bluuebunny/crossref_metadata_2025 huggingface dataset:
Looking Within: An Analysis of Intimate Partner Violence Victimization Among Sexual Minority Youth
Authors: Hazelwood Andrea
Published: February 2023

Sexual minority youth are at increased risk of intimate partner violence (IPV) victimization compared to their heterosexual peers. However, the sexual minority population is not a homogenous group and risk of IPV victimization varies by LGB+ subgroup (e.g., gay/lesbian, bisexual, and unsure). Using two waves of data (2017, 2019) from the National Youth Risk Behavior Survey (YRBS), this study analyzes (a) differences in physical and sexual IPV victimization between heterosexual and sexual minority youth, (b) within group differences among sexual minority youth, and (c) if the relationship between IPV victimization and sexual identity is attenuated after controlling for sociodemographic characteristics and theoretically relevant risk factors. Results indicate that sexual minority youth are at elevated risk of IPV victimization compared to their heterosexual peers. Within-LGB+ analyses show that bisexual youth are more likely than gay/lesbian youth to be victims of sexual IPV. The association between physical and sexual IPV victimization and sexual identity is partially attenuated by sociodemographic variables and observed risk factors. Findings indicate that intervention and prevention programming should be tailored to identify, and treat, the risks and needs of unique, at-risk populations.
Uncertainty Management Strategies in Communication About Urinary Tract Infections
Authors: Leverenz Alaina , Hernandez Rachael A.
Published: February 2023

Urinary tract infections (UTIs) are the most common bacterial infection, and yet the etiology, treatment, and prevention of UTIs are often clouded by uncertainty. UTIs can cause severe pain and may lead to serious infection, but communication about UTIs can help individuals manage this condition and avoid recurring UTIs. Grounded in uncertainty management theory (UMT), this study explored how individuals with female anatomy manage uncertainty surrounding UTIs. Iterative analysis was employed using UMT to analyze 21 qualitative interviews. Participants used uncertainty management strategies of talking to health care providers, eliciting social support, and using the internet to gather information. Results indicated that talking to heath care providers was a dominant strategy intended to reduce uncertainty about the diagnosis and treatment of their symptoms. However, these interactions inadvertently increased uncertainty as well, as providers did not provide information about the causes and prevention of UTIs. Some participants also engaged in deception to reduce uncertainty about how their providers would respond to their pain and their illness. Finally, participants employed metaphors to interpret and neutralize uncertainty related to their experiences. Implications for these findings include guidelines and support for patient and provider communication, communication in social networks, as well as deeper nuances and development for UMT.
Preservice Teachers as Policy Actors: Developing Policy Consciousness in a Student-Led Arts Partnership Program
Authors: Bylica Kelly
Published: February 2023

The purpose of this study was to consider how the experiences of nine preservice music educators who participated in the development of Project B impacted their understandings of and participation in policy. Project B is an after-school program that seeks to provide music education classes for children at several metropolitan elementary schools as part of an arts partnership program. Drawing from the four dispositions of policy consciousness, I considered how preservice educators grappled with their complex roles as policy actors within this setting. In particular, I focused on the dispositions cultivated by these preservice teachers as they developed this program, as well as the ways in which participating in the creation of this program impacted how they engaged as policy actors and leaders as inservice music educators. Participants’ experiences offer implications related to the importance of participating in contextualized policy-oriented experiences for preservice music educators.
What Parents Think Versus What Parents Do: Examining Parental Accommodation Beliefs and Behaviors in Relation to Youth Anxiety in the Presence of Externalizing Concerns
Authors: McGuire Austen , Kriegshauser Katie , Blossom Jennifer B.
Published: February 2023

Anxiety and externalizing concerns create notable challenges for families. One factor that has been widely studied in relation to anxiety concerns, which may also be influenced by externalizing symptoms, is parental accommodation. Most research on parental accommodation has tended to focus on behaviors, while not accounting for accommodation beliefs. The current study sought to examine the relation between both parental accommodation beliefs and behaviors and also determine to what extent externalizing symptoms may influence this relation in youth. Treatment-seeking youth ( N = 260; Mage = 13.48, range: 8–17) and their caregivers in the U.S. Midwest completed measures on anxiety symptoms, externalizing symptoms, and parental accommodation. Results indicated that parental accommodation behaviors had a direct influence on anxiety-related family impairment and avoidance but not anxiety symptom severity. There were no direct associations for parental accommodation beliefs. Externalizing symptoms moderated the relation between accommodation behaviors and family impairment, suggesting that the influence of parental accommodation on reported family impairment is attenuated at greater levels of externalizing symptoms. These findings highlight the importance of considering externalizing symptoms when examining the relation between parental accommodation and anxiety presentations, as well as further researching how accommodation-specific beliefs may influence accommodation behaviors and anxiety in youth.
Palliative Medicine Referral and End-of-Life Interventions Among Racial and Ethnic Minority Patients With Advanced or Recurrent Gynecologic Cancer
Authors: Tabuyo-Martin Angel , Torres-Morales Angelica , Pitteloud Marie J. , Kshetry Alisha , Oltmann Carina , Pearson Joseph Matthew , Khawand Mariana , Schlumbrecht Matthew P. , Sanchez Julia C.
Published: February 2023

Background

Referral to palliative medicine (PM) has been shown to improve quality of life, reduce hospitalizations, and improve survival. Limited data exist about PM utilization among racial minorities with gynecologic malignancies. Our objective was to assess differences in palliative medicine referrals and end of life interventions (within the last 30 days of life) by race and ethnicity in a diverse population of gynecologic oncology patients.

