bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of optimisation model for black soldier fly-based aquaculture feed supply chains in Malaysia
Authors: Ng C A , Chan C W , Andiappan V , Ng L Y , Ng D K S
Published: November 2021

Aquaculture is identified as one of the critical food supplies in Malaysia. Due to the increasing demand for aquaculture products, the demand for protein sources for fish feed is also increased accordingly. Black soldier fly larvae is identified as one of the main protein sources that can be used in fish feed. Such larvae can be grown using different types of organic materials, such as food waste, agriculture waste, etc. As Malaysia is the second-largest palm oil producer in the world, therefore, a large number of agricultural wastes, also known as palm-based biomass (e.g., empty fruit bunches, mesocarp fibre, decanter cake, etc.) are generated annually. Based on the current industry practise, palm-based biomass can be converted into value-added products. However, using palm-based biomass as feedback to grow black soldier fly larvae is a relatively recent discovery. Thus, a viable supply chain model has yet to be established. In this work, a mathematical optimisation model is developed via commercial optimisation software (Lingo v. 16) to synthesise an optimum black soldier fly-based aquaculture feed supply chain that utilised palm–based biomass as the feedstock. Based on the optimised result, the annual operating cost of the aquaculture feed supply chain is estimated as RM 5.2 million.
Functionalization of polylactic acid thin films via polydopamine-assisted chelation of copper (II) ions for antibacterial applications
Authors: Leron R B , Tayo L L , Aquino R R
Published: November 2021

Polylactic acid (PLA) is a biodegradable polymer, which has been widely investigated for use in biomedical and packaging applications due to its excellent biodegradability, biocompatibility, non-toxicity, low cost, good stability, and thermal processability. In this work, PLA was functionalized to improve the membrane’s hydrophilicity and impart antimicrobial activity by simultaneously depositing polydopamine (PDA) and chelating Cu2+ metal ions on the membrane surface. Pristine PLA films were modified via one-pot dip coating method using dopamine-copper (II) solution at different coating times (6, 12, 24 h). FTIR analysis confirmed the deposition of PDA on the modified membranes (PLA/PDA/Cu) as indicated by the presence of catechol and amine moieties on the samples. TGA results revealed the degradation of the same functional groups on PLA/PDA/Cu. The hydropilicity of PLA was significantly reduced upon coating with PDA as indicated by the decrease in the membrane’s contact angle from 96.5 ± 5.3° to 56.2 ± 4.7°. SEM images and EDS results clearly showed that copper particles were deposited on the PLA/PDA/Cu membranes (atomic % ~ up to 0.88) and coating with PDA did not alter the porous structure of the pristine PLA film. Results also demonstrated that the concentration of copper immobilized on the modified membranes increased with longer coating; thus, offering a way of tailoring the metal concentration on the membrane for its specific use. PLA/PDA/Cu membranes showed antibacterial property against the B. subtilis, which could be attributed to the chelation of Cu2+ ions with the catechol moiety of the PDA coating.
Effect of external heat source on temperature and moisture variation for composting of food waste
Authors: Rose J , Lai J C , Then Y L , Vithanawasam C K
Published: November 2021

This paper investigates the outcome of having an external heat source on temperature and moisture variations in the food waste composting process. Food waste accumulation is a growing concern in many countries. Converting food waste into usable compost is a more desirable tactic than dumping to crowded landfill sites. Closed composting was applied in this work, which relies on a controlled but uninterrupted airflow during the organic material degradation process. However, undesirable odour released at low aeration rate due to low temperature and high moisture content found in the compost. Finding the ideal aeration rate with the least possible loss of moisture is needed, which was discussed in this paper. The vegetable-fruit waste used in the experiment was given an aeration rate of 0.3 L/min at a moisture setting of 60% and 70%. For 15 mins/day, the forced aeration was carried out at 3-day intervals. Results showed that 0.3 L/min with 60% and 70% moisture content attained best temperature peaks of 32.4°C and 31.6°C, respectively at day 13 for 28 days composting. A strong odour continued to exist with the compost and was mitigated by using an external additional heat source (light bulb). The light bulb also helped to provide a higher temperature for the compost of 41.5°C by day 1 for 10 days composting.
Pure oxygen separation from air using dual-phase SDC-SCFZ disc membrane: A modelling approach
Authors: Chua J , Li C , Sunarso J
Published: November 2021

Novel Ce0.8Sm0.2O1.9-SrCo0.4Fe0.55Zr0.05O3-δ (SDC-SCFZ) disc membranes consist of 25 wt.% SDC fluorite ionic conducting phase and 75 wt.% SCFZ perovskite mixed conducting phase, which is more promising than perovskite oxide SCFZ single-phase membrane in terms of the oxygen permeation flux. This work features a modelling approach to simulate the oxygen permeation fluxes of the SDC-SCFZ membrane. Simplified model equations from the Zhu model and Xu-Thomson model based on the limiting cases of surface exchange reactions and bulk diffusion are compared. The Zhu model is found to be more applicable for the membranes with overall good correlation and low sum of squared error. Furthermore, modelling studies revealed that the oxygen transport is limited by surface exchange reactions from 700 to 850 °C and a mixture of both limiting cases above 850 up to 950 °C. It is concluded that the membranes exhibit high oxygen permeation flux of up to 2×10−6
mol s−1 cm−2
at 950 °C with Pair
of 5 atm and Po
2 of 0.005 atm. The optimum range of operating conditions of the membrane are found to be at 950 °C with minimum Pair
of 1 atm and P11
2
lower than 0.025 atm.
Engineering solutions for the palm mill of the future: Increasing extraction rate and sustainability through biotechnology
Authors: Silvamany Hemavathi , Mat Hassan Nik Suhaimi , Mat Yasin Nik Mohd Farid , Abdul Hamid Amirul Al Hafiz , Khairi Muhammad Izhar , Arnan Muhammad Zaidy , Mohammed Yunus Mohammed Faisal , Kulaveerasingam Harikrishna , Dunning Christopher J. R. , Nagalingam Karthini , Chew Chien Lye
Published: November 2021

