kind of partnership arrangements and that most Joint Venture partnership arrangements are being converted into Build Own Operate and Transfer. Likewise, rules governing partnership arrangement, personal interest, operational policies, poor maintenance culture, lack of transparency and the politicisation of developmental initiatives are hindrances to private sector participation in LED activities. This study concludes that it is imperative to put in coping mechanisms that will enhance the active participation of the private sector in LED initiatives.
Differential DNA methylation profiles of Alzheimer's disease-related genomic pathways in the blood of cognitively-intact individuals with and without high impact chronic pain
Authors: Strath Larissa J , Meng Lingsong , Zhang Yutao , Rani Asha , Huo Zhiguang , Foster Thomas C , Fillingim Roger B , Cruz-Almeida Yenisel
Published: November 2024

Background

Chronic pain and Alzheimer's disease (AD) are prevalent in older age and their etiologies remain to be understoodand evidence supports potential associations between the two. Both high impact pain and AD have been previously associated with differences in the epigenome. Interactions with the epigenome may serve as a possible underlying mechanism linking high impact pain and AD.

Objective

To complete epigenetic canonical pathways analyses related to AD in individuals with and without high-impact knee pain.

Methods

This manuscript aimed to explore differences in DNA methylation patterns in genes and pathways associated with AD. Blood samples of cognitively intact, community-dwelling adults with high impact knee painmversus pain-free controls were compared on their DNA methylation levels of AD-related genes. Pathway enrichment analysis was performed on significantly different DNA Methylation probes by pain group.

Results

There were significant DNA methylation differences between the high impact versus the pain-free control groups in genes and pathways associated with AD (p < 0.05). We found a total of 17,563 differentially methylated CpG probes, including 13,411 hypermethylated CpG probes and 4152 hypomethylated CpG probes. Further, pathway analysis revealed these differences were significantly associated with AD-related pathways associated with AD progression.

Conclusions

This study sample showed AD-related DNA methylation differences and associated potential canonical pathways in those with and without high impact knee pain. These results highlight the need to study overlapping epigenetic modifications underlying high impact pain and AD pathologies. Further studies, including gene expression, are needed to further explore the relationship between epigenetics, chronic pain, and AD.
The association between activities and cognitive health: Stratified analysis by APOE ε4 status
Authors: Lee Yeonjung Jane , Gonzales Ernest , Wu Yanyan , Braun Kathryn L , Martin Peter , Willcox Bradley , Andel Ross
Published: November 2024

Background

Despite the growing evidence on the modifiable and genetic factors associated with cognitive health, little is known about the role of the apolipoprotein E ( APOE) gene ε4 allele in the associations between productive or leisure activities and cognitive health.

Objective

This study fills a gap of knowledge by examining the associations among employment, civic engagement, and leisure activities and cognitive health by the presence of APOE ε4 allele, an established risk factor of Alzheimer's disease (AD).

Methods

Using pooled data from the Health and Retirement Study (HRS) Psychosocial and Lifestyle Questionnaires (2010–2016) and the HRS data on APOE ε4 alleles, linear regression models with a lagged dependent variable were performed to examine associations between productive or leisure activities and cognitive functioning at the follow-up time point, as well as the role of APOE ε4 in these associations.

Results

Among all participants, employment, low or high-intensity volunteering, and cognitive/social leisure activities were associated with higher levels of cognitive functioning. The presence of at least one ε4 allele was related to poorer cognitive functioning at the follow-up time point. Among people without the APOE ε4 allele, employment, high-intensity volunteering, and cognitive/social leisure activities were significantly associated with cognitive functioning. Among people with at least one APOE ε4 allele, low-intensity volunteering and cognitive/physical leisure activities were significantly associated with better cognitive functioning.

Conclusions

We found that employment, civic engagement, and leisure activities all contribute to cognitive health, although the benefits may be restricted to low-intensity volunteering and cognitive/physical leisure activities among individuals with at least one APOE ε4 allele, who are known to be inherently at a greater risk of AD, highlighting an avenue to a relatively easily implementable strategy to promote cognitive health in this subpopulation.
Critical evaluation of COSMIN scores in scales for mild cognitive impairment and Alzheimer's disease: A comprehensive review
Authors: Peng Xia , Li Run-Chen , Liang Ting , Xu Shi-Fen , Cao Yan
Published: November 2024