Methods

A retrospective cohort study of patients receiving gynecologic oncologic care at a tertiary referral center between 2017 – 2019 was conducted. Patients had either metastatic disease at the time of diagnosis or recurrence. Demographic and clinical data were abstracted. Exploratory analyses were done using chi-square and rank sum tests. Tests were two-sided with significance set at P < .05.

Results

A total of 186 patients were included. Of those, 82 (44.1%) were referred to palliative medicine. Underrepresented minorities accounted for 47.3% of patients. English was identified as the primary language for 69.9% of the patients and Spanish in 24.2%. Over 90% of patients had insurance coverage. Ovarian cancer (37.6%) and uterine cancer (32.8%) were the most common sites of origin. Most patients (75%) had advanced stage at the time of diagnosis. Race and language spoken were not associated with referral to PM. Black patients were more likely to have been prescribed appetite stimulants compared to White patients (41% vs 24%, P = .038). Black patients also had a higher number of emergency department visits compared to White patients during the study timeframe. Chemotherapy in the last 30 days of life was also more likely to be given to Black patients compared to White ( P = .019).

Conclusions

Race was associated with variation in interventions and healthcare utilization near end-of-life. Understanding the etiologies of these differences is crucial to inform interventions for care optimization as it relates specifically to the health of minority patients.
Pharmacokinetics and Dosing Regimens of Direct Oral Anticoagulants in Morbidly Obese Patients: An Updated Literature Review
Authors: Zhao Ying , Guo Mingxing , Li Dandan , Xu Wanyi , Pan Chen , He Chaoran , Cui Xiangli
Published: February 2023

Data on the impact of morbid obesity (body mass index [BMI] ≥ 40 kg/m2) on the pharmacokinetics (PK), pharmacodynamics (PD) of direct oral anticoagulants (DOACs) are relatively limited, making it difficult to design optimal dosing regimens in morbidly obese patients.

To review literature on PK/PD profile, efficacy, and safety of DOACs in venous thromboembolism (VTE) and nonvalvular atrial fibrillation (AF) patients with morbid obesity and make recommendations regarding optimal dosing regimens in these patient populations.

A detailed literature search was conducted (from inception to June 22, 2022) for relevant articles involving PK/PD and clinical data on DOACs use in morbidly obese patients with VTE or AF, or healthy volunteers.

A total of 28 studies were identified. DOAC-specific PK variations and clinical outcomes have been observed. Obesity may have a modest effect on PK/PD of dabigatran, apixaban, or rivaroxaban. Dabigatran was effective in AF patients with morbid obesity but might increase the risk of gastrointestinal bleeding. Standard dosing of apixaban or rivaroxaban is effective and safe for VTE and AF patients with morbid obesity. Trough edoxaban concentration and anti-Xa activity were similar in different BMI groups (18.5 to >40 kg/m2), and standard dosing of edoxaban may be effective and safe for AF patients.

Current evidence suggests dabigatran should be used with caution in patients with AF as it might increase the risk of gastrointestinal bleeding; Standard dosing of apixaban or rivaroxaban can be used in VTE or AF patients; Standard dosing of edoxaban may be considered in AF patients.
Ribociclib-induced hepatotoxicity
Authors: Er Muhammed Muhiddin , Araz Murat , Hendem Engin , Eryılmaz Melek Karakurt , Artaç Mehmet
Published: February 2023

Introduction

Cyclin-dependent kinase (CDK) 4/6 inhibitors have shown a different adverse effect. In this case, persistent grade 3 hepatoxicity was observed after ribociclib. Therefore, ribociclib therapy was stopped, and then palbociclib was introduced. Transaminase levels returned to normal by switching to palbociclib therapy.

Case report

71-year-old postmenopausal female patient with luminal subtypes of metastatic breast cancer treated with ribociclib.

Management & outcome

Grade 3 hepatotoxicity secondary to ribociclib developed. She was successfully treated with palbociclib 125 mg.

Discussion

In our case, palbociclib was started with a full dose, to increase treatment success. Starting with a 125 mg dose was not cause any toxicity. Nevertheless, laboratory follow-up is required in terms of neutropenia and increased transaminases.
An Overview of Gene Editing Modalities and Related Non-clinical Testing Considerations
Authors: Vats Srishti , Ballesteros Cristina , Hung Selly , Sparapani Samantha , Wong Karen , Haruna Julius , Li Christian , Authier Simon
Published: February 2023