The edible oil industry involving extraction and processing of oils and fats from vegetable sources has witnessed a tremendous growth over the decade accounting for rapid expansion of urbanization and industrialization. Consequently, concerted efforts have been undertaken to increase the palm oil extraction rate (OER) at processing mills. This paper explores the commercial application of enzymatic treatment of sterilised palm fruitlets and diluted crude oil (DCO) stream in a 60 t/hr oil palm mill. Incubation of sterilised palm fruitlets mixed with enzymes in a pre-digester vessel at 70 °C and retention time of 30 minutes resulted in an increment of 1.15 % OER. Parallelly, dosing of enzyme into DCO with simpler system yielded in OER increment up to 1.19 %. This study offers insight into the potential oil left in pressed fibre using different methods, such as prolonged Soxhlet extraction, ultrasonic treatment, and supercritical fluid extraction. Additionally, confocal microscopy images of treated samples showed disintegration and thinning of cell walls resulting in higher free oil droplets.
Optimization of the medication-use process for fentanyl patches at a small community hospital
Authors: Roberts Patricia , Glowczewski Julia , Wise Celeste
Published: November 2021

Purpose

To describe a community hospital pharmacy department’s novel approach to addressing safe use of fentanyl patches in acute and subacute care patients.

Beginning in 2017, improvement opportunities were identified within the medication-use process for fentanyl patches at Cleveland Clinic Euclid Hospital. Prescribing was addressed through development of a procedure requiring an opioid status verification by a pharmacist for all fentanyl patch orders. This procedure includes determination of indication, review of prior opioid use, and documentation within the medical record. At baseline in 2017, 11 of 45 fentanyl patches were initiated for acute pain. In the first year of the procedure, 1 of 13 orders was initiated for acute pain, and in the second year 2 of 24 orders for fentanyl patches were initiated for acute pain. With each review, the pharmacy department identified additional safety and clinical education opportunities. Subsequently, inventory and dispensing practices for patches were assessed. The hospital’s inventory was decreased and dispensing practices were altered to mitigate accessibility of the patches. This resulted in a decrease of 73.65% in the on-hand quantity from 2018 to 2020. The overall morphine milligram equivalents (MME) per 24 hours of this dosage form available in the hospital were reduced from 56,073.6 MME in 2018 to 13,557.6 MME in 2020 (75.82% decrease).

Conclusion

Evaluation of the fentanyl patch medication-use process and pharmacy-driven interventions resulted in an increase in appropriate utilization of fentanyl patches and a decrease in accessible MME of this potent dosage form.
Facial Arterial Variations in Asians: A Study on Computed Tomographic Angiography
Authors: Wang Dawei , Xiong Shixuan , Zeng Ning , Wu Yiping
Published: November 2021

Background

A consensus on facial artery anatomy has not been established due to the discrepancies in previous studies.

Objectives

The authors sought to assess the branches, course, and location of the facial artery in Asians by utilizing computed tomographic angiography.

Methods

The computed tomographic angiography images of 300 facial arteries from 150 Asian patients were evaluated. The FA was classified as follows: type 1, facial artery terminates superior labial or inferior labial artery; type 2, facial artery terminates lateral nasal or inferior alar artery; type 3, facial artery terminates medial canthal artery; or type 4, facial artery is divided into duplex branches with dominant medial canthal artery laterally. The relationship between nasolabial fold and FA was evaluated, and the distances from anatomical landmarks to FA were measured to position the course.

Results

Seventy (23.3%), 163 (54.3%), 49 (16.3%), and the other 18 arteries (6.0%) were classified as type 1, 2, 3, and 4, respectively. A total 72.3% of facial arteries were located medially to the nasolabial fold, and only 14.7% of arteries were lateral to the nasolabial fold. The vertical distance between the facial artery and the inner canthus or the midpoint of the inferior orbital rim decreased from type 1 to type 4 facial artery (P < 0.0001). The 4 types did not significantly differ in distance between the mandibular angle (P = 0.1226) or oral commissure (P = 0.1030) and the facial artery at inferior of mandible.