Background: Timely diagnosis and intervention of mild cognitive impairment (MCI) can delay the development of Alzheimer's disease (AD). Objective: The purpose of this study was to analyze assessment tools for cognitive function using the Consensus Criteria for Selection of Health Measurement Instruments (COSMIN) method. Comparing the validity, reliability, and practicality of these assessment tools helps clinicians select appropriate assessment tools for patients, thereby improving diagnostic accuracy. Methods:We followed the updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used the COSMIN checklist to conduct a thorough methodological quality assessment of the studies. The measurement properties were evaluated and rated on a scale from excellent to poor, based on adapted criteria. We then synthesized the best evidence by combining the COSMIN outcomes with the quality of findings to ensure a precise and comprehensive analysis. Results: We identified a total of 156 publications, which included 19 different cognitive assessment instruments. Among these, the Telephone version of the Cantonese Mini-Mental State Examination (T-CMMSE), the Montreal Cognitive Assessment (MoCA), and the Hong Kong versions of the MoCA (HK-MoCA-A1 and A2) demonstrated distinguished qualities. The assessment of measurement properties included internal consistency, reliability, validity, and sensitivity and specificity. Notably, the T-CMMSE showed superior methodological quality based on our rigorous analysis. Conclusions: The T-CMMSE, MoCA, and HK-MoCA-A1 and A2 were found to be notable cognitive assessment tools for MCI and AD. Future research should aim to expand on these findings by exploring a wider range of tools and contexts.
Association between dementia, Alzheimer's disease, and liver cancer: A Mendelian randomization analysis
Authors: Li Tianze , Yi Jianwei , Hu Xuliang , Wu Huajun , Wang Kai , Zhou Binghai
Published: November 2024

Background

Epidemiological studies have indicated an inverse association between neurodegenerative diseases and cancer. However, the relationship between liver cancer and dementia, particularly Alzheimer's disease (AD), remains underexplored.

Objective

This study aimed to determine the association between dementia, specifically AD, and liver cancer using Mendelian randomization (MR) analysis.

Methods

We conducted a bidirectional, two-sample MR analysis using publicly available genome-wide association studies data. The inverse-variance weighted method was employed as the primary analytical approach. To detect and correct for the effects of horizontal pleiotropy, we applied three complementary methods: MR Egger, weighted median, and Maximum likelihood.

Results

The analysis indicated significant associations between dementia and a reduced risk of hepatocellular carcinoma (HCC) (OR: 0.87; 95%CI: 0.81–0.95; p < 0.001) and intrahepatic cholangiocarcinoma (ICC) (OR: 0.81; 95%CI: 0.72–0.92; p < 0.001). AD was significantly associated with a decreased risk of HCC (OR: 0.94; 95%CI: 0.88–0.99; p = 0.033), ICC (OR: 0.85; 95%CI: 0.78–0.93; p < 0.001), and combined hepatocellular-cholangiocarcinoma (CHC) (OR: 0.64; 95%CI: 0.43–0.93; p = 0.020). Conversely, inverse MR analyses indicated that ICC was associated with increased dementia risk (OR: 1.05; 95%CI: 1.01–1.09; p = 0.019) and CHC with increased AD risk (OR: 1.03; 95%CI: 1.00–1.04; p = 0.014).

Conclusions

This study suggests that dementia, particularly AD, is associated with a reduced risk of liver cancer. Conversely, liver cancer may be associated with a slightly increased risk of developing dementia and AD, although some observational studies have reported a lower risk of these conditions among cancer survivors.
Swallowing assessments: A unique methodology to enhance medical research
Authors: Solomon Beth I , Muñoz Andrea M , Sinaii Ninet , Mohamed Hibaaq O , King Monique , Dang Do An , Farhat Nicole M , Porter Forbes D
Published: November 2024

Background

There is no consistent approach in assessing swallowing function both in clinical or research settings. However, its significance in ensuring proper nutrition, growth/ development, and overall quality of life is undeniable. We aim to introduce a novel methodology that enhances swallowing function as an outcome measure in clinical and rare disease research and demonstrate its efficacy in Niemann-Pick Type C1 (NPC1).

Methods

We reviewed commonly implemented qualitative and quantitative swallowing assessments in current clinical practice, including patient/proxy/clinician reports, clinical swallowing evaluation, videofluoroscopic swallow assessment (VFSS), and post-VFSS interpretive measures [American Speech Hearing Association National Outcomes Measures Scale (ASHA-NOMS) and National Institutes of Health penetration and aspiration scale (NIH-PAS)]. Data analysis involved descriptive statistics, longitudinal statistical modeling to account for NPC1-specific covariates, and Kappa weighting correlations to determine inter-rater reliability.