Gene therapy has become an important modality for a wide range of therapeutic indications with a rapid increase in the number of therapeutic candidates being developed in this field. Understanding the molecular biology underlying the gene therapy is often critical to develop appropriate safety assessment strategies. We aimed to discuss some of the commonly used gene therapy modalities and common preclinical toxicology testing considerations when developing gene therapies. Non-viral gene delivery methods such as electroporation, microinjection, peptide nanoparticles and lipid nanoparticles are deployed as innovative molecular molecular construct which are included in the design of novel gene therapies and the associated molecular biology mechanisms have become relevant knowledge to non-clinical toxicology. Viral gene delivery methodologies including Adenovirus vectors, Adeno-Associated virus vectors and Lentivirus gene therapy vectors have also advanced considerably across numerous therapeutic areas, raising unique non-clinical toxicology and immunological considerations. General toxicology, biodistribution and tumorigenicity are the pillars of non-clinical safety testing in gene therapies. Evaluating the tumorigenicity potential of a gene editing therapy often leverages molecular pathology while some translational challenges remain. Toxicology study design is entering a new era where science-driven customized approaches and program specific considerations have become the norm.
Anterior versus posterior retractor reinsertion with a lateral tarsal strip for involutional entropion repair: A multicentric experience
Authors: Mateos-Olivares Milagros , Belani-Raju Minal , Sánchez-Tocino Hortensia , Ye-Zhu Cristina , Sales-Sanz Marco , Bragante André , Fernandes de Sousa Meneghim Roberta Lilian , Schellini Silvana A. , Galindo Ferreiro Alicia
Published: February 2023

Purpose

The aim was the comparison of two different approaches to re-insert the inferior eyelid retractors within addition to lateral tarsal strip at lower eyelid involutional entropion (LEIE) surgical correction.

Method

This multicentric retrospective case series involved 233 consecutive patients (195 eyelids) who underwent LEIE repair. All the lids had a lateral tarsal strip (LTS) in addition to the reinsertion of retractors onto the tarsal plate via the anterior approach (group 1) or the posterior approach (group 2). The desired normal position of the eyelids at 6-month follow-up was considered ‘surgical successes, while entropion recurrence and overcorrection (ectropion) were considered ‘surgical failures’.

Results

One-hundred ninety-one (82%) surgeries were included in group 1 and 42 (18%) in group 2. The success rate was 92.1% (176 lids) in group 1 and 85.7% (36 lids) in group 2 (p = 0.188). The recurrence rate was statistically higher for group 2 (14.3%) than for group 1 (3.7%) (p = 0.016). Overcorrection only described in group 1 (3.1%). Both groups had a similar complication rate (p = 0.268), with trichiasis being the most frequent (14, 6%). Ten eyelids (47.6%) from the 21 overall failures were satisfactorily reoperated, and the remaining ones were treated conservatively.

Conclusion

The anterior or posterior approach to reinsert lower eyelid retractors to tarsal plate in addition to LTS to correct LEIE can provide a similar outcome. However, the anterior approach achieves a slightly higher success rate with fewer recurrences but with a higher overcorrection rate.
A Literature Review: ECG-Based Models for Arrhythmia Diagnosis Using Artificial Intelligence Techniques
Authors: Boulif Abir , Ananou Bouchra , Ouladsine Mustapha , Delliaux Stéphane
Published: February 2023

In the health care and medical domain, it has been proven challenging to diagnose correctly many diseases with complicated and interferential symptoms, including arrhythmia. However, with the evolution of artificial intelligence (AI) techniques, the diagnosis and prognosis of arrhythmia became easier for the physicians and practitioners using only an electrocardiogram (ECG) examination. This review presents a synthesis of the studies conducted in the last 12 years to predict arrhythmia’s occurrence by classifying automatically different heartbeat rhythms. From a variety of research academic databases, 40 studies were selected to analyze, among which 29 of them applied deep learning methods (72.5%), 9 of them addressed the problem with machine learning methods (22.5%), and 2 of them combined both deep learning and machine learning to predict arrhythmia (5%). Indeed, the use of AI for arrhythmia diagnosis is emerging in literature, although there are some challenging issues, such as the explicability of the Deep Learning methods and the computational resources needed to achieve high performance. However, with the continuous development of cloud platforms and quantum calculation for AI, we can achieve a breakthrough in arrhythmia diagnosis.
Designing cranial fixture shapes and topologies for optimizing PEEK implant thickness in cranioplasty
Authors: Jindal Prashant , Bharadwaja Shreerama Shiva Sai , Rattra Shubham , Chaitanya  , Gupta Vipin , Breedon Philip , Reinwald Yvonne , Juneja Mamta
Published: February 2023