Conclusions

Detailed findings of the facial artery will provide a valuable reference for filler injection in cosmetic procedures and flap design in reconstructive surgery.
Exploring the Usefulness and Validity of Democratic Professionalism for Social Work Practice: A Cross-National Qualitative Case Study
Authors: van der Tier Michelle , Hermans Koen , Potting Marianne
Published: November 2021

Democratic professionalism challenges social workers to see social institutions as potential fields for democratic action and to act as bridge agents between citizens and social institutions. Although scholars have identified democratic professionalism as a promising theory, the relevance of this approach has hardly been empirically explored and operationalised in social work practice. To address this gap, this article explores empirical examples of bridging practices in social welfare organisations and private shelter organisations in the Netherlands, Belgium and Germany. Data were gathered by means of a mixed method design (interviews N13, and focus groups N10). Based on our case analysis, we identify three types of practices that aim to close the gap between citizens and social institutions: task-sharing with citizens; raising public awareness about social issues and facilitating a public dialogue about social issues in close proximity to the lives of citizens. We found indications that the policy environment shapes both the relationship between social institutions and society, and social workers’ actions and beliefs. Although we conclude that democratic professionalism is a promising theory for social work, more research is needed to further substantiate our findings and to explore the relevance of other aspects of democratic professionalism for social work practice.
Role of mTOR in the Development of Asthma in Mice With Cigarette Smoke-Induced Cellular Senescence
Authors: Lee Hyun Seung , Park Heung-Woo
Published: November 2021

The role of cellular senescence in the development of asthma is not well known. We aimed to evaluate the susceptibility of mice with cellular senescence to asthma development and determine whether the mTOR pathway played an important role in this process. Cellular senescence was induced in mice by intranasal instillation of 2% cigarette smoke extract (CSE). Subsequently, a low dose (0.1 μg) of house dust mite (HDM) allergens, which cause no inflammation and airway hyperresponsiveness (AHR) in mice without cellular senescence, was administered intranasally. To evaluate the role of the mTOR pathway in this model, rapamycin (TORC1 inhibitor) was injected intraperitoneally before CSE instillation. CSE significantly increased senescence-associated β-gal activity in lung homogenate and S100A8/9+ p-mTOR+ population in lung cells. Moreover, S100A8/9+ or HMGB1+ populations in airway epithelial cells with p-mTOR activity increased remarkably. Rapamycin attenuated all changes. Subsequent administration of low-dose HDM allergen induced murine asthma characterized by increased AHR, serum HDM-specific immunoglobulin E, and eosinophilic airway inflammation; these asthma characteristics disappeared after rapamycin injection. In vitro experiments showed significant activation of bone marrow-derived cells cocultured with S100A9 or HMGB1 overexpressing MLE-12 cells treated with HDM allergen, compared to those treated with HDM allergen only. CSE increased the levels of senescence markers (S100A8/9 and HMGB1) in airway epithelial cells, making the mice susceptible to asthma development due to low-dose HDM allergens by activating dendritic cells. Because rapamycin significantly attenuated asthma characteristics, the mTOR pathway may be important in this murine model.
“We Are Good Neighbors, But We Are Not Carers!”: Lived Experiences of Conflicting (In)dependence Needs in Retirement Villages Across the United Kingdom and Australia
Authors: Carr Sam , Fang Chao
Published: November 2021

Background and Objectives

This study sought to qualitatively explore the lived experiences of 80 older people living in retirement villages across the United Kingdom and Australia. We focused on residents’ narratives around the themes of independence/dependence.

Research Design and Methods

Qualitative semistructured interviews permitted in-depth exploration of how older people understood and experienced issues related to independence/dependence in the context of retirement living.

Results

Core themes identified strikingly different and often competing needs and narratives around independence/dependence. Of note was the fact that narratives and needs around independence/dependence frequently collided and conflicted, creating a sense of “us” and “them” in the retirement community. The primary source of such conflict was reflected by the fact that residents seeking a “prolonged midlife” often felt that frailer and more dependent residents were a burden on them and were not suited to an “independent living community.”

Discussion and Implications

Our findings are discussed in relation to the challenges such competing narratives create for retirement villages as living environments for a group of people who are far from homogenous.
A Glass Half Full: Critical Assessment of EU Regulation 2017/821 on Conflict Minerals
Authors: Macchi Chiara
Published: November 2021

EU Regulation 2017/821, bound to enter into force in early 2021, is the most recent legislative initiative aiming to sever the links between minerals trade, conflict dynamics and human rights abuses. The Regulation, which is meant to complement US legislation on conflict minerals, creates requirements for direct importers of 3TG in the EU and preludes to the establishment of a list of responsible EU smelters and refiners. While marking a historic step forward in the global efforts to curb conflict minerals trade, the Regulation presents some critical aspects. These include the exact definition of its geographical scope, its limitation to the 3TG metals and minerals and, most importantly, the exemption from its binding provisions of all downstream companies. While the functioning and effectiveness of the Regulation, as well as its possible unintended social and economic consequences on producing countries, will become clearer after its entry into force, this article provides an interim assessment of its strengths and weaknesses. The article starts by putting the Regulation in the context of global efforts to curb trade in conflict minerals, and addresses the ongoing debate on the possible adverse economic and social consequences of this type of legislation (Section 2). It then analyses the contents of the Regulation, critically focusing attention, in particular, on its hybrid combination of binding and voluntary measures, and on its scope of application (Section 3). In Section 4, an interim appraisal of the Regulation is carried out by highlighting both its undeniable potential and the shortcomings that might hamper its effectiveness in achieving its stated goals. Finally, Section 5 summarizes the article’s conclusions in the light of the likely adoption by the EU, in the near future, of a cross-sectoral mandatory human rights due diligence instrument.
Interspecific Gene Flow and Mitochondrial Genome Capture during the Radiation of Jamaican Anolis Lizards (Squamata; Iguanidae)
Authors: Myers Edward A , Mulcahy Daniel G , Falk Bryan , Johnson Kiyomi , Carbi Marina , de Queiroz Kevin
Published: November 2021