Results

Our NPC1 cohort ( n = 120) underwent baseline and longitudinal evaluations, ( n = 269 VFSSs). We identified three statistically significant ( p < 0.05) NPC1-specific variables associated with post-VFSS interpretive measures, providing insights into disease progression and treatment effects. Inter-rater reliability correlations for ASHA-NOMS and NIH-PAS demonstrated strong agreement between two speech pathologists [ASHA-NOMS: 0.76 (95% CI 0.70-0.83); NIH-PAS: 0.88 (95% CI 0.82- 0.93)]. VFSS mean radiation dosage was calculated ( n = 129) and fell within the acceptable range declared by the American College of Radiology (263.79 ± 147.44 cGy*cm2).

Conclusions

This comprehensive methodology successfully documented functional swallowing status with dietary modifications and aspiration risk in a rare disease cohort (NPC1). Additionally, we effectively employed this methodology to support swallowing function as a research endpoint, specifically for phenotyping and developing therapeutic interventions for rare diseases.
Overcoming Compassion Fatigue and Burnout in Pediatric Oncology Nurses: Implementation of a Staff Well-Being Program
Authors: Blackwell Angie
Published: November 2024

Background: As frontline healthcare workers, pediatric oncology nurses are at high risk for burnout, compassion fatigue, and decreased compassion satisfaction. Research indicates that up to 60% of oncology staff experience some form of burnout. This can lead to difficulties in personal and professional relationships, decreased staff retention, and negative effects on patient safety. This evidence-based practice project evaluated the impact of a staff well-being program on pediatric oncology nurses in a 28-bed hematology–oncology unit at a children's hospital. Method: After reviewing the literature related to compassion satisfaction, compassion fatigue, burnout, and well-being, an interdisciplinary team identified best practices for implementing a staff well-being program. This program integrated the components of Code Lavender, which is an alert designed to reduce stress and provide psychological first aid, including social support and a purposeful break from the unit, with staff debriefings, or dedicated time to reflect and focus on the team's emotional response and coping strategies. Results: Nurses reported that Code Lavender met their expectations; 69% agreed or strongly agreed that it had an immediate positive impact on their well-being. The team experienced challenges in coordinating debriefings with consistency, so the process was modified to develop a format that would address the needs of those who access the well-being program. There was a marginally significant improvement in compassion satisfaction from baseline to 12 months ( p = .05). Discussion: Promoting healthcare worker well-being continues to be a priority to reduce burnout and to improve compassion satisfaction. Implementation of Code Lavender and debriefings is an important step toward improving the well-being of pediatric oncology nurses.
“Music Played a Role in Saving My Life and Getting Me Through All of This”: A Descriptive Qualitative Study of Hope in Adolescents and Young Adults Living With Advanced Cancer
Authors: Bennett C. Robert , Weaver Crystal , Coats Heather L. , Hendricks-Ferguson Verna L.
Published: November 2024

Background: Adolescents and young adults (AYAs) living with advanced cancer may experience a heightened risk for existential distress. Addressing AYAs’ hopes can stimulate a dialogue about their concerns, values, and goals, provide a path to holistically support their existential needs, and potentially alleviate their distress. This study aimed to evaluate hope's role in a sample of AYAs living with advanced cancer. Method: This study used a Husserlian phenomenology-informed descriptive qualitative research design to elicit AYAs’ experiences with hope while living with advanced cancer. Participants were virtually recruited from an academic medical center and an online non-profit organization. Thematic analyses were performed across the data set to identify final themes. Results: Fifteen AYAs aged 12–21 years diagnosed with advanced hematological (80%) or solid (20%) malignancies participated in this study. A main theme of Simple Supports of Hope with a subtheme of Diversion was identified. Participants described music as a form of diversion, which supported their hope. Participants found listening to music calming and comforting and helped them cope with their distress. Performing music provided a creative outlet for negative feelings associated with cancer treatment. Participants reported creating music transformed and deintensified the treatment environment and helped spread hope to healthcare staff. Discussion: AYAs may intentionally use music to improve emotional expression, empowerment, connection, and coping strategies throughout the treatment process for cancer. Additional research needs to be conducted exploring the use of music interventions such as therapeutic songwriting or compositional music therapy to assist AYAs with building coping strategies during treatment for cancer.