Cranial defects are often caused by trauma, diseases or malignancy. To repair such defects, skull reconstruction or cranial implants are required for protecting intracranial structures and normalizing cerebral hemodynamics. To relieve Intracranial Pressure (ICP) surgeons restore cranial defects using the preserved bone of a patient. In case of non-availability of natural bone cranial implants are fabricated using biocompatible materials including Titanium Alloys (Ti-6Al-4V) and polyether-ether-ketone (PEEK). Patient-specific implants (PSI) manufactured using 3D printing, 3D imaging technologies and 3D modeling software, are preferred over conventional manufacturing methods. During cranial fixation bone fragments, grafts and bone flaps are fixed to the cranium to offer stable closure in surgery. Effective attachment of an implant to a defective skull is influenced by the joints and fixture arrangements at the interface. These fixtures can have various designs, materials and joining procedures. PEEK behaves similarly to bone during deformation, which means it is receptive to titanium fixations and supports soft tissue adhesion due to its inert nature. This study considers PEEK as an implant material for reconstructing a bone-defected skull with Ti-6Al-4V fixtures attached at the skull-implant interface. This work compares Ti-6Al-4V fixture shapes (Linear, Square and Burrhole) with different orientation angles and topologies (‘+’ and ‘X’) attached to PEEK cranial implants of variable thicknesses (1–7 mm). Using Finite Element Method (FEM)/Finite Element Analysis (FEA), von Mises stress analysis was analyzed to identify the implant thicknesses that would bear an external load of 1780 N and ICP of 15 mmHg without failure. With a yielding limit of 100 MPa for PEEK, all proposed design arrangements for the fixture plates in the skull-implant assembly were well within these limits exhibiting a maximum von Mises stress of 51.985 MPa for the least implant thickness of 1 mm and weight 12.90 g. Considering all the designs, a Linear Fixture shape with 45° angular orientations placed in ‘X’ topology exhibited least stress of 18.477 MPa and was therefore proposed as the most optimized design for the skull-implant fixture assembly. Selection of an optimized design arrangement is also dependent upon other clinical factors, such as number of screws used, the Additive Manufacturing (AM) technique for fabricating/cutting of precise slots within the implant. The skull and flexibility of the fixture plates are also considered in relation to the required operating theatre time and skills of the surgical team.
An honest man?: Rousseau's critique of Locke's character education
Authors: T Tennyson Timothy , Schwarze Michelle
Published: February 2023

John Locke's educational program has long been considered to have two primary aims: to habituate children to reason and to raise children capable of meeting the demands of citizenship that he details in his Two Treatises of Government. Yet Locke's educational prescriptions undermine citizens’ capacity for honesty, a critical political virtue for Locke. To explain how Locke's educational prescriptions are self-undermining, we turn to Rousseau's extended critique of Locke's Some Thoughts on Education in his Émile. We argue that Rousseau explains why such an education allows a natural desire to dominate to flourish, rendering children who receive it dishonest and incapable of self-government. Rousseau's critique exposes how a liberal education focused solely on autonomy cannot produce the kinds of citizens a Lockean politics requires.
Microsurgical resection of a ruptured right peri-ventricular brain arteriovenous malformation with preoperative embolization
Authors: Khattar Nicolas K , Meyer Kimberly S , Ding Dale , Abecassis Isaac Josh
Published: February 2023

A 41-year-old female presented with a headache and left inferior quadrantanopia. Imaging demonstrated a clot spanning the atrium of the ventricle to the superior parietal lobule (SPL), with a small arteriovenous malformation (AVM) nidus outside the atrium of the ventricle. The nidus was supplied by parieto-occipital arterial (P4) feeders with a single atrial draining vein. Pre-operative embolization of a pedicle with Onyx provided a surgical marker. A parietal craniotomy was performed with a trans-cortical SPL approach. During AVM resection, the draining vein was injured, which was stabilized using a temporary clip to “spot weld” the defect and continue nidus dissection with patent venous outflow. After careful dissection, coagulation, and division of all the arterial feeders, the AVM was mobilized and the draining vein was clipped, coagulated, and divided. Follow-up indocyanine green angiography and cerebral angiography both confirmed complete resection of the AVM. The patient consented to the procedure and to publication.
Does negation influence the choice of sentence continuations? Evidence from a four-choice cloze task
Authors: Albu Elena , Dudschig Carolin , Warren Tessa , Kaup Barbara
Published: February 2023

Event plausibility facilitates the processing of affirmative sentences, but little is known about how it affects negative sentences. In six behavioural experiments, we investigated negation’s impact on the choice of sentence continuations that differ with respect to event plausibility. In a four-choice cloze task, participants saw affirmative and negative sentence fragments ( The child will [not] eat the . . .) in combination with four potential continuations: yoghurt (a plausible word), shellfish (a weak world knowledge violating word), branch (a severe world knowledge violating word), and minivan (a word resulting in a semantic violation). Across all experiments the plausible word was highly preferred in both affirmative and negative sentences. Experiment 2 replicated Experiment 1 while ruling out the possibility that the lack of effect of negation in Experiment 1 stemmed from participants not fully processing the negation. Experiment 3 showed that the observed plausibility effects can be generalised to other aspectual forms ( The child has [not] eaten the yoghurt). Experiment 4 ruled out the possibility that the choices were mainly driven by lexical associations and additionally suggested a role for informativity. Experiment 5 replicated Experiment 4 and reinforced the general pattern according to which negative sentences express the denial of plausible positive events. Experiment 6 provided evidence that informativity might be driving patterns of choices in the negative sentences. All in all, these findings suggest that upcoming continuations are chosen to maximise the plausibility of the event in the affirmative sentences and to deny that event in the negative sentences. The observed plausibility effects do not seem to be modulated by the internal representation of events, but they can be modulated by changes to the expected informativity of the sentence.
The player makes the coach: Exploring player development among Division I basketball coaches
Authors: Croft Chris , Paulson Courtney , Stokowski Sarah , Berri David , Mondello Michael
Published: February 2023