Gene flow and reticulation are increasingly recognized as important processes in the diversification of many taxonomic groups. With the increasing ease of collecting genomic data and the development of multispecies coalescent network approaches, such reticulations can be accounted for when inferring phylogeny and diversification. Caribbean Anolis lizards are a classic example of an adaptive radiation in which species have independently radiated on the islands of the Greater Antilles into the same ecomorph classes. Within the Jamaican radiation at least one species, Anolis opalinus, has been documented to be polyphyletic in its mitochondrial DNA, which could be the result of an ancient reticulation event or incomplete lineage sorting (ILS). Here, we generate mtDNA and genotyping-by-sequencing (GBS) data and implement gene tree, species tree, and multispecies coalescent network methods to infer the diversification of this group. Our mtDNA gene tree recovers the same relationships previously inferred for this group, which is strikingly different from the species tree inferred from our GBS data. Posterior predictive simulations suggest that our genomic data violate commonly adopted assumptions of the multispecies coalescent model (MSCM), so we use network approaches to infer phylogenetic relationships. The inferred network topology contains a reticulation event but does not explain the mtDNA polyphyly observed in this group; however, coalescent simulations suggest that the observed mtDNA topology is likely the result of past introgression. How common a signature of gene flow and reticulation is across the radiation of Anolis is unknown; however, the reticulation events that we demonstrate here may have allowed for adaptive evolution, as has been suggested in other, more recent, adaptive radiations. [Adaptive radiation; hybridization; introgression; multispecies network coalescent; posterior predictive simulation.]
Perinatal Outcome of Pregnancies With Prenatal Diagnosis of Vasa Previa: Systematic Review and Meta-analysis
Authors: Zhang W. , Geris S. , Al-Emara N. , Ramadan G. , Sotiriadis A. , Akolekar R.
Published: November 2021

(Abstracted from Ultrasound Obstet Gynecol 2021;57:710–719)

Pregnancies with vasa previa are at risk for fetal death and hypovolemic shock due fetal blood loss. Several studies have shown that prenatal diagnosis of vasa previa improves the rate of live births.
Mediastinal Masses, Anesthetic Interventions, and Airway Compression in Adults: A Prospective Observational Study
Authors: Hartigan Philip M. , Karamnov Sergey , Gill Ritu R. , Ng Ju-Mei , Yacoubian Stephanie , Tsukada Hisashi , Swanson Jeffrey , Barlow Julianne , McMurry Timothy L. , Blank Randal S.
Published: November 2021

Background

Central airway occlusion is a feared complication of general anesthesia in patients with mediastinal masses. Maintenance of spontaneous ventilation and avoiding neuromuscular blockade are recommended to reduce this risk. Physiologic arguments supporting these recommendations are controversial and direct evidence is lacking. The authors hypothesized that, in adult patients with moderate to severe mediastinal mass–mediated tracheobronchial compression, anesthetic interventions including positive pressure ventilation and neuromuscular blockade could be instituted without compromising central airway patency.

Methods

Seventeen adult patients with large mediastinal masses requiring general anesthesia underwent awake intubation followed by continuous video bronchoscopy recordings of the compromised portion of the airway during staged induction. Assessments of changes in anterior–posterior airway diameter relative to baseline (awake, spontaneous ventilation) were performed using the following patency scores: unchanged = 0; 25 to 50% larger = +1; more than 50% larger = +2; 25 to 50% smaller = −1; more than 50% smaller = −2. Assessments were made by seven experienced bronchoscopists in side-by-side blinded and scrambled comparisons between (1) baseline awake, spontaneous breathing; (2) anesthetized with spontaneous ventilation; (3) anesthetized with positive pressure ventilation; and (4) anesthetized with positive pressure ventilation and neuromuscular blockade. Tidal volumes, respiratory rate, and inspiratory/expiratory ratio were similar between phases.

Results

No significant change from baseline was observed in the mean airway patency scores after the induction of general anesthesia (0 [95% CI, 0 to 0]; P = 0.953). The mean airway patency score increased with the addition of positive pressure ventilation (0 [95% CI, 0 to 1]; P = 0.024) and neuromuscular blockade (1 [95% CI, 0 to 1]; P < 0.001). No patient suffered airway collapse or difficult ventilation during any anesthetic phase.

Conclusions

These observations suggest a need to reassess prevailing assumptions regarding positive pressure ventilation and/or paralysis and mediastinal mass–mediated airway collapse, but do not prove that conventional (nonstaged) inductions are safe for such patients.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Hemodynamic Responses to Crystalloid and Colloid Fluid Boluses during Noncardiac Surgery
Authors: Reiterer Christian , Kabon Barbara , Halvorson Sven , Sessler Daniel I. , Mascha Edward J. , Kurz Andrea ,   Crystalloid-Colloid Research Group
Published: November 2021

Background

Colloids are thought to sustain blood pressure and cardiac index better than crystalloids. However, the relative effects of intraoperative hydroxyethyl starch and crystalloid administration on the cardiac index and blood pressure remain unclear. This study therefore tested in this subanalysis of a previously published large randomized trial the hypothesis that intraoperative goal-directed colloid administration increases the cardiac index more than goal-directed crystalloid administration. Further, the effects of crystalloid and colloid boluses on blood pressure were evaluated.

Methods

This planned subanalysis of a previous trial analyzed data from 973 patients, of whom 480 were randomized to colloids and 493 were randomized to crystalloids. Fluid administration was guided by esophageal Doppler. The primary outcome was the time-weighted average cardiac index during surgery between the colloid and crystalloid group. The secondary outcomes were the cardiac index just after bolus administration, time elapsed between boluses, and the average real variability during surgery. The study recorded cardiac index, corrected flow time, and blood pressure at 10-min intervals, as well as before and after each bolus.

Results

Time-weighted average of cardiac index over the duration of anesthesia was only slightly greater in patients given colloid than crystalloid, with the difference being just 0.20 l · min–1 · m–2 (95% CI, 0.11 to 0.29; P < 0.001). However, the hazard for needing additional boluses was lower after colloid administration (hazard ratio [95% CI], 0.60 [0.55 to 0.66]; P < 0.001) in a frailty time-to-event model accounting for within-subject correlation. The median [quartiles] number of boluses per patient was 4 [2, 6] for colloids and 6 [3, 8] for crystalloids, with a median difference (95% CI) of –1.5 (–2 to –1; P < 0.001). The average real mean arterial pressure variability did not differ significantly between the groups (difference in means [95% CI] of –0.03 (–0.07 to 0.02) mmHg, P = 0.229).

Conclusions

There were not clinically meaningful differences in the cardiac index or mean pressure variability in patients given goal-directed colloid and crystalloids. As might be expected from longer intravascular dwell time, the interval between boluses was longer with colloids. However, on a case basis, the number of boluses differed only slightly. Colloids do not appear to provide substantial hemodynamic benefit.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Factors that Influence Acquisition of Lower Extremity Braces in the Pediatric Orthopaedic Population
Authors: Rambo Anna , Rhodes Leslie , Lomax Justin , Cao Xueyuan , Steele Jack , Romer Karen , Spence David , Sheffer Benjamin W. , Warner William C. , Sawyer Jeffrey R. , Kelly Derek M.
Published: November 2021

Background:

Lower extremity brace-wear compliance has been studied in pediatrics, but failure to acquire a prescribed brace has not been included. The purpose of this study was to evaluate brace acquisition as a component of brace-wear compliance.

Methods:

Records of patients (0 to 21 y) prescribed lower extremity braces from 2017 to 2019 were reviewed. Diagnoses included cerebral palsy, spina bifida, short Achilles tendon, clubfoot, and other. Brace type was categorized as clubfoot foot abduction orthosis, ankle-foot orthosis, knee, hip, or custom/other braces. Brace prescription and acquisition dates were recorded. Insurance was classified as government, private, or uninsured. Patient demographics included age, sex, race, and calculated area deprivation index.

Results:

Of the 1176 prescribed lower extremity braces, 1094 (93%) were acquired while 82 (7%) were not. The odds ratios (OR) of failure to acquire a prescribed brace in Black and Hispanic patients were 1.64 and 2.71 times that in White patients, respectively (95% confidence interval: 1.01-2.71, P=0.045; 1.23-5.6, P=0.015); in patients without insurance, the OR was 8.48 times that in privately insured patients (95% confidence interval: 1.93-31.1, P=0.007). The ORs of failure to acquire were 2.12 (P=0.003) in patients 4 years or more versus 0 to 3 years, 4.17 (P<0.0001) in cerebral palsy versus clubfoot, and 4.12 (P=0.01) in short Achilles tendon versus clubfoot. There was no significant association between sex or area deprivation index and failure of brace acquisition.

Conclusions:

In our cohort, 7% of prescribed braces were not acquired. Black or Hispanic race, lack of insurance, and older age were associated with failure to acquire prescribed braces. Braces prescribed for clubfoot were acquired more often than for cerebral palsy or short Achilles tendon. Brace-wear compliance is an established factor in treatment success and recurrence. This study identified risk factors for failed brace acquisition, a critical step for improving compliance. These results may help effect changes in the current system that may lead to more compliance with brace wear.

Level of Evidence:

Level III—retrospective cohort study.
Parents' Preferences for Behavioral Services in Primary Care During the COVID-19 Pandemic
Authors: Petts Rachel A. , Walker Bethany L. , Hails Katherine A. , Simoni Marisa , Raglin Bignall Whitney J. , Hostutler Cody A. , Riley Andrew R.
Published: November 2021

Objective:

Pediatric primary care is an ideal setting to provide behavioral health services to young children and their families during the COVID-19 pandemic. However, it is unclear how the pandemic altered parents' priorities and preferences to obtain behavioral services in this setting.

Method:

Between July 2020 and January 2021, 301 parents of young children in 5 pediatric sites across the United States completed survey measures on their preferences for behavioral topics and service delivery methods in primary care. The current sample was compared with a previous sample of parents (n = 396) who completed the same measures in 2018.

Results:

Child self-calming was the only behavioral topic that was rated as significantly more important in the pandemic cohort in comparison with the prepandemic cohort. The pandemic cohort also reported significantly more interest in using certain media resources (e.g., mobile apps and videos) as a delivery method and less interest in group classes/seminars. After controlling for demographic differences between the samples, there was an increased preference for multimedia resources overall in the pandemic cohort, as well as a decreased preference for usual care.