Head Men's Basketball coaches at the collegiate level are often portrayed as teachers with the ability to dramatically elevate the productivity of their players. However, there is also the perception that perhaps head coaches are only as talented as the players on their team. Thus, a debate has ensued, do Men's Basketball coaches develop the players on their team, or is it in fact the talent of the players themselves that make a coach successful? Over the course of 17 seasons, and through the use of absorbed regression, over 80 coaches, as well as 28,581 player observations at the Division I level, were included in the data set. Results indicated that there were no substantial effects that most coaches significantly alter the productivity of the players. Some evidence was shown that there are some coaches who alter the productivity of the players. Thus, recruiting is essential to a team's success, and coaches should (re)consider how to develop their athletes throughout their tenure.
Beyond moralising, disciplining and normalising discourses: Re-thinking geographies of alcohol, drinking, drunkenness
Authors: Jayne Mark , Valentine Gill
Published: February 2023

Despite significant advances over the past few decades, geographies of alcohol, drinking, drunkenness remain under-theorised and researched. Indeed, even when applying critical thinking, geographers have tended to unreflexively reproduce, rather than question ‘alcohol studies’ ontologies and epistemologies infused with moralising, disciplining, and normalising discourses. In response, we present three intertwined research trajectories, informed by broader human geography debates, which offer opportunities to engage with alcohol, drinking, drunkenness more carefully and critically through; relational, flat, and decolonising ontologies; de-determination and intensities of (non)human relations; and ethical and political imperatives of research that ask questions of ‘worth’ and ‘reason’. Specifically, this involves, firstly, reinvigorating theoretical challenges to dominant and long-entrenched political, policy, popular, and academic debates; secondly, pursuing focused empirical accounts of heterogeneous and complex knowledges, practices, materialities, emotions, embodiment, affective experiences, and performances; and thirdly, paying attention to topographies, qualities, forms, and intensities of relational time/spaces beyond alcohol consumption per se. Our conclusion reflects on the challenges and opportunities of re-thinking geographies of alcohol, drinking, drunkenness within and beyond the discipline.
Sociodemographic Aspects and Healthy Behaviors Associated With Perceived Life Satisfaction in Health Professionals
Authors: Durand-Sanchez Esther , Ruiz-Alvarado Carlos , Contreras-Valderrama Ricardo , Morales-García Wilter C. , Mamani-Benito Oscar , Huancahuire-Vega Salomón , Saintila Jacksaint , Morales-García Mardel , Ruiz Mamani Percy G.
Published: February 2023

Background:

Life satisfaction is a determining factor for the improvement of mental and physical health. Health care workers are a vulnerable population to suffer alterations in the factors that affect life satisfaction. Determining the influence of these factors on quality of life is important for their proper management.

Objective:

To examine sociodemographic factors and healthy behaviors influencing life satisfaction in Peruvian professionals.

Methods:

A cross-sectional study was conducted with 506 health care workers, who had a mean age of 40.34 years (SD = 10.39). A sociodemographic questionnaire, sleep quality, physical activity, eating habits, and life satisfaction were used. A regression model was fitted with the life satisfaction variable as the dependent variable.

Results:

In multivariable analysis, age (β = −.938, P < .01) and perception of poor health status (β = −4.743, P < .001) were found to be associated with lower life satisfaction. On the other hand, higher university education level (β = 1.667, P < .001), absence of smoking (β = 3.202, P < .01), absence of depressive symptoms (β = 3.390, P < .001), interest in daily activities (β = 3.503, P < .05), good sleep quality (β = 1.027, P < .01), a high frequency of physical activity (β = 1.056, P < .01), and healthy eating are variables associated with higher life satisfaction.

Conclusion:

Sociodemographic aspects such as age and the perception of poor health are associated with lower life satisfaction. On the other hand, healthy behaviors such as absence of smoking, absence of depressive symptoms, interest in daily activities, good quality of sleep, high frequency of physical activity, and a healthy diet were associated with higher life satisfaction.
The Neglected Role of Concentration at the Extremes in Tests of the Racial Invariance Thesis
Authors: McNulty Thomas L. , Bellair Paul E. , Lei ManKit (Karlo)
Published: February 2023

Research seeking to test racial invariance in neighborhood violence emphasizes concentrated disadvantage despite the problem of “restricted distributions.” We investigate whether spatial polarization of disadvantage and affluence accounts for racial differences when there are few extremely poor, white neighborhoods for comparison. Drawing on data for Atlanta, GA neighborhoods (N = 314), the analysis evaluates the racial invariance thesis by assessing (1) whether racial/ethnic differences in neighborhood violence are better explained by the index of concentration at the extremes (ICE) than alternative socioeconomic measures, and (2) whether it exerts expected effects on violent crime in white, black, and mixed-race neighborhoods. Findings reveal that heightened violence in black and mixed-race neighborhoods (relative to white) is fully explained by the ICE index, but not by concentrated disadvantage or within-neighborhood inequality (GINI). Theoretically expected effects of the ICE index on violent crime across white, black, and mixed-race neighborhoods are also evident.
Opioid Sparing by ERAS Protocol in Cleft Lip and Palate Craniofacial Surgery
Authors: Thawanyarat Kometh , Waitt Taylor , Navarro Yelissa , Collar John , Doroodchi Atbin , Yu Jack
Published: February 2023

Background:

Enhanced Recovery After Surgery (ERAS) protocols have been shown to improve both clinical outcomes and cost savings in various perioperative settings. Our study focuses on the effects of ERAS protocol in craniomaxillofacial surgery in a single institution within 2 years leading up to and following implementation. The purpose of this research is to quantify the changes in effective pain management in pediatric patients undergoing craniomaxillofacial procedures before and after our ERAS protocol, which did not include IV acetaminophen. We hypothesize that ERAS protocol, even without IV acetaminophen, will provide effective pain management while decreasing the opioid use4 in the perioperative and postoperative period without associated complications from NSAID therapy.