Conclusion:

Parents generally endorse similar priorities for behavioral topics in primary care during the pandemic as they did before the pandemic. However, there is a clear preference for more remote and media-based services during the pandemic. Pediatric practices may consider augmenting behavioral health services with multimedia resources during and after the COVID-19 pandemic to meet parents' needs.
PREVALENCE AND RISK FACTORS OF ELLIPSOID ZONE DAMAGE AFTER PARS PLANA VITRECTOMY FOR IDIOPATHIC EPIRETINAL MEMBRANE
Authors: Post Michał , Cicinelli Maria Vittoria , Zanzottera Emma Clara , Marchese Alessandro , Bandello Francesco , Coppola Michele
Published: November 2021

Purpose:

To assess factors associated with external limiting membrane (ELM)/ellipsoid zone (EZ) damage after pars plana vitrectomy (PPV) for epiretinal membrane and evaluate ELM/EZ damage impact on functional and anatomical outcomes.

Methods:

Patients who underwent PPV with epiretinal membrane ± inner limiting membrane peeling were retrospectively analyzed. Best-corrected visual acuity and central macular thickness were longitudinally collected based on the available follow-up. Demographic data, clinical data, and surgical details were included in logistic regression models having ELM/EZ damage as a binary outcome.

Results:

Overall, 179 eyes (171 patients) were included; 93 had a 12-month follow-up. Thirty-four eyes (19%) had ELM/EZ damage after surgery; in nine eyes (5%), ELM/EZ damage persisted at 12 months. Phacoemulsification during PPV (odds ratio = 6.97; P = 0.007) and ELM/EZ damage before PPV (odds ratio = 6.91; P = 0.007) were risk factors for postoperative ELM/EZ disruption. Thicker outer nuclear layer (P = 0.002), thicker ectopic inner foveal layer (P < 0.001), and higher endoillumination power (P = 0.03) were associated with slower visual recovery. Inner limiting membrane peeling (P = 0.04) was associated with slower anatomical recovery.

Conclusion:

Cataract extraction and outer retinal damage before PPV are associated with higher risk of photoreceptor damage postoperatively. The rate of visual improvement varies as a function of retinal layers' distortion before surgery; additional retinal manipulation slows restoration of the macular anatomy.
Anxiety in cirrhosis: a prospective study on prevalence and development of a practical screening nomogram
Authors: Dang ThucNhi T. , Patel Kinjal , Farhat Kamal , Abraldes Juan , Ma Mang , Bailey Robert J , Burak Kelly W. , Mitchell Nicholas , Tandon Puneeta
Published: November 2021

Objectives

The prevalence and effects of anxiety on health-related quality of life and clinical outcomes in cirrhosis are not well understood. This is increasingly relevant during COVID-19. Our aim was to use the Mini-International Neuropsychiatric Interview (MINI) to determine the prevalence of anxiety, its association with clinical outcomes in cirrhosis and to develop a rapid cirrhosis-specific anxiety screening nomogram.

Methods

Adults with a diagnosis of cirrhosis were prospectively recruited as outpatients at three tertiary care hospitals across Alberta and followed for up to 6 months to determine the association with unplanned hospitalization/death. The Hospital Anxiety and Depression scale (HADS) was used as a screening tool as it is free of influence from somatic symptoms. Anxiety was diagnosed using the MINI.

Results

Of 304 patients, 17% of patients had anxiety by the MINI and 32% by the HADS. Anxious patients had lower health-related quality of life as assessed by the chronic liver disease questionnaire (P < 0.001) and EuroQol Visual Analogue Scale (P < 0.001), and also had higher levels of frailty using the Clinical Frailty score (P = 0.004). Multivariable analysis revealed smoking and three HADS subcomponents as independent predictors of anxiety. These were used to develop a rapid screening nomogram.

Conclusion

A formal diagnosis of anxiety was made in approximately one in five patients with cirrhosis, and it was associated with worse HrQoL and frailty. The use of a 4-question nonsomatic symptom-based nomogram requires validation but is promising as a rapid screen for anxiety in cirrhosis.
Tandem high-dose 131I-MIBG therapy supported by dosimetry in pediatric patients with relapsed-refractory high-risk neuroblastoma: the Bambino Gesu’ Children’s Hospital experience
Authors: Altini Claudio , Villani Maria F. , Di Giannatale Angela , Cassano Bartolomeo , Pizzoferro Milena , Serra Annalisa , Castellano Aurora , Cannatà Vittorio , Garganese Maria C.
Published: November 2021

Objective

131I-meta-iodobenzylguanidine (131I-MIBG) combined with myeloablative chemotherapy represents an effective treatment in children affected by relapsed/refractory neuroblastoma (NBL) for disease palliation and in improving progression-free survival. The aim of our study is to evaluate the feasibility, safety and efficacy of tandem 131I-MIBG followed by high-dose chemotherapy with Melphalan.

Methods

Thirteen patients (age range: 3–17 years) affected by relapsed/refractory NB, previously treated according to standard procedures, were included in the study. Each treatment cycle included two administrations of 131I-MIBG (with a dosimetric approach) followed by a single dose of Melphalan with peripheral blood stem cell rescue.