Methods:

A retrospective chart review was conducted on 137 pediatric patients that underwent craniofacial surgery between July 1, 2014, and June 30, 2020. Patients were divided into 2 cohorts: Pre-ERAS and Post-ERAS with the implementation of ERAS on July 1, 2017.

Results:

Post-ERAS cohort showed increased NSAID use in the preoperative and postoperative period for both IV and PO ( P = .006 and P = .0064). Morphine use showed no immediate changes until a year after implementation with a statistically significant reduction ( P = .0051). When stratified by procedure type, IV NSAID (Ketorolac) use increased in Palatoplasty procedures ( P = .0154) while PO NSAID (Ibuprofen) use increased in Cleft Lip Repair ( P = .0224).

Conclusion:

ERAS protocol implementation can provide benefit for pediatric patients undergoing craniomaxillofacial surgery by decreasing opioid use, even in the absence of IV acetaminophen. Outcomes may potentially be delayed in the immediate post-implementation period. This study can add to the expanding literature for the use of ERAS protocol in craniomaxillofacial surgical settings. Further studies can include analyzing potential barriers to implementation and future complications related to ERAS long term outcomes.
Serum pro-B-type natriuretic peptide levels and cardiac index as adjunctive tools of blunt cardiac injury
Authors: Bae Chae-Min , Cho Joon Yong , Jung Hanna , Son Shin-Ah
Published: February 2023

Background

Blunt cardiac injury (BCI) has a variety of symptoms that may be a potentially life-threatening injury that can lead to death. Depending on the diagnosis of BCI, treatment direction and length of stay may vary. In addition, the utility of other diagnostic tests for cardiac disease as diagnostic tools for BCI remain unclear. The purpose of this study was to investigate the competence of N-terminal pro-B-type natriuretic peptide (NT pro-BNP) and cardiac index (C.I) as adjunctive diagnostic tools for BCI.

Methods

From January 2018 to March 2020, severe trauma patients with sternum fracture who were admitted to the traumatic intensive care unit (TICU) were included this study. Patients with sternum fracture, 18 years of age or older, and with an injury severity score > 16 who required intensive care were included. Invasive measurement for the analysis of the pulse contour for C.I monitoring and intravenous blood sampling for NT pro-BNP measurement were performed. Sampling and 12-lead electrocardiogram were performed at different time points as follows: immediately after TICU admission and at 24 h and 48 h after trauma.

Results

Among 103; 33 patients with factors that could affect NT pro-BNP were excluded; therefore, 63 patients were included in this study. According to the American Association for the Surgery of Trauma Cardiac Injury Scale, 33 patients were diagnosed with non-BCI, and 30 patients constituted with BCI. The median ages of the patients were 58 (52–69), and 60 (45–69) years in the non-BCI and BCI groups, respectively (p = 0.77). The median NT pro-BNP values were higher in the BCI group on admission, hospital day (HD) 2, and HD 3, however, no statistical difference was observed (125 (49–245) vs. 130 (47–428) pg/mL, p = 0.08, 124 (68–224) vs. 187 (55–519) pg/mL, p = 0.09, and 121(59–225) vs. 133 (56–600) pg/mL, p = 0.17, respectively). On the contrary, significantly lower values were observed in the median C.I measurement on admission and HD 3 in the BCI group (3.2 (2.8–3.5) vs. 2.6 (2.3–3.5) L/min/m2, p < 0.01 and 3.2 (3.1–3.9) vs. 2.9 (2.4–3.2) L/min/m2, p < 0.01, respectively); however, no significant difference was observed on HD 2 (3.4 (3.0–3.7) vs. 2.6 (2.4–3.4) L/min/m2, p = 0.17), Furthermore, The median lactate levels in the BCI group upon admission, HD 2, and HD 3 were significantly higher than those in the non-BCI group (1.8 (1.1–2.6) vs. 3.1 (2.1–4.4) mmol/L, p < 0.01; 1.3 (0.8–2.3) vs. 3.0 (2.2–4.7) mmol/L, p < 0.01; and 1.5 (0.9–1.5) vs. 2.2 (1.3–3.7) mmol/L, p < 0.01, respectively).

Conclusion

Consecutive values of NT pro-BNP and C.I show no correlation with ECG-based BCI diagnosis. However, lactate level measurement may help in the early recognition of BCI as an adjunctive tool. It should be noted that this is a hypothesis-generating study for BCI diagnosis. Further studies should be conducted in larger populations with a prospective approach.
Associations of financial toxicity with symptoms and unplanned healthcare utilization among cancer patients taking oral chemotherapy at home: a prospective observational study
Authors: Chen Yongfeng , Chen Zhenxiang , Jin Haiyun , Chen Yanrong , Bai Jinbing , Fu Guifen
Published: February 2023

Background

Cancer patients with financial toxicity experience psychological distress and often miss medical appointments and quit treatments early, which could be a barrier to the effective management of oral chemotherapy drugs at home. This study explores whether financial toxicity predicts symptoms and unplanned healthcare utilization among cancer patients taking oral chemotherapy at home, which will contribute to the safe management of oral chemotherapy.

Methods

Data in this study was from a prospective observational study, which was conducted between October 2018 and December 2019. 151 patients completed the Comprehensive Score for Financial Toxicity at discharge and completed the MD Anderson Symptom Inventory and unplanned healthcare utilization questionnaires after finishing one cycle of oral chemotherapy at home. Regression analyses were conducted to explore the associations of financial toxicity with symptoms and unplanned healthcare utilization.

Results

Among 151participants, 88.08% reported severe or moderate financial toxicity, 43.05% reported symptom interference, and 31.79% reported unplanned healthcare utilization while taking oral chemotherapy at home. Patients between the age of 45-60y (p = 0.042) have higher financial toxicity, while those living in urban areas (p = 0.016) have lower financial toxicity. Patients with worse financial toxicity suffered increased symptoms of fatigue, emotional distress, disturbed sleep, and lack of appetite. Consequently, their mood and personal relation with other significant suffered. However, no statistical differences in unplanned healthcare utilization were found among patients with different levels of financial toxicity.

Conclusion

Middle-aged adults and those living in suburban or rural areas experienced worse financial toxicity than other groups. Patients with worse financial toxicity experienced more severe psychological symptoms (e.g., fatigue, distress, disturbed sleep, and lack of appetite) and affective interference (e.g., mood and relations with others). Identifying at-risk patients is necessary to offer tailored support for psychological symptom management.
Acute promyelocytic leukaemia: population-based study of epidemiology and outcome with ATRA and oral-ATO from 1991 to 2021
Authors: Gill Harinder , Raghupathy Radha , Lee Carmen Y.Y. , Yung Yammy , Chu Hiu-Tung , Ni Michael Y. , Xiao Xiao , Flores Francis P. , Yim Rita , Lee Paul , Chin Lynn , Li Vivian W.K. , Au Lester , Au Wing-Yan , Ma Edmond S.K. , Mohan Diwakar , Kumana Cyrus Rustam , Kwong Yok-Lam
Published: February 2023

Background

The epidemiology and treatment of acute promyelocytic leukaemia (APL) are changing. We have incorporated oral arsenic trioxide (oral-ATO) into induction/maintenance.

Methods

Newly-diagnosed APL from 1991 to 2021 divided into three 10-year periods were studied to define its epidemiology and how oral-ATO impacted on its outcome. Primary endpoints included APL incidence, early deaths (ED, first 30 days), and overall survival (OS). Secondary endpoints included post-30-day OS, relapse-free survival (RFS), and incidence of second cancers.

Results

APL occurred in 374 males and 387 females at a median age of 44 (1–97) years. Annual incidences increased progressively, averaging 0.32 per 100,000 people. All-trans retinoic acid (ATRA)-based and oral-ATO-based regimens were used in 469 and 282 patients. There were 144 EDs, occurring almost exclusively in ATRA-based inductions (N = 139), being more with males, age > 50 years, leucocyte > 10 × 109/L, diagnosis during 1991–2009 and fewer with oral-ATO-based regimens. After a median of 75 (interquartile range: 14–161) months, 5-year and 10-year OS were 68.1% and 63.3%, inferior with males, age > 50 years, leucocyte > 10 × 109/L, high-risk Sanz score and superior with oral-ATO-based regimens. Factoring out EDs, 5-year and 10-year post-30-day OS were 84.0% and 78.1%, inferior with males and superior with oral-ATO-based regimens. In 607 CR1 patients, the 5-year RFS was 83.8%, superior with diagnosis in 2010–2021 and oral-ATO-based regimens. Second cancers developed in 21 patients, unrelated to oral-ATO-based regimens.

Conclusions

There was an increasing incidence of APL, and all survivals were superior with the use of oral-ATO-based regimens. This study formed part of the Acute Promyelocytic Leukaemia Asian Consortium Project (ClinicalTrials.gov identifier: NCT04251754).
A peer group intervention implemented by community volunteers increased HIV prevention knowledge
Authors: Kumbani Lily C. , Jere Diana L. , Banda Chimwemwe K. , Chang Cecilia , Liu Li , McCreary Linda L. , Patil Crystal L. , Norr Kathleen F.
Published: February 2023

Background

HIV prevention knowledge levels are low in sub-Saharan Africa. In our efficacy study, the Mzake ndi Mzake (Friend-to-Friend; hereafter Mzake) 6-session peer group intervention, delivered by health workers, improved HIV prevention knowledge and other outcomes in Malawi. To expand HIV prevention approaches, this implementation study tested whether the intervention remained effective when implemented by trained community volunteers. HIV prevention knowledge findings are presented.