Results

At the end of the treatment, ten patients experienced grade 4 neutropenia, two grade 3 and one patient grade 2, three patients presented febrile neutropenia and all needed RBC and platelets transfusions; one patient presented grade 4 mucositis, four grade 3 and one patient grade 2 mucositis. One patient showed progressive disease, eight patients showed stable disease and four patients showed partial response.

Conclusion

High-dose 131I-MIBG therapy combined with chemotherapy represent a well-tolerated and effective modality of treatment in heavily pretreated patients affected by relapsed/refractory NBL. However, further studies, including a wider cohort of patients, are needed.
YouTube as a Source of Information on Blenderised Tube Feeding
Authors: Walsh Anna , Bamkole Omowunmi , Gerasimidis Konstantinos
Published: November 2021

Blenderised tube feeding (BTF) has become an increasingly popular method of nutrition support for long‐term tube‐fed patients mostly children. This study surveyed perceptions and experiences on BTF shared on YouTube. From 71 videos analysed, attitudes towards BTF were mostly positive (91%) and included psychosocial benefits and improvements in gastrointestinal symptoms; no differences between caregivers and healthcare professionals were observed. Very few speakers (8%) felt there was a lack of support regarding use of BTF in schools and from healthcare professionals, because it is not part of the standard clinical management protocols. The most commonly used food items in blends included carrots (n = 16) and chicken (n = 11), and experiences from those who have used BTF included tips on recipes for blends, storing feeds and ensuring nutritional adequacy. Analysis of YouTube content on BTF was considerably positive and suggests that BTF is feasible and safe way to provide nutrition to tube‐fed patients.
Evolving Clinical Care in Esophageal Button Batteries
Authors: Sinclair Elizabeth M. , Santore Matthew T. , Agarwal Maneesha , Kitzman Jamie , Sauer Cary G. , Riedesel Erica L.
Published: November 2021

Background/Objectives:

Esophageal button battery impactions (BBI) in children pose a significant danger to children. Although there are expert‐opinion guidelines to help manage this population, few studies detail the impact of guidelines on the clinical care of these patients. With this study, we aimed to describe the care of these patients before and following adoption of guidelines at a single center.

Methods:

Retrospective cohort study of patients with esophageal BBI at a single center, large volume, urban academic pediatric hospital system before adoption of expert‐opinion guidelines (2007–2017) and following adoption (2018–2020).

Results:

Cohort was comprised of 31 patients before adoption and 32 patients following adoption of guidelines. Patient characteristics did not differ between groups. After 2018, significantly more patients received acetic acid irrigation, initial cross‐sectional imaging, and serial cross‐sectional imaging. There was also an increase in intensive care unit (ICU) stays, number of intubations, nil per os time, and hospital length of stay. There was no difference in patient outcomes.

Conclusion:

This study describes a large cohort of pediatric esophageal BBI before and following adoption of guidelines. Findings detail increased adherence to guidelines resulting in more cross‐sectional imaging which led to ICU stays, longer length of stays, and more nil per os time. This study emphasizes the need for multi‐disciplinary guidelines as well as further multi‐institutional study.
Angiosarcoma of the Uterus: A Systematic Review
Authors: Deb Pratik Q. , Weiss Robert E. , Heller Debra S.
Published: November 2021

Primary uterine angiosarcoma is an extremely rare neoplasm. Due to its rarity, knowledge regarding this malignancy is limited to a few scattered case reports. To better understand the prognostic factors and optimal management of these neoplasms, we have performed a systematic analysis of the disease. A systematic literature search of this entity yielded 25 reported cases of this entity. In addition, we searched the National Cancer Institute Surveillance, Epidemiology, and End Results database to find 4 additional cases and added a case diagnosed in our institution. We analyzed the patients’ demographic characteristics and the different treatment protocols utilized to treat this malignancy. Patients were primarily treated by surgery with or without adjuvant chemotherapy and radiotherapy. Survival analysis was performed to examine the role of various factors in the outcome for the patients. There was no correlation with age of diagnosis, or treatment modality used, however, better outcomes were seen in patients presenting with smaller sized tumors. Our study is the first attempt to systematically study this rare malignancy in hopes of leading to a more standardized, evidence-based, and improved treatment protocol.
Intimate Partner Violence and the HIV Care and Treatment Cascade Among Adolescent Girls and Young Women in DREAMS, South Africa
Authors: Gibbs Andrew , Reddy Tarylee , Closson Kalysha , Cawood Cherie , Khanyile David , Hatcher Abigail
Published: November 2021

Background:

Intimate partner violence (IPV) may affect the HIV-treatment cascade.

Setting:

Four high HIV-prevalence DREAMS health districts in South Africa.

Methods:

Secondary analysis of cross-sectional data collected March 2017–June 2018, using random household sample of young (12–24 years) girls and women. Face-to-face interviews assessed IPV and HIV-status knowledge, and finger-prick blood draws assessed ART (antiretroviral therapy) uptake and viral suppression. We used logistic regression to estimate crude and adjusted effects of IPV on HIV knowledge, ART uptake, and viral suppression.