Methods

Using a stepped wedge design, three communities implemented the Mzake program sequentially in randomly assigned order. Repeated surveys assessed outcomes, and participants served as controls until they completed the program. At Time 2, Community 1 became the intervention group, and at Time 3, Communities 1 and 2 were the intervention group. HIV prevention knowledge, the primary outcome, was assessed through two indicators: UNAIDS comprehensive knowledge (UNAIDS Knowledge), defined as correctly answering five HIV prevention questions (Yes/No), and a 9-item HIV/PMTCT Knowledge Index (number correct). Multivariate generalized estimating equation logistic regression (UNAIDS Knowledge) and mixed-effects regression models (HIV/PMTCT Knowledge Index) were used to assess knowledge controlling for five sociodemographic factors.

Results

In bivariate analyses of UNAIDS Knowledge, more persons answered correctly in the intervention group than the control group at Time 2 (56.8% vs. 47.9%, p  < 0.01), but the difference was not significant at Time 3. In logistic regression, there was a significant linear increase in the proportion who correctly answered all questions in the control group, but the increase was significantly higher in the intervention group (log-odds estimate = 0.17, SE = 0.06, p-value < 0.01). The HIV/PMTCT Knowledge Index scores increased over time for both groups, but in the intervention group the increase was significantly higher than the control group (0.11 at Time 2; 0.21 at Time 3). In youth and adult subsamples analyses, the intervention was highly effective in increasing knowledge for youth, but not for adults.

Conclusion

This implementation study showed that Mzake was effective in increasing HIV prevention knowledge when delivered by community members. Community approaches offer an important strategy to increase HIV prevention in rural communities without burdening healthcare systems.

Trial registration

ClinicalTrials.gov NCT02765659. Registered 06/05/2016
The application of a novel hydrodynamic cavitation device to debride intra-articular monosodium urate crystals
Authors: Xu Hanlin , Li Shengkun , Cao Ling , Zhu Xiaoxia , Xue Yu , Huang Yu , Hua Yinghui
Published: February 2023

Introduction

Efficient and complete debridement of intra-articular deposits of monosodium urate crystals is rarely achieved by existing arthroscopic tools such as shavers or radiofrequency ablation, while cavitation technology represents a prospective solution for the non-invasive clearance of adhesions at intra-articular interfaces.

Methods

Simulation modeling was conducted to identify the optimal parameters for the device, including nozzle diameters and jet pressures. Gouty arthritis model was established in twelve rats that were equally and randomly allocated into a cavitation debridement group or a curette debridement group. A direct injection nozzle was designed and then applied on animal model to verify the effect of the cavitation jet device on the removal of crystal deposits. Image analysis was performed to evaluate the clearance efficiency of the cavitation device and the pathological features of surrounding tissue were collected in all groups.

Results

To maximize cavitation with the practical requirements of the operation, an experimental rig was applied, including a 1 mm direct injection nozzle with a jet pressure of 2.0 MPa at a distance of 20 mm and a nitrogen bottle as high-pressure gas source. With regards to feasibility of the device, the clearance rates in the cavitation group were over 97% and were significantly different from the control group. Pathological examination showed that the deposition of monosodium urate crystals was removed completely while preserving the normal structure of the collagen fibers.

Conclusions

We developed a promising surgical device to efficiently remove intra-articular deposits of monosodium urate crystals. The feasibility and safety profile of the device were also verified in a rat model. Our findings provide a non-invasive method for the intraoperative treatment of refractory gouty arthritis.
Incorporating end-users’ voices into the development of an implant for HIV prevention: a discrete choice experiment in South Africa and Zimbabwe
Authors: Browne Erica N. , Manenzhe Kgahlisho , Makoni Wanzirai , Nkomo Sikhanyisiwe , Mahaka Imelda , Ahmed Khatija , Shapley-Quinn Mary Kate , Marton Tozoe , Luecke Ellen , Johnson Leah , van der Straten Ariane , Minnis Alexandra M.
Published: February 2023

Background

Input from end-users during preclinical phases can support market fit for new HIV prevention technologies. With several long-acting pre-exposure prophylaxis (PrEP) implants in development, we aimed to understand young women’s preferences for PrEP implants to inform optimal design.

Methods

We developed a discrete choice experiment and surveyed 800 young women in Harare, Zimbabwe and Tshwane, South Africa between September–November 2020. Women aged 18–30 years who were nulliparous, postpartum, or exchanged sex for money, goods or shelter in prior year were eligible; quotas were set for each subgroup. The DCE asked participants to choose between two hypothetical implants for HIV prevention in a series of nine questions. Implants were described by: size, number of rods and insertion sites, duration (6-months, 1-year, 2-years), flexibility, and biodegradability. Random-parameters logit models estimated preference weights.

Results

Median age was 24 years (interquartile range 21–27). By design, 36% had used contraceptive implants. Duration of protection was most important feature, with strong preference for a 2-year over 6-month implant. In Zimbabwe, the number of rods/insertion sites was second most important and half as important as duration. Nonetheless, to achieve an implant lasting 2-years, 74% were estimated to accept two rods, one in each arm. In South Africa, preference was for longer, flexible implants that required removal, although each of these attributes were one-third as important as duration. On average, biodegradability and size did not influence Zimbabwean women’s choices. Contraceptive implant experience and parity did not influence relative importance of attributes.

Conclusions

While duration of protection was a prominent attribute shaping women’s choices for PrEP implants, other characteristics related to discreetness were relevant. Optimizing for longest dosing while also ensuring minimal detection of implant placement seemed most attractive to potential users.