Results:

Of 18,230 adolescent girls and young women, 8413 (46%) reported ever having had sex, of whom 1118 (13%) were HIV positive. The 90:90:90 benchmarks were 61% knew their status, 86% had ART present in their blood sample, and 91% were virally suppressed. Among the entire sample of young women living with HIV, 65.6% were virally suppressed. Past year IPV was reported by 15%. In adjusted models, IPV trended toward increasing the odds that a young woman was aware she was living with HIV [adjusted odds ratios (aOR) = 1.40, 2.00–9.98, P = 0.067]. There was no association between IPV and reduced treatment use (aOR = 0.73, 0.41–1.29). IPV was independently associated with reduced viral suppression (aOR = 0.30, 0.13–0.66).

Conclusions:

Addressing the role of IPV in undermining the treatment cascade for adolescent and young women is a critical issue for HIV programming.
Azithromycin consumption during the COVID-19 pandemic in Croatia, 2020
Authors: Bogdanić Nikolina , Močibob Loris , Vidović Toni , Soldo Ana , Begovac Josip
Published: November 2021

Background

During the initial phase of the COVID-19 pandemic, there was great enthusiasm for the use of azithromycin with or without hydroxychloroquine.

Objectives

We analyzed azithromycin consumption in Croatia in 2020 and compared this to the period 2017–2019.

Methods

Azithromycin consumption was evaluated using the IQVIA Adriatic d.o.o. database which collects data on azithromycin distribution from wholesale pharmacies to hospital and non-hospital pharmacies in Croatia. We analyzed data for the period from January 2017 to December 2020. Azithromycin distribution was measured as days of therapy (DOT) and reported as per 1000 inhabitants or per 1000 inhabitant-days.

Results

In the period 2017–2020, total azithromycin DOT in Croatia increased in 2017, 2018, 2019, and 2020 (1.76, 1.91, 1.91 and 2.01/1000 inhabitant-days, respectively). Non-hospital pharmacies received 2.18 times and hospital pharmacies 4.39 times more DOT units/1000 inhabitants of azithromycin in March 2020 compared to the average distribution rate in March 2017–2019. During the peak of the COVID-19 epidemic (November and December 2020) azithromycin distribution increased considerably in hospital (3.62 and 3.19 times, respectively) and non-hospital pharmacies (1.93 and 1.84 times, respectively) compared to the average consumption in the same months in 2017–2019.

Conclusions

Our data showed increased azithromycin distribution in the period 2017 – 2020 which indicates azithromycin overuse. Preliminary information on COVID-19 treatments with a desire to offer and try what is available even in the absence of strong scientific evidence may have influenced practices of antimicrobial prescriptions.
Digitalisation and the performance measurement and management system: reinforcing empowerment
Authors: Korsen Eirik Bådsvik Hamre , Ingvaldsen Jonas A.
Published: November 2021

Purpose

This study explores how information and communication technologies (ICT) can contribute to empowerment in an Industry 4.0 setting.

Design/methodology/approach

The results are based on a case study of a Norwegian manufacturing organisation that has highly automated production and an integrated ICT platform. Data analysis was guided by the Smith and Bititci (2017) framework for performance measurement and management.

Findings

When powered by advanced ICT, the performance measurement system matures. The design and development of the ICT platform also reinforce the organisation's existing performance management practices. Empowerment is strengthened when automated collection, analysis and reporting of performance data free up middle managers' time so that they, together with operators, can drive continuous improvement.

Research limitations/implications

The findings are limited to a single case study and require further testing for transferability to other organisations. Future research should explore whether performance management practices are also reinforced by ICT in more command- and control-oriented organisations.

Practical implications

The paper suggests an alternative strategy of Industry 4.0 transformation for organisations committed to empowerment. Such organisations should rely on in-house, iterative ICT development and build digital competence broadly.

Originality/value

This article contributes to the understanding of how performance measurement and management are interrelated and evolve in the context of Industry 4.0. To the best of the authors’ knowledge, highlighting the role of middle managers in empowering operators through continuous improvement is novel in the performance measurement and management literature.
National cultures and their impact on electronic word of mouth: a systematic review
Authors: Dang Anh , Raska David
Published: November 2021

Purpose

This paper aims to summarize peer-reviewed journal articles on national cultures and electronic word of mouth (eWOM) behavior, identify the main findings and patterns among those studies and discuss research gaps that need to be addressed in the future.

Design/methodology/approach

A systematic review process was utilized to analyze peer-reviewed journal articles on both eWOM and national cultures. The main research questions were defined, then proceeded by the identification of exclusive and inclusive criteria to search for relevant articles, which were further filtered based on abstracts and full texts, and then scrutinized for main findings and major variables such as countries, cultural variables and data collection methods.

Findings

An analysis of 52 papers shows that national cultures, primarily Hofstede's dimensions, influence the willingness of individuals to share eWOM, how they write eWOM and the extent to which they use eWOM to make decisions. Although the reviewed studies have provided insightful implications for marketing theory and practice, the present paper has identified a number of important questions that warrant future research attention.

Originality/value

eWOM is continually being employed as a popular source of information for consumers throughout different countries to make their purchase decisions. However, eWOM behavior differs from country to country due to national cultures, and managers' eWOM strategies that work in one country may not be applicable in another. Therefore, there has been an increasing interest in this topic. Nevertheless, it remains unclear which subjects have been addressed and what areas are yet to be investigated. This paper presents a comprehensive review of how national cultures affect eWOM behavior by drawing upon prior research and provides directions for future research contributions.